Nocturnal motor activity in fibromyalgia patients with poor sleep quality

Excessive daytime sleepiness: considerations for the psychiatrist

Excessive daytime sleepiness or pathologic sleepiness is a complaint found in patients who experience somnolence at unwanted times and adversely affects their daytime function. Although psychiatric illness, chronic medical illness, or medication side effects may be causes for fatigue, insufficient sleep is the most common cause of excessive daytime sleepiness in the general population. When an individual complains of frank sleepiness, in addition to insufficient sleep, important considerations in these patients are disturbances in the normal homeostatic mechanisms that govern sleep and wakefulness. This article summarizes the clinical presentation, the differential diagnosis, commonly used diagnostic tools, and treatment options for patients complaining of excessive daytime sleepiness.

Sleep quality and the role of sleep medications for veterans with chronic pain

OBJECTIVE

The purpose of this study was to investigate the nature of sleep problems in veterans presenting to a pain clinic, factors that predict likelihood of being prescribed a sleep medication, types of medications prescribed, and the relationships between sleep medication use and sleep quality, pain, and depression.

DESIGN/SETTING/PATIENTS

Participants were 201 consecutive patients referred to a Veterans Affairs outpatient pain clinic. They were administered the Pittsburgh Sleep Quality Index, Multidimensional Pain Inventory, and Beck Depression Inventory at intake and 2-month follow-up. Sleep and opioid medication prescriptions were also monitored.

RESULTS

Pain severity did not predict global sleep quality; global sleep quality was not predictive of pain severity. Greater depression predicted both more severe pain and more sleep impairment. Having previously been prescribed such medications was the only significant predictor of being prescribed a sleep medication at the time of the 2-month assessment. For the 45% of participants on sleep medications, these medications were not associated with any significant change in pain factors or depression. However, sleep medication use was associated with worse global sleep quality, sleep duration, and sleep efficiency. Opioid prescription was not a significant predictor of sleep factors, pain-related variables, or depression symptoms.

DISCUSSION

Results suggest depression may contribute more significantly to sleep problems than pain-related variables in this population. The data suggest the need for controlled, prospective studies of sleep medication to further investigate the impact of sleep medications on sleep components in patients with chronic pain.

Self-reported sleep quality and fatigue correlates with actigraphy in midlife women with fibromyalgia

BACKGROUND

Limited data are available on the relationship between self-reported sleep quality, fatigue, and behavioral sleep patterns in women with fibromyalgia (FM).

OBJECTIVES

To compare self-reported sleep quality, fatigue, and behavioral sleep indicators obtained by actigraphy between women with FM and sedentary women without pain, and to examine relationships among these variables.

METHODS

Twenty-three women with FM (M = 47.3, +/- 6.7 years) and 22 control women (M = 43.5, +/- 8.2 years) wore an actigraph on the nondominant wrist for 3 consecutive days at home. Each day women reported bedtimes, rise times, and ratings of sleep quality and fatigue in a diary. Self-reported sleep quality, fatigue, and indicators of sleep quality obtained from actigraphy (e.g., total sleep time, sleep efficiency, sleep latency, wake after sleep onset, and fragmentation index) were averaged. The Mann Whitney U test was used to assess group differences. Pearson Product Moment Correlation was used to evaluate relationships between sleep quality and fatigue, and among sleep quality, fatigue, and actigraphy sleep indicators.

RESULTS

Women with FM reported poorer sleep quality and more fatigue compared to controls (both p <.001). Actigraphy sleep indicators were not different between groups. In women with FM but not in controls, self-reported sleep quality was directly related to actigraphy indicators of total sleep time (r =.635, p <.01) and inversely related to sleep fragmentation (r = -.46, p <.05). Fatigue in women with FM was directly related to actigraphy indicators of wake after sleep onset (r =.57, p <.01), and inversely related to sleep efficiency (r = -.545, p <.01).

DISCUSSION

Self-reported sleep quality and fatigue are associated with behavioral indicators of sleep quality at home in women with FM. Actigraphy is a useful objective measure of improved sleep outcomes in intervention studies.

