Managing Chronic Fatigue Syndrome and Fibromyalgia
4. Treating Sleep
Poor sleep is an almost universal problem for people with CFS and fibromyalgia. Sleep problems include difficulty getting to sleep, waking in the middle of the night or early in the morning, and over sleeping.
Addressing sleep problems can be good initial focus for symptom management because treating sleep can both improve quality of life and reduce other symptoms. If you are troubled by poor sleep, consider creating a sleep management plan using a combination of strategies selected from the three approaches described below: improved sleep hygiene, use of medications and treatment of sleep disorders.
1. Have a Comfortable Environment. Provide yourself with an environment conducive to good sleep by using a good mattress, and by exercising control over light, noise and temperature. (Note: Noise includes snoring by your sleep partner. Some people with CFS or FM sleep in a separate bedroom from their partner.)
2. Establish a Routine. Go through the same routine each night and have a consistent bedtime. Prepare for sleep by gradually reducing your activity level in the several hours before bedtime and by having a regular routine you go through consistently at the same time each night.
3. Use Relaxation and Distraction. If you find it difficult to fall asleep, consider listening to quiet music or distracting yourself in some other way, such as by counting or watching your breath.
4. Control Stress and Worry. Stress often leads to muscle tension, which makes falling asleep more difficult. Practicing relaxation methods can help you ease tense muscles. Try relaxation procedures (you'll find examples in articles on in the Stress Management section of our Library) or soak in a hot tub or bath before going to bed.
If you have difficulty falling asleep because you are preoccupied with problems, consider setting aside a "worry time" each night before going to bed. Write down all your worries and what you'll do about them. If worries come up as you are trying to go to sleep, tell yourself "I've dealt with that. I don't have to worry because I know what I'm going to do."
5. Get Up at the Same Time. If you are going to bed later and later, setting an alarm so that you get up at the same time each day can help you adjust gradually back to more normal hours. Usually, you may not need to compensate by changing your bed time to an earlier hour; your body can adjust itself.
6. Use Pacing. Being too active during the day or early evening can create a sense of restlessness called feeling "tired but wired." Keeping activity within limits and having a winding down period before going to bed are antidotes.
7. Limit Daytime Napping. Often, daytime napping interferes with night time sleep. If you nap during and day and find that you have trouble falling asleep, or your sleep is worse than usual when you nap, you might consider sleeping only at night. (On the other hand, if napping does not disturb your nighttime sleep, you may need more rest.)
8. Avoid Caffeine, Alcohol & Tobacco. Consuming too much caffeine, drinking alcohol and smoking can make getting good rest more difficult. Avoid products with caffeine, such as coffee, tea, soft drinks and chocolate, for several hours before going to bed. Avoid alcohol before bedtime; it can create restless and uneven sleep. The nicotine in tobacco is a stimulant, thus smoking is a barrier to falling asleep.
If you think medications might improve your sleep, you might start with non-prescription substances. These include over the counter products like melatonin and valerian, antihistamines such as Benadryl and Tylenol PM. If you prefer prescription medications, a reasonable approach is to find a physician willing to work with you to find what helps in your unique situation.
While medications can improve sleep, they can also make it worse. Some sleep medications that are effective when used occasionally can produce poor sleep if used frequently. Also, some drugs produce side effects, like a feeling of grogginess in the morning. Medications taken for other problems may interfere with sleep if they contain substances like antihistamines or caffeine.
Sleep apnea, meaning absence of breathing, occurs when a person's airway becomes blocked during sleep and he or she stops breathing. An episode can last from a few seconds to a few minutes. The person then awakens, gasps for air and falls asleep again, usually without being aware of the problem.
Apnea is a treatable condition. A common remedy is the use of a CPAP (continuous positive airway pressure) machine. The patient wears a mask through which a compressor delivers a continuous stream of air, keeping the airway open and thus allowing uninterrupted sleep. Use of a CPAP machine can eliminate 90% to 100% of a person's sleep apnea. Other treatments are also used for this condition. If you are excessively tired in the morning or have trouble staying awake during the day, you may have apnea.
Restless legs syndrome (RLS) involves "twitchy limbs," strong unpleasant sensations in the leg muscles that create an urge to move. The problem is often at its worst at night.