Fibromyalgia and sleeping all day

Here’s The Latest On How To Tackle Fibromyalgia Sleep Problems

I treat a number of patients with fibromyalgia syndrome. They often come to me with chronic insomnia, and difficulty staying asleep throughout the night. Even when they do manage to get a decent night of sleep, my patients with fibromyalgia tell me they still feel exhausted and worn out the next day.

The fatigue that comes with fibromyalgia affects their work lives, their social lives, and their relationships, and compromises their quality of life. So often, I hear these patients talk about needing to cut back on activities and commitments they want to pursue, because they’re tired and in pain.

I thought of these patients recently, as new research has been released with some promising news about how to treat fibromyalgia and its sleep problems. Two recently published studies show that a couple of sleep therapies I’m particularly interested in—mindfulness meditation and Vitamin D—may have particular effectiveness in helping people with fibromyalgia improve their sleep, as well as reducing the severity of other fibromyalgia symptoms.

Fibromyalgia basics

Before we dive into the latest news on sleep treatments, let’s take a quick walk through the fundamentals of fibromyalgia.

Many of us probably know someone with this condition, which affects somewhere between 2-6 percent of the population, according to estimates. Women are significantly more likely than men to develop fibromyalgia, often during early adulthood or middle age. But this condition can occur in anyone, at any age—including during childhood.

The most prominent symptom of fibromyalgia is physical pain that’s often chronic and also comes in heightened waves, sometimes called flares. These flares can last for a few days or as long as several weeks. The pain associated with fibromyalgia can be localized at specific tender points and can also be widespread throughout the body.

But pain isn’t the only symptom of fibromyalgia. Other common symptoms include:

  • Headaches
  • Cognitive problems, including trouble with memory and clarity of thinking
  • Depression, anxiety
  • Mood swings, including feelings of anger and irritability
  • Fatigue, which sometimes is severe and debilitating
  • Low tolerance for exercise
  • Tingling or numbness in hands and feet
  • Irritable bowel syndrome

Sleep problems, including insomnia, restless, poor quality and unrefreshing sleep, all commonly occur among people with fibromyalgia.

Many people think of fibromyalgia as an autoimmune disorder. It’s actually not. The confusion likely comes from the similarities of fibromyalgia symptoms with several autoimmune disorders, including rheumatoid arthritis and thyroid disorders.

What causes fibromyalgia?

We don’t know for sure. Many scientists think heightened activity of the central nervous system is involved, particularly related to how the brain processes information about pain and pain perception. There often appears to be a stress-related trigger that launches the condition. That stress may be physical, such as an injury, an infection, or the onset of another condition, such as arthritis. The stress can also be emotional, whether an acute response to an event, or the cumulative effect of chronic stress and overwhelm. There appears also to be a genetic component to fibromyalgia that makes people more vulnerable to developing the syndrome.

Without a diagnostic test, physicians diagnose fibromyalgia based on a person’s symptoms, while at the same time ruling out other conditions with similar symptoms and characteristics, including hypothyroidism, rheumatoid arthritis, and lupus.

Sleep problems are a key component of fibromyalgia

It wasn’t always the case, but today, sleep problems are recognized as central characteristics of fibromyalgia. The presence of disrupted sleep and insomnia, as well as lack of restorative sleep and daytime fatigue are used as markers to diagnose the disorder, alongside physical pain, issues with mood, and cognitive symptoms.

Nearly all people with fibromyalgia experience some form of sleep problem. Their poor sleep contributes to a whole range of challenges with mental and physical health and daily functioning, including its ability to exacerbate other fibromyalgia symptoms. One study found that 99 percent of fibromyalgia patients suffered poor sleep quality that influenced how severely they experienced physical pain, fatigue, and difficulty with social functioning.

In addition to restless, unrefreshing sleep and insomnia, people with fibromyalgia are more likely to suffer other sleep disorders. Recent research found obstructive sleep apnea present in one half of a group of fibromyalgia patients. Restless leg syndrome also appears to occur at higher rates in people with fibromyalgia. One recent study found RLS occurring in more than 42 percent of fibromyalgia patients. (Recent estimates suggest restless leg syndrome occurs in somewhere between 4-29 percent of the general population.)

These are serious, sometimes debilitating sleep disorders that also carry their own risks to health and our ability to function at our best. The relationship between fibromyalgia and sleep disorders is an important area of research that needs additional attention.

Fibromyalgia’s cycle of pain and poor sleep

Pain and sleep problems frequently co-exist in a difficult cycle that can be tough to break. That’s true for everyone who experiences physical pain and discomfort. It’s particularly true for people with fibromyalgia, as well as others with conditions that involve chronic pain.

When it comes to chronic pain conditions and sleep, pinpointing cause and effect can be difficult. It’s a chicken and egg cycle—which comes first and leads to the other? But there are scientific clues emerging that sleep may play a role in the onset of fibromyalgia. A 2014 study from the United Kingdom found that non-restorative sleep—the kind where you wake feeling tired and worn out after a night’s rest—was linked to the development of widespread pain in adults over age 50. And a 2011 study by Norwegian scientists found the risk of developing fibromyalgia was higher in women who experienced sleep problems—and the more severe the women’s sleep troubles, the higher their fibromyalgia risk.

Here’s some of what else we know about the tangled relationship between fibromyalgia and sleep:

Poor sleep lowers pain thresholds, making us more sensitive to pain. For people with fibromyalgia, whose pain signaling may already be overactive, this additional sensitivity can further escalate an already painful problem.

Insufficient, unrefreshing sleep undermines our coping skills, emotional balance and emotional resilience. These skills are both critical for and challenged in people with fibromyalgia, who face psychological as well as physical distress and pain.

