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| | Polysomnography: One Tool in Helping in the Diagnosis and Treatment of FibromyalgiaWritten by Shirise J. Wilson, BA, CRT, NREMT, RPSGT
Stop! and imagine for one moment that your body is being savagely and brutally attacked by chronic pain. This pain is so intense that you become less active. As you become less active you start to develop muscles weakness. Just trying to do normal daily activities such as, working, housekeeping, cooking, playing with kids, shopping, walking dog and sleeping has become an extreme ordeal. All is not peaceful in Land of Nod. In fact, you as a fibromyalgia (FM) sufferer are downright restless. As of this writing, fibromyalgia is most misdiagnosed and misunderstood syndrome of 21 century. Because it mimics other diseases and conditions, many people with FM initially have often been diagnosed as having multiple sclerosis, scleraderma, rheumatoid arthritis or lupus. Fibromyalgia has also been closely associated with chronic fatigue syndrome, it shares many of same qualities. Since so many fibromyalgia sufferers have been misdiagnosed, experts have categorized fibromyalgia as a syndrome rather than a disease. A syndrome is defined as “an aggregated of signs and symptoms associated with any morbid process.” Although it does occur in men, women in their late 40’s and older are at least four times more likely to develop disorder. Pain, it is most common symptom and complaint of FM sufferer. Some people experience pain, fatigue, muscle stiffness and swelling in their joints, especially in morning. This stiffness can be quite distinct and be accompanied by pain in key areas of body, usually in neck, shoulder, lower back and buttoch. Irritable bowel syndrome has been reported in approximately 40-70 percent of these patients. It is not unusual for those afflicted to have diarrhea, constipation or a frequent need to empty their bladder. Fatigue and restlessness in FM patients can cause poor concentration, memory loss, non-restorative sleep and secondary endocrine malfunction involving hypothalamic pituitary and adrenal glands. Approximately 50 percent of FM sufferers experience some sort of increase sensitivity to stimuli, such as, flashing lights (photophobia), increase sounds (phonophobia), and varies odors. Some patients often present with a chronic runny nose, congested head cold, and a throat clearing cough. Another common complaint is restless leg syndrome. When a FM sufferer presents to their doctor their are two things they want more than anything in this whole wide world. They want their pain alleviated and one of greatest pleasures known to all creatures, ability to get a good night of rest and sleep. Fibromyalgia and Sleep Sleep is vital to our very existence, it is during sleep that our temperature decreases conserving energy, sugars are stored for future use, our immune system is blasted into action and growth hormones are released fostering repair of cells and tissues.# That important journey into sleep is a beautiful time for our bodies and brains to heal themselves from vigorous wear and tear of daily living. But, numerous studies have been conducted which reveal that persons with fibromyalgia have a sleep disturbance that prevents them from receiving these healing powers. Many physicians are unaware of importance of getting a sleep study done on their FM patients. Here’s what we know, a landmark study published in 1975 discovered that 70 percent of patients with FM had NREM (non-rapid eye movement) stages of sleep “contaminated” by an abnormal EEG pattern called alpha-delta sleep, in which incurrent alpha waves (seen when you are awake) are riding on large, slow delta waves. This constant alpha-delta intrusion robs body of deep sleep (stage 3 and 4 sleep). It is during this stage of sleep that our body is being repaired. There is also some evidence indicating that fibromyalgia syndrome and sleep disorders are intimately related, but know one is certain which causes other. Many FM sufferers exhibit bruxism (tooth-grinding), periodic limb movement (PLM), and obstructive sleep apnea (OSA). The absence of stage 3 and 4 sleep in FM can also cause chronic sleep deprivation and may contribute to rapid physical decline many doctors see in their patients. Diagnosing FM is not an easy task. To actually receive a diagnosis of fibromyalgia, American College of Rheumatology, identified 18 separate points on body called “tender points,” by applying pressure with index, third and fourth fingers of examiner’s hand at nine key bilateral surface sites. These include side of hip joint, and buttock and inside of knee. In addition, patient must complain of widespread pain lasting at a duration of 3 months or more. pain must be radiating on both sides of body, and be above and below waist. Fibromyalgia and Polygragh There is no cure for fibromyalgia. The only relief FM sufferers can hope for is treatment of their symptoms. Majority of FM patients complain that no matter how long they sleep, it is never restful. Their sleep may be interrupted by frequent awakenings, or they wake up gasping for air, or in pain. Even more common most patients complain of waking up day after day feeling exhausted. Many of symptoms that FM patients experience are shared by those with other sleep disorders. As sleep care professionals, we do know symptoms. Now we must raise awareness to patient and doctors treating FM, that their lack of sleep can be caused by so many factors. Such as, pain, sleep apnea, PLM and bruxism. But how, (you ask) would a doctor know for sure in a patient complaining of sleep deprivation that their lack of sleep is because of pure fibromyalgia verses fibromyalgia overlap with another sleep disorder? Here’s your answer, “Polysomnography.” The polygraph can be used as one of tools to help doctors battle problem. In order for you to better understand how fibromyalgia works in sleep. I invite you to come along with me and peek in on inner workings of fibromyalgic brain. I had been working in sleep medicine as a polysomnography technician for only six months when I saw my first client with fibromyalgia. LT was a forty-eight years old female, mildly over-weight and in poor overall health. Her chief complaint was, (Yep you guess it), pain and lack of sleep.
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