Unrefreshing Sleep in Fibromyalgia

Waking Up Exhausted

Unrefreshing sleep has long been noted as a feature of fibromyalgia, and it's one that may be linked to many of our symptoms. One study reports that as many as 95 percent of people with fibromyalgia report unrefreshing sleep.

A growing body of research is leading to a better understanding of unrefreshing sleep in this condition, its features, its effect on us, and how it may be alleviated.

What is Unrefreshing Sleep?

Unrefreshing sleep, also called nonrestorative sleep, is not the same thing as insomnia (which can also be present in fibromyalgia).

It's not tied to how hard it is to get to sleep or to how long you sleep.

Instead, unrefreshing sleep is more about the quality of your sleep. It's light, and even after sleeping for a full night, you wake up feeling exhausted and as if you've hardly slept. However, the impact of unrefreshing sleep can go well beyond feeling tired.

While unrefreshing sleep and other sleep-related problems are considered a symptom of fibromyalgia, research shows that they're tied to abnormalities in brain chemistry and the immune system in a complex way and, according to a 2012 study, may serve as "both a cause and a consequence of fibromyalgia."

Impact of Unrefreshing Sleep

Research links this poor-quality sleep to multiple symptoms of fibromyalgia, including:

  • Stiffness
  • Fatigue
  • Psychological distress

Why is Sleep Unrefreshing in Fibromyalgia?

So far, it's not well understood why sleep is generally unrefreshing in people with this condition.

The most obvious explanation is that it's hard to sleep when you're in pain, and many people with fibromyalgia report significant pain from simply lying down on their tender muscles.

The tendencies to get chilled or become overheated and sweat excessively may also contribute to sleep problems.

Research shows that dysfunction in the autonomic nervous system (ANS) may play a key role, as well.

The ANS is separated into two parts -- the sympathetic (fight-or-flight mode) and parasympathetic (rest-and-digest mode.) According to an emerging theory of fibromyalgia, the sympathetic nervous system appears to be stuck "on," preventing the body from truly relaxing and being able to sleep.

This state is similar to "sleeping with one eye open," such as new parents do when they're alert to a baby's every cry, or like you might experience when you're especially worried about oversleeping and therefore wake up and check the clock over and over.

A 2009 study (Prados) suggests that heart-rate variability, which is a measure of autonomic function, was abnormal during sleep in participants with fibromyalgia. This supports the theory of increased sympathetic activity that disrupts sleep.

Because pain disrupts sleep and poor sleep leads to pain, it can become a self-perpetuating cycle.

Treating Unrefreshing Sleep

Research suggests that several medications may be able to improve sleep quality in fibromyalgia.

These include:

Lyrica, Cymbalta and Savella are FDA-approved for this illness. Elavil is a tricyclic antidepressant, and Xyrem is a narcolepsy drug that's strictly controlled.

Some people with fibromyalgia report success with other prescription or over-the-counter sleep aids as well.

Research suggests that melatonin supplementation may improve sleep and pain in fibromyalgia.

If your sleep is unrefreshing, you should talk to your doctor about what options may be right for you.


Chervin RD, et al. Journal of rheumatology. 2009 Sep;36(9):2009-16. Objective measures of disordered sleep in fibromyalgia.

Citera G, et al. Clinical rheumatology. 2000;19(1):9-13. The effect of melatonin in patients with fibromyalgia: a pilot study.

Clauw DJ. PM & R: the journal of injury, function, and rehabilitation. 2010 May;2(5):414-30. Perspectives on fatigue from the study of chronic fatigue syndrome and related conditions.

Hussain SA, et al. Journal of pineal research. 2011 Apr;50(3):267-71. doi: 10.1111/j.1600-079X.2010.00836.x. Adjuvant use of melatonin for treatment of fibromyalgia.

Moldofsky H. CNS spectrums. 2008 Mar;13(3 Suppl 5):22-6. The significance, assessment, and management of nonrestorative sleep in fibromyalgia syndrome.

Moldofsky H. Joint, bone, spine: revue du rhumatisme. 2008 Jul;75(4):397-402. The significance of the sleeping-waking brain of the understanding of widespread musculoskeletal pain and fatigue in fibromyalgia syndrome and allied syndromes.

Moldofsky H, et al. The Journal of rheumatology. 2011 Dec;38(12):2653-63. Effects of bedtime very low dose cyclobenzaprine on symptoms and sleep physiology in patients with fibromyalgia syndrome: a double-blind randomized placebo-controlled study.

Moldofsky H, et al. Journal of rheumatology. 2010 Oct;37(10):2156-66. Effects of sodium oxybate on sleep physiology and sleep/wake-related symptoms in patients with fibromyalgia syndrome: a double-blind, randomized, placebo-controlled study.

Moldofsky H. Rheumatic diseases clinics of North America. 2009 May;35(2):275-83. The significance of dysfunctions of the sleeping/waking brain to the pathogensis and treatment of fibromyalgia syndrome.

Moldofsky H. Sleep medicine reviews. 2001 Oct;5(5):385-396. Sleep and pain.

Prados G, Miro E. Revista de neurologia. 2012 Feb 16;54(4):227-40. Abstract referenced, article in Spanish. Fibromyalgia and sleep: a review.

Continue Reading