People with fibromyalgia spend less time in deep, slow-wave sleep. Their heightened brain activity appears to keep them in lighter stages of sleep, where they may wake twice as often as people who don’t have the condition. Deep, non-REM sleep is essential for the brain and body to repair and refresh at a cellular level. This lack of restorative deep sleep can help to explain the fatigue, physical pain, and “brain fog” that so many people with fibromyalgia experience.

Exercise is considered one of the most important therapies for managing fibromyalgia. It’s also among the very best habits for sleep. Lack of high-quality sleep makes us less likely to engage in regular exercise. Their sleep deprivation can aggravate fatigue and an already low tolerance for exercise, keeping people with fibromyalgia from taking advantage of the benefits of exercise in improving their condition and quality of life.

Ready for some encouraging news about how we can address sleep problems that occur with fibromyalgia syndrome? Two brand-new studies point in some promising directions.

Vitamin D may help boost sleep quality in people with fibromyalgia

You’ve heard me talk about the science that’s emerging about the importance of Vitamin D for sleep. Our levels of Vitamin D appear to affect both the quality and the quantity of sleep. When we’re low on Vitamin D (and many of us are, without knowing it) we’re more likely to sleep poorly and sleep less overall.

New research suggests that Vitamin D can help improve sleep in people with fibromyalgia. The study investigated the effects of Vitamin D used in combination with a low-dose antidepressant to treat fibromyalgia symptoms, in people who are deficient in Vitamin D.

The study participants were divided into two groups. For a period of 8 weeks one group was given a low dose of the anti-depressant trazodone and Vitamin D, and the other group was given trazodone and a placebo.

Scientists evaluated the effects on a range of fibromyalgia symptoms, including physical pain, mood, and sleep. Both groups experienced improvements to their symptoms. But the group that combined anti-depressant medication with Vitamin D saw more significant improvements, including:

  • Less morning tiredness
  • Less pain and stiffness
  • Decreased anxiety and depression
  • Better sleep quality
  • Less daytime fatigue

The possible link between Vitamin D deficiency and fibromyalgia has been of interest to scientists for several years, and studies have returned mixed results. Among its important roles in the body, Vitamin D helps to regulate the musculoskeletal system and help control inflammation. Vitamin D deficiency has been linked to joint pain, muscular hypersensitivity, to chronic pain. Those are hallmark symptoms of fibromyalgia.

A 2017 analysis of a dozen studies that examined the possible association between fibromyalgia and Vitamin D showed that:

  • A majority of those studies found people with fibromyalgia had lower Vitamin D levels than healthy individuals in control groups
  • Several studies found significant correlations between a lack of Vitamin D and higher pain intensity in people with fibromyalgia.

This study appears to be among a handful of its kind (a randomized, controlled trial) to investigate the effects of Vitamin D on fibromyalgia. But other research has shown benefits for fibromyalgia from Vitamin D. A 2014 study found women with fibromyalgia who were deficient in the vitamin experienced less chronic pain and less morning fatigue when they took supplemental Vitamin D.

There’s still a lot we need to learn about the role Vitamin D deficiency may play in fibromyalgia, and how the vitamin may be useful as a therapy. With as many as 50 percent of Americans deficient in Vitamin D, we all need to be more cognizant of our risk for deficiency. If you have fibromyalgia, talk with your healthcare provider about your Vitamin D levels, and whether adding a Vitamin D supplement makes sense for your individual needs.

Mindfulness mediation can soothe fibromyalgia-related sleep problems

A new study by sleep scientists in Spain shows mindfulness meditation (also called “flow” meditation) can improve disrupted, poor quality sleep in people with fibromyalgia.

This study focused specifically on the effects of mindfulness training for women. (Women make up 70-90 percent of people with fibromyalgia.)

A total of 39 women were randomly assigned to one of two groups. One group received 7 weeks of mindfulness therapy and training, including mindfulness meditation and guided body scans. The other group was put on a waiting list and served as a control group.

Scientists found women who underwent mindfulness training experienced significant improvement to their sleep compared to women on the waiting list. Mindfulness meditation reduced insomnia and improved sleep quality.

This isn’t the first study to show improvements for fibromyalgia from mindfulness therapy. A series of studies in the past few years have shown benefits of mindfulness exercises in treating fibromyalgia, including:

  • Reducing depression, anxiety, and feelings of anger
  • Reducing pain
  • Increasing quality of life and social functioning

Other studies have shown mindfulness has specific benefits for sleep in people with fibromyalgia. Studies point to mindfulness therapy’s ability to reduce sleep disturbance and lessen fatigue in fibromyalgia patients. That’s consistent with a strong and growing body of research that shows mindfulness is a highly effective therapy in improving sleep quality and sleep efficiency, helping us sleep more soundly and with fewer interruptions.

Particularly good news here? The latest study out of Spain, as well as several earlier studies, show the benefits of mindfulness therapy is lasting, with benefits continuing for at least 3 months.

I’m a big fan of mindfulness meditation and other mind-body exercises and therapies as natural, low-cost, easy to use methods for improving sleep. I’ve seen countless times in my patients what a difference mindfulness treatments can have over sleep itself, and our attitudes about sleep. I also know firsthand that mindfulness meditation is easy to learn and to integrate into a daily (and nightly routine). I use it myself, every day, and it makes a big difference in my outlook, my focus, and my ability to relax and sleep at the end of a long day.

Sweet Dreams,

Michael J. Breus, PhD, DABSM

The Sleep Doctor™

Fibromyalgia, an example of a central pain syndrome, is a chronic health condition characterized by symptoms like widespread muscle pain, fatigue, memory problems and mood changes. Many people with fibromyalgia complain that sleep – or lack thereof – is one of the most frustrating challenges of living with fibromyalgia.

