By Angela Terry, RPSGT @ OBAND Medical Group Las Vegas

Life as an RPSGT sometimes means that I don’t always get enough sleep. Sometimes my body becomes sore and achy after working a long night shift and caring for my family. One thing that I can always count on though is that after a proper sleep cycle, I can wake up rested and pain free. This relief is thanks to the restorative process of chemical and hormonal releases/balances that naturally occur during deep sleep. Could you imagine not getting that relief? Waking up in the same pain that you laid down with? Some people live this way every day and they call it fibromyalgia. There is no cure and there are many controversial causes.

Symptoms of fibromyalgia include muscle and connective tissue pain, chronic fatigue, sleep disturbance, joint stiffness and difficulty swallowing (possible narrow throat or damage and swelling of the throat from severe obstructive apneas). These symptoms also coexist with depression, anxiety and stress related disorders (also symptoms that I have found to be first signs of improper sleep cycle). Most fibromyalgia patients have complained of prolonged or severe stress and chronic sleep disturbances. Many patients experience cognitive dysfunction, memory problems and short attention spans. All are signs and symptoms of improper sleep cycles or not enough sleep for several nights in a row. Researchers have proven, through trials, that the muscles ache and become tender to touch if patients have been interrupted during deep sleep for several nights but quickly recovered and returned back to normal after a sufficient, uninterrupted night’s sleep. Also, if fibromyalgia were primarily a muscle/tissue pain condition, then why so many psychological symptoms? My theory is that these patients are suffering from a sleep disorder which prevents the achievement of slow wave (Delta) or REM sleep stages.

To dig a little deeper, low levels of dopamine (a natural analgesic within our bodies that also plays a part in pain perception) have been reported in fibromyalgia patients and is also found in Restless Leg Syndrome patients. Restless Legs Syndrome is usually reported by fibromyalgia patients. Research also suggests that serotonin (a neurotransmitter that regulates sleep patterns, mood, concentration and pain) could be directly involved in the pathophysiology of fibromyalgia symptoms. Hormones under the direct (or indirect) control of the growth hormones (insulin-like growth factor-1, leptin, neuropeptide Y, and cortisol) have also been reported at low levels in fibromyalgia patients. Low cortisol levels (hypocortisolemia) and low levels of IGF-1 indicate adult growth hormone deficiency and hyposecretion of adrenal androgens. Fibromyalgia patients also have demonstrated low levels of circulating epinephrine and norepinephrine…ESPECIALLY AT NIGHT!

These low levels of crucial hormones and chemicals(especially at night) tell me that these people are not reaching Slow wave sleep nor REM stages, causing their muscles and joints to endure the damage of daily living without any restoration at night. My feeling is that one week of these conditions would be enough to cause a person to have fibromyalgia, much less years! Fibromyalgia gets progressively worse as time goes by which is frustrating to doctors and patients, but makes perfect sense if it were symptoms of a sleep disorder. Years of this kind of neglect (lack of rest/restoration) is sure to cause permanent damage to the fibers in muscle tissue or any soft tissues of the body.

My theory is that a sleep disorder, be it sleep apnea, restless legs, insomnia, etc. could be the blame for many of our patients’ fibromyalgia symptoms. Sleep techs should pay close attention to histories and explain these things to patients that may be suffering from this horrible condition. Once they are diagnosed with sleep apnea for instance, have them keep a diary of their pain before and after CPAP therapy. This could help future patients get diagnosed and treated for the real cause of all that pain, A SLEEP DISORDER! Also, labs should consider recruiting pain specialists into their list of referring doctors.

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Tags: cpap, fibromyalgia, insomnia, muscle pain, REM sleep, sleep apnea, sleep cycle, sleep deprivation, sleep disorder, sleep disorders, sleep medicine, sleep study, sleep study preparation