My Kingdom for a Good Night's Sleep!
How often have you lain awake at night longing to fall into a restful sleep? Your brain decides that this is the time of day that it wishes to go through all those nagging little problems and simply refuses to switch off. I don't know how many times I've lain there either listening to a cassette trying to lull my brain into drowsiness or wondering who I can phone this time of night to relieve the boredom. However, even if I do manage to drift off and have what I would call a good night’s sleep, I still wake up feeling more tired than when I went to bed and my body aches as though the previous day I had run the New York Marathon.
As anyone with fibromyalgia will tell you, these are classic symptoms. Canadian researcher Dr Harvey Moldofsky was the first one to take an interest in this aspect of fibromyalgia and carried out some revealing experiments. One experiment he did back in the 1970s was to take a group of healthy people and repeatedly wake them up during the night. In the morning they complained of muscle pain and fatigue, symptoms which miraculously disappeared following a night of undisturbed sleep. He figured that something must be going on in people with fibromyalgia that was disturbing their deep sleep and made them feel unrested in the morning even if they felt they had slept for the majority of the night. He gathered a group of people with fibromyalgia and carried out a sleep study measuring their sleep wave patterns as they slept. Normally when you fall asleep you go through various stages of what is known as the sleep cycle. The first waves to appear as you start to drift off are alpha waves and as you fall more deeply asleep the waves become slower and slower until you reach deep sleep, characterized by very low-frequency delta waves. What Dr. Moldofsky found was that the majority of people with fibromyalgia had their deep delta wave sleep interrupted by the intrusion of the faster alpha waves; he called this the alpha-delta anomaly and reasoned that this was the likely cause of the non-refreshing sleep and muscle pain reported by those with fibromyalgia.
It seems obvious that if your deep sleep is interrupted you are going to feel tired the next day, but why do you also feel as if you have been run over by a bus? The answer may lie with the fact that 80 percent of growth hormone produced per day is released during deep delta wave sleep. Growth hormone is not only responsible for making you grow taller, it also has the vital role of repairing and restoring any damage that occurs to the muscles and tissues during the rough and tumble of everyday life. If its release is disrupted your body doesn't get its nightly self-exam and a backlog of repairs accumulate, leading to worn-out tissues and a weakened immune system; tiny tears in the muscles, that occur due to activity and exercise, are left unrepaired. This could lead to aching muscles and the feeling of being totally worn out. Other researchers have measured growth hormone levels in people with fibromyalgia and found that they are significantly lower when compared with healthy people; the alpha-delta anomaly could be partly responsible for this. Growth hormone is known to decline with age and people with fibromyalgia appear to be about 33 years older in terms of their growth hormone levels.
More recent research by Dr. Stuart Silverman and his colleagues at UCLA has suggested another reason why those with fibromyalgia find it so hard to fall asleep. This research has focused on the autonomic nervous system, already shown to be out of balance in fibromyalgia by Dr. Martinez-Lavin (currently Chief of the Rheumatology Department at the National Cardiology Institute of Mexico) and colleagues in 1998.
The autonomic nervous system basically controls the things that happen in our bodies over which we have no conscious control, for example, our heart rate, blood pressure, sweating, the digestion of food and breathing. Sometimes we can choose to override the system—like with breathing, we can choose to start breathing more slowly or more quickly but then we get on with our daily tasks and the autonomic nervous system takes over again. Typical symptoms of a disrupted autonomic nervous system are: dizziness & vertigo, night sweats, abnormal temperature control, palpitations, chronic diarrhea/constipation and orthostatic hypotension (when you experience dizziness and fainting on standing up due to low blood pressure). This special part of the nervous system is operated by two opposing teams: the sympathetic system, which mainly speed things up and is often referred to as the 'fight or flight' response due to its ability to gear us up to respond to danger; and the parasympathetic system, which works in opposition to slow things down and is nicknamed the 'rest and digest' period.
At night when you settle down for sleep the parasympathetic system normally takes over to slow everything down, reducing your heart rate and slowing your breathing, to allow you to feel restful and drift off to sleep. Unsurprisingly, when Dr. Silverman and his colleagues looked at 93 people with fibromyalgia at nighttime they found that the activity of the parasympathetic system was greatly reduced. So, rather than preparing to "rest and digest," these people were still being stimulated by the "fight or flight" system causing them to toss and turn as they remained alert listening for the proverbial tiger.
Researchers are unsure why this excessive state of arousal occurs and further research will be needed to track down the answers.
Getting the best night's sleep you can is essential when dealing with fibromyalgia. There are various medications and herbal remedies you can try; those that increase the time spent in deep sleep are believed to be the most effective, but if you can find something that will help you fall asleep and stay asleep that is a good place to start. Some prescribed medications can be split into two doses so that if you awaken during the night you can take a second dose. You can also do practical things to increase your chances of a good night's sleep:
- Establish a regular sleeping pattern: go to bed at the same time each evening and get up at the same time every morning
- Do an activity to relax you before going to bed. This could be listening to music or a novel on cassette, having a warm bath with lavender bath oil, doing some relaxation exercises, or simply reading a book. Watching something scary or thrilling on TV can sometimes be a little too stimulating.
- Ensure that your bed and pillow are comfortable and supportive. Try out various mattresses and ergonomic pillows; an Adjustamatic bed or a Tempur mattress and pillow come with good recommendations, though they are quite expensive.
- Make sure you stay warm during the night and avoid being near any drafts from open windows.
When you get a good night's sleep it is much easier to face the day and cope with the nagging pain and fatigue. It is certainly worth persisting with good sleeping habits and various medications to achieve the best night's sleep you can.
