Last week I had an appointment with a sleep specialist to get the results of my sleep study. I did this study back in December 2013, and it was a hellish experience. By the time they were done wiring me for the study, I looked like a modern Frankenstein, and it was as uncomfortable as it was unsightly. Before the study I only took half of my sleep aid, because I was determined to ‘prove’ that I don’t sleep well. The first horrible part was being wired to the bed and not being able to get up without the nurse coming to unplug me. Of course I had to go to the bathroom twice that night and both times when I went to get up the wires jerked my head back down! After my neck muscle spasmed, I couldn’t bear lying there in the dark hurting any longer, so I took the other half of my sleeping pill and a muscle relaxant. Unfortunately I still ended up counting down from 3000. When the technician came to wake me, I joked that I had just fallen back to sleep, and she replied “What do you mean? You’ve been asleep all night!” I almost screamed.
At least the sleep study results backed up my experience. Of the 6 1/2 hours of recording time, I slept about 4 1/2. This means that my sleep efficiency was very low, at 64.5% (total sleep time divided by total recording time). The other interesting finding was that I woke up 66 times during the night, or about 14.3 times per hour. The good news is that I don’t have sleep apnea or restless leg syndrome. I also had “abundant slow wave sleep” but minimal REM sleep – meaning that I had a lot of deep sleep, where your body repair and recovery takes place, but minimal dream sleep. Apparently this is consistent with the medications that I take.
Like a lot of other people with fibromyalgia, getting enough sleep is probably the single most important factor that determines my quality of life. In my case, I need to get about 10 to 11 hours of sleep to be able to function the next day. If I don’t, I am miserably exhausted and everything seems to go wrong (pain goes up, mood goes down and brain fog sets in). In order to get enough sleep I take a sleep aid called doxepin (brand name Silenor). It is a low dose of a tricyclic antidepressant that helps me stay asleep for the length of time that I need. Although not as effective as some other sleeping pills that I have tried, I chose this one because it is nonaddictive and I can take it for the long term. I also take my pain medications at night (pre-gabalin and long-acting tramadol) to help me fall asleep. Finally, I take melatonin and a natural anti-anxiety supplement called Relora too.
I think I am lucky to have found a cocktail that generally works. The sleep specialist recommended continuing with doxepin/Silenor. However, she had some interesting advice regarding the length of time that I sleep. She told me that if a person actually requires, say, eight hours of sleep, but they stay in bed for 10, they will not lie asleep for eight and then lie awake for two. Instead, their body will spread their sleep over 10 hours, but the quality of the sleep will be lighter and less restful. This could explain the low sleep efficiency and high rate of awakenings that I experience. She recommended that I gradually try sleep restriction as a means of improving the quality of the sleep that I get. I have to admit that this makes me very nervous, because I am such a disaster when I don’t get my 11 hours. On the other hand, I hate spending half my life in bed. I still have to look into it further but it would mean getting up a little bit earlier every day. I think even making it down to nine hours would make me feel like I have more time to enjoy my days, as long as I can still function. The other key part is to get to bed earlier because the quality of your sleep is better at night than in the morning. I have a lot of trouble getting to bed before 12. It’s ridiculous because I know that I would feel so much more productive getting up around 9 than 11. Part of my problem making myself go to bed early is that I enjoy the company of my partner in the evening and the other part is that after I take my nightly medication I get a little bit ‘high’ – very chatty, impulsive and easily distracted! I think my new top goal has to be bedtime by 11.
Finally, the sleep specialist recommended a book called No More Sleepless Nights by Dr.Hauri. I bought the book and it looks really good so far. I thought I had read everything under the sun about sleep hygiene and relaxation techniques, but I am already learning new things, and I am only on the first chapter. I think I will leave it there for now, but follow up with a post of the most relevant things I learn from this book.
Skillfully Well & Painfully Aware 
I have just had an interesting thing happen. I don’t know if this will apply to your situation, but I thought I’d share it. I recently went to a new internist. She advised me that as we know with FM, our bodies are inflamed. She said that dairy further inflames them. I went off most dairy. Wonderful things are happening. I have more energy, clearer thinking, etc. But one thing I didn’t expect is that I sleep so much better. I not only can get to sleep, but I sleep through the night. I used to wake up periodically during the night.
That’s so interesting! My naturopath had me do a food sensitivity test, which came up with gluten, eggs, beef and some veggies. I avoid these now and my digestive system is much happier. I haven’t had any problems digesting dairy, but it might be worth of waiting to see if it affects my energy and sleep!
It’s great that the specialist recommended a book instead of just more drugs! I thought about asking to try doxepin but haven’t yet and none of my doctors has suggested it. Cymbalta is their go-to suggestion and I always say no since it can cause insomnia. I’m a disaster without at least 7 hours of sleep. I hope cutting back on sleep hours works for you.
I tried cymbalta several years ago and it gave me severe insomnia. As far as anti-depressant options for sleep I think trazodone and doxepin are the best as far as effectiveness and lack of side effects. But lifestyle strategies are definitely the best option. I try to incorporate mainstream and alternative treatments.