Health-related quality of life regarding sleep and fibromyalgia

Fibromyalgia (FM) is a syndrome defined by chronic widespread pain with multiple tender points, fatigue, sleep dysfunction, cognitive dysfunction and abnormal pain processing. Sleep dysfunction affects the quality of sleep people get but also often people can have more than one sleep disorder associated with their sleeping problems. Sleep is said to be one of the components to increasing fibro fog the next day, some of the cognitive issues as well as muscle stiffness and pain.

Sleep dysfunction

Typically a person cycles every ninety minutes from alpha progressively deeper into beta, then gamma, until they reach delta sleep. Delta sleep is the restorative and most ‘refreshing’ of the stages. With Fibromyalgia Delta sleep is disrupted, even when they feel they have slept well or long. A person with FM can, in fact, sleep 8 hours or 10 hours and still wake up tired since this sleep is not as restorative. This is due to the very fact in delta sleep this is when energy is recovered and muscles are repaired. What can happen in some cases is that the levels of growth hormone in the body become low as 80% of the growth hormone we get comes from and is distributed during delta sleep. It is suggested that lower levels of growth hormone can lead to more muscle pain and degeneration. Some people with FM can also be low in a hormone called cortisol during the day causing fatigue and have higher levels at night causing insomnia. Cortisol is usually released during REM sleep but can be during any stage of sleep with its peak in the early morning to waking. Finally, the last issue to do with sleep dysfunction has to do with the automatic nervous system. It has been suggested with Fibromyalgia the sympathetic part of the ANS which controls our ‘flight or fight’ responses is permanently stuck ‘on’. This gives for an easy startle response. However, it also seems to prevent the body from being able to totally relax in order to sleep deeply. What happens is someone with FM becomes a very light sleeper, essentially partly always on alert. It might explain why many people with Fibromyalgia frequently wake up during the night and then have difficulty falling back to sleep.

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Fibromyalgia sleeping problems

-delayed onset insomnia- cannot fall asleep

-Morning insomnia- wake up really early and can’t get back to sleep

-Frequent waking

-Difficulty falling back to sleep after waking

-Difficulty reaching stage four sleep

-Unrefreshing sleep

-Sleep apnea

-Restless leg syndrome

-nighttime muscle contractions, twitching or nocturnal jerks

-Grinding teeth (bruxism)

-Pain and discomfort causing problems with falling asleep or staying asleep

A study looking at sleep difficulties and health-related quality of life (HRQoL)

A summary of the study: published in BMC Musculoskeletal Disorders, 17 October 2012, aimed to look at Fibromyalgia patients and their sleep disorders to see what sort of effects the sleep had one their health-related quality of life (HRQol). In other words, how much did sleep impact their life and Fibromyalgia? A very valid question to ask as we know sleep is a very important thing to have and poor quality sleep can affect a great deal. They used data from a 2009 National Health and Wellness Survey of 75,000 people which is a cross-sectional, internet-based survey of the adult US population. Out of that, they had 2196 patients with Fibromyalgia compared with matched controls of 2194. “Additionally, the relationship between the number of sleep difficulty symptoms (none, one, or two or more) and HRQoL (using the SF-12v2) was assessed using regression modeling, controlling for demographic and health history variables.” (Biomed) 

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Results

11.2% reported no sleeping difficulties

25.7% reported one sleep symptom

63.05% reported two or more sleep difficulty symptoms.

“The prevalence of sleep difficulty symptoms was significantly higher than matched controls. Patients with one and two sleep difficulty symptoms both reported significantly worse HRQoL summary and domain scores relative to those with no sleep difficulty symptoms (all p<.05). Further, the relationship between sleep difficulty symptoms and HRQoL was significantly different between those with FM than matched controls, suggesting a uniqueness of the burden of sleep difficulties within the FM population.” (Biomed)

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The study concluded that among the FM population as a whole sleep difficulties were associated with decrements in mental and physical health-related quality of life. Therefore these results suggested there should be greater emphasis on the treatment of these issues.

Conclusion

Sleep plays an important role in fibromyalgia. Sleep dysfunction and forms of sleep disorders are core symptoms of the syndrome. It would be a mistake for doctors to ignore it. First of all, sleep and chronic pain can play complicated roles with each other. Chronic pain alone can begin to affect sleep and if a person already suffers from complex sleep issues then the situation can get quite a bit worse. Secondly, as stated someone with Fibromyalgia can have more than one sleep issue and so already their sleep is a complex problem. If someone is getting only five hours of poor quality sleep how can that not affect their health-related quality of life? Addressing the issue properly can help relieve symptoms or reduce the intensity of others one might have assumed were simply the Fibromyalgia and greatly improve their health.

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