Sleep Problems with Fibromyalgia

Sleep problems are common among people with fibromyalgia. It is unclear whether lack of restorative sleep makes fibromyalgia symptoms worse or if pain from fibromyalgia makes it difficult to attain a good night’s sleep.

“We know that pain makes sleep quality worse,” says Daniel Clauw, MD, professor of anesthesiology, rheumatology and psychiatry at the University of Michigan in Ann Arbor. “But we also know that lack of sleep makes pain and other symptoms worse. They’re not independent of each other.”

Sleep issues in people with fibromyalgia often can send patients into a never-ending cycle of pain versus sleep.

“When I see patients with fibromyalgia who are also facing sleep issues, they’re often in a downward spiral,” Dr. Clauw says. “They’re in pain, which keeps them from getting good sleep, which leads to more pain. It just goes downhill from there.”

Unfortunately, a person who sleeps long hours can still wake up feeling unrefreshed. That’s because it’s not the amount of sleep that matters, but rather the kind of sleep. According to Dr. Clauw, many people with fibromyalgia do not achieve deep, slow wave sleep, also known as delta sleep. During slow wave sleep, the body fully relaxes, allowing tissue, muscles and energy to be restored. Without deep sleep, it is virtually impossible to wake up feeling refreshed.

How to Improve Sleep With Fibromyalgia

Before heading to your medicine cabinet, consider the habits you can adopt – or break – to improve your sleep quality.

“First, I recommend non-drug therapies and improvements to sleep hygiene,” Dr. Clauw says.

Sleep hygiene means doing things to make it easier for you to go to sleep and stay asleep. Dr. Clauw recommends:

  • Only get in bed when you’re tired. If you haven’t fallen asleep after 15 minutes, go into another room and pursue a quiet activity until you’re sleepy.
  • Use your bed for sleep. Avoid working, watching TV, eating, reading or checking your phone once you’re in bed.
  • Don’t engage in stimulating activities right before bedtime. Avoid intense movies, books or projects that might make your mind restless before bedtime.
  • Keep a schedule. Do your best to wake up and go to bed at the same time each day, even on weekends. Give your body about six weeks to get used to your new routine.
  • While it is ok to have a small snack before bedtime, avoid having a heavy meal or a lot of liquid.
  • Avoid caffeine at least four to six hours before bedtime. Caffeine can sneak into desserts, medications and tea, so be aware of what you’re putting in your body.
  • Resist alcohol. While alcohol can help you sleep initially, it also contributes to frequent waking and increased trips to the bathroom.

“People drink caffeine in the morning and throughout the day to stay awake,” Dr. Clauw says. “But then they need something to help them relax, so they drink alcohol, which can be disruptive to sleep in the long run.”

While it may sound counterintuitive, especially when afternoon fatigue sets in, Dr. Clauw strongly cautions against napping during the day for people with fibromyalgia because it disrupts the body’s normal sleep patterns.

“The single most important thing is not to nap,” Dr. Clauw says. “Napping during the day virtually ensures a bad night’s sleep.”

If calming down after a busy day is your challenge, try relaxation techniques such as deep-breathing exercises or guided imagery. Take a warm lavender-scented bath to ease your mind and body. Make your room a calm, quiet place of rest and relaxation by adjusting the noise level, temperature and decor.

If improving your sleep hygiene isn’t effective after a few months, consider talking to your doctor about sleep medications, understanding that they may not offer the type of relief you need.

“There are medications that will definitely help you sleep,” Dr. Clauw says. “The issue is that they might help you sleep longer, but they won’t necessarily achieve that deep restorative sleep that you really need.”

Related Resources:

  • Learn more about Fibromyalgia
  • Sleep Tips for Arthritis (Slideshow)

I’m no stranger to insomnia. It has been part of my life since childhood — as has fibromyalgia. Despite applying the knowledge I’ve accumulated about improving sleep andsleep hygiene, I still have occasional nights when I’m staring at the clock at 3 a.m. In an attempt to avoid as many of these nights as possible, I follow the guidelines suggested by the National Sleep Foundation:

  • Limit daytime naps to 30 minutes. A 30-minute nap is a challenge for me. My napping needs are unpredictable. Some days, after only four hours of sleep, I may not need a nap at all. Other days, after sleeping my optimum nine hours, my eyelids droop before I get through lunch. Typically, I can make it until 4 p.m. without a problem. The type and amount of activity I’ve done that day determines if and how long I nap. I must confess, it’s rarely less than an hour.
  • Avoid stimulants such as caffeine and alcohol close to bedtime. My sensitive body doesn’t do well with caffeine at any time of day. Other than an occasional cup of regular tea, I stick to decaf Subscribe or log in to access all post and page content.

Natural Energy Boosters To Fight Fatigue

Natural Energy Boosters to Fight Fatigue

Fatigue is a common condition among adults. Sleep disorders are one of the major health issues that experts focus on because of how vital sleep is to our health—and because of how easy it is to neglect.

Fatigue happens for several reasons, but for many people, it’s the result of not getting enough regular and consistent sleep. Research has linked poor sleep quality with chronic illnesses such as diabetes and heart disease and even shortened life expectancy. Fatigue also has its share of immediate risks, including impaired driving and other safety concerns. Productivity and focus at work can also dwindle due to a lack of rest.

If you find yourself fatigued most mornings, as 38% of adult Americans reportedly do, then it’s essential to look at your lifestyle habits, including your sleep, exercise and the types of food you eat that contribute to chronic fatigue. Instead of automatically reaching for another cup of coffee for a quick fix, try building healthier habits that help you get natural energy and maintain endurance.

Here are eight of the top natural energy boosters for fighting fatigue. These tips will help you address some of the possible underlying causes playing a role in your lack of energy.

