How Fibromyalgia Affects Sleep: Restless Nights Explained (Part 1

It’s a busy and stressful world, and most people experience sleep deprivation or report poor quality sleep at various stages of their lives. But within the fibromyalgia community, sleep disturbances are pervasive and long-term and observed in most FM patients.  

For example, in a study of six hundred FM patients (Bigatti, et al. 2008) the researchers identified 96% of the study sample as “problem sleepers”. Furthermore, the authors demonstrated a strong correlation between poor quality sleep and the participant’s experience of pain, fatigue, depression, and diminished physical functioning. (1)  

This should come as no surprise - individuals who are depressed or in pain will have greater difficulty attaining quality sleep and people who are functioning on too little sleep can’t perform at their best.  

In this two-part blog, we’ll review some of the studies that shed light on how fibromyalgia is believed to disrupt sleep patterns. A subsequent blog will then explore concrete steps that we folks with FM can take to interrupt the vicious cycle between poor quality sleep and our diminished health and well-being.  

The Connection Between Fibromyalgia and Sleep Disturbances 

We know that fibromyalgia affects various physiological systems, including the nervous and endocrine systems, which play a critical role in regulating sleep. Sleep disturbances in fibromyalgia patients are characterized by non-restorative sleep, frequent awakenings, and difficulty falling and staying asleep. Researchers have identified underlying mechanisms that contribute to this phenomenon. 

Altered Sleep Cycle 

In addition, fibromyalgia patients often experience an alteration in their sleep stages and cycle. Research shows that individuals with FM may spend less time in the deeper stages of sleep, which is crucial for restorative sleep. It’s during deep sleep that our muscles and tissues are regenerated and repaired (due to an increase in the growth hormone secretion) and toxic waste products are cleared from the brain. It makes sense that a lack of deep sleep could lead to fatigue, brain fog, and muscle aches— which sounds like common fibromyalgia symptoms, right? In a study by Roizenblatt et al. (2001), fibromyalgia patients were found to have a significantly reduced level of deep sleep (also called slow-wave sleep), leading to non-restful sleep. (2) 

Increased Alpha-Delta Sleep Anomaly 

One prevalent sleep abnormality in fibromyalgia patients is called the alpha-delta sleep anomaly. This phenomenon is created by the intrusion of alpha waves (usually present during wakefulness) into delta waves (which are dominant during deep sleep). This intrusion disrupts the restorative nature of deep sleep, leaving patients feeling fatigued even despite a full night’s sleep. Moldofsky et al. (1975) were among the first to identify this anomaly, referring to fibromyalgia as a “non-restorative sleep syndrome”. (3) Abnormal “awake” brain waves have remained a hallmark of sleep disturbances in fibromyalgia. 

Hypervigilance, Hyperarousal and Sleep Disturbances 

Research indicates that individuals with fibromyalgia experience symptoms of hypervigilance and hyperarousal which interestingly resembles that of people with PTSD. (4) Hypervigilance is characterized by extreme alertness and awareness (ie. being highly focused on the symptoms of your FM) while hyperarousal is the body's physiological response to stress and pain, and the potential dysregulation of those stimuli.

A study conducted by A. McDermid et al established that chronic pain patients have a heightened sensitivity to pain (e.g. low threshold and tolerance) because of increased attention to external stimulation and a preoccupation with pain sensations. The study determined that individuals with fibromyalgia have a “generalized hypervigilant” pattern of response that extends beyond pain to include any noxious stimuli, resulting in the amplification of perceptions of pain. (5) 

Hyperarousal processes from the molecular to the higher system level play a key role in insomnia. Numerous studies demonstrate that heightened brain activity (arousal) is present day and night. (6) 

As a result, individuals with fibromyalgia tend to experience changes in sleep architecture, which refers to the different stages of sleep. These patients often report reduced amounts of deep, slow-wave sleep which is essential for physical recovery, and increased awakenings during lighter sleep stages. Hypervigilance contributes to this altered sleep pattern by making it difficult to remain in the more restful stages of sleep. 

Neurotransmitter Imbalances 

Neurotransmitter imbalances, particularly involving serotonin and norepinephrine, are also implicated in the sleep disturbances experienced by fibromyalgia patients. Both neurotransmitters play a key role in mood regulation and sleep. Studies have shown that fibromyalgia patients frequently have lower levels of serotonin, which can lead to reduced sleep quality and increased pain perception.  

Moreover, serotonin is a precursor to melatonin, the hormone responsible for regulating the sleep-wake cycle. Low serotonin levels can thus result in decreased melatonin production, further disrupting sleep. 

Frequent Arousals and Micro-Arousals 

People with fibromyalgia often experience frequent arousals or micro-arousals throughout the night, which can fragment sleep and prevent them from reaching deeper, more restful stages of sleep. (5) 

Obstructive Sleep Apnea Syndrome (OSAS) 

Up to 50% of people with FM have obstructive sleep apnea, distributed between mild OSAS (33%), Moderate (25%) and Severe (42%). Symptoms include loud snoring and periodic pauses in breathing for 10 - 20 seconds, after which breathing resumes with a snort.  

