In this blog, we will look into insomnia, sleep interruption, sleep-wake cycle and associated symptoms of chronic fatigue.
Restorative sleep has a relation to overall health and wellbeing. A normal physiological sleep restores energy in the body, helps in eliminating toxins, and rest different physiological systems. Normal human sleep has dream sleep or REM sleep (Rapid Eye Movement sleep) and non-REM sleep, which is the phase of sleep where there is no REM; it could be superficial sleep or deep sleep. Normal REM sleep and deep sleep has a relation to normal physiological restoration of organ systems like digestion, cardiovascular system, hormonal system, etc. A person who is chronically not having good restorative sleep may have symptoms of heartburn, abdominal gas, constipation, thyroid imbalance, hypertension, depression, arthralgias, etc.
Insomnia may be sleep onset insomnia or sleep maintenance insomnia or early awakening. In sleep onset insomnia, generally, the person has difficulty falling asleep (the normal time to fall asleep is less than 30 minutes), takes a longer period of time to fall asleep and feels uncomfortable falling asleep. Sleep maintenance insomnia is a condition where the person is able to fall asleep but cannot maintain the sleep throughout the night and has multiple sleep awakenings which will last for a few seconds to minutes or sometimes hours. Early awakening is where a person generally has no problem falling asleep or maintaining sleep but will wake up early and cannot fall asleep. They wake up by 2:00 am or 3:00 am and are unable to fall asleep. This leads to a sense of low-grade fatigue.
Normal physiological sleep has a relation to restoration of energy and decreased symptoms of fatigue. The patient with fibromyalgia generally has significant sleep interruption and has a lighter sleep with difficulty going into dream sleep or deep sleep. In fibromyalgia, there is significant pain and pain related arousals.
Keeping a sleep-wake cycle, sleep diary with associated events of the day may help in understanding one’s own sleep-wake cycle. The goal of sleep cycle should be sleeping between 10:00 pm and 6:00 am. The person with insomnia may need sleep restriction therapy. Meaning, if the person has difficulty falling asleep for 2 hours and cannot fall asleep until 12-midnight or 1:00 am, then one needs to go to bed at 12-midnight and keep the same wake cycle irrespective of time to fall asleep. If they generally wake up around 8:00 or 9:00 am then they should try to condense the sleep to a total of 6 hours and wake up at 6:00 am for the next few months and not to sleep at other hours. If they wake up in the middle of the night and if cannot fall asleep for more than 15 minutes then they need to be out of the bed, relax, may do some deep breathing exercises or light reading to relax, and then fall back to sleep but still wake up at 6:00 am. This is a general guideline but may vary from person-to-person. The goal is to have 90% of the sleep in the bed or higher between the time they go to bed until they wake up. Sleep restriction is a significant part of insomnia treatment. Pharmacological treatment works for a shorter period of time. For chronic insomnia, the key treatment is sleep restriction therapy, keeping the same sleep-wake cycle, sleep diary, regular exercise, high-fiber diet, good bowel movement, avoiding stimulants such as caffeine and alcohol may help. With improvement in the sleep, this may help the chronic fatigue symptoms. Patients with fibromyalgia may have more difficulty adhering to the schedule in view of significant pain, but improvement in sleep generally leads to decrease in bodily pain and fatigue.