Fibromyalgia may be a sleep disorder

A neurologist can detect alpha intrusion on a sleep study. JR

A study claims that fibromyalgia syndrome may be a sleep disorder, or at least linked to one.

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.

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Are women more at risk for insomnia?

Women have a higher risk than men of developing insomnia at some time in their lives.

Insomnia is a common sleep disorder characterized by the inability to obtain sufficient sleep— typically seven to eight hours for adults, enough to feel refreshed and alert throughout the day—and leads to associated symptoms such as excessive daytime sleepiness. Patients with insomnia dedicate enough time to sleep, but they either cannot fall asleep easily (known as sleep onset insomnia), or they wake up and can’t fall back to sleep easily (sleep maintenance insomnia). Some have both. There is a tendency for insomnia to run in families, although the genetic component is not yet known.

There are two types of insomnia—primary and secondary.

Primary insomnia occurs spontaneously, meaning that nothing in the environment, including medical issues, is to blame.

Secondary insomnia is far more common than the primary variety. Causes include depression, anxiety, chronic pain from conditions such as arthritis or fibromyalgia, dementia, sleep apneaand restless leg syndrome. Some medicationsand too much alcohol, caffeine or nicotine also can lead to secondary insomnia.

Some causes of secondary insomnia, such as depression and fibromyalgia, are more common in women. Restless leg syndrome is often the result of iron deficiency anemia, which occurs more often in women than men.

Read more: http://www.healthcanal.com/mental-health-behavior/23902-Are-women-more-risk-for-insomnia.html

Sleep problems triple women's risk of developing fibromyalgia

Women plagued by sleep problems have more than triple the risk of developing the pain disorder fibromyalgia compared with their better-rested peers, a new study from Norway suggests.

The more often a woman experienced insomnia and other sleep problems, the more likely she was to have developed fibromyalgia 10 years later, according to the study, the largest to date to follow women who were initially free from chronic pain.

The findings imply that sleep problems may lead to fibromyalgia, but the researchers say the relationship isn't so clear-cut. Although sleep deprivation has been shown in previous research to increase inflammation and reduce the body's ability to manage pain, experts haven't been able to draw a straight line from sleep difficulties to fibromyalgia.

"Sleep problems are just one factor that may contribute to the development of fibromyalgia," says Paul J. Mork, Ph.D., a study coauthor and a researcher at the Norwegian University of Science and Technology, in Trondheim. "Fibromyalgia is a complex pain syndrome and there are numerous other factors that may contribute to the development of this illness.

Doctors have long been aware of the link between poor sleep and fibromyalgia, a chronic condition characterized by widespread pain and tender points in the soft tissues. Fibromyalgia patients -- more than 90% of whom are women -- nearly always report trouble sleeping, while poor sleep is in turn associated with worse pain. (A 1975 experiment found that depriving healthy volunteers of sleep caused them to develop fibromyalgia-like symptoms.)

"In the clinic we really do see a reciprocal relationship between fibromyalgia and sleep quality," says Lesley Arnold, Ph.D., a professor of psychiatry and behavioral neuroscience at the University of Cincinnati College of Medicine. "Pain can affect your sleep; it results in poor sleep for many patients, and that in turn increases the pain and results in the persistence of the problem."

Read more: http://www.cnn.com/2011/11/14/health/insomnia-triple-women-risk-fibromyalgia/index.html