Sleep disturbance

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mrsfizz11
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by mrsfizz11 on Wed Aug 14, 2013 12:50 pm

Sleep disturbance

Since I have been diagnosed with Fibro my sleep patterns have changed significantly. I do not go into the deep sleep phase anymore, hence I wake up in the morning not refreshed and still fatigued. Is there a reason for this sleep problem? how can I make any changes. I already make sure the room is dark, cool, and I am relaxed before going to bed. Going to sleep is no problem but staying in deep sleep is!.

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Adam Eason
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by Adam Eason on Wed Aug 14, 2013 3:20 pm

Re: Sleep disturbance

There are probably experts on this clinic who can offer more extensive responses to the subject of sleep, however I have a lot of experience in dealing with insomnia and sleep effected by FM - and the field of hypnosis does have an impressive evidence base for helping advance sleep.

On a generic note, studies such as that conducted by Parkes (1985) gives an average number of hours of sleep as 16 out of 24 for neonates, 8 for 12-year-olds, 7 for adults and 6 in old age.

However, people vary in the amount of sleep that they require, and duration of sleep may be influenced by habit so that, for example, people may find that they manage on less sleep after an imposed period of reduction in sleeping time, according to Home (1992) over several days, healthy adults may adapt without difficulty to up to 2 hours' less sleep.

Complainers of sleep-onset insomnia habitually overestimate the time they take to fall asleep (Franklin 1981). In a study by Stepanski et al (1988), the total monitored night-time sleep in patients complaining of insomnia was 364 minutes, compared with 419 minutes for people not complaining of insomnia. Therefore, many of the people complaining of insomnia may still have sufficient sleep. I realise that stating this can serve to get people's backs up; that is not my intention, promise! :)

Moreover, daytime EEG monitoring revealed that sleepiness in the complainers was no higher than in the non-complainers. However, complainers of insomnia usually report feeling drained and fatigued during me day, and rather than loss of sleep, this may involve anxiety and depression (which may include anxiety about not sleeping sufficiently).

Hence, insomniacs may underestimate the time they are asleep. (This is something that nurses on night shifts often notice with patients who complain that they are having little sleep.)

Nevertheless, it is possible that sleep quality is poorer in complainers of insomnia, with more periods of restlessness and troubled dreams. I think this is more relevant to your own query.

Whatever the case, psychological factors such as stress, anxiety and tension appear to be inextricably linked with complaints of poor sleep. According to Home (1992), psychological factors play some role in as many as 80% of all insomnia cases. I can only really comment on psychological factors and those within my own sphere of professional competence, I am no GP or physician.

For the benefit of others reading this, and I apologise that this is not wholly relevant to your own query, here is some general advice for those suffering with sleep disorders related to FM:

I realise that people who seek treatment for insomnia are usually well appraised of the rules and ploys for maximising the likelihood of a good night's sleep.
Obvious requirements are a comfortable bed and a dark, quiet environment that is neither cold nor overly stuffy.
Avoidance of any central nervous system stimulants in the hours before retiring is commonly advised, with tea and coffee particularly in mind. On the other hand, it is considered that = warm milky drink may be of benefit.
Alcohol may facilitate sleep onset but muse waking later in the night, so is not usually advised.
Poor sleepers sleep even more poorly if the period immediately prior to retiring is spent studying. Conversely, many people find that light reading or an easy-to-watch television programme is of assistance (see Home 1992, Parkes 1985).
A heavy meal, taken soon before retiring, or vigorous exercise, is not recommended. There is an idea, however, that regular exercise does promote good sleep. It may be the case that this is more to do with establishing a regular, healthy routine of work, rest, play and eating. Too restrictive a diet and hunger exacerbate insomnia.

If possible, times of retiring to bed and rising in the morning should be fixed, although lie-ins are fine at weekends and during holiday breaks. Daily naps are not precluded although it is better that these are taken at a fixed time of the day. Around 20 minutes should not pose a problem.
However, in the initial stages of treating insomnia, it is a good idea to prohibit napping until the sleeping pattern has been restored.

Many patients will be taking night-time sedation and may have done so for some considerable time, maybe months and even years. Nowadays, however, doctors are much more reluctant to allow repeat prescriptions of sleeping tablets, except perhaps in the elderly. Sleeping tablets can be helpful for short-term insomnia (up to 4 weeks). Thereafter, patients find that when they try to do without them, the insomnia returns, sometimes with a vengeance. It is difficult for many patients to go 'cold turkey', so a period of gradual withdrawal, in tandem with a psychological approach, is recommended. Some doctors consider that the withdrawal of medication may be facilitated by substituting the existing prescription with a longer-acting tranquilliser such as diazepam.

