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

Managing Sleep Disturbance in FMS
Despite the chronicity of the difficulties experienced and the high prevalence of sleep
disturbance in FMS (as is the case for patients with other chronic pain conditions), poor
sleep quality often receives little attention in current treatment of the condition, and the
most common treatment approach is the prescription of hypnotic or tricyclic
antidepressant medications. Clinical trials have demonstrated the efficacy of these
medications to reduce symptoms of sleep disturbance in the short term for FMS. For
example, tricyclic medications have been found to improve sleep for one month
(Moldofsky, 2002). However, there is little evidence of the efficacy of medications after
prolonged use as the treatment effects disappear after discontinuation. The prolonged
use of medications to aid sleep may also lead to impaired daytime functioning and may
change the underlying sleep architecture. For example, benzodiazepines can reduce
stages three and four of sleep (Morin, 1993) and indeed some people experience
„rebound insomnia‟ after discontinuing their hypnotic medication, stating that their
sleep quality is more impaired than before they started the medication. This can often
lead to, or trigger dependence on taking hypnotic medications (Soldatos, Dikeos, &
Whitehead, 1999).
Common side effects of hypnotic and tricyclic medication (such as drowsiness and
confusion) can also exacerbate other symptoms of FMS such as fatigue and cognitive
difficulties, and may not be well tolerated by some patients (Lautenschlager, 2000;
Moldofsky, 2002; Shaver et al., 1997). In addition to the limitations of
pharmacotherapy, there is also wide variation in patients‟ adjustment to FMS,
suggesting that psychological factors are important to the course and outcome of the
condition (Burckhardt et al., 1992; Rao & Bennett, 2003). Consequently, there is an
urgent need to explore the effectiveness of non-pharmacological interventions to
improve sleep for people with FMS. Promising findings were observed in a pilot study
of cognitive behaviour therapy to improve sleep quality for people with FMS (Edinger,
Wohlgemuth, Krystal, & Rice, 2005). In comparison to participants randomized to
receive sleep hygiene advice and usual care, participants who received the cognitive
behaviour intervention on an individual basis for six weeks demonstrated almost a 50%
reduction in the number of night-time awakenings experienced. A current full
randomized controlled trial is underway to explore the efficacy of cognitive behaviour
therapy, however some may argue that the costs of individual therapy may be too
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