Sleep disturbances and Fibro

A recent article discusses a study that looked at the relationship between sleep problems, pain, depression, and physical functioning in patients with Fibromyalgia Syndrome (Fibro). [1]

The article, Sleep disturbances in fibromyalgia syndrome: Relationship to pain and depression, from researchers at Indiana University and Purdue University, Indianapolis, USA, was e-published ahead of print in the journal Arthritis and Rheumatism.

The study involved a baseline assessment and then 1-year follow up of Fibro patients, diagnosed according to the 1990 ACR criteria. who were recruited from a Southern California health maintenance organization. Measures used to evaluate sleep, pain, depression, and physical functioning included the Center for Epidemiologic Studies Depression Scale, the McGill Pain Questionnaire, the Pittsburgh Sleep Quality Index, and the Fibromyalgia Impact Questionnaire. Six hundred patients completed the baseline assessment and 492 completed the 1-year assessment. [1]

The majority of the participants (96% at baseline and 94.7% at 1 year) were found to have problems sleeping. The results were analysed to find if there was a link between any of the variables at the baseline measurement and a change in another variable at the 1-year measurement. No variable was found to be significantly linked to a worsening of sleep problems, but poor sleep at the baseline measurement was linked to more pain at the 1-year measurement. More pain at the baseline measurement was also linked to poorer physical functioning at the 1-year measurement, and poorer physical functioning at the baseline measurement was linked to higher depression scores at the 1-year measurement. [1]

The researchers concluded that:

"These findings highlight the high prevalence of sleep problems in this population and suggest that they play a critical role in exacerbating [Fibromyalgia Syndrome] symptoms. Furthermore, they support limited existing findings that sleep predicts subsequent pain in this [the Fibro patient] population, but also extend the literature, suggesting that sleep may be related to depression through pain and physical functioning." [1]

This study is interesting in that, as well as highlighting how prevalent sleep problems are with Fibro, it also suggests a pathway for the development of depression as a result of Fibro. It is often thought that many Fibro patients have symptoms of depression, but it is not always considered whether problems due to the Fibro were the direct cause of the depression. [2] This study suggests that this is so, corroborating many anecdotal reports that depression is a result of Fibro. [1]

Fibro patients need to keep in mind that a lack of restorative sleep, no matter how much sleep is got overall, is in itself a sleep problem. When you could sleep for much of the day, it can seem unintuitive to say that you have a problem sleeping, but the lack of restorative sleep was one of the first recorded symptoms of Fibro. [3] And as this study suggests, poor sleep can lead to more pain, which can then lead to further problems. [1]

References:

1. Bigatti SM, Hernandez AM, Cronan TA, Rand KL. Sleep disturbances in fibromyalgia syndrome: Relationship to pain and depression. Arthritis Rheum. 2008 Jun 24;59(7):961-967. [Epub ahead of print]
2. Arnold LM. Management of fibromyalgia and comorbid psychiatric disorders. J Clin Psychiatry. 2008;69 Suppl 2:14-9.
3. Moldofsky H. Sleep and fibrositis syndrome. Rheum Dis Clin North Am. 1989 Feb;15(1):91-103.