1. Eat the Right Foods

Eating natural energy foods is foundational not just to your energy levels but to your overall health. Food and nutrition are also vital to disease-prevention and longevity. Natural energy foods keep our various systems operating at their optimal levels for proper health. However, eating too much of the wrong foods can lead to nutrient deficiencies and conditions that affect metabolism and cause chronic fatigue.

To help sustain energy, it’s important to avoid high-glycemic foods that cause a blood sugar spike, resulting in the inevitable crash. Natural energy foods are high in protein and fat content and are low on the glycemic index, meaning their sugars are absorbed by the body slowly and provide a longer-lasting energy source.

2. Take Energy Supplements As Needed

Certain nutritional deficiencies cause sluggishness and an inability to focus. If you aren’t getting enough nutrients from your regular diet, you can take natural energy supplements to help compensate and ensure you’re getting enough nutrition.

A common supplement taken to help boost energy and mental clarity is B complex—a group of eight B vitamins. Known as the “energy vitamins”, B vitamins are vital for converting food into usable energy. Nutrition from B vitamins ensures the proper functioning of several body systems, including the circulatory and nervous systems. B vitamins can only be obtained through food sources such as meat, fish and eggs or by taking natural energy supplements.

Other supplements that may boost energy levels include iron, zinc and magnesium. Though dietary supplements aren’t a substitute for food-based nutrition, they can be beneficial for people who notice a difference in their energy levels when taking them.

3. Exercise Daily

Many people don’t exercise as intensely or as often as they should because they get exhausted from working out. But physical activity is critical for keeping up energy levels as exercise gives you endorphins. Working out also boosts circulation and improves cardiovascular health. Active bodies also tend to sleep more soundly as exercise is an excellent stress-management tool and mood elevator.

For mostly sedentary people, getting up every 30 minutes to stretch, walk or perform light exercises can also help reactivate the body and boost blood flow. The more you exercise regularly, the more your energy levels will improve. You will begin to notice that with consistent, moderate exercise, you will better maintain your endurance throughout the day.

4. Go Outside

Fresh air can do wonders for the mind, body and soul. Research has shown that increased outdoor activity improves concentration and creativity levels. Additionally, being in nature and sunlight has benefits for improved memory and elevated mood, making you less likely to feel the effects of fatigue.

If you’re suffering from an energy drop, spending even five minutes outdoors can help stimulate your circulation and give you the jolt of energy you need to regain focus. Heading outdoors as soon as you feel a wave of fatigue coming on can help reinvigorate your body and wake up your mind.

5. Stay Hydrated

If you start to feel tired around the same time each day, it could be due to dehydration—one of the most overlooked causes of fatigue and headaches. Because our bodies are mainly comprised of water, dehydration can affect metabolism, leading to that sluggish feeling. As soon as you feel an afternoon slump coming on, choose water instead of coffee and see how your energy improves.

Experts suggest that your body weight divided in half corresponds to the number of ounces of water you should drink per day. Remember that if you exercise often, you also require electrolyte replenishment—these are essential minerals like sodium, potassium and calcium. Drinking coconut water provides a great source of electrolytes and can help you stay energized.

6. Use Aromatherapy

Aromatherapy is the use of essential oil extracts to create a pleasant and therapeutic aroma for stress-management and healing. Essential oils like peppermint, orange and cinnamon are refreshing to the senses, helping to wake you up and make you feel more alert and energized.

You can use aromatherapy as a natural energy booster by adding a few drops of your favorite energy-boosting essential oil or oil blend to a diffuser. Or you can rub essential oils on your wrists or neck and breathe in the stimulating scent.

7. Reduce Stress

Stress can have detrimental effects on the body, including chronic pain and fatigue. Chronic stress means that your body is often in fight-or-flight mode, which releases stress hormones like cortisol and adrenaline. Being under a lot of pressure can lead to burnout and a lack of motivation, which often results in feeling tired for no obvious reason.

Additionally, people who are overworked and overstressed don’t usually make time for healthy habits, such as diet, exercise and sleep that are required to keep your body operating at peak performance. If you’re feeling exhausted, it’s important to look at the load you’re carrying and lighten it however you can.

8. Improve Sleep Quality

Finally, and arguably most importantly, if you’re feeling fatigued each morning and throughout the day, it’s important to look at your sleep habits. In many cases, poor sleep quality is what’s contributing to chronic fatigue and exhaustion. Going to bed at different times each night, getting less than 7 hours of sleep and tossing and turning throughout the night are contributors to poor sleep hygiene.

To improve sleep quality and get natural energy, it’s essential to cultivate better sleep habits. By following a consistent bedtime routine, getting enough hours of sleep and improving your sleep comfort, you can get a deeper sleep and wake up feeling refreshed and energized. There is no better natural energy booster than proper sleep. With better sleep comes greater endurance and higher energy levels that you can sustain.

Rest Better With Sleep Solutions From Relax The Back

These natural energy boosters are also long-term solutions for improved overall health. The more care and attention you give your body, the more you will feel energized. Of course, if you suspect you have an underlying medical condition related to chronic fatigue, then it’s important to discuss your concerns with a physician.

Being diligent about your sleep habits is a long-term solution for fighting fatigue and maintaining total body wellness. Relax The Back can help you build the perfect sleep solution. From mattresses to pillows to adjustable bases, we can help you achieve the highest level of comfort designed to support your body. To help improve the quality of your sleep, browse through Relax The Back’s selection of sleep support and wellness products for a better night’s rest.

5 ways to help with fatigue

To those familiar with fatigue, the idea that it’s simply ‘feeling a bit tired’ is something of an understatement. The extreme exhaustion that characterises fatigue is particularly common in rheumatoid arthritis and is thought to be partly caused by the chemicals that are released most intensely by the body when the condition is in the inflammation stage. This is known as a flare-up and can cause flu-like symptoms – one of which is fatigue.

