Most people have felt it before: a bad night’s sleep; the aches and pains, and the lack of focus the next day. It’s occasional, and usually brought on by stress. For people with Fibromyalgia, though, this is a regular occurrence, a vicious cycle that is difficult to break.
Fibromyalgia, or FM, is a chronic pain condition that as of yet has no specific cause and very few effective medical treatments. A study by Bennet et al in 2007 found that 79 percent of people surveyed reported that sleep problems made FM symptoms worse. The study also found that fatigue and nonrestorative sleep were rated higher in symptom intensity than pain itself.
What if one good night’s sleep could change that?
A new study by Nancy Hamilton and Ruth Ann Atchley, associate professors of psychology at the University of Kansas is examining the effects of FM—particularly its effects on the ability to pay attention, and prioritize. The study, called Sleep Neuroscience and Pain, hopes to prove the existence of a link between a lack of ability to pay attention to positive things and the persistence of FM symptoms.
The study could have an impact on the treatment of FM, which, for now, relies primarily on over-the-counter painkillers, antidepressants, and living a healthier lifestyle, according to Patty Quinlan, the nursing supervisor at Watkins Student Health Center.
As of yet, there is no undisputed source of FM, and proving its existence has been a challenge. Doctors must first rule out any other potential causes of the symptoms, which means that individuals are subjected to a variety of medical tests. Doctors will only test for FM after all other possibilities have been ruled out, Quinlan said. In order to be diagnosed with FM, a person must have widespread aching pain for a minimum of three months, in 11 different locations. Still, though, not all doctors will consider diagnosing someone with Fibromyalgia.
“Doctors will tell you that it’s all in your head,” Atchley, Hamilton’s collaborator and cognitive neuroscientist, said. According to her, FM has been, and still is by some, considered largely psychosomatic.
The study observes three different groups of people: normal women who don’t have FM or sleep problems, women with sleep problems, and women who have been diagnosed with FM, according to Natalie Stevens, a graduate research assistant for the study.
Participants wear an Actiwatch, which monitors their movements, for five days and four nights. The data collected in the Actiwatch is used to determine when participants fall asleep and how much they move during the night. This can be used to determine sleep efficiency, the ratio of time spent in bed to time actually spent asleep. According to Atchley, a ratio 85 percent or higher is considered healthy.
This is a sample print out of the data gathered by the Actiwatch. The black spikes indicate movement; the more black spikes there are, the more the person is moving about. Image contributed by Nancy Hamilton
Participants then come in for a lab visit. Participants are hooked up to an electro encephalograph, or EEG, which measures brain activity. They are shown 4 sets of images and words. Most of them in are inanimate and neutral, but embedded in each set are certain other images: positive things, living things, negative things, and painful things. The measurements are then converted into a P3 wave, which indicates when someone is attending to something.
This is a sample of the data collected by the EEG. It is then averaged and converted to the the P3 wave below. Image contributed by Ruth Ann Atchley
The steeper the spike in the P3 wave, the more attention the person is paying to the stimulus. Image contributed by Ruth Ann Atchley
The purpose of this is to determine what the participants respond to most often. According to Atchley, when someone is deprived of sleep, she has fewer mental resources available to pay attention to. When fewer resources are available, the brain is forced to prioritize.
“You might be better able to [pay attention] to things that are sort of threatening, and be less able to pay attention to things that are less threatening, which might make you feel crummy all of the time,” Hamilton, principal investigator and clinical psychologist, said.
This is what her research with Atchley is based on. They believe that people with FM are genetically disposed to feel pain more acutely than others. This affects their ability to sleep, which in turn limits their ability to pay attention. This means that they are more inclined to pay attention to things that are negative and painful. It becomes a vicious cycle that is difficult to break.
This flowchart, first drawn by Atchley, visualizes the cycle they believe leads to fibromyalgia.
Hamilton said that the first line of inquiry in her research is whether such a link exists. If it does, then their research should show that the quality of sleep for people with FM is lower than both the control group and the people with sleep problems. This data will then be compared to the second part of the experiment, which measures what the participants are attending to.
Atchley said that they would expect to see that people with FM pay much greater attention to the negative and painful things than either of the other groups. More importantly, they would pay far less attention to the positive and living things than even the neutral ones. In short, it’s a vicious cycle.
According to Hamilton, sleep problems are actually fairly common. Approximately a third of the adult population reports occasional problems, and up to 10 percent report chronic sleep problems.
Hamilton said she believes that people with FM already have sleep trouble before ever being diagnosed with it. This is the product of a genetic predisposition to pain, but for most people, sleep problems are a product of stress.
“It’s your body’s way of saying ‘hey, things are kind of messed up right now. You may want to pay attention to [them],’” Hamilton said.
According to Hamilton, sleep problems are fairly evenly spread across gender in the U.S. Some of those conditions, however, such as sleep apnea, are more common in one gender than the other. Sleep apnea is a condition where a person stops breathing in the middle of the night, which forces him or her to wake up. While it does occur in women, it is more prominent in men possibly because of physiological differences. For example, men have bigger necks and chins, and the jaw line is different. Men also carry their weight more in the center of their chests, which puts pressure on the lungs.
Sleep apnea is also affected by weight, and so Hamilton said that the increasing rate of obesity in the U.S. could be linked to the rising prevalence of sleep disorders. Fibromyalgia is more prevalent among women, almost eight times more so than in men. Onset of FM frequently coincides with menopause. One of the complaints of menopause is that sleep becomes harder; weight gain is also common. Hysterectomies are also common among women with FM.
There is hope, though. According to Hamilton, many sleep disorders can be successfully treated. If sleep problems are what causes Fibromyalgia, then treating them could in turn reduce the symptoms of FM.