When does your pain kick into high gear? For some it’s first thing in the morning, others at random times, but for most with fibromyalgia, the pain seems amplified at night. You know the routine: you try to be social and hang with a friend for dinner, but you have to come home early because you’re in agony. Or you actually made it to work today and successfully managed to block out the pain all day, but now that you’re home it feels like all the pain you were supposed to feel is happening right now. Sleep is not even an option at this point. You lie there, tossing if you’re able, with your muscles tensed and in more pain than you can remember. Of course, there are other nights where the pain isn’t that intense. So what gives? As always, a journal of diet and activities can be helpful in determining if there are any particular triggers that seem to exacerbate the pain. But what if there still is no apparent explanation?
WebMD offers one possible reason for what appears to be an oddity: “Research shows that with fibromyalgia, there is an automatic arousal in the brain during sleep. Frequent disruptions prevent the important restorative processes from occurring. Growth hormone is mostly produced during sleep. Without restorative sleep and the surge of growth hormone, muscles may not heal and neurotransmitters (like the mood chemical serotonin) are not replenished. The lack of a good night’s sleep makes people with fibromyalgia wake up feeling tired and fatigued. The result: The body can’t recuperate from the day’s stresses — all of which overwhelms the system, creating a great sensitivity to pain.” This sounds like a very vicious cycle.
Some speculate that by the end of the day our minds are beginning to clear as we focus on resting which makes us more aware of our fibromyalgia pain. However, conventional wisdom dictates that by the end of the day our minds have been flooded with information gathered by our senses and processed in our brains and bodies. Indeed, this is why we must sleep at night so that we can process all we have absorbed and refresh our bodies. Thus, this flood makes us the least clear at night. Compare it to the clarity you have when you first wake each day. What seems like a much more reasonable conclusion is that the body itself is fatigued just from the activities of the day. Therefore, by the evening, it takes far less to stress the muscles and create more inflammation. In fact, while it may seem like an exaggeration, the muscles of fibromyalgia patients might be mildly compared to rigor mortis wherein the muscles are always contracted. Because fibro patients cannot usually relax their muscles.
Since fibromyalgia patients almost universally struggle with good and restful sleep, WebMD goes on to offer tips to facilitate better sleep, specifically for fibro patients:
- Take a soothing, warm bath in the evening (provided you have the energy to get in the tub).
- Bruch your body with a loofah or long handled brush in the bath (your ability to do this may vary from day to day given your level of pain).
- Ease painful tender points with a self-massage device, such as a tennis ball.
- Practice yoga or other stretching exercises to relax (Amazon offers several yoga DVD options specifically for fibromyalgia).
- Listen to calming music (Pandora has a station called “Calm Meditation Radio” that sounds just like what you’d hear at a spa during a massage).
- Meditate to calm intrusive thoughts and tension.
- Sleep in a dark room (consider an eye mask if necessary).
- Keep the room as quiet as possible (or use a white-noise machine or fan to drown out subtle sounds).
- Make sure the room temperature is comfortable.
- Avoid foods and beverages that contain caffeine, including teas, colas, and chocolate.
It seems there may be a variety of reasons for fibromyalgia pain to increase at night, but all of them point to muscles as the key player. Again, try a journal that keeps up with food and basic activities for a month or so and see if you find any common themes or triggers. Also try the list of tips here, knowing that there are going to be days when even just one of the tips is an impossible task. Simply do what you can and share your results with the rest of us!