Posted by Heidi/Mermie Like Christina, the majority of FM patients are fatigued, even after sleeping for ten hours at night. One woman said, "I go to bed tired and feel tired all night. I awaken tired, and then I feel tired the next day." Patients complain that no matter how long they sleep, it is never restful. Their sleep may be interrupted by frequent awakening that is, becoming awake enough that they remember these times the next day. Even more common are awakenings that are not enough to remember but that definitely break up their deep sleep. Most patients tell of waking up day after day feeling exhausted. They feel more tired in the morning, and many have great difficulty in concentrating during the day, just as in other situations where sleep is disrupted. Because obtaining restful sleep is a crucial problem with this disease, it is helpful to understand the characteristics of normal sleep and how this differs from the sleep experienced by FM patients. Understanding the Stages of Sleep Studies have demonstrated that we have a built-in cycle of sleep-wake times along with many other cyclic variations in bodily functions, such as glandular secretions, body temperature, heart rate, blood pressure, and bronchial function. These intrinsic cycles are controlled by a group of nerve cells called a circadian pacemaker. This pacemaker is closely related to parts of the retina (in the back of the eye) and the hypothalamus in the brain. The circadian cycle is actually 25 hours long. Since the cycle is longer than the 24-hour day, some factor must serve to synchronize the body's pacemaker with the external clock time. These are cues from the environment called zeitgebers (from German, meaning "time givers"). The most important and powerful one is light. The hormone most closely linked to the circadian system is melatonin, which is made by the pineal gland in another part of the brain. Melatonin has been shown to synchronize the sleep-wake cycle to 24 hours in some blind subjects who were otherwise unable to live on a 24-hour day. In adults, sleep is made up of distinct types or stages with specific characteristics defined by brain waves, eye movements, and muscle tension. The two broad categories of sleep include rapid eye movement (REM) and non-rapid eye movement sleep (NREM). It is during REM sleep that that we have almost all our dreams. (Arousals from this stage of sleep are usually associated with recall of vivid imagery.) In NREM sleep, there are four difference stages - 1, 2, 3, and 4 - characterized by different combinations of brain waves, eye movements, and reduced but not absent muscle tension. In FM, stages 3 and 4 NREM sleep are of the most importance. These stages are defined by relatively large, slow brain waves (delta waves), absent eye movements, and reduced muscle tension. Other names for these stages are "slow-wave sleep" or "delta sleep." About 60 years ago, it was recognized that sleep intensity is reflected by the amount of delta sleep. The depth of sleep is correlated with this stage, and it is from delta sleep that arousal is most difficult. The wake state is associated with small, variable, but mostly rapid (seven to eleven cycles per second) brain waves called alpha waves. There are quick, alert eye movements along with variable, generally high tension in the muscles. The stages of sleep are distributed through the normal sleep period in a particular pattern.
on 8/27/2007, 4:32 am
End Sleepless Nights
Sleep deprivation was written all over Christina's face. Until she started treatment for fibromyalgia (FM), this 47 year-old woman lived for months with dark circles under her eyes from lack of restful sleep.
Christina made it a point to be in bed by 9:00 each night, but then tossed and turned until sunrise and always felt too tired to go to work the next day.
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