Sleep Disorders - Insomnia

INSOMNIA It is not unusual to have sleep troubles from time to time. But, if you feel that you do not get enough sleep or satisfying sleep, you may have insomnia, a sleep disorder. People with insomnia have one or more of the following:
• difficulty falling asleep
• waking up often during the night and having trouble going back to sleep
• waking up too early in the morning;
• unrefreshing sleep
Insomnia can cause problems during the day, such as sleepiness, fatigue, difficulty concentrating, and irritability. A person with insomnia may also have another sleep disorder such as sleep apnea, narcolepsy, and restless legs syndrome. (Link these three disorders to their respective pages)
Insomnia is not defined by the number of hours you sleep every night. The amount of sleep a person needs varies. While most people need between 7 and 8 hours of sleep a night, some people do well with less, and some need more.
About 60 million Americans each year suffer from insomnia, which can lead to serious sleep deficits and problems. Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men.

TYPES OF INSOMNIA
1. Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem.
2. Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition (like depression, heartburn, cancer, asthma, arthritis), pain, medication they are taking, or a substance they are using (like alcohol).
3. Acute (short-term) insomnia can last from one night to a few weeks. It is often caused by emotional or physical discomfort, and can be related to a single specific event. Causes of acute insomnia can include:
• significant life stress (job loss or change, death of a loved one, moving)
• illness
• environmental factors like noise, light, or extreme temperatures (hot or cold) that interfere with sleep
• things that throw off a normal sleep schedule (like jet lag or switching from a day to night shift).
4. Chronic (long-term) insomnia is when a person has insomnia at least 3 nights a week for 1 month or longer. It can be caused by many things and often occurs along with other health problems. Common causes of chronic insomnia are depression, chronic stress, and pain or discomfort at night.
• environmental factors like noise, light, or extreme temperatures (hot or cold) that interfere with sleep
• things that throw off a normal sleep schedule (like jet lag or switching from a day to night shift).

DIAGNOSING INSOMNIA
If you think you have insomnia, talk to your health care provider. An evaluation may include a physical exam, a medical history, and a sleep history. You may be asked to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day. Your health care provider may want to interview your bed partner about the quantity and quality of your sleep. You may be referred to a sleep center such as Kearney Sleep Lab for special tests.






Sleep Apnea  

Sleep apnea is a serious and common sleep disorder affecting about 12 million Americans, according to the National Institutes of Health (NIH). Its name comes from a Greek word, apnea, meaning "without breath." People with sleep apnea stop breathing briefly many times during the night. The breathing pauses last at least 10 seconds, and there may be 20 to 30 or more pauses per hour.

The main symptoms of sleep apnea are persistent loud snoring at night and daytime sleepiness. Another symptom is frequent long pauses in breathing during sleep, followed by choking and gasping for breath. People with sleep apnea don't get enough restful sleep, and their daytime performance is often seriously affected. Sleep apnea may also lead to high blood pressure, heart disease, heart attack, and stroke. However, it can be diagnosed and treated.

Sleep apnea occurs in all age groups and both sexes but is more common in men, people who are overweight or obese, and older persons. The disorder is made worse by fat buildup in the neck or loss of muscle tone with aging. People most likely to have or develop sleep apnea include those who snore loudly and are overweight, have high blood pressure, or have some other limitation in size of the upper airways.



CAUSES OF SLEEP APNEA
Intermittent (comes and goes) blockage in some part of the upper airways, often due to the throat muscles and tongue relaxing during sleep, can cause sleep apnea. When the muscles of the soft palate at the base of the tongue and the uvula (the small fleshy tissue hanging from the center of the back of the throat) relax and sag, the airway becomes blocked. The blockage makes breathing labored and noisy and even stops it altogether.

EFFECTS OF SLEEP APNEA
During the pauses in breathing, the oxygen level in your blood drops. Your brain reacts to the drop in oxygen by waking you enough to resume breathing (and snoring), but not necessarily enough to fully awaken you. The cycle of snoring, not breathing, waking, and resuming breathing means that you do not get good quality sleep. Because of this, you may often feel very sleepy during the day, find it hard to concentrate, and your daytime performance may suffer.

