If you have fibromyalgia, it’s likely that you already know, people with fibromyalgia often can’t sleep. Difficulty sleeping, or Insomnia, is often cause by an area of your brain (mesencephalon or upper brain stem) that is over active. The Mesencephalon influences the autonomic nervous system, specifically the sympathetic nervous system (known as fight or flight system) which is the part of your nervous system that controls involuntary functions. Research suggests that this increase in sympathetic activity is related to insomnia associated with Fibromyalgia. 1 In clinical practice we see that treating the brain using functional neurology and functional medicine (aka clinical nutrition), to slow upper brain stem activity is often very effective at alleviating symptoms associated with fibromyalgia induced insomnia.
In the past, I’ve discussed the role of stress on cortisol production via the hypothalamus-pituitary-adrenal axis (HPA axis) and how elevated cortisol can create many of the symptoms of fibromyalgia (fibro fog, full body pain, and loss of normal sleep patterns). You see, cortisol follows a daily rhythm of production. During the day your cortisol should be low, and at night it should rise while you sleep. This natural rhythm helps your body function while you sleep, by increasing cortisol in the blood, which stimulates the release of glucose (blood sugar) from your liver. This increase in blood sugar is important for you as you sleep, because your brain, organs and tissues need blood sugar to survive and function normally. When you sleep your not eating, when your not eating, your not getting blood sugar from your food, so the body has to increase your blood sugar levels by getting cortisol to stimulate your liver (your liver stores blood sugar) to release it. When you cortisol rhythm is off, you will have difficulty sleeping. In our office, we sometimes perform salivary adrenal stress index testing. This test allows us to plot your cortisol levels throughout the day, and know if your normal rhythm is off. If your levels are off we will make dietary, lifestyle, and temporary supplemental recommendations to work on normalizing your cortisol levels. After a month or two, we will re-test your cortisol levels again to see what progress has been made. We will continue this process of retesting for a few months until your cortisol levels are normalized. We use several methods to lower cortisol, including exercise that is appropriate for patients with fibromyalgia. Evidence suggests that improved regulation and sensitivity of the HPA axis using exercise and cognitive behavorial therapy (CBT) will improve cortisol and pain levels in people with fibromyalgia.2,3 In our office we do various forms of exercise with you, and we may have you perform CBT such as guided imagery to specifically stimulate areas of your brain to help regulate the HPA axis, and lower cortisol.
The first step to improve your inability to sleep, or sleep normally should begin with an assessment of your diet, and the addition of a few nutritional supplements to help you with cortisol imbalances.
1. Chervin RD, Teodorescu M, Kushwaha R, Deline AM, Brucksch CB, Ribbens-Grimm C, Ruzicka DL, Stein PK, Clauw DJ, Crofford LJ. 2009. Objective measures of disordered sleep in fibromyalgia. J Rheumatol. Sep;36(9):2009-16.
2. Bonifazi M, Suman AL, Cambiaggi C, Felici A, Grasso G, Lodi L, Mencarelli M, Muscettola M, Carli G. 2006. Changes in salivary cortisol and corticosteroid receptor-alpha mRNA expression following a 3-week multidisciplinary treatment program in patients with fibromyalgia. Psychoneuroendocrinology. Oct;31(9):1076-86.
3. Ortega E, García JJ, Bote ME, Martín-Cordero L, Escalante Y, Saavedra JM, Northoff H, Giraldo E. 2009. Exercise in fibromyalgia and related inflammatory disorders: known effects and unknown chances. Exerc Immunol Rev. 2009;15:42-65.
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