Sleep Hygiene

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Disturbed, non-restful sleep is one of the most defining symptoms of fibromyalgia. Studies have shown that upwards of 85% of fibromyalgia patients report insomnia and non-restorative sleep. Accordingly, current diagnostic criteria for fibromyalgia recognize insomnia and other sleep disturbances as legitimate symptoms that can be useful in establishing an unequivocal diagnosis of fibromyalgia (Roizenblatt et al., 2011). Despite the fact that scientists have yet to fully uncover the link between sleep and fibromyalgia, the good news is that effective treatments to improve sleep can also result in improvements in pain-related symptoms for many fibromyalgia patients. A necessary first-line approach at improving sleep quality and duration is to practice good sleep hygiene practices. Making thoughtful behavioral changes and improving the overall quality of the sleeping environment can make great strides toward achieving a more restful night’s sleep.

Sleep hygiene is a term used to describe a group of lifestyle and behavioral practices that can promote normal, good-quality sleep and lead to improved daytime alertness. Above all, the most important sleep hygiene practice is to maintain a regular sleep/wake pattern each day – even on the weekends. It is also extremely important not to spend an excessive amount of time in bed. The “appropriate” amount of time that one should spend in bed will vary by individual. For example, individuals who experience excessive daytime sleepiness should remain in bed slightly longer (a minimum of eight hours is recommended), whereas someone who has difficulty sleeping at night should set a maximum of no more than seven hours in order to maintain an efficient sleep/wake pattern.

Good Sleep Hygiene Practices

The following sleep hygiene practices can help individuals achieve and maintain a regular sleep/wake pattern and avoid spending an excessive amount of time in bed.

Things to Avoid

For many individuals, the urge to climb into bed or flop down on the couch for a nap can be practically irresistible when they are experiencing excessive daytime sleepiness. Unfortunately, naps can do more harm than good for those who suffer from sleep related problems, as they have the potential to disturb sleep/wake patterns. Therefore, naps should be avoided when trying to regulate sleep/wake patterns and improve the overall quality of sleep.

In addition, stimulants such as nicotine, caffeine, and alcohol can keep the mind and body on alert and prevent the onset of sleep; therefore, they should not be used too close to bedtime. Alcohol has a reputation for speeding up the onset of sleep; however, as the body metabolizes alcohol, it disrupts the second stage of sleep and can cause nighttime awakenings.

Food should also be avoided right before bed. Eating large meals too close to bedtime can prevent the onset of sleep by promoting heartburn, indigestion, and overall discomfort. It is also important to note that certain food can trigger sleeping difficulties, therefore sweeping dietary changes should not be attempted when simultaneously trying to tame one’s sleep schedule and behaviors.

Things to Do

One of the many benefits of exercise is its ability to promote good, restful sleep. Therefore, regular moderate-intensity exercise – performed during the morning or late afternoon – can be incredibly effective at not only improving sleep quality, but for fibromyalgia patients, it has also been shown to help relieve pain and tenderness, and improve overall well-being. Be careful not to perform vigorous exercise too close to bedtime, as the endorphins that are released into the body produce a stimulant effect and can prevent sleep onset. More relaxing exercises, such as yoga or stretching, can be done before bed, however. Activities such as these can help wind down the body and mind and serve as a good transition into sleep.

Along the same lines, establish and maintain a relaxing bedtime routine every night. It is best to avoid emotional conversations or unpleasant activities prior to attempting to sleep. Again, activities such as yoga, stretching, meditation, or relaxation techniques can help to clear the mind and help prepare the body for rest.

Light exposure is another important factor in establishing and maintaining an ideal sleep/wake cycle. Adequate exposure to natural light is essential to the body and mind and helps to regulate our body’s internal clock. During the daytime hours, open blinds and drapes, spend time in well- lit rooms, and weather-permitting spend time outdoors. Activities such as walking, bicycling, gardening, or simply walking to the mailbox and back can boost exposure to sunlight and help boost the body to maintain a good sleep/wake pattern.