The effects of sleep apnea range from annoying to life threatening. They include depression, high blood pressure, irritability, sexual dysfunction, learning and memory problems, and falling asleep while at work, on the phone, or driving. People with severe sleep apnea are two to three times more likely to have automobile crashes. Risk for heart attacks, high blood pressure, heart failure, and stroke also increase with sleep apnea.

Do I have sleep apnea?
People with sleep apnea are often not aware that they have it. You should suspect sleep apnea if you often feel sleepy during the day, and you have been told that you snore loudly and frequently, or seem to have trouble breathing during the night.

Your bed partner may notice your heavy snoring and struggles to breathe during sleep. Coworkers or friends may notice that you tend to fall asleep during the day at inappropriate times. If you think that you have sleep apnea, it is important that you see a doctor for evaluation of the sleep problem.

DIAGNOSING SLEEP APNEA
In addition to your primary care provider, a sleep medicine specialist needs to be involved in the diagnosis, as well as treatment. Diagnosis of sleep apnea is not simple because there can be many different reasons for disturbed sleep. If sleep apnea is suspected, the sleep medicine specialist will need to perform a sleep study. This usually means going to a sleep center, where tests are done while you sleep. This test is called polysomnography, which records a variety of body functions during sleep. You may be referred to a sleep center such as Kearney Sleep Lab for special tests.




Narcolepsy  

Narcolepsy is a chronic, or long-lasting, sleep disorder with no known cause. It affects the body's central nervous system, which is made up of nerves that carry messages from the brain to other parts of the body. When a person has narcolepsy, messages about when to sleep and when to be awake can get mixed up. This can cause a person to fall asleep when they do not want to, and often without any warning like feeling drowsy.

The desire to sleep can be overwhelming and hard to resist, and can happen to a person several times during the day. Night sleep may also be poor, broken up by waking up often during the night. If not controlled with medication, narcolepsy can cause serious problems in a person's personal, social, and work life. It can also limit a person's activities, such as driving a car, work, and exercising. Studies indicate that narcolepsy may run in families.

Symptoms of narcolepsy

While it can happen at any age, symptoms of narcolepsy most often begin between the ages of 15 and 30. The main symptoms are cataplexy and being extremely sleepy during the day, even after a good night's sleep. There are other symptoms of narcolepsy, listed below, which may not occur in all people. These symptoms often come and go. But being very sleepy during the day is a symptom that can be chronic, or long lasting. Other symptoms include waking up during the night, tossing and turning in bed, leg jerks, and nightmares.

  • Cataplexy - sudden loss of muscle control, ranging from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or slurred speech) to complete body collapse. Attacks can be triggered by sudden and strong emotions such as laughter, anger, or fear. Attacks can last from a few seconds to several minutes.
  • Sleep paralysis - not being able to talk or move when falling asleep or waking up. This is temporary and may last from a few seconds to several minutes.
  • Hypnagogic hallucinations - seeing things that are not there. These images can seem very vivid and dreamlike and sometimes scary. They happen when a person is dozing or falling asleep.
  • Automatic behavior - doing tasks that are familiar, routine, or boring without knowing that you are doing them. For example, getting to work with no memory of actually driving there.

 

 

Will I get narcolepsy?

 Some 200,000 Americans are thought to have narcolepsy. It is sometimes mistaken for depression, epilepsy, or the side effects of medications.

You should be checked by a sleep medicine specialist for narcolepsy if:

  • You often feel extremely sleepy during the day, even after having had a full night's sleep.
  • You fall asleep when you do not want to, such as while having dinner, talking, driving, or working.
  • You collapse suddenly or your neck muscles feel too weak to hold up your head when you laugh or become angry, surprised, or shocked.
  • You are not able to talk or move for a short period of time when falling asleep or waking up.


