Management of sleep disorders in fibromyalgia

The studies of sleep physiology show that nonrestorative sleep is important in the pathogenesis of fibromyalgia (FM). More than 90% of patients with FM describe disturbed sleep. The sleep is usually perceived to be light and unrefreshing, irrespective of its duration. On the rare occasion that there is a night of restful sleep, the patient often finds that pain and fatigue are substantially improved on the following day. Some patients may be aware of restlessness with kicking and involuntary leg movements, which may delay or disrupt sleep. Sometimes the bed partner may complain that the loud snoring is disturbing his sleep. There may be pauses in the snoring with the appearance of interruptions to breathing during sleep, or the patient may awaken with choking, gasping or a sense of suffocation. Some patients complain of difficulty keeping awake and have uncontrollable sleepiness during the day that is interfering with their social life, work, and their ability to drive safely. This article describes the methods for assessing these various sleep disorders and how they might be managed as part of the comprehensive approach in treating FM patients.