“Fatigue is a feeling of overwhelming tiredness, lack of energy and weakness,” says rheumatologist Dr Sarah Rae, of BMI The Manor Hospital.

“It impacts hugely on the person living with arthritis, affecting all aspects of their lifestyle, from family and friends to jobs and careers. That said, it can be managed – the trick is to achieve and build on small victories. These can be more successful and sustainable if you make good lifestyle choices, such as eating well and staying as physically active as you can.”

Your fatigue could be better managed by taking these five easy steps.

1. Get tested for other conditions

Anaemia is often found alongside arthritis and is a common cause of fatigue. Anaemia can be caused by lack of iron in your diet, and this means your red blood cells can’t carry enough oxygen to the parts of your body that need it.

“GPs are generally very good at diagnosing and treating anaemia,” says Dr Rae.

“However, thyroid disease remains a major concern, because it can masquerade as so many other conditions. Dry skin and thinning hair are common symptoms, alongside the fatigue and aching joints that people put down to arthritis. Your rheumatologist or GP should offer tests to check your thyroid function.”

If thyroid disease is diagnosed, it’s reasonably easy to manage with the right medication.

2. Check for vitamin deficiencies

“Vitamin D deficiency affects most of the population. If you haven’t topped up your levels during the summer because of work or fatigue making you stay inside, you may be lacking come winter,” says Dr Rae.

“This can lead to weakness of muscles, low mood and lethargy – all typical symptoms of fatigue. Vitamin D levels are often low in forms of inflammatory arthritis, such as fibromyalgia, rheumatoid arthritis and lupus.

I recommend using a vitamin D spray under the tongue each morning – this gets straight into the blood stream.”

B-group vitamins and folate are essential for good energy levels and optimal nerve function, which are both important in fighting fatigue. Folic acid also seems to reduce the chance of heart attacks and strokes. Vitamin K is vital for bone health, which can improve muscle function and fitness.

3. Eat a healthy diet

While it’s tempting to tuck into comfort foods, your mind and body will thank you for giving the creamy pasta dishes a miss.

“A low-carb diet rich in plant-based foods, such as nuts, olives, beans, fermented products and green leafy vegetables, boosts gut health and strengthens immunity,” explains Dr Rae. “This is because a more diverse microbiome improves the gut barrier and prevents ‘leaky gut syndrome’.”

This isn’t a recognised condition, but some professionals claim it is the cause of many long-term conditions, including chronic fatigue syndrome.

Health Supporters claim that many symptoms and conditions are caused by the immune system reacting to germs or other substances absorbed into the bloodstream through a leaky bowel. “It’s estimated that we need 30 different plant-based foods per week, so challenge yourself to see how many you can eat over seven days,” says Dr Rae.

4. Practice good sleep hygiene

It’s ironic that those with fatigue often find their sleep is disturbed and unsatisfying. “Sleep hygiene techniques can be very helpful,” says Dr Rae.

“Simple things such as establishing consistent times for going to bed and getting up, and sleep rituals such as screen shutdown followed by slow, deep breathing and stretching, can help.

“Japanese researchers found that a routine of holding and releasing tension throughout the body in a systematic way is effective in preparing the body for sleep. Start by stretching the hands for the count of several deep breaths and then gradually relaxing them. Next, clench a fist and release. Progress slowly down the body, extending out the spine while clenching and releasing the glute muscles in the bottom.

Finally, stretch out the legs, releasing the knees and tensing and stretching the toes, each time releasing the tension over the course of four or five deep breaths.”

5. Use the four Ps

These ‘Ps’ are problem-solving, planning, prioritising and pacing. Use problem-solving to pinpoint activities that cause you to become most fatigued. This means you can plan your day around them, and rest before and after. That allows you to prioritise and save your energy for the things you enjoy, and activities you’ll be able to sustain for longer if you pace yourself.

This article is from our Spring edition of Inspire magazine. Read it in full here.

10 Ways to Fight MS Fatigue

The majority of people living with multiple sclerosis (MS) — a chronic autoimmune disease affecting the central nervous system — say that fatigue is their most prominent symptom, according to the National Multiple Sclerosis Society (NMSS).

“Other MS symptoms may come and go, but fatigue seems to be a constant, no matter what stage of MS they’re in,” says neurologist Jeffrey Cohen, MD, director of the Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research in Ohio.

For many people living with MS, however, the word “fatigue” doesn’t quite capture the feeling of being completely depleted.

“I’ve always wished there was another to term to describe MS ‘fatigue,’” says Michael Wentink, a 42-year-old writer with MS who lives in San Antonio, Texas, with his wife and two children. “When people hear fatigue as a symptom of MS, they often think, ‘Oh, sure, I’m tired, too,’ but it’s not at all the same feeling,” he says.

“I remember what it was like to feel tired or fatigued before I had MS, and this is totally different,” says Wentink.

The kind of fatigue that comes with MS isn’t the kind that comes from exertion, Wentink explains. “I can wake up from a night of sleep and feel fatigued. After my shower and shaving, sometimes I literally need to go lie down on the bed for a little bit afterward to recover.”

What Causes MS Fatigue?

“There are many reasons someone with MS experiences fatigue,” Dr. Cohen says. “Some are directly related to MS, and some are not.”

Some of the types of fatigue that may affect people with MS are:

  • Indirect Fatigue Stress, trouble sleeping due to muscle spasms, side effects from medication, and depression that may go along with a chronic illness like MS can all cause fatigue. “Doctors should also rule out unrelated causes of fatigue, such as anemia or thyroid disease,” Cohen says.
  • Neurologic Fatigue “MS symptoms, like tremors, muscle weakness, and muscle spasms, use up a lot of energy and can lead to fatigue,” Cohen says. “Damage that has been sustained over time along nerve pathways can be aggravated by stress, activity, fever, and heat exposure. All of these factors contribute to MS fatigue.”
  • Autoimmune Fatigue “Persistent tiredness, or lassitude, is common in many autoimmune diseases and is probably the most common type of MS fatigue,” Cohen says. “It is very similar to the type of fatigue experienced in chronic fatigue syndrome.”

