DOES IT SEEM LIKE EVERY NIGHT AT 2–4 A.M. YOUR INTERNAL ALARM CLOCK GOES OFF? THIS IS ONE OF THE MOST COMMON PROBLEMS PEOPLE WITH FIBROMYALGIA HAVE, AND IS INCREASINGLY COMMON IN THE GENERAL POPULATION AS WELL.
But what if it was optional?
Here are some of the major causes:
1. Drops in blood sugar. This is a major problem in people with adrenal fatigue. It can be especially common in people who are exhausted and "hangry" (hungry when angry) all day and whose minds suddenly go wide-awake at bedtime. The drop in blood sugar triggers an adrenaline rush and you're suddenly wide-awake.
The solution? Have a 1–2 ounce high protein snack at bedtime such as a hard-boiled egg or some cheese, meat or fish. A sugary or high carbohydrate snack will actually make the problem worse. You will know if this is helping after one or two nights.
2. Frequent urination. In addition to the other hormonal problems seen in fibromyalgia, people often have a drop in antidiuretic hormone (ADH or vasopressin). This makes it hard to hold onto water so you "drink like a fish and pee like a racehorse." This can keep you up at night as well.
- Because we are an upright species, gravity pools fluid in our legs. As much as a quart or two. When you lie down, it goes back into the rest of your body. Kind of like drinking a quart or two of water while you're sleeping. To prevent this, prop your feet up for a few hours before bedtime when you are sitting around. This way they can drain and you can pee the fluid out before you go to bed.
- A simple prescription nose spray or tablet called DDAVP supplies the antidiuretic hormone. So you aren't up all night peeing. This is the same treatment they give kids who bed wet. Taken during the day, it also has been helpful for low blood pressure problems (orthostatic intolerance). The dose is 1/10 mg, one or two sprays or tablets at bedtime.
- Avoid drinking a lot of fluids, especially with caffeine, for a few hours before bedtime.
- If you are only urinating small volumes, hold off on going to the bathroom for five minutes. You will often have fallen back asleep by then, and this will retrain your bladder to sleep through the night.
- If you have urinary urgency (including incontinence during the day), try the herb Angelica (SagaPro by EuroPharma) which helps promote healthy bladder function. This way you can more easily sleep all night. And during the day you won't find yourself laughing so hard that the tears run down your leg!
3. Night sweats. This can come from a number of problems. In fibromyalgia, I find that the most common ones are hormonal deficiencies (estrogen and testosterone), and infections (especially Candida). We have discussed how to treat these in earlier articles.
Another common cause is nighttime acid reflux. Although you may sometimes notice the heartburn when you wake up, other times you won't and you'll just wake up in a sweat after inhaling the stomach acid. This is especially likely to be a problem if you have daytime indigestion as well. After three weeks doing the below, you may find your daytime heartburn starts to settle down as well.
A. Start by taking an acid blocker such as Prilosec or Nexium an hour before bedtime for three to four nights. If this helps, you've identified the problem. Stop the acid blocker, as it is quite addictive and toxic when used long-term. Instead follow the instructions below.
Though it's a bad idea to keep your stomach acid "turned off" during the day (you need it to digest food), you don't need stomach acid at bedtime while sleeping. So here are a few tips:
B. Bicarbonate of soda. Take ½ tsp of bicarbonate of soda (e.g., Arm and Hammer) in 4 oz of water at bedtime to neutralize the acid in your stomach (not for children under 16 years old).
C. Don't eat within two hours before bedtime and take two caps of a plant based digestive enzyme an hour before sleep. This will ensure your stomach is empty when you sleep.
D. Sleep with your upper body elevated. Raise your upper body at least 6–8 inches when in bed (just raising your head with pillows won't work). One way to do this is to place a 6–8" brick or phone book under the legs of the bed (just the two legs by the end of the bed where your head is). Another wonderful solution is to use a sleep wedge pillow (you can find one online at www.Hammacher.com.
E. Melatonin. Take 5–6 mg at bedtime. This decreases reflux.
F. Immediate Heartburn Relief chewable antacids. Keep a few at bedside to take if needed.
4. Pain. If pain is keeping you awake at night, it absolutely should be eliminated. Getting sleep will then actually help the pain to decrease over time. Some especially helpful treatments, which also can help support healthy sleep, include (these can all be used in combination in the low doses recommended):
- Flexeril (cyclobenzaprine) 5 mg. One half—one tablet at bedtime.
- Ultram (tramadol) 50–100 mg. Although this is treated like an addictive medication, I've never seen anybody with a tramadol addiction, nor have the addiction specialists I've asked. Still, use the other medications instead if you are taking low dose naltrexone.
- Zanaflex (tizanidine) 4 mg. One half one at bedtime. Stop it in the rare event that it causes severe nightmares and it should not be combined with Cipro.
- Neurontin (gabapentin) 100–600 mg.
- Elavil (amitriptyline) 10–25 mg. This medication combined with Neurontin can be especially helpful for people with pelvic pain, such as interstitial cystitis or vulvodynia.
- Curamin. This mix has been a pain relief miracle for many people, and can be taken one or two capsules, three times a day as well. It continues to increase in effectiveness over six weeks and can be taken with any pain medications.
- 5 HTP 300 mg. After six weeks, it helps sleep, decreases pain, and even improves mood.
- Terrific ZZZZ. It will also have a calming effect.
For more sleep information, see my recent articles in which we discussed medications and natural remedies as well as treating sleep apnea and restless leg syndrome.
You can get a solid eight to nine hours of sleep a night—even with fibromyalgia!
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Jacob E Teitelbaum, MD
Jacob Teitelbaum, MD, is a board certified internist and Medical Director of the national Fibromyalgia and Fatigue Centers and Chronicity. He is author of the popular free iPhone application "Cures A-Z," and author of the best-selling books
- The Fatigue and Fibromyalgia Solution: The Essential Guide to Overcoming Chronic Fatigue and Fibromyalgia
- From Fatigued to Fantastic!
- Pain Free 1-2-3
- Three Steps to Happiness: Healing Through Joy
- The Complete Guide to Beating Sugar Addiction
- Beat Sugar Addiction Now! Cookbook
- Real Cause, Real Cure: The 9 root causes of the most common health problems and how to solve them
Dr. Teitelbaum knows CFS/fibromyalgia as an insider — he contracted CFS when he was in medical school and had to drop out for a year to recover. In the ensuing 25 years, he has dedicated his career to finding effective treatments.