Treating CFIDS & Fibromyalgia

Solutions for Sleep

http://cfidsselfhelp.org

(Third in a series on treatment options for major symptoms of CFS and fibromyalgia. Other articles discuss fatigue, pain, and cognitive problems.)

By Bruce Campbell

Having CFIDS or fibromyalgia means living with symptoms that persist. The absence of a cure does not mean that there are no treatments. On the contary, there are many ways to alleviate the symptoms of the two illnesses. This series discusses the major treatment options for four of the most common symptoms of CFS and fibromyalgia: fatigue, pain, poor sleep and cognitive problems. This article focuses on treatments to improve sleep.

As mentioned in the first article, the approach taken in this series is based on three principles:

1. Feeling better: The focus of treatment is not on curing but rather on reducing the effects of symptoms, bringing greater stability and lessening psychological suffering.
   
    

2. Multiple strategies: Because most patients have more than one symptom and most symptoms have more than one cause, it is helpful to use multiple coping strategies.
   
    

3. Experimentation: Because patients are different and because there is no standard treatment for either illness, symptom control is usually achieved through trial and error.

Treating Sleep

Poor sleep is one of the most common problems for fibromyalgia patients and also very prevalent among people with CFS. With both illnesses, poor sleep is a major source of intensified symptoms. You may spend a night in bed, but awaken as tired as you were the night before. Other sleep problems are common as well, such as difficulty getting to sleep, waking in the middle of the night or early in the morning, and sleeping more than you want.

It is widely believed that a major cause of sleep problems, especially for fibromyalgia patients, is abnormal patterns of brain waves. Our brains are active during sleep, moving among several different types of sleep, each with a characteristic brain waves. The deepest and most restorative type of sleep is referred to as delta sleep. Patients with CFS and fibromyalgia often get less delta sleep than they need, and thus don’t feel refreshed when they get up in the morning. When healthy volunteers were deprived of delta sleep in an experiment, they developed symptoms of fibromyalgia in a few days.

Treating sleep is especially challenging because there is no single medication that has proven helpful in solving sleep problems for people with CFS and fibromyalgia. Also, many patients develop drug tolerance, so that a medication becomes less effective over time. For both these reasons, sleep problems can benefit from a flexible, experimental approach that utilizes a variety of strategies.

Medications commonly used to treat sleep problems include over the counter products like melatonin and valerian, antihistamines such as Benadryl, clonazepam (Klonopin), tricyclic antidepressants such as amitriptyline (Elavil), benzodiazepines such as Halcion, and the hypnotic drug Ambien. Often a combination of two drugs is prescribed, one to initiate sleep and another to maintain sleep. If you think medications might improve your sleep, a reasonable approach is to find a sympathetic physician with whom you can experiment to find what works for you.

Another way to improve your sleep is by looking at the interactions among pain, fatigue and sleep to determine how the vicious cycle of the three symptoms intensifying one another can be interrupted and an upward spiral begun. For the interaction between fatigue and sleep, ask whether daytime napping might be interfering with your ability to fall asleep. Also, if your activity level leaves you feeling “wired,” pacing strategies may be helpful. Pain can make it difficult to get good sleep, so reducing pain before going to bed can help. You might experiment with pain medications and time in the bath or hot tub before going to bed.

Poor sleep can have other causes as well, including the following:

• Overactivity: Too much activity can create a sense of restlessness sometimes called the “tired but wired” feeling. Pacing can be an antidote. By keeping your activity level within the limits imposed by your illness and by having a quiet, winding down period before going to bed, you can avoid having your sleep affected by the edgy tired-but-wired feeling.
  
   

• Stress and Worry: Stress often leads to muscle tension, which makes falling asleep more difficult. Preoccupation with problems can make getting asleep harder. Relaxation methods help you ease tense muscles and thereby may make it easier to get good rest. Try relaxation procedures like those described in "Stress Reduction: Five Practical Techniques" or soak in a hot tub or bath before going to bed. If you have difficulty falling asleep because you are preoccupied with problems and lie awake with thoughts running through your head, consider setting aside a "worry time" each night before going to bed. Take a half hour to write down all your worries and what you’ll do about them. If worries come up as you are trying to go to sleep, tell yourself "I’ve dealt with that. I don’t have to worry because I know what I’m going to do."
  
   

• Sleep Habits & Environment: Sleep can be disturbed by factors like irregular hours, a noisy environment, an uncomfortable bed or a noisy sleeping partner. For suggestions on improving sleep habits, see the next section.
  
   

• Food, Alcohol & Tobacco: Consuming too much caffeine, drinking alcohol and smoking can make getting good rest more difficult. Avoid products containing caffeine, like coffee, tea, soft drinks and chocolate, for several hours before going to bed. Avoid alcohol before bedtime; it can create restless and uneven sleep. The nicotine in tobacco is a stimulant, thus smoking is a barrier to falling asleep.
  
   

• Medications: Some sleep medications that are effective when used occasionally can produce poor sleep if used frequently. Also, some drugs produce side effects like a feeling of grogginess in the morning. Medications taken for other problems may interfere with sleep if they contain substances like antihistamines or caffeine.

Improving Sleep Environment and Habits

You may be able to improve your sleep by changing your sleep environment or your sleep habits.

1. Have a Comfortable Environment: Provide yourself with an environment conducive to good sleep by using a good mattress, and by exercising control over light, noise and temperature. (Note: noise includes snoring by your sleep partner.)

2. Establish a Routine: Go through the same routine each night and have a consistent bedtime. Prepare for sleep by gradually reducing your activity level in the several hours before bedtime and by having “going-to-bed” rituals you do consistently at the same time each night. Things like brushing your teeth or doing light reading every night before retiring can help you wind down and get ready psychologically for sleep.

3. Get Up at the Same Time: Setting an alarm so that you get up at the same time each day can help you adjust gradually back to more normal hours. Usually you don’t need to compensate by changing your bed time to an earlier hour; your body will adjust itself.

4. Limit Daytime Napping: Often daytime napping interferes with night time sleep. If you find that you have trouble falling asleep at night when you nap during the day or your sleep is worse than usual, you might consider sleeping only at night. (On the other hand, if napping does not disturb your sleep, you may need more rest.) 

5. Use Relaxation or Distraction to Fall Asleep: It may be easier to fall asleep if you listen to quiet music or distract yourself in some other way such as by counting or watching your breath. Relaxation techniques can help you fall asleep.

Other Sleep Problems

Some patients have one or more additional sleeping problems besides insufficient delta sleep. Two of the most common are restless legs syndrome and sleep apnea. The former involves “twitchy limbs,” strong unpleasant sensations in the leg muscles that create an urge to move. The problem is often at its worst at night. Self-management techniques that may help include reducing consumption of caffeine and other stimulants, the use of exercise involving the legs, and taking supplements to counteract vitamin deficiencies. Medications, such as Requip, may help. Check with your doctor if you believe you might have this condition.

Apnea, meaning absence of breathing, occurs when a person’s airway becomes blocked during sleep. An episode can last from a few seconds to a few minutes. The person then awakens, gasps for air and falls asleep again. This can occur many times a night. A common remedy is the use of a CPAP (continuous positive airway pressure) machine to keep the airway open. The patient wears a mask through which a compressor delivers a continuous stream of air, keeping the airway open. Other treatments are also used for this condition. If you suspect you have this problem, consult a sleep specialist.