My own work tends to comprise of psychological treatments for insomnia:
Three main psychological approaches for alleviating insomnia have been investigated by well-conducted clinical trials that have incorporated plausible placebo controls. These approaches are stimulus control, paradoxical intention, and relaxation (including hypnosis). All appear equally effective, although relaxation methods may yield subjective ratings of more restful sleep (Espie et al 1989, Turner & Ascher 1979).
It is important to remember that all three methods involve the gradual breaking down of the habit of lying awake, and the re-installation of a regular sleeping pattern. This can only take place over a period of time. I know you stated that you relax before bed, but sustained and developed relaxation skills may be more beneficial (if you are not using them already, apologies if so).

The vast majority of psychological processes are designed to lull to sleep or to get to sleep, however, you have no issue with that.

Some self-hypnosis processes can also help with quality of sleep. If you bear with me for a day or so, I may be able to post another blog entry here on this site to offer up a simple step-by-step self-hypnosis process to help. Believing in your ability to sleep is also another method that has been shown to help. Having a positive expectancy about your ability to sleep aids the process, whereas trying to 'will yourself' to sleep for longer or more deeply or getting annoyed, frustrated or anxious about not sleeping for long enough often impairs our ability further.

I'll add a note here when I post the article on the blog which I hope will offer you something a lot more tangible.

Best wishes, Adam.
Adam Eason
Clinical & Cognitive Behavioural Hypnotherapist

http://www.talkhealthpartnership.com/on ... _eason.php

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pam stewart
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by pam stewart on Wed Aug 14, 2013 4:49 pm

Re: Sleep disturbance

Lack of non restorative sleep is one of the main symptoms of Fibromyalgia. One of the first researches showed that people with fibromyalgia suffered from this and volunteers who were woken deliberately during research eventually developed similar symptoms to those with fibromyalgia. So it is not the length if time spent sleeping but the quality of that sleep that matters.

Studies have shown that during deep delta sleep hormones are released that help repair the damage we have done to our bodies during the day.

The usual first line of treatment is a low dose of an anti depressant (normally amytriptyline). This is nowhere near the dosage for depression and it prescribed to allow relaxation of mind and body so that deeper sleep is possible.

Other non pharmacological treatments such as the hypnotherapy and meditation may also work. It is important not to stress about lack of sleep as this can lead to the problem becoming worse. If you wake during the night accept it and relax. If you have woken with thoughts of things that need to be done or ideas, write them down for the morning and you can then forget about them. It is not a good idea to get up and become active.
Pam Stewart
Fibromyalgia Association UK (Chair)

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Adam Eason
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by Adam Eason on Wed Aug 14, 2013 5:01 pm

Re: Sleep disturbance

Additionally, when it comes to lulling back to sleep - evidence suggests that using mental imagery of a safe or favourite place and truly immersing yourself in it or a basic mindfulness body scan protocol can help greatly.

And yes, learning to accept thoughts and sensations without resistance or fighting them is really valuable. There are a number of means and ways to employ a basic ACT (acceptance and commitment therapy) protocol in these instances which can help advance your ability to lull yourself back to sleep.
Adam Eason
Clinical & Cognitive Behavioural Hypnotherapist

http://www.talkhealthpartnership.com/on ... _eason.php

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Wendy Green
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by Wendy Green on Wed Aug 14, 2013 8:06 pm

Re: Sleep disturbance

Hi mrsfizz11,

As the other experts on the panel have covered psychological, behavioural and drug-based approaches to help tackle your sleep problems I thought I'd take a nutritional viewpoint.

First of all, ensure you are eating a balanced diet consisting of oily fish, low-fat protein foods, low-fat dairy foods, whole grains, fruit and vegetables and nuts and seeds, to improve your general wellbeing.

As Adam suggests, I would limit your tea and coffee intake - especially from around 6pm at night - opt instead for caffeine-free drinks such as herbal teas, rooibos (red bush) tea, or de-caffeinated tea or coffee.

Ensure your diet is rich in calcium - found in dairy foods, nuts, dark green leafy vegetables and dried fruits - and in magnesium - again found in nuts and dark green leafy vegetables and also in whole grains and seafood; calcium and magnesium are naturally calming, so they help to promote sound sleep. Also magnesium is involved in healthy muscle functioning and pain regulation.

You may also want to try a supplement known as 5-HTP, which is thought to improve sleep by boosting serotonin levels (which the body uses to make the sleep-inducing hormone melatonin) and to also ease pain, boost mood and clear 'fibro-fog'.

I hope these suggestions help you.

Best wishes,

Wendy
Wendy Green
Health Expert and Author

http://www.talkhealthpartnership.com/on ... _green.php

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