Diagnosing narcolepsy

After having a complete medical history and physical exam, a person's doctor may order further tests. It is important to see a sleep medicine specialist at a sleep center such as Kearney Sleep Lab for evaluation, since narcolepsy can be hard to diagnose and treat effectively. It can be mistaken for other conditions like depression and epilepsy, or the side effects of medications.

Two common tests for narcolepsy are:

  • Polysomnogram - records brain activity and body movements during nighttime sleep, along with nerve and muscle function. This test is done in an overnight sleep lab.
  • Multiple Sleep Latency Test - a person is given a chance to sleep every two hours during the day, when they are normally awake. This test measures the time it takes to fall asleep and the time it takes to go into rapid eye movement (REM) sleep (dreaming).


Treating narcolepsy

There is no cure for narcolepsy . It is a life-long condition, but there is help for a person with this condition to have a good and productive life. Symptoms can be controlled with medicine and lifestyle changes. The extreme daytime sleepiness can be treated with stimulant drugs (or drugs that keep you awake) such as modafinil (Provigil). Caffeine and over-the-counter stimulants do not work to reduce daytime sleepiness. Antidepressants are sometimes used to treat cataplexy, hypnagogic hallucinations, and sleep paralysis.

People with narcolepsy who have other health conditions, such as high blood pressure, diabetes, or heart disease, should talk with their doctor about other medicines they are taking. Some over-the-counter and prescription drugs may interact with those drugs taken for narcolepsy.

Changes in lifestyle can help to treat and control narcolepsy. Taking daytime naps and developing good sleep habits are important. Taking short naps (10 to 15 minutes) 2 to 3 times a day can help control extreme daytime sleepiness and sleep attacks. Having good sleep habits helps a person to get good quality nighttime sleep. What helps is to: not have caffeine or alcohol and not smoke in the late afternoon or evening; get regular exercise, but don't exercise up to 3 hours before you go to bed; don't use your bed for anything but sleeping and physical intimacy; and get enough sleep (around 8 hours) every night.

If you have narcolepsy, it is important to talk on a regular basis with your health care provider. This will help you to get the best treatment possible for your symptoms.

Talk with your health care provider often. Tell her/him about any changes in your symptoms or what you are experiencing in daily life. Let her/him know about any side effects you may be having from medications you are taking for narcolepsy or other conditions.

Don't forget to schedule regular nap times during the day, exercise regularly, and make sure you get enough sleep (around 8 hours) every night.

Avoid jobs that require driving long distances or handling hazardous equipment, or that need you to be alert for long times.
 


Restless Leg Syndrome (RLS) 

Restless legs syndrome (RLS) is a sleep disorder in which a person has unpleasant feelings or sensations in the legs. These feelings are described as creeping, crawling, tingling, pulling, or painful. While these sensations happen most often in the calf or lower leg area, they can be felt anywhere from the ankle to the upper thigh. RLS symptoms can occur in one or both legs and can also be felt in the arms. These symptoms occur most often when lying down, but can also occur when sitting for long periods of time, such as at a desk, riding in a car, or watching a movie. People with RLS talk about having an irresistible urge to move the legs. Moving the legs, walking, rubbing or massaging the legs, or doing knee bends can bring relief, at least for a short time.

Unlike other conditions, RLS symptoms get worse when relaxing or lessening activity, particularly during the evening and nighttime sleeping hours. Many people with RLS have trouble falling asleep and staying asleep. If not treated, RLS can cause extreme tiredness and daytime fatigue. A person's job, personal life and daily activities can be strongly affected due to exhaustion. A person can lose their ability to focus and have memory loss.

Many people with RLS also have a related sleep disorder called periodic limb movements in sleep (PLMS). With PLMS, a person jerks or bends their legs unintentionally during sleep. These movements can happen every 10 to 60 seconds, or hundreds of times, during the night. They can wake a person, disturb sleep, and wake bed partners. People who have both RLS and PLMS have trouble falling and staying asleep and can have extreme sleepiness during the day.

Who has RLS?

