Why am I so tired?! – 5 Easy Habits for a Better Night’s Sleep
Updated: May 14, 2021
Poor sleep is a very common experience in people with fibromyalgia. It affects approximately 90% of fibromyalgia sufferers. Sleep studies performed on people with fibromyalgia have shown deviations in what we would expect from a normal sleep cycle. On studies measuring brain waves during sleep, there is evidence of alpha brain waves intruding upon delta brain waves. Alpha brain waves are the type present when you are awake or during periods of relaxation, such as meditation. Delta brain waves are present in deeper sleep, also called slow wave sleep.
In addition to the abnormalities we can measure on sleep studies, people with fibromyalgia report much difficulty with various aspects of sleep. Restlessness through the night, involuntary leg movements, feeling sleepy through the day, and an experience of non-refreshing sleep are common concerns in people with fibromyalgia. People with fibromyalgia also report more difficulty falling asleep. The compounded effect of lacking deep sleep and waking frequently through the night means you wake feeling tired and unrefreshed. When this happens night after night, it’s no wonder you have trouble functioning because you’re so tired.
You may have noticed that after having a particularly bad night, you not only feel extremely tired, but you are also in much more pain. Research has shown that the relationship between sleep quality and pain in people with fibromyalgia appears to go both ways. Poor sleep quality leads to increased pain and high pain levels can also disrupt sleep. We see this relationship with fibrofog and sleep as well. Sleep is a time when the body does a ton of healing and re-balancing.
Studies performed on the effects of sleep deprivation show detrimental effects in functioning of the cardiovascular system, endocrine (hormone) system, immune system, and nervous system with chronic sleep times less than seven hours per night. In addition, people who were sleep deprived were more likely to suffer from anxiety and depression. In fibromyalgia specifically, with poor sleep quality measures of cognitive performance declines and symptoms of fibrofog may be more prominent. When we don’t sleep well, every little task feels so much harder. It takes much more concentration and effort to get things done compared to when we feel well rested. It’s harder to manage our emotions and much easier to get frustrated.
I’m not telling you all of this to scare you, although I know it can feel scary to read about the effects of not sleeping well when all you want to do is get a good night’s sleep. I’m telling you this so you understand how important it is to focus on supporting your body in getting a good night’s sleep. It’s one step I always emphasize early on with my patients, because it can improve so many other symptoms and help your body heal much faster.
5 Easy Habits to Support a Good Night’s Sleep
1. Maintain a Consistent Bedtime (ideally around 10pm)
In an ideal world, a bedtime between 10pm and 11pm is the best time to go to bed based on how your cortisol (stress hormone) and melatonin (sleep hormone) circadian rhythm works. Most of the time, the people I see with fibromyalgia have bedtimes much later than this (in the 1am to 4am range). I understand how this happens. When sleep is challenging, you start to dread going to bed. You associate the whole bedtime process with frustration and anxiety. Despite your best efforts, you still can’t sleep how you’d like to, so why bother trying? You can get to an earlier bedtime, but it’s a gradual process.
The first step is to determine what your starting bedtime is. You may decide this is what time you climb into bed, but in reality, your bedtime is shortly before the time you are getting sleepy and your body is ready for rest. Lying in bed awake for hours is common with fibromyalgia and this is the pattern we want to break, as it trains your body that the bed is not necessarily associated with sleep. If you are going to bed at 12am, but not falling asleep until 2am, your starting bedtime is 1:30am (about 30 minutes before you are falling asleep).
If your starting bedtime is 1:30am and we want to work towards an earlier bedtime, we want to push your bedtime earlier by 30 minutes to a new bedtime of 1:00am. You stick with this new bedtime of 1:00am until you are consistently falling asleep by 1:30am at the latest. I generally find it takes about two weeks to adjust to a new bedtime. Once you are consistently falling asleep at your new bedtime, we push your bedtime earlier by another 30 minutes (to 1:00am in our example). This process continues until you are consistently falling asleep at a time closer to 10pm, without lying awake in bed for hours. I know this process sounds long, but it will be much less frustrating that trying to go to bed at 10pm right from the start. Your body will not adjust to that routine very easily or quickly and you will be more likely to give up on adjusting your bedtime and honouring your body’s natural circadian rhythms.
2. Optimize Your Bedroom – Quiet, Cool, and Dark
An ideal bedroom environment is quiet and is cooler in temperature. It may be necessary to have conversations with other members of your household about quiet hours or moving more noisy activities (such as televisions) to rooms further away from sleeping areas. Some noise may be unavoidable. If this is the case, placing a fan or white noise machine in the bedroom can help to muffle other sounds that may wake you.
In regards to temperature, your body temperature naturally drops slightly when you sleep. When you are too warm through the night, you’ll have a more restless sleep and wake more frequently. Dropping the temperature slightly at night, having a window open, or using lighter bedding and bed clothes can all help to support sleep by encouraging this drop in body temperature.
Exposure to light suppresses melatonin production (your sleep hormone). Turning off all lights and using blackout curtains or blinds can help to encourage proper melatonin release and promote restful sleep. Opening the curtains and exposing yourself to sunlight upon waking for the day suppresses melatonin production and helps you to feel more awake in the morning.