How to Reduce Your MS Fatigue

Is there anything you can do to reduce your fatigue? Experts say yes. Here are some tips for preserving your energy so you can get the most out of each day:

1. Work Closely With Your MS Healthcare Providers

Make and keep regular appointments with your doctor to assess whether your disease is under the best control possible.

“In many cases, when MS is well-controlled, it can help in terms of fatigue levels,” says Devon Conway, MD, a neurologist at Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research in Ohio.

2. Avoid Heat Exposure

Getting overheated is a surefire way to increase fatigue, so staying cool is a must. To survive summers in Texas, Wentink does plenty of advance planning.

“When it gets really hot, I know that if I’m going to do an activity, it has to be before the sun rises or after the sun sets,” he says. “If I’m going to one of my kids’ sporting events, I make sure I bring plenty of water.” Seeking out shade and wearing an ice pack around his neck also help Wentink from getting overheated.

3. Take Good Care of Your Overall Health

Maintaining a healthy weight and optimal blood pressure and cholesterol levels, and avoiding diabetes can all help with MS fatigue, says Dr. Conway.

“A healthy diet and a regular exercise program can really help,” says Cohen. “If you are physically out of shape and overweight, everything you do requires more energy.”

4. Practice Mindful Movement, Such as Yoga or Tai Chi

Forms of exercise that include some form of meditation and mind-body connection, such as tai chi and yoga, may be helpful for MS fatigue, according to a review published in January 2014 in BMC Neurology.

“Yoga can be beneficial, as it incorporates mindfulness, stretching, and low-impact exercise,” says Conway. “There haven’t been a lot of studies about this, but in my personal experience, it can help,” he says.

5. Take Breaks and Pace Yourself

Pacing yourself and taking breaks during the day can help you stay healthy, says Wentink. “When I’m drained and continue to push, I think I’m putting myself at risk for getting sick,” he says. “When I feel fatigued, I take it as a sign that I need to step back and take a break.”

Symptoms tend to get worse when severe fatigue sets in, says Wentink. “I try to slow down before that happens because I don’t want to bring on a relapse,” he adds.

6. Get Plenty of Sleep

Practice good sleep hygiene, which includes going to bed and getting up at around the same time every day, suggests Conway. “If you sleep a lot but you still feel fatigued, you should be screened for a potential sleeping disorder,” he says.

7. Discuss Energy-Boosting Medication With Your Doctor

Provigil (modafanil) is a wakefulness-promoting medication that works for some people with MS. The antiviral medication Symmetrel (amantadine) can also be helpful. Ampyra (dalfampridine) is a drug approved to help with walking in people with MS.

“Ampyra improves nerve conduction and seems to improve MS fatigue,” Cohen says.

8. Get Help for Depression

If you are feeling down and hopeless, or if things that used to be enjoyable don’t interest you anymore, you may be depressed. Depression is one of the most common symptoms of MS, and left untreated, it can make your fatigue worse.

Depression is treatable, so if you think you might be depressed, tell your healthcare provider right away.

9. Engage in Regular Physical Activity

“I encourage exercise for my patients,” says Conway. “In my experience, it can make fatigue worse at first, but if a person can get over the initial hump, it can actually improve fatigue,” he says.

If you’re not sure how to get started with exercise or need some help identifying exercises that will improve your fitness without wearing you out, trying working with a physical therapist or a personal trainer who is knowledgeable about MS.

10. Simplify Your Life

“I have to resist being overcommitted, especially during the holidays,” says Wentink. Even though the chaos can be “beautiful chaos” with friends and loved ones, it can still cause health issues, he says. “I’ve experienced relapses in January or February, and I believe it’s because I pushed myself too hard during the holidays,” says Wentink.

Simplifying and choosing commitments carefully helps preserve energy, he says. “I feel at peace letting some things go to improve my quality of life in the long term,” he says. “I’m hoping that my overall state of health 20 or 30 years down the road will be better because of how I’m managing my life now.”

Additional reporting by Becky Upham.

Fibro Fatigue: Why It Happens and How to Manage It

7. Consider alternative therapies

There’s not a lot of evidence regarding complementary and alternative medicines (CAMs) for fibro fatigue.

Massage therapy has been shown to provide some benefits. Results from one study of 50 women with fibromyalgia suggested that a specific type of massage, known as manual lymph drainage therapy (MLDT), may be more effective than regular massage for reducing morning tiredness and anxiety.

More research is needed, however.

If you’re interested in trying MLDT, search for massage therapists in your area who are experienced in this type of massage therapy for fibromyalgia. You can also try some lymphatic drainage massage techniques yourself at home using this guide.

Balneotherapy, or bathing in mineral-rich waters, has also been shown to help people with fibromyalgia in at least one older study. Participants in the study who spent 10 days at a Dead Sea spa had a reduction in:

  • pain
  • fatigue
  • stiffness
  • anxiety
  • headaches
  • sleep problems

Acupuncture is also often touted as a way to reduce pain, stiffness, and stress. However, a review of several studies in 2010 found no evidence for reduction of pain, fatigue, and sleep disturbances in people with fibromyalgia receiving acupuncture treatment.

8. Nutritional supplements

There isn’t much research to show whether supplements work well for treating the symptoms of fibromyalgia.

