We talk about sleep a great deal. We don’t seem to get
enough and when we do, we still don’t feel rested. But what really is dysfunctional sleep?
Dysfunctional sleep is loss of sleep and ineffective sleep
patterns. This problem can cause agitation, phobia, sleep deprivation
psychosis, headaches, cognitive deficit, problems with gait, weight problems, and
it can affect our mental, physical, emotional, and spiritual health and weaken
our immune response. Though sleep
dysfunction can be part of any chronic pain condition, its effects are prevalent
fibromyalgia (FM), and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Both disorders affect multiple body
systems and have particular overlapping conditions of bruxism, severe
headaches, and restless leg syndrome accompanied by periodic limb movement
during sleep.
Dysfunctional sleep can be caused by some type of airway
obstruction causing sleep apnea where the person stops breathing several times
a night, and it can be due to abnormal cycles of sleep, where certain cycles are
not present or brain activity, measured by brain waves, is abnormal. These
abnormalities have an effect on maintaining sleep or sleep quality. Insomnia,
which is not being able to get to sleep, is also considered dysfunctional. Many
of us seldom, if ever, enter deep stages of sleep
In sleep apnea or other obstructions to air flow, a person is deprived of oxygen needed for
cellular metabolism and energy resulting in many of the symptoms listed in the
introduction, and it can cause problems with the cardiovascular system. Obstructive sleep can also create disrupted sleep cycles and in a recent review, it was found that as many as one third
of patients diagnosed with ME/CFS actually had primary sleep problem and not
ME/CFS at all. For certain other
patients, dysfunctional sleep is comorbid to FM and CFS/ME.
Symptoms of bruxism, teeth grinding, are unusual wear and
tear on your teeth, continued breakdown of dental restorations, teeth breaking,
and tooth sensitivity. Though the exact cause is unknown, it could be mediated
in the central nervous system creating an unconscious response to pain or stress.
While it is usually your dentist who notices the wear pattern on your teeth, it
can also be identified in sleep studies. Teeth grinding can also increase the
incidence of myofascial trigger points, TMJ, and migraine. You can read more on
this connection here.
In a small study done at Johns Hopkins University, Richard
Allen, PhD, using an MRI, found glutamate, a chemical messenger in the central nervous
system associated with arousal, to be abnormally high in patients with RLS and
the quantity was associated with sleep quality. Maybe not so coincidentally, glutamate levels were also found to be elevated in the muscle of FM patients.
Restless leg syndrome is often misused interchangeably with
periodic limb movement. Periodic limb movement (PLM) is repeated movement of
legs, and sometimes arms, during sleep. While RLS and PLM often occur
together, they are not the same. Restless leg occurs during wakefulness and PLM
occurs during sleep.
In summary, could disrupted sleep patterns, obstructive
sleep function, bruxism, and periodic limb movement, be major contributing
factors to our sleep quality? The answer is yes. And, should all fibromyalgia
and chronic fatigue syndrome (ME/CFS) patients have their sleep evaluated with
a sleep study, not only considering sleep wave progression and presence of
obstructive sleep function, but also a specific assessment for bruxism and PLM?
Sleep deprivation can impede healing, foster agitation, and
when severe, cause psychosis. This might explain why so many of us have
difficulty fighting off viruses and recovering from injury, which is normally
repaired during sleep. The prevalence of
bruxism, RLS and PLM in fibromyalgia is significant and can be factors in sleep
quality which is a primary symptom of fibromyalgia. I felt it so important
that I wrote a couple of letters and advocated with one of the authors of the diagnostic criteria for an
automatic referral for a sleep study.
In light of the significance of sleep in both FM and ME/CFS,
I feel it important to discuss your symptoms with your doctor. They may or may not know the many factors
associated, but most important is to get a sleep study. You could have a
treatable condition that might improve your symptoms overall.
Resources:
Allen RP, Barker PB, Horská A, Earley CJ.
Thalamic glutamate/glutamine in restless legs syndrome: increased and related
to disturbed sleep. Neurology. 2013 May 28;80(22):2028-34. doi:
10.1212/WNL.0b013e318294b3f6. Epub 2013 Apr 26.
Carra MC, Huynh N, Lavigne G. Sleep
bruxism: a comprehensive overview for the dental clinician interested in sleep
medicine. Dent Clin North Am. 2012 Apr;56(2):387-413. doi:
10.1016/j.cden.2012.01.003.
Fernandes G, Franco AL, Gonçalves DA,
Speciali JG, Bigal ME, Camparis CM. Temporomandibular disorders, sleep bruxism,
and primary headaches are mutually associated. J Orofac Pain. 2013
Winter;27(1):14-20. doi: 10.11607/jop.921.
Gerdle B, Larsson B, Forsberg F, Ghafouri
N, Karlsson L, Stensson N, Ghafouri B. Chronic Widespread Pain: Increased
Glutamate and Lactate Concentrations in the Trapezius Muscle and Plasma. Clin J
Pain. 2013 Jul 24. [Epub ahead of print]
Jackson ML, and Bruck D. Sleep
Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review.
J Clin Sleep Med. 2012 December 15; 8(6): 719–728.
doi: 10.5664/jcsm.2276 PMCID:
PMC3501671
van der Zaag J, Naeije M, Wicks DJ,
Hamburger HL, Lobbezoo F. Time-linked concurrence of sleep bruxism, periodic
limb movements, and EEG arousals in sleep bruxers and healthy controls. Clin
Oral Investig. 2013 May 9. [Epub ahead of print]
(Signature line appended, April
2018)
Celeste Cooper, RN / Author, Freelancer, Advocate
Think adversity?-See opportunity!
~ • ~ • ~ • ~ • ~ • ~
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