Fibromyalgia is renowned for wreaking havoc on sleep, and these problems range from not waking up refreshed despite sleeping all night, to full blown insomnia, and everything in between. Whatever the sleep disturbance is, it can make a Fibro Warrior feel extremely fatigued, can increase pain levels, and pretty much exacerbate all their symptoms. Before we delve into the world of how to try and improve our sleep, I thought it would be useful to look a little at the physiology behind sleep and what normal (does some air quote marking) sleep actually is. This way we can better understand what part of our sleep is the problem, and therefore remedy the issue more effectively.
Normal sleep will mean different things for everybody. However, the over arching rule is getting the right amount of undisturbed sleep to wake up in the morning feeling refreshed. Sleep is our way of recovering physically and processing the events of our day mentally. For some of us this will be 9 hours, and for others it will only be 4 or 5 hours. All sorts of factors contribute to this need including age, existing health problems, and daily physical activity. We generally need less sleep as we get older, and possibly need more more if we are more active or have an exhausting health problem. There is no one size fits all approach when it comes to sleep, and the best way to work out if you are sleeping well is going by how you feel. If you are spending large portions of the night awake, or waking up multiple times per night, then this is not effective sleep. If you sleep through the night but wake up feeling worse than you did when you went to sleep, taking a couple of hours to get going, this again is not effective sleep.
I didn’t realise that I wasn’t sleeping well until I went from sleeping through the night to not being able to sleep at all. I then did some research into how to sleep better and recognised very quickly that it had been a number of years since I’d woken up in the morning and had the bouncing energy I should be able to expect at my age. At the time I was putting it down to being a busy working mother with a fast paced full time job and not giving enough respect or enough time to my sleep. I would often look at my 6 year old daughter, who gets up with the early bird, and wonder how on earth she managed to wake in the morning with so much energy, but I now realise it’s because she sleeps very well! Children generally do. However, we should all be able to expect to wake up in the morning with (almost) this amount of energy, but perhaps not the enthusiasm.
To begin to understand normal sleep patterns we need to first understand circadian rhythms. I wont go on too much about this as it is quite complex and would take a whole bunch of posts to really get into the nitty gritty of it, but will give an overview in a nutshell (if you would like to learn more then I would recommend this website).
Our circadian rhythm is our internal clock, that is ticking by 24 hours a day, 7 days a week, 365 days a year. It never stops. It is controlled within our brain and is responsible for maintaining balances in sleeping, eating, hormone production, temperature and mood amongst other things. You cannot change your circadian rhythm, it is engrained within you, following many years of evolution of the human race. But sometimes what our bodies want to do and what we want them to do can conflict. Our modern lives and way of working have made us move further and further away from our natural rhythms and this is causing many problems for some people such as unhealthy weight gain, unbalanced hormones, lowering of mood, and of course, disturbed sleep.
Typically our bodies want us to wake up in the morning and rise with the sun. The sun shining onto our skin would naturally wake us up and get the hormones responsible for giving us energy flowing. Our bodies and mind would then be alert and able to be active during the day, and then as night time comes and the sun sets, our bodies begin to secrete melatonin which increases our urge to sleep. This usually begins at around 9pm for your Average Joe, and peaks at around 2-3am. Melatonin also causes your body temperature to drop which again increases your urge to sleep. Night shift workers will be all too familiar with the battle to stay awake at 2-3am and the feeling of not being able to get warm no matter what you do. That is your circadian rhythm right there, telling you to sleep. Over the years of working night shifts as a midwife I grew to know this feeling all too well, and after fighting the urge to sleep all night I would leave the hospital feeling almost drunk.
Ok, so lets all assume we have a well oiled internal clock and we can all go to bed at a reasonable time to get the right amount of sleep for our own needs. We do something relaxing, like reading, listening to gentle music or meditation, in an environment suitable to sleep. See my last sleep post for more information on how to prepare your bedroom for sleep. Suddenly our eyelids become heavy and we decide to roll over and go to sleep. So we do (a girl can dream right? No pun intended). This is when we begin to ride the sleep rollercoaster.
Our sleep, as many of you will know, is made up of cycles, and these typically last around 90 minutes, and each cycle is made up of 4 stages.
Stage 1 – Drifting off – Non REM
This is the stage where you get that lovely floaty, woozy feeling, somewhere between sleeping and being awake. This is also the stage where you may ‘jerk’ or feel like you are falling and wake up suddenly, which at the time is scary as hell until you realise you are still in bed and not falIing down the stairs! It doesn’t take very much to be woken up in this stage, someone slamming a door, or dropping something is likely to wake you easily.
Stage 2 – Light sleep – Non REM
This is the stage in which our heart rate slows and our body temperature begins to drop slightly, and this is where we spend most of our sleeping hours. We can still be woken easily at this stage, by someone calling our name or giving us a good shake. This is the stage of sleep where our brains consolidate the information of the day, and our motor skills improve. Do not be fooled by the name of this stage of sleep, is it incredibly beneficial, even though it is light, as part of a cycle that is well balanced. However, getting stuck in this stage all night is not good and those people who wake up feeling unrefreshed from a nights sleep despite not waking are likely to spending too much time here.
Stage 3 – Deep sleep – Non REM
Now, Even though we only spend about 20% of the night in this stage of sleep it is where you are aiming to get to in each cycle. This is where to real rest and recovery takes place. If you have ever been woken by somebody shaking you, or by your alarm in this stage, then you will know how it feels like you are punch drunk and you will find it very difficult to wake up. You will also know if you have woken someone in this stage as you will really have to shake them to wake them, and when you do wake them they may speak in tongues! This is sleep inertia. For people who sleep walk, this is also the time where you will go have your night time adventures. We need to try and wallow in the bath of deep sleep as much as possible to gain its very beneficial restorative effect. It is also in this stage that we secrete human growth hormone which is responsible for repair of tissues and cells.
Stage 4 – Dreaming – REM
This is the stage that we will be aware of even though we are sleeping because this is the stage in which we dream. This is the stage that is responsible for creativity, so if you make it to here then you are onto a winner. Again, we spend about 20% of our time here. At the end of this stage we temporarily wake up although we won’t remember this. We then go back to sleep and start the whole cycle again.
In ideal sleep we would cycle through these four stages of sleep for as many cycles as our bodies need, be that 3, 4, 5, or 6. As the night goes on we would be spending less time in deep sleep and more time in REM sleep, making it easier to wake up refreshed and ready to face our day, rather than groggy.
To work out which way your sleep is being affected, if at all, it can be useful to monitor your symptoms for a week or two, along with the parts of sleep you remember. Did you wake up? Did you see through but still feel terrible? Did you sleep at all? Once you have worked this out you can then go on to find a solution, and we will be exploring this more in the upcoming chapters of the Sleep Chronicles.
I hope you found this little post useful, and please do check back on the last sleep post for advice on how to make you le sleeping environment as conducive to sleep as possible. I will try and write again in this series as soon as I can 🙂 but for now you can keep up to date with fibromyalgia news on my Facebook and Twitter pages, and I post regularly on Instagram