Sick and Tired: Understanding and Managing Sleep Difficulties in ...

pauses in breathing indicative of sleep apnea are considered to be between 20-30
seconds asc classified by the International Classification of Sleep Disorders, Second
Edition (American Academy of Sleep Medicine, 2001), they have revealed high
prevalence of nocturnal pauses in breathing (known as periodic breathing) in FMS
participants (Gold, Dipalo, Gold, & Broderick, 2004; Jennum et al., 1993; Sarzi-Puttini
et al., 2002; Sergi et al., 1999). Periodic breathing has been linked to increased
nocturnal arousals and daytime sleepiness in FMS (Sarzi-Puttini et al., 2002; Shah et al.,
2006) and has been found to occur more often in stage one light sleep (Jennum et al.,
1993; Sergi et al., 1999). Risk factors for sleep apnoea include age, obesity and gender,
and indeed the frequency of sleep apnoea has been found to be higher in obese women
and for men with FMS (May, West, Baker, & Everett, 1993; Shah et al., 2006). Sleep
apnoea and disordered breathing are unlikely to directly influence the onset of FMS, as
high levels of disordered breathing have also been found in other musculoskeletal
conditions (Hyyppa & Kronholm, 1995) and many people with sleep apnoea do not
have FMS (Alvarez Lario et al., 1992; Molony et al., 1986). Although disordered
nocturnal breathing patterns and sleep disorders may not be directly causal to FMS, they
may be linked and contribute to poor sleep quality and symptoms of FMS.
High frequency of restless legs syndrome, (a disorder displayed by involuntary
movement of the limbs occurring at 20-40 second intervals both during the day and at
night, has also been revealed in people with FMS (Yunus & Aldag, 1996). However, the
lack of control groups in these studies makes it difficult to compare rates of these
disorders in FMS, with levels experienced in the general population based on equivalent
measures. As effective treatments are available for sleep apnoea and restless legs
syndrome, further research is needed to identify if treatment of these sleep disorders can
also help to improve symptoms of FMS for patients with a sleep disorder and FMS
(Moldofsky, 2010).
As sleep is primarily a subjective experience, people‟s perceptions of their sleep
difficulties are likely to be of key importance to the way people understand and manage
their sleep and daily activities. As outlined at the beginning of this chapter, a high
proportion of people with FMS perceive that they experience some type of sleep
disturbance.
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