Fibromyalgia & Chronic Pain LIFE Spring 2015, Issue 11 | Page 13

TIPS FOR BETTER SLEEP
high blood pressure, stroke, heart
attack, and diabetes to name a few,
and is extremely treatable with
CPAP (continuous positive pressure)
for severe cases, and oral appliances
and other techniques for milder
cases. It is now recommended that
anyone with FM and any forms of
sleep complaint should undergo a
sleep study to be evaluated for this
sleep disordered breathing.

S

ignificant differences were also
present in the qEEG ratio of
delta to alpha frequency power.
Basically the alpha frequencies disrupt the deeper restorative delta
frequencies. This is thought by
some sleep experts to be related to
non-refreshing sleep and fatigue
that FM patients commonly experience and may not be identified in
a routine sleep study that does not
specifically look at the Delta/Alpha (D/A) ratio. In Dr. Rosenfeld’s
study, a D/A ratio of less than 10
was highly sensitive for fibromyalgia, meaning it would pick up
most cases, and a D/A ratio of >10
most likely means the patient did
not have FM. A D/A ratio of <1 was
highly specific for FM, meaning
the diagnosis is 95% likely.

I

nterestingly the use of common
sedatives and sleep aids did lower
the D/A ratio in both the fibromyalgia and non-fibromyalgia groups
but did not affect the overall results.
Periodic limb movements thought
to be related to FM actually were not
commonly seen in his study. Even
though patients with FM complain
of poor quality sleep and their ability to sleep, the “sleep efficiency” did
not differ significantly. Again, the
non-refreshing quality of the sleep
in FM, thought to be related to the
alpha intrusions, was easily measured by the D/A ratio using qEEG,
and now can be used as a biological
marker or measure of FM. It will be

interesting to see if other
large scale studies can replicate and confirm these
important findings.

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1. Have a good “wind-down”
routine at bedtime
2. Manage stress!
3. If you have RLS, avoid medicines
that worsen RLS (such as OTC
antihistamines and dopamine
antag oni st s / Ant ip sy chot i c s /
and Tricyclic Antidepressants)
4. Consider a sleep study to look
for:
• Sleep Apnea
• Periodic Limb Movements
• “Alpha Intrusions”
• Consider a logical medication
regimen for sleep if needed

he level of brain activity during sleep is
controlled by many factors
related to the autonomic
systems of the body. Sleep
apnea can also exacerbate
the autonomic disruptions
of the body. The autonomic
system has been difficult
to test, but newer methods
such as testing for Heart
Rate Variability (HRV)
are becoming more widespread. It terms of what
can be done to improve the
low Delta/Alpha ratio seen
in FM patients, there is no
current FDA approved medication;
however, experimental approaches
such as the use of Sodium Oxybate,
which is FDA approved for narcolepsy and cataplexy, has been shows to
reduce alpha intrusions, reduce pain
and fatigue in patients with FM in
large, multi-center, double-blind
placebo controlled trials.

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he results of Dr. Rosenfeld’s
study demonstrated that
sleep disorders identified by
routine polysomnography, including obstructive sleep apnea,
are common in fibromyalgia, but
periodic leg movement disorder
and poor sleep efficiency are
not. Most remarkably, this study
showed that a qEEG low delta/alpha ratio during non-REM sleep
can differentiate patients with
fibromyalgia from others who
are referred for polysomnography. Additionally, consideration
of the use of benzodiazepine and
benzodiazepine agonist medications by the sleep study participants played a role when the delta/
alpha ratio data was analyzed.

S pring 201 5

A

fter so many years of searching for more answers regarding the lack of sleep with FM
symptoms, it is satisfying to see
that Dr. Rosenfeld has been able
to consistently show a type of
sleep anomaly that is specific to
FM. This study should spur interest in further research looking at the relevance of sleep, the
autonomic arousal system and
their influence on the development of FM symptoms. Perhaps
better treatments involving alleviating sleep abnormalities FM
will also evolve.

Dr. Victor Rosenfeld, Neurology
Department Head and Medical Director of the Sleep Center at SouthCoast Health in Savannah, Georgia.

Fibromyalgia & Chronic Pain

Life  13