Fibromyalgia and sleep

Obstructive sleep apnea (OSA) in fibromyalgia (FM) patients is a concern that is growing. These FM patients have 10 times as much sleep disordered breathing problems which include OSA according to Victor Rosenfeld, MD.

For a FM patient, in order to find out if they have OSA, there are two tests. First is the polysomnogram (PSG) done in a sleep lab. We have two in this area. The second is a home sleep test (HST) done in your own home. The HST is much less expensive than the PSG and does not cover as many conditions as the PSG. Both are effective in diagnosing OSA and both may be covered by your health insurance or medicare. Either of these tests will identify the apnea-hypopnea index (AHI) which is basically the number of times per hour that a patient stops breathing for 10 seconds or longer. Some patients stop breathing for over 100 seconds at a time! And this happens sometimes dozens of times each hour of sleep. No wonder many untreated patients feel so tired all the time.

If the AHI is below 5, the patient has no OSA. If the AHI is 5 to 15, the OSA is diagnosed as mild. If the AHI is 15-30, the OSA is diagnosed as moderate. And if the AHI is above 30, it is diagnosed as severe. Treating OSA in FM patients can be more difficult than treating OSA in non-FM patients due to pain, etc. One form of therapy is continuous positive airway pressure (CPAP) which delivers compressed air through a hose to the patient, keeping the airway open. Of course, this can be difficult to adjust to since air comes into the lungs faster than normal and the patient has to force air out of the lungs against the pressure. The newer machines, called AutoPAP, reduce the pressure automatically during different stages of sleep or different sleeping positions. This reduces the number of arousals (interruptions in sleep) the patients have as a result of this type of therapy.

For FM patients with OSA, oral appliance therapy (OAT) with a mandibular advancement device known as an oral appliance can be used and can be better tolerated than CPAP or AutoPAP in many cases. Adherence to OAT is usually better that PAP therapy. These oral appliances advance the lower jaw which moves the tongue forward and opens the airway. They are custom made for patients by qualified dentists.

Some FM patients have a higher AHI while sleeping on their back. This may be resolved if they sleep on their side. There are devices which can be worn at night that will not allow the patient to sleep on their back. This has the potential of reducing the AHI substantially.

FM is the most prevalent and widespread condition of pain in the world. Most FM patients have sleep complaints often at a greater frequency than pain complaints. If you have FM, a sleep study is a great place to start to find out if treatment for OSA can reduce your symptoms and improve your health and your quality of life.

• • • Dr. Donald Johnson founded Northwest Treatment Center for Snoring & Sleep Apnea in Coeur d’Alene to help patients stop their snoring and live free with no limits! Obstructive sleep apnea is usually able to be treated with a small oral appliance. Dr. Johnson’s office is at 114 W. Neider Ave., near Costco. The website for more information is www.NWSleepDoc.com and the office phone is (208) 667-4551. Schedule a free consultation appointment today!