Aside from the oxygen deprivation caused by intermittent breathing (an obvious problem), OSAS creates a highly disrupted environment for the brain. When breathing stops and oxygen levels drop the brain is briefly awakened (aroused) to ensure breathing resumes. These interruptions can occur 5 to 100 times per hour, and the constant “emergency” responses required of the brain make a deep and restful sleep impossible. (7) 

Restless Leg Syndrome (RLS) 

Approximately one-third of people with FM experience restless leg syndrome, which involves numbness and tingling in the lower limbs and restless, twitching legs. A study conducted by Viola-Saltzman et al. confirmed the high prevalence of RLS within the FM community and also determined that the symptoms and effects of RLS were experienced more strongly by the FM group versus the control. (8)  

Conclusion 

As we saw, the role of FM in contributing to sleep disturbances is very complex. The main takeaway is that if you have FM, the quality of your sleep is almost certainly being affected - most likely a lot. Because of the many ways FM can impact sleep, a multifaceted and highly customized approach is often necessary to improve sleep quality. Better sleep quality will go a long way in reducing the severity of your FM symptoms, making this a high-payoff priority in your FM wellness journey. 

In our follow-up blog on getting better sleep for people with FM, we’ll discuss some of the options you may want to discuss with your healthcare providers, as well as a few simple changes in habits and sleep environment that you can try on your own. You will also find a checklist to help focus your efforts as you work on getting better, more restful sleep.  

Rooted & Rising is a weekly newsletter about intentional living and nervous system regulation. It’s designed to support people navigating the world with chronic illness, burnout, or neurodiversity—offering gentle tools to shift limiting beliefs and deepen self-connection. Join here.

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Citations and References 

1. Bigatti, S.M., Hernandez, A.M., Cronan, T.A. and Rand, K.L. (2008), Sleep disturbances in fibromyalgia syndrome: Relationship to pain and depression. Arthritis & Rheumatism, 59: 961-967. https://doi.org/10.1002/art.23828  

2. Roizenblatt, S., Moldofsky, H., Benedito-Silva, A.A. and Tufik, S. (2001), Alpha sleep characteristics in fibromyalgia. Arthritis & Rheumatism, 44: 222-230. https://doi.org/10.1002/1529-0131(200101)44:1<222::AID-ANR29>3.0.CO;2-K 

3. Moldofsky, Harvey MD; Scarisbrick, Phillip BS; England, Robert BA; Smythe, Hugh MD. Musculosketal Symptoms and Non-REM Sleep Disturbance in Patients with “Fibrositis Syndrome” and Healthy Subjects. Psychosomatic Medicine 37(4):p 341-351, July 1975.Ann J McDermid, Gary B Rollman, Glenn A McCain 

4. Winfried Häuser, Alexandra Galek, Brigitte Erbslöh-Möller, Volker Köllner, Hedi Kühn-Becker, Jost Langhorst, Franz Petermann, Ulrich Prothmann, Andreas Winkelmann, Gabriele Schmutzer, Elmar Brähler, Heide Glaesmer, Posttraumatic stress disorder in fibromyalgia syndrome: Prevalence, temporal relationship between posttraumatic stress and fibromyalgia symptoms, and impact on clinical outcome, PAIN®, Volume 154, Issue 8, 2013 https://doi.org/10.1016/j.pain.2013.03.034. 

5. McDermid, Ann Ja,*; Rollman, Gary Ba; McCain, Glenn Ab. Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification. Pain 66(2):p 133-144, August 1996. | DOI: 10.1016/0304-3959(96)03059-X  

6. Dieter Riemann, Kai Spiegelhalder, Bernd Feige, Ulrich Voderholzer, Mathias Berger, Michael Perlis, Christoph Nissen, The hyperarousal model of insomnia: A review of the concept and its evidence, Sleep Medicine Reviews, Volume 14, Issue 1, Pages 19-31, https://doi.org/10.1016/j.smrv.2009.04.002. 

7. Köseoğlu Hİ, İnanır A, Kanbay A, Okan S, Demir O, Çeçen O, İnanır S. Is There a Link Between Obstructive Sleep Apnea Syndrome and Fibromyalgia Syndrome? Turk Thorac J. 2017 Apr;18(2):40-46. doi: 10.5152/TurkThoracJ.2017.16036. Epub 2017 May 1. PMID: 29404158; PMCID: PMC5783078.  

8. Viola-Saltzman M, Watson NF, Bogart A, Goldberg J, Buchwald D. High prevalence of restless legs syndrome among patients with fibromyalgia: a controlled cross-sectional study. J Clin Sleep Med. 2010 Oct 15; 6(5):423-7. PMID: 20957840; PMCID: PMC2952743. 8m