While many natural supplements haven’t been shown to offer any help, a few supplements have shown promising results:


A small older pilot study showed that 3 milligrams (mg) of melatonin taken at bedtime significantly improved sleep and pain severity in people with fibromyalgia after four weeks.

The study was small, with only 21 participants. More, newer research is needed, but the early results were promising.

Co-enzyme Q10 (CoQ10)

A double-blind, placebo-controlled clinical trial found that taking 300 mg a day of CoQ10 significantly reduced pain, fatigue, morning tiredness, and tender points in 20 people with fibromyalgia after 40 days.

This was a small study. More research is needed.

Acetyl L-carnitine (LAC)

In a study from 2007, 102 people with fibromyalgia who took acetyl L-carnitine (LAC) experienced significant improvements in tender points, pain scores, depression symptoms, and musculoskeletal pain.

In the study, participants took 2,500 mg LAC capsules a day, plus one intramuscular injection of 500 mg LAC for 2 weeks, followed by three 500 mg capsules per day for eight weeks.

More research is needed, but early results were promising.

Magnesium citrate

Researchers who conducted a 2013 study observed that 300 mg a day of magnesium citrate significantly reduced pain, tenderness, and depression scores in premenopausal women with fibromyalgia after eight weeks.

The study was relatively small, and included 60 participants.

While magnesium citrate was shown to offer relief, participants who also received 10 mg a day of the antidepressant medication amitriptyline saw increased reduction of symptoms, too.

9. Schedule in your rest time

A good way to manage fatigue caused by fibromyalgia is to schedule rest into your day. A quick nap or just lying down at some point could be what you need.

Try to plan your most rigorous tasks for times when you think you’ll have the most energy.

Fighting Fatigue

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By Bruce Campbell

(Note: From the series Treating ME/CFS and Fibromyalgia.)
Fatigue is the central symptom in ME/CFS and a significant problem for most people with fibromyalgia. The term ‘fatigue’ may be a misleading way to refer to refer to the physical and mental exhaustion experienced by people with the two conditions.
Manifesting as listlessness, sleepiness and a reduced tolerance for exercise, fatigue can be brought on by low levels of activity or for no apparent reason. Fatigue is often much greater than and lasts far longer than it would in a healthy person (“post-exertional malaise”).
For people with ME/CFS and/or FM, fatigue can have many causes. One is the conditions themselves, which leave people with less energy for daily activities. Other causes include:

Overexertion Being too active, living “outside energy envelope”
Pain Ongoing pain produces muscle tension, which is tiring
Poor Sleep Feel tired if sleep is not restorative
Deconditioning Lower activity level makes activity more tiring
Stress/Emotions Stress leads to muscle tension. Depression produces listlessness.
Poor Nutrition Lack energty if don’t eat well or have poor digestion
Medications Drugs can cause fatigue as a side effect

You can address fatigue by matching the strategies below to the causes you experience.

  • Pacing
  • Treating pain and poor sleep
  • Exercise
  • Reducing stress
  • Addressing depression and other emotions
  • Improving nutrition
  • Considering medication changes


Probably the single most important key to controlling fatigue and other symptoms of ME/CFS and FM is to adjust activity level to fit the limits imposed by the two conditions. We call this “living within the energy envelope” or pacing. Rather than fighting the body with repeated cycles of push and crash, you seek to understand your body’s new requirements and to live within them.
Living successfully with ME/CFS or fibromyalgia requires many practical adaptations: developing through trial and error a detailed understanding of your new limits, and then gradually adjusting your daily habits and routines to honor those limits. Each person’s limits will be different, depending mainly on the severity of their illness.
Other artilces on this site explain how to define your envelope and describe many practical strategies for living within it, such as scheduled rest breaks, short activity periods, switching between high and low intensity tasks and using a schedule. (See the Pacing archive.)
Pacing also includes mental adaptation: accepting that life has changed. Acceptance is not resignation, but rather an acknowledgment of the need to live a different kind of life. This acknowledgment requires you to develop a new relationship to your body.
In the words of one person in our program, “Getting well requires a shift from trying to override your body’s signals to paying attention when your body tells you to stop or slow down.”

Treating Pain and Poor Sleep

Fatigue is intensified by pain and poor sleep. Pain is inherently tiring and also tends to produce muscle tension, which in turn intensifies fatigue. Non-restorative sleep leaves you as tired in the morning as you were before going to bed. Treating pain and sleep using the strategies described in the next two artilces in this series produces the bonus of reducing fatigue at the same time.
Reciprocally, treating fatigue can have a positive impact on sleep and pain. Since feeling tired increases the experience of pain, reducing fatigue lessens pain. In sum, fatigue, pain and sleep interact with one another. An improvement in one symptom can have a positive effect on the other two. Probably the most common symptom to attack first is sleep.


Exercise counteracts the part of fatigue caused by a lower activity level and the resulting loss of fitness. Exercise improves fitness, thus reducing the fatigue caused by deconditioning. It also helps combat pain, lessens stress and improves mood. For ideas on how to exercise safely, see the article Exercise.

Reducing Stress

Because stress is so pervasive in chronic illness and because it intensifies symptoms such as pain and poor sleep as well as fatigue, many people with ME/CFS and FM use relaxation and other stress management strategies to combat it. See articles in the Stress Management archive for our ideas on both stress reduction and stress avoidance. Like other self-management strategies, stress management techniques improve multiple symptoms.

