As those of you with CFS and fibromyalgia know, getting a decent sleep seems near impossible. Yet, those few rare nights that you do, you feel Sooo much better the next day. Some of you have found a mix of treatments that are giving you your solid eight hours of restful sleep. Others feel like they’ve tried everything and nothing works without leaving them hung over.
In this article, I will give you an overview on how to get eight hours of solid sleep a night—without a hangover. We’ll discuss a mix of lifestyle, natural remedies, and medications. I have had countless people tell me they’ve tried everything, only to find that they barely scratched the surface of what could help them. So have you been longing for a good night sleep? Well here’s how you can get it!
Helpful Medications For Fibromyalgia
Because the sleep disorder of fibromyalgia is very severe, people will usually do best with a mix of natural and prescription sleep aids. For those of you who think you have tried everything, let’s start by having you take a look at the list below.
Most Valium related medications, including Dalmane and Halcion, actually are counterproductive, forcing you into light sleep. Klonopin and Xanax are less likely to do this.For Falling Asleep:
- Ambien (zolpidem) 5 to 10 mg at bedtime with an additional 2 ½ to 5 mg taken during the night as needed is still most effective for this.
For staying asleep.
In order of preference, here are my favorite dozen. I have grouped them based on their mechanism of action. Try different ones in each group to see which feels best within that group, and combine that one with the treatments in other groups. People with fibromyalgia do better, with less side effects, combining a very low dose of several medications rather than using a high dose of one:
- Trazodone (Desyrel) 25 to 50 mg
- Neurontin (gabapentin) 100 to 600 mg or Lyrica (pregabalin) 50 to 250 mg. This also helps restless leg syndrome
- Flexeril (cyclobenzaprine) 2 ½ to 5 mg. Elavil 10 to 25 mg, Remeron 15 to 30 mg, or doxepin 10 to 25 mg can also be helpful but have more side effects
- Benadryl (diphenhydramine) or doxylamine 25–50 mg or Dramamine (no prescription required)
- Zanaflex (tizanidine) 2 to 4 mg
- Klonopin or Xanax ½ to 1 mg
- Belsomra 10 mg
- Xyrem (the physician will need to be familiar with the regulations for this medication)
Still not able to sleep with all of these? You’re still not out of options!
Getting a Great Night Sleep—Start Here
Start with the Basics—Sleep hygiene
The disordered sleep in fibromyalgia is not coming from poor sleep hygiene. It is coming from the hypothalamic sleep center in the brain not functioning properly. Nonetheless, other factors also play a key role in disrupting sleep in fibromyalgia and can be addressed fairly easily. Especially common ones include:
- Waking up at 2 AM because of low blood sugar—take a high protein snack (e.g. a hard-boiled egg, 1 ounce of chicken or fish, or a slice of cheese) at bedtime to see if it helps. Protein helps maintain stable blood sugar levels, where a carbohydrate/ sweet snack will make your problem worse.
- Acid reflux—waking up with heartburn? Keep a special antacid chew called Immediate Heartburn Relief at your bedside. Get the “Sleep Wedge Pillow” at www.Hammacher.com. Also, take half a teaspoon of Arm and Hammer baking soda mixed in four ounces of water at bedtime along with 5 mg of melatonin.
- Night sweats—this can often be helped by treating estrogen, progesterone, and testosterone deficiency as well as Candida (all of these will be discussed in future articles). Night sweats can also be caused by acid reflux and drops in blood sugar.
Natural Remedies for getting a great night sleep
Most of the natural sleep remedies discussed here are not sedating, yet they help you fall asleep and stay in deep sleep. The good news is that many natural remedies that are very effective for sleep also directly help pain because they are also muscle relaxants. The first six herbs listed below are available in a combination formula.
My six favorites natural sleep aids are:
- Theanine, an amino acid (protein) that comes from green tea, has been shown to not just improve deep sleep but also helps people maintain a calm alertness during the day. L-theanine likely plays a role in the formation of gamma amino butyric acid (GABA). Take 50 to 200 mg at bedtime, although it can also be used several times a day for anxiety.
