Sleep Findings Correlate with FE Symptoms
Tue, Sep 2, 2008
~Fibromyalgia Network, July 2008
It’s not normal to go to bed at night feeling exhausted and nuts with
pain, only to get up the next morning to the same symptoms. You know that something is wrong with your sleep when you don’t wake up feeling rejuvenated, and three studies offer important clues.
Waking Up Tired
If your chief symptom is fatigue or pain, how will this influence your
sleep? Benjamin Natelson, M.D., of the University of Medicine and
Dentistry of New Jersey in Newark, compared the sleep studies of chronic fatigue syndrome (CFS) patients with and without fibromyalgia
(FM) pain to healthy controls. 1 The two patient groups spent the
same amount of time in each stage of sleep, but it was more fragmented or less continuous sleep than the healthy controls.
Rather than grouping patients by diagnosis, Natelson organized them
according to how sleepy they felt in the morning. He found that increased sleepiness and achiness correlated with greater fragmented or interrupted sleep.
These short-sleep bouts during the night is unclear. Natelson is now
analyzing blood samples taken throughout the night to measure the
levels of sleep-disrupting cytokines produced by the immune system.
Ironically, the cytokines that fight pain happen to interfere with sleep.
people go through this cycle four times a night, with the duration of time spent in REM becoming longer with each cycle. Not surprisingly, the majority of the night is spent in stage 2 sleep because it enables people to transition into either the lighter or deeper stages or REM sleep (see diagram). In a way, stage 2 is like being in neutral when shifting the gears of a car-you must pass through neutral to drive
forward or back up.
If you have trouble falling into the deeper stages of sleep and sense that you are half-awake during the night, a second study by N atelson comparing CFS patients to healthy controls indicates that your perceptions could Chervin found that the shorter the time
in stage 2 sleep before slipping into stage 3, the greater the person spain.
Normally, your sleep should progress from lighter stages 1 and 2 to
deeper stages 3 and 4, then back to the lighter stage 2 before going into the dream or REM sleep stage. Most be right on target. 2 He found that once the healthy subjects were asleep, transitions to the awake stage were less likely than in CFS patients. “In contrast,” writes Natelson, “CFS patients have the propensity to awaken, especially during the later hours of sleep.”
When the brain is shifting gears from stage 2 or REM sleep, CFS patients tended to slide right into the awake mode. This shift from stage 2 or REM to awake happened substantially more often in CFS patients than healthy participants.
FM, Pain and Sleep
Ron Chervin, M.D., at the University of Michigan in Ann Arbor,
compared the sleep of FM patients to healthy controls, and like Natelson he took a closer look at the sleep-stage dynamics.3 Just calculating the total amount of time spent in each stage of sleep for the night didn’t distinguish the FM patients from the healthy controls. In fact, this is the crux of the problem: FM patients are often sent
for a sleep study and told that there is nothing wrong. Not true.
Similar to Natelson’s findings in CFS patients, Chervin noted that the
FM patients (compared to controls) spent a significantly shorter length of time in stage 2 sleep before progressing to stage 3. However, the average length of time in stage 2 before changing to any of the other sleep stages or wakefulness did not differ. Chervin fOlmd that the shorter the time in stage 2 sleep before slipping into stage 3, the greater the person’s pain. Why would FM patients have
shortened stage 2 durations? When people have a disorder that limits or disrupts the restorative function of sleep, their bodies will have a stronger drive to transition rapidly from stage 2 down into the deeper, rejuvenating levels (e.g., stages 3 and 4). Unfortunately, patients do not stay in this deep level for long, although their body keeps trying. Chervin comments that this finding might explain why Xyrem, a drug that enhances the time in stage 3 and 4 sleep, could be useful for
treating.
1. Togo F, et al. Arthritis Res Ther 10:R56, 2008.
2. Kishi A, et at. Am J Physiol Regulatory Integrative Comp Physiol 294:1980-7, 2008.
3. Burns JW, et at. Sleep Med Feb.28, 2008.
Leave a Reply