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Fibromyalgia and Sleep

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Chronic pain in fibromyalgia patients, together with its associated symptoms and co-morbidities, is now considered a result of dysregulated mechanisms in the central nervous system (CNS).

As fibromyalgia patients often report sleep problems, the physiological processes that normally regulate sleep may be disturbed and overlap with other CNS dysfunctions. Although the mechanisms potentially linking chronic widespread pain, sleep alterations and mood disorders have not yet been proven, polysomnography findings in patients with fibromyalgia and non-restorative sleep and their relationships with clinical symptoms support the hypothesis of a conceptual common mechanism called ‘central sensitisation’.

Food and Drug Administration (FDA)-approved drugs for the treatment of fibromyalgia may benefit sleep, but their label does not include the treatment of fibromyalgia-associated sleep disorders. Non-pharmacological therapies (including a thorough sleep assessment) can be considered in the first-line treatment of non-restorative sleep, although they have not yet been fully investigated in patients with fibromyalgia. Both pharmacological and non-pharmacological treatments should be used cautiously in patients with fibromyalgia, bearing in mind the patients’ underlying disorders and the potential interactions of the therapies.

Section snippets

Definitions

The exact mechanisms of the relationship between sleep and health are still a subject of research, but it is generally agreed that sleep is regulated by a complex network of physiological processes and substantially contributes to multiple physiological functions, including cardiovascular, endocrine, immunological, psychiatric and neurological functions [12], *[13], *[14], *[15]. Consequently, poor sleep quality or quantity increases the risk of medical and psychiatric diseases [16], [17], [18].

Epidemiology and clinical features

FM patients often report sleep disturbances, including NRS, insomnia, early morning awakening and poor quality sleep [31], [32]. Roizenblatt et al. [32] found that FM patients experience significantly poorer sleep quality than controls, and reported worsening pain symptoms after poor sleep. An Internet survey of more than 2500 FM patients in the USA listed morning stiffness, fatigue, NRS, pain and concentration and memory problems as the most severe symptoms [33], and a German study of almost

Aetiology and pathophysiology

On the basis of the concept that central sensitisation is a common pathway of chronic sensitivity syndromes, it is presumed that sleep disturbances are due to FM-related pathophysiological changes. However, various researchers have suggested a bidirectional relationship between NRS and FM-associated pain *[46], *[47]. A number of prospective clinical studies demonstrated a correlation between FM symptoms and poor sleep quality. One statistical path analysis has shown that a night of greater

The assessment of sleep in FM patients

Despite the existence of clinical data published many years before 1990, the universally accepted diagnostic criteria of FM established by the ACR in 1990 [39] did not include disturbed sleep or NRS, or any symptoms other than pain. The newly proposed 2010 ACR Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity [38] do include patient-reported measures of unrefreshing sleep and sleep disturbances (assessed by means of visual analogue scales) to support a

Treatment options

As sleep and its integrity are clearly involved in the pathogenesis of widespread pain, it has been hypothesised that improving the various dimensions of sleep may reduce pain. This hypothesis is supported by the findings of a 15-month prospective study conducted in the UK, which showed that subjects with CWP who reported an improvement in sleep quality were more likely to experience relief from CWP [46]. It can therefore be concluded that any therapeutic approach capable of reducing or even

Summary

Recent progress in our understanding of chronic pain in FM patients has mainly been due to scientific interest moving away from attempts to identify peripheral structural muscle and tissue diseases and towards CNS mechanisms that may explain the variety of clinical features other than pain.

Sleep is an integral part of human health, and is regulated by a complex network of physiological processes. As FM patients often report sleep problems, some researchers have investigated the potential

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