RLS affects about 2 to 15 percent of Americans. But, it may actually affect more people. Some people with RLS do not seek treatment because they fear they won't be taken seriously, their symptoms are too mild, or that the condition can't be treated. Health care providers sometimes think the symptoms of RLS are caused by something else, like nervousness, insomnia (not being able to sleep), stress, arthritis, muscle cramps, or aging.

RLS is thought to affect women more often than men. It can start at any age, even in young children, but most people with RLS are middle-aged or older. And, older people with RLS have symptoms more often and for longer periods of time. Young people who have RLS are sometimes thought to have "growing pains" or may be considered "hyperactive" because they cannot sit still in school.

RLS symptoms

 RLS symptoms are not the same for every person. They range from uncomfortable to painful and can vary in frequency. A person can have periods when RLS does not cause problems, but the symptoms usually return. Another person can have severe symptoms every day.

Common symptoms of RLS include:

  • Unpleasant or uncomfortable feelings or sensations in the legs often described as creeping, crawling, tingling, pulling or painful, often producing an irresistible urge to move the legs. These feelings most often occur deep inside the leg, between the knee and ankle. While rare, they can also occur in the feet, thighs, arms, and hands. Most of these feelings involve both sides of the body, although they can happen on just one side of the body.
  • Leg discomfort that occurs and gets worse when lying down or sitting for long periods of time. Long car trips, sitting in the movies, long-distance flights, and having a cast on can trigger RLS.
  • Symptoms that happen and are worse later in the day, evening, and during the night.
  • The need for constant movement of the legs (or other affected body parts) to lessen discomfort. People may pace the floor, move their legs when sitting, and toss and turn in bed.
  • Having leg and sometimes arm movements when sleeping that you can't control.
  • Trouble falling asleep or staying asleep.
  • Sleepiness or tiredness during the day.

Certain medications, such as drugs for nausea, seizures, and psychosis, as well as some cold and allergy medicines, may make symptoms worse. Talk with your health care provider if you are taking any prescription or over-the-counter medicines.

 

Causes of Restless Legs Syndrome (RLS)

In most cases, the cause of RLS is not known. For about half of all RLS cases, there is a family history of the condition. People who have RLS in the family tend to be younger when symptoms start and develop symptoms slowly.

RLS is thought to be related to the following factors or conditions:

  • Some women get RLS during pregnancy, especially in the last 3 months. But the symptoms usually go away about 4 weeks after having the baby.
  • People with anemia (low iron levels) may be more likely to get RLS. Once low iron levels or anemia is corrected, symptoms can lessen.
  • Chronic diseases such as kidney failure, diabetes, Parkinson's disease, and peripheral neuropathy (loss of feeling or numbness in the hands and feet) may be linked to RLS.

Diagnosing RLS

There are no tests for RLS. It can be hard to diagnose and is easily confused with other conditions. When someone with RLS goes to see a doctor, there is often nothing wrong that the doctor can see or detect with a physical exam. Diagnosis therefore depends on what a person describes to the doctor. To help make a diagnosis, the doctor may ask about all current and past medical problems, family history, and current medications. A complete physical and neurological exam may help identify other conditions that may be linked with RLS, such as nerve damage (neuropathy or a pinched nerve) or abnormalities in the blood vessels. Basic lab tests may be done to assess overall health and to rule out anemia.

Sleep Walking 
What is Sleepwalking (Somnambulism)? 

Sleepwalking (Somnambulism) is a series of complex behaviors that are initiated during slow wave sleep and result in walking during sleep.

What are the symptoms of Sleepwalking?

Ambulation (walking or moving about) that occurs during sleep. The onset typically occurs in prepubertal children.

Associated features include:

  • difficulty in arousing the patient during an episode
  • amnesia following an episode
  • episodes typically occur in the first third of the sleep episode
  • polysomnographic monitoring demonstrates the onset of an episode during stage 3 or 4 sleep
  • other medical and psychiatric disorders can be present but do not account for the symptom
  • the ambulation is not due to other sleep disorders such as REM sleep behavior disorder or sleep terrors

How Common is Sleepwalking?