A review of sleep in selected immune and autoimmune disorders

Evidence for the reciprocal role of the immune system in sleep is growing. Sleep disturbances are believed to be both a cause and a consequence of various immune and autoimmune conditions.

Sleep and methods of assessment

Sleep is a complex behavior; adequate sleep is essential for healthy functioning and even for survival. Poor sleep quality and insufficient sleep have been linked to increased risk for various illnesses, as well as with an increased prevalence of excessive daytime sleepiness and reduced quality of life. Daytime sleepiness can lead to dangerous outcomes associated with drowsy driving and has become an important public health issue. Routine health examinations that include questions about sleep habits, daytime sleepiness, and problems with sleep at night can help to educate people about the importance of good sleep habits. They provide a way to identify sleep disorders so that appropriate therapies can be instituted or proper referrals to a sleep specialist can be given.

Alpha sleep characteristics in fibromyalgia

OBJECTIVE

To characterize the patterns of alpha electroencephalographic sleep and their associations with pain and sleep in patients with fibromyalgia.

METHODS

Pain and sleep symptoms of 40 female patients with fibromyalgia and 43 healthy control subjects were studied before and after overnight polysomnography. Blinded analyses of alpha activity in non-rapid eye movement (non-REM) sleep were performed using time domain, frequency domain, and visual analysis techniques.

RESULTS

Three distinct patterns of alpha sleep activity were detected in fibromyalgia: phasic alpha (simultaneous with delta activity) in 50% of patients, tonic alpha (continuous throughout non-REM sleep) in 20% of patients, and low alpha activity in the remaining 30% of patients. Low alpha activity was exhibited by 83.7% of control subjects (P < 0.01). All fibromyalgia patients who displayed phasic alpha sleep, activity reported worsening of pain after sleep, compared with 58.3% of patients with low alpha activity (P < 0.01) and 25.0% of patients with tonic alpha activity (P < 0.01). Postsleep increase in the number of tender points occurred in 90.0% of patients with phasic alpha activity, 41.7% of patients with low alpha activity, and 25.0% of patients with tonic alpha activity (P < 0.01). Self ratings of poor sleep were reported by all patients with phasic alpha activity, 58.3% of patients with low alpha activity (P < 0.01), and 12.5% of patients with tonic alpha activity (P < 0.01). Patients with phasic alpha activity reported longer duration of pain than patients in other subgroups (P < 0.01). Additionally, patients with phasic alpha sleep activity exhibited less total sleep time than patients in other subgroups (P < 0.05), as well as lower sleep efficiency (P < 0.05) and less slow wave sleep (P < 0.05) than patients with a tonic alpha sleep pattern.

CONCLUSION

Alpha intrusion during sleep can be of different patterns. Phasic alpha sleep activity was the pattern that correlated better with clinical manifestations of fibromyalgia.

Sleep in fibromyalgia patients: subjective and objective findings

Fibromyalgia (FM) patients report early morning awakenings, awakening feeling tired or unrefreshed, insomnia, as well as mood and cognitive disturbances; they may also experience primary sleep disorders including sleep apnea. Longitudinal studies have demonstrated the chronic nature of these disturbances in patients with FM. A distinct relationship exists between poor sleep quality and pain intensity. Polysomnographic findings during sleep in these patients include an alpha frequency rhythm, termed alpha-delta sleep anomaly, which is also seen in normal controls during stage 4 sleep deprivation; deep pain induced during sleep in normal controls also causes this anomaly. Sleep architecture is altered in FM patients showing an increase in stage 1, a reduction in delta sleep, and an increased number of arousals. Before prescribing pharmacologic compounds aimed at modifying sleep, adequate pain control and sleep habits should be achieved; tricyclic antidepressants, trazadone, zopiclone, and selective serotonin reuptake inhibitors, however, may be required. More research is needed to elucidate the cellular and molecular mechanisms involved in the sleep disturbances occurring in patients with FM.