Fibromyalgia and Sleep


Approximately five million American adults suffer from a painful syndrome called fibromyalgia (FM). Symptoms of this poorly understood syndrome include chronic muscle pain and stiffness, frequent headaches, and trouble sleeping. Particularly, sleep is one of the main focuses of fibromyalgia research.

What Is Fibromyalgia?

Fibromyalgia and its causes still elude researchers. However, scientists believe that this syndrome causes pain, memory issues, and mood disorders by changing the way a person’s brain processes pain signals.

Sometimes, symptoms begin after some triggering event. Surgery, car wrecks and physical trauma can all activate fibromyalgia. However, some patients develop fibromyalgia without any apparent prompt. This makes research more difficult, but all that more important.

What Happens to Sleep with Fibromyalgia?

In a 2007 survey of fibromyalgia patients, sleep passed pain as the biggest concern. Fibromyalgia and sleep are inextricably linked. If a person who suffers from fibromyalgia can get adequate sleep, they can lessen other symptoms.

However, because trouble sleeping is one of the primary symptoms of fibromyalgia, this can be easier said than done. It’s important that people with FM get a clear understanding of the interaction between sleep and fibromyalgia.

Can Lack of Sleep Cause Pain?

Fibromyalgia causes a vicious cycle of sleep deprivation and pain. The all-over muscular pain makes it difficult to sleep. Then, the sleep deprivation causes worse pain and stiffness. Those increased symptoms make sleep more elusive, and the cycle continues.

Even with a full night sleep, fibromyalgia sufferers often feel like they got very little sleep. This is because fibromyalgia makes REM sleep (or deep sleep) difficult to come by. Without deep sleep, the vicious cycle of pain and insomnia gets worse.

Other Sleep Symptoms

Not only can a lack of sleep exacerbate the pain and stiffness of fibromyalgia, but it can also make other symptoms worse. Without adequate sleep, fibromyalgia sufferers can experience more fatigue and a decrease in mental clarity.

Together, these symptoms create what’s known as “fibro fog.” As the name suggests, fibro fog makes people feel as though they are living life in a mental fog of sorts. This can cause not only physical harm but also impact work and family life.

Sleep Habits

They say that practice makes perfect, and that’s true when it comes to fibromyalgia and sleep. It can take time for someone with FM to find the right sleep routine and even more time to make it become a habit. However, until researchers find a cure for FM, establishing a healthy routine is vital.

Set an Alarm

When a person has trouble sleeping, his or her instincts might say to sleep in as long as possible. However, it may be best to ignore that reflex. The first step to creating good sleep hygiene is to have a consistent bedtime and wake-up time.

Start by setting the alarm for a reasonable waking time that the patient can adhere to every day. Then, the person must commit to getting out of bed when the alarm goes off, even without much sleep the night before. After a few days, the body will naturally want to sleep earlier to compensate.

Avoid Naps

Waking up at the same time every day is pointless if the patient spends the whole day napping. Daytime sleeping can make the body less tired at night, thus taking away the incentive to sleep at a reasonable hour. Napping can make insomnia worse and ruin a sleep routine.

However, it’s important to take this advice with a grain of salt. If naps tend not to disturb someone’s ability to fall asleep at night, they may be helpful. As with all fibromyalgia-related tips, this must be customized to each individual.

Kick the Caffeine Habit

When a person feels chronic fatigue, as those with FM often do, it can be easy to turn to caffeine to get through the day. While coffee and energy drinks may seem like a great solution at the moment, they can do more harm than good. Caffeine can disturb sleep cycle and keep people up well into the night.

Avoid Alcohol and Tobacco

Alcohol can help some people get to sleep, but it does not lead to restful or even sleep. The same goes for tobacco. These substances can exacerbate existing sleep problems and lead to worse sleep hygiene than before.

Look at Current Medications

If the person takes any medication before bed, the pills might be making insomnia worse. Some medicines can make it difficult to sleep at night. On the other hand, some medications cause grogginess and should only be taken at night.

Pace Yourself

Regardless of fibromyalgia, always being “on” can make restful sleep difficult to get. It’s important to have a period of calmness before bed. This restful period gives the mind time to wind down before the pressure to fall asleep kicks in.

During this time, limit any stress triggers. For some people, this may mean putting away all electronics and reading a good book. For others, this may mean practicing yoga or meditation. Whatever the activity, the goal should be to limit stress and calm the body.

