Fibromyalgia

Getting a Good Night’s Sleep

Melatonin is a pineal hormone that has been widely studied for its ability to produce sleep. In the body, melatonin is secreted in response to darkness, causing sleepiness.

Because so many patients with fibromyalgia have insomnia or unrefreshing sleep, researchers have sought to determine whether melatonin can be of specific help to them as a sleep agent. Studies have found that people with fibromyalgia have low melatonin levels. Supplementation with melatonin resulted in improved sleep and lowered requirements for prescription drugs (Rohr UD et al 2002). A Swedish study determined that patients with fibromyalgia produce less melatonin during hours of darkness than do healthy control subjects, making melatonin therapy potentially helpful as a sleep aid (Wikner J et al 1998). Researchers in Argentina conducted a pilot study in which they found that sleep patterns, sleep quality, and pain measures markedly improve in patients with fibromyalgia after 4 weeks of treatment with melatonin (Citera G et al 2000). In the United States, a double-blind, placebo-controlled study showed that 20 percent of the patients with fibromyalgia significantly improved their sleep patterns and quality when they took 6 mg of melatonin each night before bed.

Diet and Lifestyle Approaches

Patients with fibromyalgia can do a number of things to help diminish their pain, deepen their sleep, and generally improve their quality of life.

Diet. No controlled studies have been undertaken to date to test whether specific foods can alleviate symptoms of fibromyalgia. The following dietary guidelines may help patients with fibromyalgia (Hanninen O et al 2000):

• Consume plenty of calcium to support bone density. Foods high in calcium include milk, ice cream, yogurt, broccoli, hard cheeses, oysters, sardines, spinach, and oranges.
• Apples are high in malic acid, an antioxidant important in limiting muscle pain.
• Blueberries have been shown by the USDA to be higher in antioxidants than any other fruit, vegetable, nut, or herb.
• Carbohydrates increase serotonin levels, essential fatty acids reduce fatigue, and protein helps improve mental alertness (Wallace D et al 2002).
• Caffeine, a strong stimulant, should be avoided, particularly late in the day, to ensure that it does not negatively affect sleep.
• Alcohol should never be used to alleviate or mask pain.

Exercise. Moderate, regular exercise has been shown to reduce symptoms. Patients with fibromyalgia should work some of the following exercises into their schedule:

• Walk 20 to 40 minutes daily. Walking—outdoors when possible—is perhaps the best regular exercise.
• Swim 30 to 60 minutes three times a week. Swimming can successfully strengthen and tone painful muscles.
• Do isometric and stretching exercises. These types of exercises, particularly those focused on muscle groups susceptible to fibromyalgia pain, are vitally important.
• Strengthen and stretch muscles through yoga. Yoga is also an excellent way to engage with other people and take your mind off pain.
• Maintain good posture at all times. Don’t stay in a single position for long periods.
• Use supports such as armrests, railings, pillows, and slings to help avoid needlessly stressing sensitive muscles.
• Focus as much as possible on relaxation and stress reduction. Deep breathing, meditation, and other forms of conscious relaxation are often quite helpful.

Tobacco use. People with fibromyalgia should not smoke or use tobacco. Smokers with fibromyalgia have lower pain thresholds and more sleep problems than nonsmokers. Nicotine withdrawal can cause muscle spasms, and vascular constriction is worsened by smoking, leading to increased numbness, burning, and tingling (Wallace D et al 2002).

Other Treatments. Many patients with fibromyalgia report excellent results fighting pain with the help of therapists trained to use a variety of the following musculoskeletal and psychological treatments:

• Regular massage. Offers significant pain relief.
• Chiropractic. Chiropractors work to align the spine for optimal nerve flow and to increase range of motion and relax muscles.
• Physical and occupational therapy. Physical and occupational therapists, particularly those specifically trained to work with patients who have fibromyalgia, can design rehabilitation programs involving both manipulation and exercise that often show positive results.
• Acupuncture. A 2500-year-old treatment system, using very thin needles, that has shown moderate degrees of effectiveness in treating both pain and fatigue in patients with fibromyalgia.
• Psychotherapy, counseling, and support groups. These groups can be enormously beneficial to people with fibromyalgia, offering great assistance with issues such as anxiety, loss of self-esteem, anger, shame, depression, and relationship challenges.