Medical reports show that about 18% of the population are prone to sleepwalking. It is more common in children than in adolescents and adults. Boys are more likely to sleepwalk than girls. The highest prevalence of sleepwalking was 16.7% at age 11 to 12 years of age. Sleepwalking can have a genetic tendency. If a child begins to sleepwalk at the age of 9, it often lasts into adulthood.

How serious is Sleepwalking?

For some, the episodes of sleepwalking occur less than once per month and do not result in harm to the patient or others. Others experience episodes more than once per month, but not nightly, and do not result in harm to the patient or others. In its most severe form, the episodes occur almost nightly or are associated with physical injury. The sleepwalker may feel embarrassment, shame, guilt, anxiety and confusion when they are told about their sleepwalking behavior.

If the sleepwalker exits the house, or is having frequent episodes and injuries are occurring -- DO NOT delay, it is time to seek professional help from a sleep disorder center in your area. There have been some tragedies with sleepwalkers, don't let it happen to your loved one!

What can be done about sleepwalking?

There are some things a sleepwalker can do:

  • Make sure you get plenty of rest! Being overtired can trigger a sleepwalking episode.
  • Stress can be another trigger for sleepwalking. Develop a calming bedtime ritual. Some people meditate or do relaxation exercises.
  • Remove anything from the bedroom that could be hazardous or harmful.
  • The sleepwalker's bedroom should be on the ground floor of the house. The possibility of the patient opening windows or doors should be eliminated.
  • An assessment of the sleepwalker should include a careful review of the current medication so that modifications can be made if necessary.
  • Hypnosis has been found to be helpful for both children and adults.
  • An accurate psychiatric evaluation could help to decide the need for psychiatric intervention.
  • Benzodiazepines have been proven to be useful in the treatment of this disorder. A small dose of diazepam or lorazepam eliminates the episodes or considerably reduces them.

 

  Cataplexy 

Cataplexy is a medical condition which often affects people who have narcolepsy, a disorder whose principal signs are EDS (Excessive Daytime Sleepiness), sleep attacks, and disturbed nighttime sleep.

The term cataplexy originates from the Greek kata, meaning down, and plexis, meaning a stroke or seizure.

Cataplexy manifests itself as muscular weakness which may range from a barely perceptible slackening of the facial muscles to the dropping of the jaw or head, weakness at the knees, or a total collapse. Usually the speech is slurred, vision is impaired (double vision, inability to focus), but hearing and awareness remain normal. These attacks are triggered by strong emotions such as exhilaration, anger, fear, surprise, orgasm, and laughter.

Cataplexy often affects people who have narcolepsy, a disorder in which there is great difficulty remaining awake during the daytime. Cataplexy is also sometimes confused with epilepsy, where a series of flashes or other stimulus cause similar seizures. Despite its relation to narcolepsy, cataplexy must be treated differently and separate medication must be taken. Cataplexy is treated with the drug Xyrem.

Cataplexy manifests itself as muscular weakness which may range from a barely perceptible slackening of the facial muscles to the dropping of the jaw or head, weakness at the knees, or a total collapse. Usually the speech is slurred, vision is impaired (double vision, inability to focus), but hearing and awareness remain normal. These attacks are triggered by strong emotions such as exhilaration, anger, fear, surprise, orgasm, and laughter. Cataplexy often affects people who have narcolepsy, a disorder in which there is great difficulty remaining awake during the daytime. Cataplexy is also sometimes confused with epilepsy, where a series of flashes or other stimulus cause similar seizures. Despite its relation to narcolepsy, cataplexy must be treated differently and separate medication must be taken. Cataplexy is treated with the drug Xyrem.
Nocturnal Bruxism  

Bruxism is the grinding or clenching of teeth , most often at night. Teeth grinding isn't something most people are aware they are doing: many people only become aware they are "bruxers" when their dentist notices signs of tooth or jaw damage caused by the disorder.

Nocturnal teeth grinding is one of the most common sleep disorders: thirty to forty million Americans brux on a nightly basis. 5 - 10% percent of bruxers clench or grind their teeth so forcefully that teeth are damaged and jaw problems, such as TMJ disorder, develop.