Sleep Medication

Sometimes a person can try and try to establish a healthy sleep routine, but nothing works. It’s important to know when to lean on medications for assistance. There is nothing to be embarrassed about; millions of people rely on sleep medicine every night.

It’s important not to group all sleep medicines as the same. There are several different types. What may have irritated one person may work wonders for another. A medical professional should always help choose the right type of pill for each patient.

Bed is For Sleep

Once a person hits the hay, all work should stop. Avoiding work, television, and smartphones is bed is key to creating a great sleep routine. This rule helps the brain recognize that when the body is in bed, it’s only there to sleep.

Sleep Environment

Without an ideal sleeping environment, all the healthy habits in the world may not help. Creating the right atmosphere for sleep is half the battle for anyone, especially people with fibromyalgia. Here are a few ways to make sure a sleep environment is conducive not only to sleep but to deep REM sleep.

Limit Noise

Blaring sirens, barking dogs, and snoring spouses all make it difficult to sleep even in the best conditions. When you factor in systemic pain and stiffness, the noise can be the unbearable straw on the proverbial camel’s back. Fibromyalgia patients who have difficulty sleeping should try to limit this when possible.

Of course, people are not always in control of their surroundings. One way to block out noise that can’t be controlled is with ear plugs and a vibrating alarm. The ear plugs will drown out sound while the silent alarm wakes you on time. It’s a great combo.

Wrong Temperature

Some people like a cozy warm bedroom and some people like it chilly. Fibromyalgia patients should control the temperature as much as possible when bedtime rolls around. If changing the settings on the HVAC system is not an option, consider a fan or extra blankets for temperature control.

Too Much Light

Often, a little light can peek through the window in the early hours of the morning and cause a person to wake up sooner than expected. Even if he or she doesn’t fully wake up, REM sleep can be off the table. Although nobody can control the sun, there are a few things people can do to help this situation:

  • Go to bed and rise with the sun
  • Use eye masks during sleep
  • Purchase blackout curtains for the bedroom

Uncomfortable Bed

All the sleep strategies in the world can be useless with a lumpy, uncomfortable bed. For many fibromyalgia patients, a new mattress makes a world of difference. Many FM victims find that memory foam is helpful.

Sleep Problems Common with Fibromyalgia

Fibromyalgia often co-exists with other chronic conditions, many of which can also cause sleep disturbances. These additional issues can make sleep harder. However, understanding some of these underlying sleep issues can help fibromyalgia patients tackle their sleep problems.


“Insomnia” is the general term for not being able to sleep. Most often in fibromyalgia sufferers, it’s often caused by stiffness and pain. One of the most important ways to overcome insomnia is to create a routine before bed.

Here are a few other tips for overcoming insomnia that fibromyalgia causes:

  • Lay in bed for 15 minutes. If you still can’t sleep, distract yourself for at least 30 minutes before trying again.
  • Distractions can help. Try watching a television show you’ve already seen or listening to relaxing music.
  • Try stress management techniques. Meditation and visualization are popular with insomnia patients.


People with fibromyalgia often suffer from hyperarousal. This condition can make the person feel easily irritated and tightly wound. Although the person may feel low on energy and in need of a recharge, he or she merely cannot turn off or cool down. Some people call this “tired but wired.”

There are a few relaxation methods that can help curb hyper-arousal.

  • Relaxation yoga
  • Meditation
  • Breathing exercises
  • A sleep journal
  • Journal of racing thoughts

The point is to find something that calms the mind and body. Ideally, the patient should create a daily habit with the relaxation technique of his or her choice. This routine should produce a signal that lets the mind and body know that it’s time to be “off.”

Sometimes, hyper-arousal is too much to tackle alone. Working with a sleep professional can help. This professional can help create a routine and mindset that works for the individual.

Sleep Apnea

A study published in the Journal of Clinical Neurophysiology found that as much as 45 percent of fibromyalgia patients also have sleep apnea. By itself, sleep apnea is a common condition, However, when FM is also present, the symptoms can compound.

Sleep apnea is a condition in which a person’s breathing pauses during sleep. The break in breathing can last up to a few minutes. The person may resume breathing after a loud sound that often resembles choking or snoring. This cycle can repeat as much as 30 times every hour.

Understandably, sleep apnea alone can leave a person feeling exhausted. After all, he or she may never get to REM sleep, which is necessary for a restorative night. This shallow sleep can leave a person feeling exhausted and make them more likely to have an accident that causes injury.