3. Schedule 1 Hour Before Bed for Your Bedtime Routine.
Your bedtime routine includes all of the normal things you do before bed, such as brushing your teeth, washing your face, putting on your bed clothes, etc. This time also includes relaxing and unwinding. Most people would include watching TV or playing on their phone as relaxing and unwinding. The caveat to this one hour period is that it is a screen-free period. Light, especially blue light from electronic devices, suppresses melatonin release and will disrupt sleep. Most people will argue that they have a blue light filter on their phones or computers. In my opinion sleep is absolutely essential to your health and improvement, so I recommend that you have a screen-free one hour before bed. Schedule some time to spend on your phone or computer before the one hour bedtime period.
It is best to avoid eating or drinking during the one hour bedtime routine period. Avoid drinking shortly before bed to help prevent you from waking through the night to go to the bathroom. Digesting food can also disrupt your sleep and is not ideal.
Beyond avoiding screens, eating or drinking, and working in the one hour before bed, you can use this time however you like as long as it’s relaxing and you’re getting to bed at your scheduled bedtime. Many people use this time to read or engage in a hobby they find relaxing.
4. Invest in a New Mattress and Pillow.
Mattresses can be a tricky subject. They can be expensive and there may be some disagreement between partners who sleep together on which mattress they like best. There is no specific mattress that is best for people with fibromyalgia. It depends on what you prefer. I highly recommend shopping at a designated mattress store where staff are trained to help you find a mattress that works for you. Carve out enough time to shop for a new mattress, as it is recommended that you lay on a mattress for 15 minutes before determining if you like it. Mattresses should be replaced every seven to ten years depending on the quality of your mattress.
A good quality pillow is also essential to your quest for restful sleep. Good quality pillows are designed to support your head and neck depending on your sleep position. A pillow for someone who sleeps on their side should not look the same as a pillow for someone who sleeps on their back. Pillows should be replaced every six months to two years, depending on the quality of your pillow. Many people with fibromyalgia notice a substantial difference in sleep quality, energy, and pain levels when they find the right mattress and pillow for them. I promise this is a worthwhile investment.
5. Train Your Brain.
While light, noise, and temperature are all important, the most important rule about the bedroom is that it is used for sleep and intimacy only. You should not be using your bedroom for work, homework, watching television, using the computer, or engaging in your hobbies. All of these activities need to be done outside of your bedroom. You need to re-train your body that the bedroom is a relaxing and sleepy environment. Removing any clutter, work-related materials, and unnecessary items from the bedroom will help to encourage this connection for your brain.
Including calming activities in your bedtime routine, such as meditation, calming audio recordings, or gentle stretching are another great way to train your brain that it’s time to unwind and go to sleep. Listening to meditations, audiobooks, or adult fairy tales are a great way to prevent worrying or mind wandering as you’re falling asleep, as they help to give your brain something less emotionally charged to think about. Over time, your brain will begin to connect bedtime with relaxing and it will be much easier to fall asleep.
Want to learn more about what you can be doing to manage your fibromyalgia symptoms? Join my free Facebook Community: Living Well with Fibromyalgia.
Chinn S, Caldwell W, Gritsenko K. Fibromyalgia Pathogenesis and Treatment Options Update. Curr Pain Headache Rep. 2016;20(4):25. doi:10.1007/s11916-016-0556-x
Rosenfeld VW, Rutledge DN, Stern JM. Polysomnography with quantitative EEG in patients with and without fibromyalgia. J Clin Neurophysiol. 2015;32(2):164–170. doi:10.1097/WNP.0000000000000134
Roth T, Bhadra-Brown P, Pitman VW, Roehrs TA, Resnick EM. Characteristics of Disturbed Sleep in Patients With Fibromyalgia Compared With Insomnia or With Pain-Free Volunteers. Clin J Pain. 2016;32(4):302–307. doi:10.1097/AJP.0000000000000261
Fang SC, Wu YL, Chen SC, Teng HW, Tsai PS. Subjective sleep quality as a mediator in the relationship between pain severity and sustained attention performance in patients with fibromyalgia. J Sleep Res. 2019;28(6):e12843. doi:10.1111/jsr.12843
Çetin B, Güleç H, Toktaş HE, Ulutaş Ö, Yılmaz SG, İsbir T. Objective measures of sleep in fibromyalgia syndrome: Relationship to clinical, psychiatric, and immunological variables. Psychiatry Res. 2018;263:125–129. doi:10.1016/j.psychres.2018.02.057
Colten HR, Altevogt BM. Sleep Disorders and Sleep Deprivation: An Umnet Public Health Problem. Washington, DC: The National Academies Press; 2006. doi: 10.17226/11617. Accessed February 7, 2020.
Carley DW, Farabi SS. Physiology of sleep. Diabetes Spectr. 2016;29(1):5-9. doi:10.2337/diaspect.29.1.5.
Wu YL, Chang LY, Lee HC, Fang SC, Tsai PS. Sleep disturbances in fibromyalgia: A meta-analysis of case-control studies. J Psychosom Res. 2017;96:89–97. doi:10.1016/j.jpsychores.2017.03.011