Symptoms of Bruxism

Unless your teeth grinding is noticed by your bed partner (grinding can cause enough noise to disturb other people's sleep), chances are good that your dentist will notice the problem before you do. A dental exam may reveal signs of:

  • Enamel loss
  • Flat chewing surfaces
  • Loose teeth
  • Fractures in teeth
  • Broken fillings
  • Signs of temporomandibular joint (TMJ) disorder.

Symptoms bruxers are more likely to notice themselves are headaches, earaches, sore jaw muscles, and "popping" sounds in the jaw (a sign of TMJ damage or an out of balance jaw).

 

Causes of Teeth Grinding

Stress, anxiety and anger are the most common causes of jaw clenching in adults, and highly competitive "Type A" personalities are often prone to bruxism. Some sleep disorders can aggravate the condition, as can alcohol consumption and some medications. Dental problems, including improper alignment of upper and lower teeth, can also lead to clenching and grinding.

Children can also brux. While a child may brux due to stress, more often an allergy, ear infection or cold are to blame. If an allergy is at fault, removing the allergen should reduce bruxing.

Treatment Options for Teeth Grinding

Night Guard
A night guard is a custom-made plastic shield made by a dentist. The night guard fits between your upper and lower teeth, and is worn while you sleep. The plastic guard prevents further dental damage. Although the idea of sleeping with the plastic night guard in their mouths discourages many people, most people who use the guards quickly get used to them.

Biofeedback and Relaxation Techniques
Stress management and relaxation techniques can reduce anxiety and stress, and possibly reduce grinding. Meditation, controlled breathing and progressive muscle relaxation can all help. Biofeedback techniques can teach a person to use less force when they bite down, which over time becomes an unconscious habit.

Other Treatments
Warm compresses can help relax jaw muscles. Extremely tight jaw muscles may require treatment with muscle relaxants. A rigorous (and often painful) massage technique called Rolfing can teach jaw muscles to relax. Rolfing is not for everyone, and should only be practiced by a qualified masseuse.

Dental Work
Even if a night guard or biofeedback helps prevent further damage, your teeth may already have taken a beating. Your dentist may need to repair cracked teeth and fractured fillings as a result of bruxism.



Fibromyalgia 

What is Fibromyalgia?
Fibromyalgia (FM) is an increasingly recognized chronic pain illness which is characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle and hands, but any body part can be involved. Fibromyalgia patients experience a range of symptoms of varying intensities that wax and wane over time.

Who is affected?
It is estimated that approximately 3-6% of the U.S. population has FM. Although a higher percentage of women are affected, it does strike men, women and children of all ages and races.

What are the symptoms?
FM is characterized by the presence of multiple tender points and several other symptoms.

Pain
The pain of FM is profound, widespread and chronic. It migrates to all parts of the body and varies in intensity. FM pain has been described as deep muscular aching, throbbing, twitching, stabbing and shooting pain. Neurological complaints such as numbness, tingling and burning are often present and add to the discomfort of the patient. The severity of the pain and stiffness is often worse in the morning. Aggravating factors which affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.

Fatigue
In today's world many people complain of fatigue; however, the fatigue of FM is much more than being tired. It is an all-encompassing exhaustion that interferes with even the simplest daily activities. It feels like every drop of energy has been drained from the body, which at times can leave the patient with a limited ability to function both mentally and physically.

Sleep Problems
Many Many Fibromyalgia patients have an associated sleep disorder which prevents them from getting deep, restful, restorative sleep. Medical researchers have documented specific and distinctive abnormalities in the stage 4 deep sleep of FM patients. During sleep, individuals with FM are constantly interrupted by bursts of awake-like brain activity, limiting the amount of time they spend in deep sleep.

Other symptoms
Additional symptoms may include: irritable bowel and bladder, headaches and migraines, restless legs syndrome (periodic limb movement disorder), impaired memory and concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness, vision problems, raynaud's syndrome, neurological symptoms and impaired coordination.