For those with fibromyalgia, REM sleep can be hard to come by. When someone has FM and sleep apnea, good sleep can feel impossible. However, sleep apnea can stop with these methods of care:

  • Weight loss in obese patients
  • Physical exercise
  • A specialized sleep mask
  • Sleep medicine
  • Surgery to remove tonsils and adenoids
  • Respiratory Therapy

A person with both FM and sleep apnea may need to use the above treatments along with relaxation techniques to get a good night’s rest. Although this may seem arduous, good sleep is well worth the effort.

Too Much Sleep

When a person is exhausted from lack of sleep and fibromyalgia, it can be tempting for that person to sleep off and on all day. It seems like common sense that someone with FM should get sleep whenever it comes. However, this may make the problem worse.

Eight to ten hours of sleep per 24 hours is ideal for adults with or without fibromyalgia. If someone with FM is sleeping throughout the day or for more than ten hours per day, it may be time to address the quality of the sleep. Better sleep is does not simply mean more sleep.

The patient should work on getting deep sleep at night. Finding the right sleep environment and routine may take some trial and effort. Here are a few questions to consider regarding the sleep environment:

  • Is it too noisy for restful sleep? Try ear plugs.
  • Is the room too hot or cold? Change the temperature.
  • Is it too light? Try blackout curtains or masks.
  • Is the bed old or uncomfortable? Consider a new mattress.

Restless Leg Syndrome

Unfortunately, many people have made this real and disruptive syndrome the butt of many jokes. However, restless leg syndrome (RLS) can cause real harm and sleep deprivation, especially in people with fibromyalgia.

Like fibromyalgia, restless leg syndrome is a neurological disorder. RLS causes the person to have an uncomfortable, creepy sensation in his or her legs, especially when staying still. The person then feels compelled to shake the legs to gain relief.

Like with fibromyalgia, even medical professionals refused to take RLS seriously until recently. Also like FM, the cause of restless leg syndrome is unknown. However, there seems to be a strong link between the two syndromes.

A 2010 study showed that people with FM are 11 times more likely to suffer from RLS compared to the general population. The researchers concluded that the correlation was so high that doctors should routinely check fibromyalgia patients for co-existing RLS.

People with both fibromyalgia and restless leg syndrome often have difficulty sleeping. Both syndromes can keep patients awake, even when the person feels exhausted. Luckily, there are some promising treatments available for RLS:

  • Iron, B12, and folate supplements
  • Replacing prescriptions medicine that aggravates RLS
  • Healthy diet and exercise regiment
  • Reducing caffeine and alcohol
  • Certain prescription medications called “dopaminergic”

The prescription drugs for RLS are similar to dopamine. While they are considered effective for RLS, the potential side effects may not be worth the risk. Many doctors may recommend trying the other strategies before taking risks associated with the medication.

When the person’s restless leg syndrome gets under control, he or she can better identify strategies to deal with FM and its effects on sleep.

Sleep Paralysis

Sleep paralysis sounds like something out of a nightmare. A person wakes up fully aware but unable to move a muscle for up to a few minutes. It can also occur as a person falls asleep. This is understandably terrifying for anyone in this situation.

One of the leading causes of sleep paralysis is a lack of sleep. Of course, people with FM often suffer from sleep deprivation. It stands to reason that people with fibromyalgia are more likely to have sleep paralysis, especially during particularly bad spells.

If the sleep paralysis only happens once, you may not need to talk to your doctor about it. However, recurring paralysis should be discussed with your medical team. The patient may want to see a doctor is sleep paralysis symptoms:

  • Make him or her anxious
  • Worsen sleep habits
  • Keep him or her awake in fear of it happening again

Sleep paralysis rarely occurs in isolation. Because sleep paralysis often occurs with underlying mental health problems, the doctor may want to treat the depression or anxiety first. The doctor may recommend antidepressants, therapy, or both. Treatment for sleep paralysis also often includes treatment for other sleep problems such as restless leg syndrome, sleep apnea, and insomnia.

Wrapping Up

Fibromyalgia is a difficult syndrome to cope with, and the lack of sleep can worsen the symptoms. That’s why it’s critical for FM patients to address sleep issues. Patients should feel comfortable to address their sleep concerns with their medical team.

Sometimes, there are underlying sleep conditions like sleep apnea, insomnia, or restless leg syndrome that contribute to the lack of sleep. However, other times the pain of FM is enough to keep someone awake for hours.

No matter what causes the sleep deprivation, a good routine and calming environment can help. Some people may also rely on pain and sleep medications to get deep, restful sleep. The most important thing is to stay hopeful.