- Wild Lettuce–Traditionally, wild lettuce has been found to alleviate anxiety and insomnia, as well as for headache, muscle, and joint pain. Wild lettuce also helps to calm restlessness and reduces anxiety, and may help calm restless legs. Take 30 to 120 mg at bedtime.
- Lemon balm extract. Take 20—80 mg at bedtime. Research has shown that in combination with Valerian, lemon balm is very helpful for sleep. An added benefit? It even has antiviral properties.
- Hops—The hops plant is a member of the hemp family, and the female flowers are used in beer making. It also has been reported to reduce hot flashes in menopausal women along with having antibiotic and antifungal activity. It has a long history of being used as a mild sedative for anxiety and insomnia and a study showed an improvement in insomnia with effectiveness similar to Valium family medications. It is considered to be very safe. As any beer drinking college student can tell you, it helps your muscles to relax and helps to promote sleep as well! Take 30–120 mg of a hop extract at bedtime.
- Passionflower (Passiflora)—This herb is commonly used throughout South America as a calming agent. Herbalists have also used it to treat muscle spasms, diarrhea, anxiety, and menstrual pain, and it may also increase men’s libidos. Take 90–360 mg of the extract at bedtime.
- Valerian—Valerian is commonly used as a sleep remedy for insomnia. A number of studies show numerous benefits, including an improvement in deep sleep, speed of falling asleep, and quality of sleep without next-day sedation. In these studies, the benefits were most pronounced when people used valerian for extended periods of time, as opposed to simply taking it for one night. Valerian’s effectiveness has been compared to a Valium family medication (Oxazepam), without the “hung-over” feeling present with most Valium medications. For around 10 percent of people, valerian is energizing and may keep them up. If this happens to you, you can use valerian during the day instead of at night, as valerian does have a calming effect. Take 200–800 mg of the extract at bedtime.
Other natural remedies include:
Magnesium. Taking 200 milligrams of magnesium at night can help your sleep. Lower the dose or choose the Jigsaw sustainedrelease magnesium if it causes diarrhea. You can also get magnesium by soaking in a hot tub of water containing two cups of Epsom salts. Make the experience even better by adding a little bit of lavender oil, savor a small amount of the best tasting chocolate you can find, a glass of wine, and add some scented candles to your experience. Rinse off after. Be sure to get out of the tub carefully because soaking can lower blood pressure a bit, and give yourself 30 to 60 minutes to cool down doing something pleasant but boring before going to bed.
Is your mind wide-awake at bedtime?
Turn off your stress hormones so you can sleep! Cortisol helps you deal with stress during the day, but can keep you up at night. Ashwaganda and Magnolia (250 mg each) are stress-busting herbs that can help lower cortisol levels of the stress hormone called cortisol, so your mind can turn off and you can sleep at night.
5 HTP (5 Hydroxytryptophan)—200 to 400 mg at night. Naturally stimulates Serotonin. Don’t take over 250 mg a day if you are on Prozac, Paxil, Zoloft, Desyrel or Celexa. Can help with pain and weight loss at 300 mg a day for at least three months.
Melatonin. This is a sleep-controlling hormone made by the pineal gland. Taking ½ mg is as effective as higher doses for sleep, but the 5–6 mg dose can also decrease bedtime acid reflux.
Isn’t it time for you to be getting a great night sleep?
For those with CFS or fibromyalgia, I invite you to read my book, The Fatigue and Fibromyalgia Solution, if you would like an “easy reading” overview. If you want more detail and the study references, I recommend From Fatigued to Fantastic. Also, do the free Energy Analysis Program at www.endfatigue.com. The free program can analyze your symptoms, and even pertinent labs if available, to tailor a regimen to optimize your energy and help you sleep. In addition, you may want to make an appointment with me for a phone or in person consultation (call Denise or Sarah in the USA at 410-573-5389. I do consults (often by phone) with people worldwide.
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 book From Fatigued to Fantastic! (Avery/Penguin Group), Pain Free 1-2-3 (McGraw-Hill), Three Steps to Happiness: Healing Through Joy (Deva Press 2003), Beat Sugar Addiction NOW! (Fairwinds Press, 2010), and his newest book Real Cause, Real Cure (Rodale Press, July 15, 2011). 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 treatment.