Fibromyalgia Syndrome and Sleep

Almost totality of fibromyalgia patients complain of disturbed sleep, but to date, this topic is at the centre of many controversies. First of all, subjective sleep complaints can be found in all patients, but not all studies observed altered objective parameters when investigating sleep using polysomnography; therefore, currently, no disease-specific sleep alterations have been found. Secondly, sleep disturbances correlate with many fibromyalgia symptoms, and it is now known that the relationship between sleep and pain is bidirectional, but it is still not clear why the sleep of fibromyalgia patients is so disrupted. Putative mechanisms include alterations in the hormonal, neurotransmitter and immune systems, and in the autonomic nervous system. There are also no interventions that are both safe and effective for improving sleep in fibromyalgia patients; hence, treatment must be multidimensional and take into account the multiple causative factors and the frequent fibromyalgia comorbidities. First, it is necessary to adopt behavioural changes, including sleep hygiene practices and regular exercise; secondly, some pharmacological treatments can be tried, such as pregabalin, amitriptyline and very low dose cyclobenzaprine, which are frequently used to treat pain and sleep disturbances in fibromyalgia patients, whilst duloxetine and milnacipran are less effective on sleep. New promising drugs are sodium oxybate, cannabis and cannabinoids. The high frequency of sleep alterations and their complex relationship with other manifestations in fibromyalgia mean that physicians should specifically address them, in order to have a positive effect on patients’ quality of life.