Improving sleep quality often leads to a significant improvement in fibromyalgia symptoms.

While most people with fibromyalgia can get to sleep at night, more than 90% have difficulty experiencing the deep sleep a person needs to wake up feeling refreshed. 1 Bigatti SM, Hernandez AM, Cronan TA, Rand KL. Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum. 2008;59(7):961-7.

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Some doctors see a connection between the fatigue, heightened sensitivity to pain, and cognitive problems associated with fibromyalgia and the lack of quality sleep. Similar symptoms were observed in people with and without fibromyalgia who were deprived of sleep in a research study. 2 Choy EH. The role of sleep in pain and fibromyalgia. Nat Rev Rheumatol. 2015;11(9):513-20.

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In those suffering with fibromyalgia, some have other conditions that also result in poor sleep quality. By addressing these other problems, people may experience more restful sleep, leading to improved daily functioning.

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Restless Legs Syndrome Symptoms and Treatment

One condition that interferes with sleep is restless legs syndrome. The condition is about 10 times more common in people with fibromyalgia than in the general population. Restless legs syndrome causes an urge to move the legs followed by discomfort. It is worse with inactivity, especially at night. Warm baths, leg massages, and warm and cold packs sometimes ease the symptoms.

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Caffeine may make the symptoms worse, and avoiding caffeine for two or three weeks may be useful to see if symptoms subside. Certain over-the-counter and prescription medications, such as the antihistamine chlorpheniramine maleate and phenylephrine HCI (brand name Actifed) and the antidepressant amitriptyline (brand name Elavil) may exacerbate symptoms.

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Sleep medications, muscle relaxants, and medications that increase dopamine levels in the brain may help relieve restless legs symptoms.

Sleep Apnea Symptoms and Treatment

Another condition that hinders restorative sleep is sleep apnea, which causes shallow breathing or brief interruptions in breathing. Sleep apnea is a serious condition, linked to heart and liver problems as well as type 2 diabetes.

Nearly half of people with fibromyalgia have sleep apnea, according to one research estimate. 3 Rosenfeld VW, Rutledge DN, Stern JM. Polysomnography with quantitative EEG in patients with and without fibromyalgia. J Clin Neurophysiol. 2015;32(2):164-70. Typical symptoms include snoring, a dry throat upon waking, and extreme sleepiness in the daytime. The symptoms are not always obvious to the individual, and a spouse or other member of the household may be the first to recognize the problem.

A common treatment consists of wearing a device overnight to keep the airway clear. Surgery is considered only if other therapies are unsuccessful.

Strategies to Improve Sleep Quality

Making some adjustments to daily routines and finding ways to reduce stress may result in more restful sleep:

  • To make sleep a priority, limit caffeine-containing beverages to the morning, stick to a regular bedtime, and set aside time to wind down—without using electronic devices—before bed. Listening to relaxation tapes, reading, or taking a bath may be good options. It may take several weeks to feel the impact of these changes.

    Practicing Good Sleep Hygiene

  • Exercising as much as possible promotes better sleep and eases stress and restless legs, among many other benefits. Low-impact aerobic activity, such as walking, biking, and/or water exercise are just a few excellent options. For those who have been inactive, it may be necessary to start with several minutes of exercise a day and gradually increase the duration and intensity. Working with a physical therapist, chiropractor, or other health professional can be helpful when careful guiding is needed to increase strength, flexibility, and stamina at a safe pace. Exercising is best done earlier in the day to avoid interfering with sleep.

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  • Stress reduction approaches can help clear the mind and make sleep easier. Cognitive behavior therapy, or CBT, teaches people how to handle negative thoughts and focus on pleasant thoughts and activities. The therapy may include keeping a diary of symptoms and feelings to pinpoint actions to increase or avoid. Approaches such as meditation and biofeedback, which teach ways to relax muscle tension, can ease the perception of pain.

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Sleep habits vary widely from person to person, so it may be necessary to try more than one approach to find what works best for an individual.

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Ask the Doctor About Sleep Medications

Taking a prescription or over-the-counter sleep medication may be an option if other approaches are unsuccessful.

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People with fibromyalgia are often sensitive to medications, so checking with the doctor before trying a sleep medication is advised. Herbal supplements such as melatonin or valerian can also be quite helpful and tend to have few side effects. However, it is important to consult the prescribing health care provider and/or a pharmacist before taking the herbal supplements as some herbal supplements can affect the performance of other medications.

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Many sleep medications depress the nervous system. Since alcohol and opioid medications (also called narcotics or painkillers) have a similar effect on the body, combining these medications could be life-threatening. Avoid taking sleep medications while drinking alcohol or using opioids.

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If problems persist, it may help to visit a sleep specialist. In some cases, sleep monitoring from home or at a sleep center may be needed to understand the problem. Effective treatments are usually available.

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Dr. Naomi Feuer is a neurologist at NewYork-Presbyterian Hospital. She has more than 10 years of clinical experience and specializes in diagnostic testing, nerve testing, pain management, and physical therapy. Dr. Feuer serves as Assistant Clinical Professor of Neurology and Neuromuscular Disease at Weill Cornell Medical Center.