Improving your Sleep: Fibromyalgia Edition
By Zeena Muhssin
If you are anything like me, a poor sleep will intensify your fibromyalgia and be a real pain in the neck (and everywhere else) when trying to carry on with your day! A long period of rough sleep led me to CBT-I, or in other words, cognitive behavioural therapy for insomnia. The techniques can be difficult and need to be implemented for a while, but if anything can possibly improve energy levels and overall well-being, it is surely worth a try!
Keeping a sleep diary
First things first, you need to begin by keeping a record of your sleep pattern. Grab a notebook or you can use a simple template online if you would like it digitally, I recommend using the free sleep diary template at mysleepwell.ca. You need to make note of this data for a full week and ask yourself the following questions.
- What time did you go to bed? This includes time spent in bed reading or listening to a podcast.
- What time did you try to sleep?
- What time did you fall asleep?
- How many times did you wake up in the night?
- In total, how long did these awakenings last?
- What time did you finally wake up?
- What time did you get out of bed to start the day?
- Note anything that may have interrupted your sleep e.g. alcohol, light, noise.
Try to be as accurate as possible but estimates will do if you are unsure.
Calculating sleep efficiency
At the end of the week, you will have all your data ready to start calculating how well your sleep is. To do this you must add up your sleep duration and your time in bed. You should start to see a pattern in your sleep diary so pick an average night's sleep to do your calculations. If you would like a quicker option you can use the sleep calculator on mysleepwell. Start by adding up the amount of time from when you fall asleep to your final awakening point. Next, subtract the total amount of your nighttime awakenings. This is your total sleep time. After this, record the total minutes from the time you got into bed and when you got out to start the day. This is your total time in bed. To get a sleep efficiency score use the following equation:
(total sleep time ÷ total time in bed) x 100%
Keep a record of your score as you will do this every week to observe your progress.
Anchoring your sleep
As you analyse your sleep diary, you should start to notice when you are naturally falling asleep and waking up. Apps like Sleep Cycle are good for this as it detects your movements. For a moment, forget the traditional advice of having to get 8-9 hours of sleep a night. It isn’t about the quantity of sleep you are getting, but rather the quality and optimal amount for YOU. It is individual for everyone. When I did this I started noticing that I would naturally wake up quite early, around 6am. This was way too early to start my day and my partner would still be fast asleep beside me, so instinctively, I would just go back to sleep and eventually go into a deep sleep. Then comes the sound of my alarm and I would wake up feeling like a tonne of bricks had hit me, clouded with fatigue which would carry into the whole day. This is why we must anchor our threshold and rising times.
Pick an optimal time, based on your sleep diary, of when to go to sleep and when to get up. When your alarm goes off you need to try and leave the bed quickly, do not press the snooze button. I’m not going to lie, sticking to these times is going to be the most difficult part and you will need to push through the fatigue. Make it a habit to get up and fill in your sleep diary straight away before you forget.
After you have done this for 3-4 weeks, you can try pushing your threshold time 15 minutes earlier or your rising time 15 minutes later. Try it for a week and see how your sleep efficiency score changes.
Constructive Worry
We live in a world where everything is go, go, go. Even before the struggle of fibromyalgia, burdens like money, work, relationships etc cause us immense stress which can sabotage our precious slumbertime. I know I’m not alone in that I’ve struggled numerous times to get to sleep as my mind just wouldn’t shut off.
That’s where the constructive worry method comes in. Grab a notebook and start with the negative stuff i.e. what’s bothering you that day or causing you stress. After that, focus on the good stuff that happened or things you are looking forward to. Then, go back to the negative list and write down an achievable task you can do for each worry, for example, if you are not happy at your job, don’t write down “find a new job,” start with “find my CV” and the next day you can update your CV , and so on, Then go to the good stuff section and think of ways to amplify this positivity in your day.
When you have a clearer view of your worries and things that you can do about them, you can put those worries to bed and therefore, help yourself to get those much needed zzz.
Sleep Hygiene
About an hour or so before you head off for a well deserved kip, you should make a routine of winding down. This is called the buffer zone and is an opportunity to separate yourself from the business of the day and focus on calming, relaxing activities. I recommend reading a book or listening to a podcast, especially something that isn’t too serious. Make yourself a nice cup of decaffeinated tea, do some light stretching if you can or even some breathing exercises. Heat is also brilliant so try having a hot shower or a bath before bed, this will also sooth your muscles and help with any aches and pains. Oh how I wish I had a bathtub in this East London flat!
Remember that what you do in the day will affect how you sleep at night. I have created a checklist below to increase your chances of getting forty winks!
No coffee past 2pm, you don’t realise how long caffeine stays in your system. I’ve recently switched to using cacao powder in the morning with oat milk, it gives you all the benefits without the caffeine rush. My tip: add a drop of orange oil for a delicious brew!
2. Try to keep the bedroom for sleeping and intimacy only. This will help the mind to only recognise the bedroom as a sleep zone, so try not to watch TV or work in the bedroom if you can.
3. Try to eliminate blue light. If you use screens a lot it might be a good idea to invest in blue light glasses, you can find some affordable options online. Start using the night mode feature on your phone or laptop to decrease the amount of blue light in the evenings.
4. Set your alarm and put your phone out of action before your buffer zone so it doesn’t stimulate you before bed. Opt to reading a book in bed instead of going on social media.
5. Don’t go to sleep on a full or empty stomach, you will either be kept awake because you are hungry or your digestive system is struggling to process your dinner! Try to eat no less than 2 hours before bedtime.
6. If you find that you are a light sleeper or your partner has a habit of snoring (unfortunately this is my case) you can try using a pair of earplugs to block out noise. You will still hear your alarm so don’t worry, but you are less likely to be disturbed by external noises.
7. Keep your room dark if possible. I personally like to have a little bit of light come through so I wake up a bit more refreshed, which I do by pulling down my black out blinds about ¾ of the way.
15 Minute Rule
There’s nothing worse than rolling around in bed, frustrated and trying to get to sleep. This scenario is one that many have experienced and makes it even harder to get to sleep in the end. The rule is if you can’t get to sleep after 15 minutes you need to get out of that bed and try to do something calming until you feel tired enough to try again. Do not go on your phone or watch TV, this will only make matters worse!
Sleep Supplements
If you are feeling quite hopeless with your sleep then you can try taking a supplement which aids sleeping. I must stress that this is a short term solution and will not investigate the root cause of your insomnia. Some popular options are melatonin tablets, which is the hormone your brain creates to regulate night and day cycles, or over the counter options such as Nytol or Sominex. Another option is finding a good quality slow-release CBD product, such as CBD patches or CBD capsules which can not only help with sleep, but is a great way of dealing with pain associated with fibromyalgia.
So, I hope that these tips can make an improvement in your sleep cycle. Remember, this is not something that will work after a week, these are techniques which need to be implemented over time to be effective. When you are pushing through the tiredness to get a regular sleep pattern, try and tell yourself that you are not doing it to get a better sleep tonight, but rather to mend and improve your sleep cycle in the long run. Sleep is the best meditation, so let's try get the most out of it!