How is it diagnosed?

   Currently there are no laboratory tests available for diagnosing Fibromyalgia. Doctors must rely on patient histories, self-reported symptoms, a physical examination and an accurate manual tender point examination. Proper implementation of the exam determines the presence of multiple tender points at characteristic locations.

It is estimated that it takes an average of five years for a FM patient to get an accurate diagnosis. Many doctors are still not adequately informed or educated about FM. Laboratory tests often prove negative and many FM symptoms overlap with the symptoms of other conditions. Another essential point that must be considered is that the presence of other diseases, such as rheumatoid arthritis or lupus, does not rule out a FM diagnosis. Fibromyalgia is not a diagnosis of exclusion and must be diagnosed by its own characteristic features.

To receive a diagnosis of FM, the patient must meet the following diagnostic criteria:

  • Widespread pain in all four quadrants of the body for a minimum duration of three months
  • Tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied (see image to the right)

What causes FM?

While the underlying cause or causes of FM still remain a mystery, new research findings continue to bring us closer to understanding the basic mechanisms of Fibromyalgia. Most researchers agree that FM is a disorder of central processing with neuroendocrine/neurotransmitter dysregulation. The FM patient experiences pain amplification due to abnormal sensory processing in the central nervous system. An increasing number of scientific studies now show multiple physiological abnormalities in the FM patient, including:

  • increased levels of substance P in the spinal cord
  • low levels of blood flow to the thalamus region of the brain
  • HPA axis hypofunction
  • low levels of serotonin and tryptophan
  • abnormalities in cytokine function

Recent studies show that genetic factors may predispose individuals to a genetic susceptibility to FM. For some, the onset of FM is slow; however, in a large percentage of patients the onset is triggered by an illness or injury that causes trauma to the body. These events may act to incite an undetected physiological problem already present.

How is FM treated?

One of the most important factors in improving the symptoms of FM is for the patient to recognize the need for lifestyle adaptation. Most people are resistant to change because it implies adjustment, discomfort and effort. However, in the case of FM, change can bring about recognizable improvement in function and quality of life. Becoming educated about FM gives the patient more potential for improvement.

Conventional medical intervention may be only part of a potential treatment program. Alternative treatments, nutrition, relaxation techniques and exercise play an important role in FM treatment as well. Each patient should, along with the healthcare practitioner, establish a multifaceted and individualized approach that works for them.

Pain Management
Over-the-counter pain medications, such as acetaminophen or ibuprofen, may be helpful in relieving pain. The physician may decide to prescribe one of the newer non-narcotic pain relievers (e.g. tramadol) or low doses of antidepressants (e.g. tricyclic antidepressants, serotonin reuptake inhibitors) or benzodiazepines. Patients must remember that antidepressants are "serotonin builders" and can be prescribed at low levels to help improve sleep and relieve pain. If the patient is experiencing depression, higher levels of these or other medications may need to be prescribed. Another beneficial pain therapy, which works well on localized areas of pain, is lidocaine injections into the patient's tender points. An important aspect of pain management is a regular program of gentle exercise and stretching, which helps maintain muscle tone and reduces pain and stiffness.

Sleep Management
Improved sleep can be obtained by implementing a healthy sleep regimen, which includes going to bed and getting up at the same time every day, making sure that the sleeping environment is conducive to sleep (i.e. quiet, free from distractions, a comfortable room temperature, a supportive bed), avoiding caffeine, sugar and alcohol before bed, doing some type of light exercise during the day, avoiding eating immediately before bedtime and practicing relaxation exercises as you fall to sleep. When necessary, there are new sleep medications that can be prescribed, some of which can be especially helpful if the patient's sleep is disturbed by restless legs or periodic limb movement disorder.

Other Treatments
Complementary therapies can be very beneficial. These include: physical therapy, therapeutic massage, myofascial release therapy, water therapy, light aerobics, acupressure, application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, aromatherapy, cognitive therapy, biofeedback, herbs, nutritional supplements, and osteopathic or chiropractic manipulation.