Treating a patient with fibromyalgia is almost inevitable regardless of the type of medicine you practice. Approximately 3% to 10% of the U.S. population, mostly women, experience chronic pain associated with the condition, characterized by widespread musculoskeletal involvement and tender points.
What many providers don’t realize is the role that sleep plays in the development of fibromyalgia. We all know that a lack of sleep can affect a patient negatively, but for some people, it can be a decisive factor in whether they develop a life-long pain syndrome.
Results from a recent study in Norway show that patients with sleep problems are three- to five-times more likely to develop fibromyalgia symptoms over time than those who sleep soundly. Similar outcomes have been observed in previous studies involving college-aged students. When the students entered slow-wave sleep, researchers used noise to bring them into lighter stages of sleep. After several days, students whose sleep was disturbed developed musculoskeletal pain similar to patients with fibromyalgia. Once they were allowed to sleep again, their pain resolved.
Another abnormality often observed in patients with fibromyalgia is the alpha electroencephalogram (EEG) anomaly, first described by Hauri and Hawkins, also known as alpha-delta sleep. Delta waves are the hallmark of deeper sleep in patients with normal sleep, but research shows that fibromyalgia patients often do not reach these deeper stages of sleep or don’t stay there long enough. In addition, alpha waves — the brain waves typically seen in a relaxed but aware state — often appear, indicating that a possible brain abnormality may be keeping these patients awake.
Insomnia, obstructive sleep apnea, bruxism and restless leg syndrome, have also been observed in patients with fibromyalgia.
Although it is likely that they may have already mentioned it as part of their ongoing symptoms, always remember to take a thorough sleep history in patients with fibromyalgia. If warranted, consider ordering a polysomnogram to rule out possible sleep abnormalities.
Educating patients with fibromyalgia about the importance of good sleep hygiene is imperative. Treating underlying sleep conditions promptly may significantly decrease the amount of pain these patients experience.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.