Fibromyalgia and the Brain: What's Sleep got to do with it?

Purpose of ReviewChronic insomnia and fibromyalgia are highly comorbid. Mounting evidence that sleep is a particularly strong pain predictor combined with the ineffectiveness of current treatments for long-term pain management has increased interest in exploring sleep's role in fibromyalgia. We seek to better understand sleep as a mechanism and intervention target in fibromyalgia.Recent FindingsResearch from the past 3 years found that fibromyalgia patients had distinct polysomnographic characteristics, lower cortisol clearance and disrupted hormonal secretion. A systematic review (N = 4) reported that melatonin had a positive effect on fibromyalgia symptoms. A randomized controlled trial (N = 113) found that cognitive-behavioral treatment for insomnia (CBT-I) improved pain at 6 months. Neuroimaging conducted pre/posttreatment in a subset (N = 39) found that CBT-I decreased brain responsiveness to painful stimuli.SummaryIncreased focus on sleep in fibromyalgia research appears warranted. Sleep interventions may improve fibromyalgia pain by impacting central pain processing. Important next steps include replicating these findings and testing their durability.