One of the most important sleep hygiene practices that can be done is to associate the bed with sleep. The bed should not become a substitute for a couch or easy chair, where one retires for hours on end to catch up on favorite TV shows, listen to the radio, or read a book. By limiting time spent in bed for the sole purposes of sleeping, the mind can begin to associate that particular environment with sleep.

Finally, it is vitally important that the sleeping environment be conducive to a restful night’s sleep. If the bedroom is plagued by extraneous noise from the outside, is too bright, or too hot or cold, restful sleep will be difficult to achieve no matter how many other lifestyle and behavioral modifications one has made. Therefore, a comfortable bed, a relatively dark, well-ventilated and thermally pleasant room are all essential to a good night’s rest.

Individualization is Key

Now that you know the basics of good sleep hygiene, it is important to understand that there is no one-size-fits-all approach to employing them. Everyone is different. Everyone’s fibromyalgia is different. And, everyone’s most effective combination of sleep hygiene practices will be different. Some may prefer their bedroom slightly warmer than others. Some may prefer to use a relaxation tape to help guide them to sleep, and others may prefer the presence of a white-noise machine or fan. Ultimately, establishing the sleep hygiene practices that are right for you will be a process of trial-and-error.

Therefore, keeping track of the modifications you make to your daytime and nighttime routines is an essential part of establishing an effective sleep hygiene routine. It is important to maintain a journal or log of the modifications you try. Be sure to record what works, what doesn’t work, and simultaneously keep track of the hours slept at night, number of nighttime awakenings, and how rested you feel in the morning. It is also important to track feelings of fatigue and sleepiness during the daytime hours in order to help gauge if the sleep hygiene practices you are currently using are helping or not. 

In addition to practicing good sleep hygiene, some individuals will find that they may also need to incorporate pharmaceutical therapy or supplements into their efforts to achieve a normal sleep/wake pattern. Melatonin is a hormone produced in the body that helps to promote normal sleep/wake patterns, and research suggests that many fibromyalgia patients may have lower than normal levels of melatonin. Supplemental melatonin is available and may be helpful to some in order to establish a regular sleep/wake pattern. In severe cases of sleep disturbances, some individuals may require the use of prescription sleep aids to help initiate and maintain sleep. Popular examples of these medications include Lunesta and Ambien. However, these medicines carry with them the risk of some serious side effects and can also be habit-forming; therefore, they are not intended for long-term use and should not be viewed as a long-term solution to disrupted sleep. Nevertheless, many fibromyalgia patients may find that a combination of good sleep hygiene practices along with occasionally incorporating a sleep-promoting medication or dietary supplement may be the most effective way to conquer their sleep-related problems.

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References

1.        Citera G, Arias MA, Maldonado-Cocco JA, Lazaro MA, Rosemffet MG, Brusco LI, Scheines EJ, Cardinalli DP. The effect of melatonin in patients with fibromyalgia: a pilot study. Clin Rheumatol. 2000;19(1):9-13.

2.        Culpepper L. Nonpharmacologic care of patients with fibromyalgia. J Clin Psychiatry. 2010l;71(8):e20.

3.        Roizenblatt S, Neto NSR, Tufik S. Sleep disorders and fibromyalgia. Curr Pain Headache Rep. 2011;15:347-357.

4.        Sleep hygiene. National Sleep Foundation. Accessed July 16, 2012.

5.        Wikner J, Hirsch U, Wetterberg L, Rojdmark S. Fibromyalgia – a syndrome associated with decreased nocturnal melatonin secretion. Clin Endocrinol (Oxf). 1998;49(2):179-183.

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{ 1 comment… read it below or add one }

Michelle jadaa February 4, 2013 at 7:00 pm

I must admit i tried earplugs because of my husbands snoring.It wasnt untill i used them that i realised how much ambient noise was affecting my sleep.You just have to find the ones that are comfortable for you,i use silicone or wax,i buy them in bulk from ebay :)

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