By Gerard Meskill, M.D.
Nobody says, "I don't believe hypertension exists," or "I don't believe 'stroke' is a real thing." People with fibromyalgia syndrome (FMS) suffer not only from constant widespread pain, but they also sometimes face judgment and distrust from medical professionals who doubt if their condition is real. They are labeled as annoying and needy. In the literal sense, insult is added to injury.
The root cause of FMS is poorly understood, which may explain why its legitimacy is questioned by some healthcare professionals. FMS is characterized by chronic widespread musculoskeletal pain, stiffness, and tenderness at multiple points. The prevalence of FMS ranges from 2 percent to 3 percent of the general population, with women affected six to nine times more frequently than men.
In addition to pain symptoms from head to toe, people with FMS also complain of poor sleep, chronic fatigue, depressed mood, headaches, and many other symptoms. However, complaints of poor sleep and chronic fatigue may be more significant to individuals with FMS than pain symptoms. Analysis of slow-wave sleep in individuals with FMS often demonstrates characteristic alpha-wave intrusions in slow wave sleep, which are thought to contribute to poor sleep in this population. Furthermore, a trial using sodium oxybate, a medication known to increase slow-wave sleep, demonstrated improvement in fibromyalgia symptoms.
As the association between FMS and sleep has been further studied, more evidence has mounted that FMS in many cases is a byproduct of a sleep disorder. A 2006 study demonstrated a more than ten-fold increase in FMS in subjects with sleep-disordered breathing (SDB) compared to the normal population.
Research suggests that FMS is a disorder of hypersensitivity of the central nervous system (CNS). The peripheral nervous system (PNS) is constantly sending signals from various areas of the body to the CNS. The CNS then filters these signals, ignoring the insignificant while responding to the more pressing. Due to the hypersensitivity of the CNS in FMS, those lesser signals are not filtered, leading to widespread pain.
Poor sleep quality has a similar effect on CNS signal filtration. Many with chronic pain syndromes (e.g., arthritis) describe improvement in pain with a good night's sleep and vice versa. It is a well-known phenomenon in the neurology community that sleep deprivation is a powerful trigger for seizures. Seizures are caused by inappropriate hyperexcitation of certain neurons leading to a cascade of electrical discharges in the cerebral cortex that overcome (or "seize") the function of that region of the brain.
Diagnosis and treatment of SDB and other chronic sleep conditions can lead to significant improvement in FMS independent of any other therapy. However, since the overwhelming majority of FMS sufferers are women, and many women with SDB have more subtle airflow disruptions than their male counterparts, it is essential that testing be sensitive enough to detect these less obvious changes. Those who have had a prior negative sleep study or who do not snore should seek a sleep center that focuses on diagnosing and treating subtle SDB, such as Upper Airway Resistance Syndrome. Esophageal manometry can be used to measure intrathoracic pressure during sleep. This metric can help detect increased respiratory effort and subtle changes in airflow during sleep that can cause sleep fragmentation and that otherwise would be missed.
FMS sufferers with poor sleep may experience frequent nighttime arousals, tossing and turning in bed, morning headaches, nasal congestion in the morning that was not present upon going to bed, dry mouth during the night, episodes of waking up with palpitations, teeth clenching or grinding at night, temperomandibular joint (TMJ) or jaw pain in the morning, and acid reflux during the night or in the morning. While these are not specific signs independently, they all are suggestive of irregular breathing during sleep.
So for the four to six million Americans suffering from FMS, perhaps it's time to see a sleep specialist. A proper night's sleep just might cure what ails you.
Sources:
Bennett RM, Jones J, Turk DC, Russell IJ, and Matallana L. "An internet survey of 2,596 people with fibromyalgia." BMC Musculoskelet Disord. 2007;8:27.
Germanowicz D, Lumertz MS, Martinez D, and Margarites AF. "Sleep disordered breathing concomitant with fibromyalgia syndrome." J Bras Pneumol. 2006 Jul-Aug;32(4):333-8.
Scharf MB, Baumann M, and Berkowitz DV. "The effects of sodium oxybate on clinical symptoms and sleep patterns in patients with fibromyalgia." J Rheumatol. 203 May;30(5):1070-4.
Sepici V, Tosun A, and Köktürk O. "Obstructive sleep apnea syndrome as an uncommon cause of fibromyalgia: a case report." Rheumatol Int. 2007 Nov;28(1):69-71. Epub 2007 Jun 23.
Wolfe F, Ross K, Anderson J, Russell IJ, and Hebert L. "The prevalence and characteristics of fibromyalgia in the general population." Arthritis Rheum. 1995;38(1):19-28.
Gerard Meskill, M.D. is a board-certified neurologist who specializes in the treatment of sleep disorders. He completed his sleep fellowship training at the Stanford Center for Sleep Sciences and Medicine. He now practices sleep disorders medicine and neurology in the Greater Houston area at Comprehensive Sleep Medicine Associates, with offices in the Woodlands, the Houston Medical Center, and Sugar Land, Texas. For more information, visit http://www.houstonsleep.net.