Addressing Depression and Other Emotions

Powerful emotions such as depression, frustration, anxiety, guilt and grief are a frequent consequence of chronic illness, a response to the disruption, losses and uncertainty it brings. One symptom of depression is fatigue, so treating depression can reduce fatigue.
As with pacing and stress management, addressing depression and other feelings triggered by illness can improve several symptoms. For ideas on managing emotions, see articles in the Emotions archive.
Improving Nutrition

People with ME/CFS and fibromyalgia often experience several kinds of problems getting good nutrition. Lack of appetite or severity of symptoms may make it difficult to spend enough time to prepare and eat balanced meals.
Some possible strategies include preparing meals in ways that respect the body’s needs (e.g. taking rest breaks, using a stool, limiting repetitive motions), buying food online or by phone, preparing and freezing meals when feeling better, and getting help.
Second, most people with ME/CFS and FM experience an intolerance of alcohol and many are sensitive to caffeine and other stimulants, sweeteners (such as sugar, corn syrup, fructose, aspartame and saccharin), food additives (such as MSG, preservatives, artificial colors and artificial flavors) and tobacco. Cutting down or eliminating these substances may reduce symptoms and mood swings, and also improve sleep
Third, a substantial number of people with ME/CFS and fibromyalgia experience food sensitivities or food allergies or have difficulty absorbing nutrients. Negative reactions include gastrointestinal symptoms (such as heartburn, gas, nausea, diarrhea and constipation), headaches, muscle pain, changes in pulse and fatigue.
Some common sources of food allergy for people with ME/CFS and FM include dairy products, eggs, soy, wheat and corn. Other sources include tomatoes and potatoes; fruits; spicy foods; gas-producing vegetables, such as onions, cabbage and broccoli; raw foods; and nuts.
There are two major treatments for food sensitivities and allergies: avoidance and the rotation diet. The first step in both treatments is the same: identifying foods that trigger allergic reactions.
To do this, eliminate foods you think might cause problems, then reintroduce them one by one. If foods produce strong reactions, such as diarrhea, nausea, headaches or hives, you will probably have to eliminate them from your diet entirely.
Often, the elimination of just a few foods can improve symptoms dramatically. Alternatively, you may find you can tolerate a food if you eat it only occasionally. This is usually called the rotation diet. After eating a food, you wait a period of four to seven days before eating it again.
If you have food sensitivities, they may be caused by other conditions such as irritable bowel syndrome (IBS); yeast infections, like candida; celiac disease, which causes a strong allergic reaction to wheat and other grains; and lactose intolerance, which is the inability to digest the sugar in milk.

Considering Medication Changes

Many medications, including some anti-depressants and drugs prescribed for pain, create fatigue as a side effect. To combat this source of tiredness, ask your doctor about fatigue when reviewing medications. A change of medication or a change in dosage may help.
You might also consider certain stimulant medications as a treatment for fatigue. Drugs such as Nuvigil, Provigil, Adderall and Ritalin can help those who are somnolent during the day, as opposed to just tired. (Somnolent individuals fall asleep watching TV, reading, riding in the car, etc.)

Note on Super Strategies

As you read through the next three articles, you will find pacing, stress management and exercise discussed repeatedly, just as they were in this article on fatigue. They are “super strategies.” Using them will help you reduce multiple symptoms.

“While fibromyalgia can cause fatigue, the dominant symptom is pain.”

“For people with chronic fatigue syndrome, however, the dominant symptom is fatigue,” he says.

What do we know about fibromyalgia?

Of the two, more information is available about fibromyalgia, or FM. It affects about 10 million Americans, mostly women.

Many patients get their diagnosis between the ages of 20 and 50. But the incidence increases with age. By age 80, about 8 percent of adults have fibromyalgia, according to statistics from the National Fibromyalgia Association.

The cause of fibromyalgia is unknown. Genetics, trauma or an infection may play a role, Dr. Bolash says.

Symptoms include:

  • Diffuse pain
  • Headaches
  • Stiffness
  • Joint swelling
  • Fatigue and morning stiffness

Fibromyalgia sufferers say it feels like having the flu all the time.

What do we know about chronic fatigue syndrome?

Those who have chronic fatigue syndrome, also called myalgic encephalomyelitis, or ME/CFS, report fatigue that is worsened with activity and not relieved by rest. Other symptoms, which may come and go, include dizziness, and trouble with concentration, sitting and standing.

The Centers for Disease Control and Prevention estimates that 836,000 to 2.5 million Americans suffer from ME/CFS, but most cases are undiagnosed.

“Both diagnoses are sometimes called into question as to not being ‘real’ diseases,” Dr. Bolash says. But the chronic pain and fatigue are real enough — and often debilitating — for those who have it.

How do doctors treat the two disorders?

People with either disorder can often get some relief with a variety of therapies. And this is where a proper diagnosis is most useful, Dr. Bolash says.

“Medical options are just the tip of the iceberg for both conditions,” he says. “But when we use medications, we need to ensure that we are targeting pain without excess sedation.”

When it comes to non-pharmacological help, doctors use a variety of tools.

Dr. Bolash talks to patients about how important it is to stay active, but pace themselves. His advice? “Set a structured activity program that avoids overexertion.”

On a good day, a patient may decide to walk four miles, then require two to three days to recover. Try to walk one mile a day so you are active every day, he tells them.

He also recommends swimming, yoga and biking.

How your family can help

Support from your family can make your condition easier to bear. “I try to make family members a partner in treatment,” Dr. Bolash says.

When you just want to spend the day in bed watching TV because of fatigue and/or pain, a family member can encourage simple, fun activities to help get you moving.

Your family can also help by spending time with you on good days as well as bad ones. “We have to understand the psychological part of the diseases as well,” Dr. Bolash says.

Whether your diagnosis is chronic fatigue or fibromyalgia, a doctor’s role in treating the disease small.

“A doctor is there as the coach and can help you with the first 10 to 15 percent of improvement; a patient has to help themselves manage the remaining 85 to 90 percent,” he says.

If you’re suffering with chronic pain and/or fatigue, talk to your doctor. A diagnosis can put you in a better position to manage your symptoms — even if there are still some mysteries surrounding your disease.

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