Sleep Dysfunction Affects Pain Sensitivity

The sleep problems associated with fibromyalgia -- insomnia and fragmented sleep -- may be the root of the pain, says Holman. It deprives people of stage IV deep sleep, the non-rapid-eye-movement sleep that helps us feel refreshed in the morning.

Fibromyalgia research is showing that an automatic arousal is triggered in the brain during sleep, Holman tells WebMD. "The basic fight or flight response is activated at night while you're sleeping. The hormones epinephrine and adrenaline are released as the body becomes vigilant, aware. That causes the transition from deep restorative sleep into light sleep."

These disruptions rob the person of restorative processes that occur during deep sleep, he explains. "It's during deep sleep that most growth hormone is produced. Muscles regenerate and heal, and neurotransmitters are replenished in the brain. The body's ability to recuperate from the day's stresses -- including small pain sensations -- is believed to occur during deep sleep."

The brain has a "pain threshold," Holman adds. "During the day, low signals in the brain can be ignored and you continue doing what you're doing. But if the system is overwhelmed, at night the normally nonpainful stimuli become painful. Lack of deep sleep amplifies all sensations -- what we call central pain amplification."

"When people finally get deep restorative sleep, fibromyalgia improves substantially," Holman says. "But the best strategy to treat the sleep is not a sleeping pill. The strategy is to turn off the arousal in the brain stem that's interrupting the sleep. We want to allow people to sleep."

Difficulty Diagnosing Fibromyalgia

As with chronic pain, sleep problems are common -- and it's not always easy diagnosing fibromyalgia syndrome as the problem.

"The primary care doctor is at somewhat a disadvantage," Berney tells WebMD. "There are no specific tests for fibromyalgia diagnosis. To make a diagnosis, one has to make sure it's not something else -- lupus, thyroid dysfunction, rheumatoid arthritis. The list of possible diseases associated with these symptoms is fairly extensive. It's the vagueness of the symptoms that delays the diagnosis."

"You won't necessarily have all of the symptoms of these disorders, but you can have a component of each," says Grabois. "Patients often go to a lot of doctors trying to figure out what's wrong. The doctors are not familiar with fibromyalgia syndrome so they don't necessarily know the diagnostic criteria for it -- and they don't necessarily check for it."

Also, the level of misery is different for each patient, he points out. "Some have pain worse than others." For some, the pain is continuous. For others, it comes and goes. Some people wake up feeling like they have been exercising all night.

Getting a Correct Diagnosis

If you have seen several doctors -- yet still don't have relief -- see a specialist, Grabois advises. The National Fibromyalgia Association provides a list of specialists who understand the disease -- experts in pain management, rheumatology, and neurology.

Prepare for your appointment. Before meeting with the doctor, prepare to accurately communicate your symptoms. Think about these:

  • What your symptoms are -- and when they started.
  • How long they've been going on -- and whether it's been continuous, or off and on.
  • Have you noticed any triggers for your symptoms?
  • How do your symptoms affect you? Is pain sharp, a dull ache, does it cause nausea?
  • How do symptoms affect your feelings? Does pain make you depressed or anxious?
  • How do symptoms affect your work or home life? Are you very fatigued and can't do normal activities?
  • What drugs, herbal remedies or supplements are you taking?
  • What surgeries have you had?
  • What current treatments has another doctor or specialist prescribed?

Keep a pain journal. "Doctors will listen more if you keep a daily record of how you feel -- even if it's just for one month or for three months," says Yencha. In your pain journal, make note of intensity of pain (on a scale of 1 to 10), what you were doing at the time, and how you felt emotionally. It will help you and your doctor see patterns in the pain, she says.

There are no lab tests or scans that can help doctors diagnose fibromyalgia. But various blood tests can help them rule out other medical conditions. Some patients need to have respiratory problems checked or get a sleep apnea study, Berney says. "On occasion, the problem is sleep apnea or snoring, both of which disturb sleep."

Find the right doctor. It's important to find a doctor who cares about you -- and wants to help you, says Mary Rose, PsyD, clinical psychologist and behavioral sleep specialist at Baylor College of Medicine in Houston. "It's very common, physicians having very little time. Sometimes they don't really hear everything a patient says."

Never stay with a physician you don't like or trust, Rose tells WebMD. "It's not all in your head -- and while you may be depressed, depression is not the whole picture of fibromyalgia. We see depression with cancer, cardiac disease, and we know those are real. Pain is very frustrating. In the medical community, we probably don't have the empathy for pain that we should."

Get emotional support. A therapist's support can be helpful when you're dealing with fibromyalgia, Rose notes. "Fibromyalgia has such a stigma. Sometimes it is really helpful to see a therapist -- not because you're crazy, but because you have to deal with pressure and stigma. It's nice to have someone objective to talk to."

Reviewed by Laura J. Martin, MD