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 Fibromyalgia  Holistic-online.com

Causes of Fibromyalgia (Contd.)

Insomnia or Sleep Disturbances 

Most people with fibromyalgia also have an associated sleep disorder known as alpha- EEG anomaly. In this disorder, the individual's deep sleep periods are interrupted by bouts of waking-type brain activity, resulting in poor sleep. (See Sleep Disturbances in Fibromyalgia below.) Some people with fibromyalgia are plagued by other sleep disorders as well, such as sleep apnea, restless leg syndrome, bruxism, and sleep myoclonus (a sudden rapid contraction of a muscle or a group of muscles during sleep or as one is falling asleep ). Given all these sleep difficulties, people with fibromyalgia often suffer from chronic fatigue that can range from mild to incapacitating.

Sleep disturbances may be responsible, in part, for the low energy levels experienced by people with fibromyalgia. There is also evidence that continued sleep problems can lead to muscle pain. This combination of pain and fatigue often limits physical activity and endurance. Current research indicates that stage IV sleep (deepest or most restful stage of sleep) is also important in repairing tissue damage and feeling psychologically rested after sleep. (Sleep laboratory studies of people with fibromyalgia often show a sleep disorder in which the stage IV sleep is disturbed or interrupted. Doctors refer to this disturbance as alpha intrusion of stage IV sleep.) 

Many doctors believe that a major factor contributing to the symptoms of fibromyalgia is the inability of the sufferer to get a good night's sleep. In one study, volunteers who did not have fibromyalgia were subjected to artificial disturbance of their stage IV sleep. They developed pain and soreness in their muscles which were very similar to those of fibromyalgia.

In another study conducted at the University of Connecticut School of Medicine, fifty women with fibromyalgia syndrome recorded their sleep quality, pain intensity, and attention to pain for thirty days, using palm-top computers programmed as electronic interviewers. They described their previous night's sleep quality within one-half hour of awakening each day. Then, at randomly selected times in the morning, afternoon, and evening, they rated their present pain. This detailed study and analysis found that poor sleep resulted in significantly more pain. However, the problems did not end there. The researchers found that a night of poor sleep was followed by a significantly more painful day, and a more painful day was followed by a night of even poorer sleep. This, in other words, started a vicious cycle.

Sleep Disturbances in Fibromyalgia

One of the key findings in patients with fibromyalgia is altered sleep patterns. Specifically, fibromyalgia patients tend to have reduced REM sleep and increased non-REM sleep. 

Based on observations of eye movement and brain-wave or electroencephalogram (EEG) recordings, sleep is divided into two distinct types: REM (rapid-eye-movement) and non-REM (non-rapid-eye-movement) sleep. During REM sleep, the eyes move rapidly and dreaming takes place. When people are awakened during non-REM sleep, they report that they were thinking about everyday matters but rarely report dreams. 

Non-REM sleep, also known as slow-wave sleep, is divided into four stages, graded 1 to 4, based on level of EEG activity and ease of arousal. As sleep progresses, there is a deepening of sleep from Stage 1 to Stage 4, with progressively slower brain-wave activity until REM sleep, when suddenly the brain becomes much more active. In adults, the first REM sleep cycle is usually triggered ninety minutes after going to sleep and lasts about five to ten minutes. After the flurry of activity, brain-wave patterns return to non-REM sleep for another ninety-minute sleep cycle. 

Most adults experience five or six sleep cycles each night. REM sleep periods grow progressively longer as sleep continues; the last sleep cycle may produce a REM sleep period that lasts about an hour. In general, non-REM sleep lasts approximately fifty percent of the ninety-minute sleep cycle in infants and about eighty percent in adults. 

The sleep defects in fibromyalgia go well beyond reduced REM sleep and increased non-REM sleep. For example, the deeper levels (Stages 3 and 4) are not achieved for long enough periods. As a result, people with fibromyalgia wake up feeling tired, worn out, and in pain. The severity of the pain of fibromyalgia correlates with the rating of sleep quality; when patients with fibromyalgia get a good night's sleep, they have less pain. Conversely, when they sleep poorly, their symptoms are more severe. 

Excerpted from Encyclopedia of Natural Medicine by Michael Murray, N.D. et. al.

Next Topic: Fibromyalgia and Neurochemicals

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