Treatment of Sleep Disorders

Non-restorative sleep is a problem for most of you and contributes to your feelings of fatigue and seems to intensify your experience of pain. Effective management involves:

1. ensuring an adherence to the basic rules of sleep hygiene,
2. regular low grade exercise,
3. adequate treatment of associated psychological problems (depression, anxiety etc.)
4. the prescription of low dose tricyclic antidepressants or TCAs (amitryptiline, trazadone, doxepin, imipramine etc.).

Some FM patients cannot tolerate TCAs due to unacceptable levels of daytime drowsiness or weight gain. In these patients, benzodiazepine-like medications such as Ambien (zolpidem) are usually very useful.

Some FM patients suffer from a primary sleep disorder, which requires specialized management. About 25% of male and 15% of female FM patients have sleep apnea. Unless specific questions about this possibility are asked, sleep apnea will often be missed. Patients with sleep apnea usually require treatment with positive airway pressure (CPAP) or surgery.

 By far the most common sleep disorder in FM patients is restless leg syndrome. This can be effectively treated with L-Dopa/ carbidopa (Sinemet 10/100 mg at suppertime) or clonazepam (Klonopin 0.5 or 1.0 mg at bedtime).