Good Night. Sleep Tight!
This is the third post in a series of six exploring the pillars of Lifestyle Medicine and how they can support a healthy life of flourishing with fibromyalgia not just surviving.
These six pillars: eating a whole food-primarily plant based diet, physical activity, restorative sleep, stress management, positive social connections and avoiding risky substances are associated with psychological flourishing, defined as optimal human functioning in positive psychology research.*
This is good news indeed for we Fibro Warriors because these six pillars give us more tools in our toolkit for taking charge of our health.
Struggling with Sleep is the Norm for Fibro Folks
We’re focusing on probably the most important issue in managing our fibromyalgia: Sleep!
I’m going to be really honest here and share that struggling with sleep has, hands down, been the most difficult part of my Fibro journey. You too? I have had to consult multiple practitioners and use medications and supplements and all the lifestyle changes and healthy sleep hygiene tools that are discussed below to improve my sleep. It has been a lot! I’m happy to say, that while my sleep is far from optimal, it has greatly improved.
So, if you are like me, and your sleep issues are severe, don’t give up. There are answers and if you need assistance in figuring this out, that’s exactly what I do as a health coach: I help my clients figure out how to navigate the maze of options in addressing their sleep issues and then I support them in implementing the strategies their health care providers recommend.
The sleep issues I encounter most often in myself and my clients include: not being able to fall asleep, not being able to stay asleep, waking frequently and not being able to fall back asleep, unrefreshing sleep, being awakened by pain and discomfort (this is a big one for me!), being too hot or too cold or both, bladder issues, restless leg syndrome, sleep apnea and more.
Do you recognize your sleep issues in this list?
The Sleep Foundation article on Fibromyalgia and Sleep describes what many of us, myself included experience:
Sleep and fibromyalgia share a bidirectional relationship. Just as painful symptoms can prevent patients from getting enough rest, sleep deprivation can exacerbate the widespread feelings of pain and tenderness brought on by fibromyalgia. Sleep loss can also lower a person’s pain threshold. As a result, lack of sleep or poor sleep quality may cause fibromyalgia symptoms to occur in otherwise healthy people.**
The symptoms of pain, and brain fog are very difficult too, but with decent sleep I can usually manage those, without decent sleep, all my symptoms of fibro are exacerbated and quicky turn into a downward spiral of despair and discomfort.
I think you know what I mean. With a lack of sleep everything looks and feels worse and makes it hard to stay motivated and hopeful.
Believe me, I know what you are going through.
Recommendations for Quality Sleep
There is a lot of valuable information available on improving our sleep and it’s important to implement as many of them as you can. Start by adding one new strategy at a time.
The Sleep Health Objective of the US Department of Health and Human Services has identified four high sleep quality indicators:
- About 85% of the time spent in bed is time sleeping.
- Falling asleep in 30 minutes or less
- Waking up no more than once per night
- Being awake for 20 minutes or less after initially falling asleep
Below are their recommendations for simple lifestyle changes to optimize sleep health:
- Aim for at least 7 hours of sleep. It is recommended that adults aged 18 and older get at least 7 hours of sleep every night. Some people may require 8 or 9 hours to feel their best. Try to find how many hours works best for you and make that your nightly goal.
- Follow a consistent sleep schedule. Going to bed and waking up at the same time each day helps to regulate our body’s internal clock. Ensuring adequate light exposure during the day while minimizing bright lights at nighttime also help to maintain a healthy sleep-wake cycle.
- Establish a relaxing bedtime routine. Allow yourself sufficient time to unwind and shift into sleep mode. This could include taking a warm shower or bath, light stretching, or enjoying a warm bedtime drink such as chamomile tea. Meditation and deep breathing techniques can also help balance the autonomic nervous system and promote a state of calmness.
- Maintain an optimal sleep environment. Mattress and pillows should be comfortable and the bedroom should be cool (60-67 degrees). Minimize exposure to bright lights, disruptive noises, and electronic distractions at least 30 minutes (preferably 1 hour) before bedtime. Avoid stimulating or stressful activities before bedtime.
- Get regular exercise and minimize sitting throughout the day. While vigorous exercise is optimal, even light exercise and increased movement can improve sleep quality. If you can perform moderate to high intensity exercise, the American College of Physicians recommends 150 minutes of moderate to high intensity exercise every week to improve sleep. Evening exercise within a few hours of bedtime may impact sleep for some individuals, however this can vary from person to person so find the time of day to exercise that works for you.
- Avoid stimulants such as caffeine and cigarettes in the afternoon. Be mindful of alcohol use close to bedtime as this can disrupt sleep quality fragmenting sleep throughout the night and particularly in the morning hours when you get more of your REM sleep.
- Avoid naps. If necessary, limit naps to less that 30 minutes and before 3 pm. Although a short power nap (20-30 minutes) can help improve performance during the day, it does not make up for inadequate nighttime sleep and can make it more difficult to fall asleep at your desired bedtime.
- Avoid large meals close to bedtime. Heavy foods can trigger indigestion and heartburn that disrupt sleep. Ideally, large meals should be eaten at least 2 to 3 hours before sleep. Light healthy snacks can help satisfy hunger and promote sleep if you have an early dinner.
- If you are having difficulty falling asleep, get out of bed. After about 30 minutes, get out of bed and go to another room and try doing something relaxing in dim light (i.e. reading a book, breathing exercises, journaling, etc). Once you begin to feel more sleepy, return to your bedroom and try sleeping again. This can help to strengthen the association between bed and sleep.
- If sleep problems persist, consider keeping a Sleep Diary or speak with your doctor about your sleep concerns. This can help identify problems with common sleeping patterns and would be beneficial if you speak with a doctor about your concerns. ***
Lifestyle Changes Alone are Not Enough
While these lifestyle changes are very important, unfortunately, lifestyle changes alone will likely not be enough for most Fibro Folks to completely address our sleep issues. You will need to have a conversation with your health care providers about how to improve your sleep.
The good news is there are many tools you can use to improve your sleep, the trick is in finding the ones that work for you. This is where a functional medicine, or lifestyle medicine practitioners are vital in identifying the root cause of your issues with sleep. It can also be helpful to get a referral to a sleep medicine doctor and have a sleep study done.
And Dr. Ginevra Liptan’s book, The Fibro Manual, my go-to resource for everything related to fibromyalgia treatment, has three chapters on improving rest, which include taming the hyperactive response, fixing fibromyalgia sleep and medications to increase deep sleep. I highly recommend you add this important guidebook to your virtual or actual bookshelf.
Improving the quality and quantity of your sleep is essential to feeling better. Knowing what to do to improve your sleep is very different than knowing how to do it and I support my clients in figuring out a step-by-step approach to improving their sleep so that they can indeed sleep tight!
References:
*https://www.frontiersin.org/articles/10.3389/fpsyg.2022.963806/full
**https://longevity.stanford.edu/lifestyle/lifestyle-pillars/lifestyle-medicine-sleep/
***https://www.sleepfoundation.org/physical-health/fibromyalgia-and-sleep
