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Fibromyalgia: The critical importance of REM sleep

Written By | Jan 26, 2014

WASHINGTON, January 26, 2013—As research reveals fibromyalgia (FMS) to be a physical syndrome and not from a psychological source, many sufferers feel substantial relief after having been told by physicians (PCP) that the affliction is “all in the mind.” Now research is finding that REM sleep may be important in controlling FMS symptoms.

Unfortunately, erroneous and unsubstantiated determinations by PCPs and other medical professionals set off a chain of events where FMS sufferers felt miscast and freakish due to frequent accusations by family members and friends of being mentally and emotionally hysterical.

Now, however, it is known beyond speculation that FMS is a physical syndrome and in some cases, a resulting series of symptoms that stem from other issues including injury. In any case, the results are the same.

The inability to determine a single cause for FMS is one problem with trying to gain support for the recognition of the condition as a syndrome. In the minds of many, if one does not have definable disease one should not be ill.

Nothing could be farther from the truth, however. The convergence of FMS symptoms can control one’s life almost immeasurably.

FMS is determined to be a syndrome and not a disease by virtue of the definition of these terms. Disease is defined as a non-injury related illness that produces specific symptoms and signs, which affect specific locations with predictable pathology and etiology. Since FMS seems all over the physiological map, it does not fit the criteria to be classified as a disease.

A syndrome, on the other hand, is essentially a group of symptoms that occur together characterized by a set of associated symptoms. FMS fits this definition with greater ease.

Most victims of FMS are familiar with the diagnostic criteria of positive indicators of 11 points of tenderness in 18 specific areas on the body. Not having all 11 does not necessarily mean one does not have FMS, however, as people respond differently to this syndrome.

Victims of FMS are familiar with muscle pain, traveling nerve pain, chronic fatigue and headaches–often migraine. Feeling so poorly that being bedridden is not unusual and chronic sleep issues are common to FMS sufferers.

While the above is only a partial list of symptoms, restorative rapid eye movement (deep, REM) sleep is essential to control all of the symptoms of FMS.

Studies confirm that lack of the deep sleep necessary to ward off symptoms is cumulative, meaning FMS will increasingly worsen in degree and magnitude over time. If lack of deep sleep is not corrected, FMS victims will symptomatically worsen on a daily basis.

Restful sleep refers not to the amount of hours of sleep one gets, but instead to the quality of one’s sleep. One reason FMS victims feel fatigued so often is they rarely reach a level of restorative sleep. Pain makes one fatigued as well, but pain, among other symptoms, will lessen with healthy levels of deep sleep.

There are several reasons FMS sufferers do not get enough REM sleep. Many FMS victims complain they cannot sleep due to discomfort; many more have symptoms of restless leg syndrome (RLS), which can make deep sleep almost impossible. The naturally occurring drop in body temperature during sleep can also serve to worsen symptoms of FMS.

A longitudinal study (over a period of time) at the University of Kansas reveals that for FMS victims, lack of restorative sleep prevents recovery from symptoms, affect’s hormonal and chemical balance, and dramatically increases muscle and nerve pain.

A study reported by the National Institutes of health (NIH) strongly suggests lack of restorative sleep causes systemic disorders. Brain imaging shows that poor sleep over time promotes atrophy in some brain structures. As a result, not only can the need of quality sleep not be overstated, but FMS will be slow to respond to treatment of any kind, if at all in some cases.

Every sentient creature has an anabolic and a catabolic process. Briefly, catabolism is the wear and tear on the brain and body. Normally, this process occurs during our waking hours when we draw on resources to garner and expend energy.

Anabolism normally occurs when we are asleep, when our cells rejuvenate and our bodies and minds are restored to vigor. Newly-released findings from a branch of NIH-Neurological Disorders and Stroke posits that the brain builds up a chemical allostasis, or build-up created by the catabolic phase, and sleep is necessary to “clean up” the chemical effects of catabolic load.

If one does not sleep well, the process is interrupted and one remains in catabolic phase, eventually sickening to a point where the immune system is affected, leaving one open to illness and disease.

For those with FMS, the imbalance can be devastating. The Food and Drug Administration (FDA) approved drugs that promote rest and pain reduction for those with FMS including Lyrica, Sevella and Cymbalta. These drugs have been known to ease symptoms for up to 40 percent of FMS victims. Sometimes, however, a doctor must try each to determine what works best for each individual patient.

A relatively new drug for FMS is a central nervous system depressant called Xyrem. Not only does it promote REM sleep, it is known to reduce FMS pain by 30 percent. Many doctors are reluctant to prescribe Xyrem, however, because it has the street name of GHB, used as a “date rape” drug.

A victim of FMS must take responsibility for their health by being firm and insistent with their doctors to get what they need. A patient does not make an appointment to assuage a doctor. It is the duty of a doctor to provide every means available to treat their patients.

There are also several non-prescription methods to induce better sleep including but not limited to creating a soothing background sound known as “white noise” with the use of something like a fan; not taking naps and trying to sleep regular nighttime hours; and avoiding caffeine, late night overeating, stress, anxiety and non-relaxing activities prior to bedtime.

One significant means of training the sub-conscious mind to induce sleep is to use the bedroom solely for sleep and intimacy and for no other reason. Eventually, the subconscious mind, responsible for 80 to 90 percent of our behavior, will recognize the bedroom as a specific place for rest and sleep and will relax the mind and body automatically.

If stress and anxiety are the order of the day, many psychologists suggest watching 30 or more minutes of comedy on TV to replace negativity and lighten stress.

Those who use this method swear by the positive, sleep inducing effect.

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Paul Mountjoy

Paul Mountjoy is a Virginia based psychotherapist and writer.