Polysomnography: One Tool in Helping in the Diagnosis and Treatment of Fibromyalgia
Stop! and imagine for one moment that your body is being savagely and brutally attacked by chronic pain. This pain is so intense that you become less active. As you become less active you start to develop muscles weakness. Just trying to do normal daily activities such as, working, housekeeping, cooking, playing with the kids, shopping, walking the dog and sleeping has become an extreme ordeal. All is not peaceful in the Land of Nod. In fact, you as a fibromyalgia (FM) sufferer are downright restless.
As of this writing, fibromyalgia is the most misdiagnosed and misunderstood syndrome of the 21 century. Because it mimics other diseases and conditions, many people with FM initially have often been diagnosed as having multiple sclerosis, scleraderma, rheumatoid arthritis or lupus. Fibromyalgia has also been closely associated with chronic fatigue syndrome, it shares many of the same qualities.
Since so many fibromyalgia sufferers have been misdiagnosed, experts have categorized fibromyalgia as a syndrome rather than a disease. A syndrome is defined as "an aggregated of signs and symptoms associated with any morbid process."
Although it does occur in men, women in their late 40's and older are at least four times more likely to develop the disorder.
Pain, it is the most common symptom and complaint of the FM sufferer. Some people experience pain, fatigue, muscle stiffness and swelling in their joints, especially in the morning. This stiffness can be quite distinct and be accompanied by pain in key areas of the body, usually in the neck, shoulder, lower back and buttoch.
Irritable bowel syndrome has been reported in approximately 40-70 percent of these patients. It is not unusual for those afflicted to have diarrhea, constipation or a frequent need to empty their bladder. Fatigue and restlessness in FM patients can cause poor concentration, memory loss, non-restorative sleep and secondary endocrine malfunction involving the hypothalamic pituitary and adrenal glands.
Approximately 50 percent of FM sufferers experience some sort of increase sensitivity to stimuli, such as, flashing lights (photophobia), increase sounds (phonophobia), and varies odors.# Some patients often present with a chronic runny nose, congested head cold, and a throat clearing cough. Another common complaint is restless leg syndrome. When a FM sufferer presents to their doctor their are two things they want more than anything in this whole wide world. They want their pain alleviated and one of the greatest pleasures known to all creatures, the ability to get a good night of rest and sleep.
Fibromyalgia and Sleep
Sleep is vital to our very existence, it is during sleep that our temperature decreases conserving energy, sugars are stored for future use, our immune system is blasted into action and growth hormones are released fostering the repair of cells and tissues.# That important journey into sleep is a beautiful time for our bodies and brains to heal themselves from the vigorous wear and tear of daily living. But, numerous studies have been conducted which reveal that persons with fibromyalgia have a sleep disturbance that prevents them from receiving these healing powers. Many physicians are unaware of the importance of getting a sleep study done on their FM patients.
Here's what we know, a landmark study published in 1975 discovered that 70 percent of patients with FM had NREM (non-rapid eye movement) stages of sleep "contaminated" by an abnormal EEG pattern called alpha-delta sleep, in which incurrent alpha waves (seen when you are awake) are riding on large, slow delta waves. This constant alpha-delta intrusion robs the body of deep sleep (stage 3 and 4 sleep).# It is during this stage of sleep that our body is being repaired. There is also some evidence indicating that fibromyalgia syndrome and sleep disorders are intimately related, but know one is certain which causes the other. Many FM sufferers exhibit bruxism (tooth-grinding), periodic limb movement (PLM), and obstructive sleep apnea (OSA). The absence of stage 3 and 4 sleep in FM can also cause chronic sleep deprivation and may contribute to the rapid physical decline many doctors see in their patients.
Diagnosing FM is not an easy task. To actually receive a diagnosis of fibromyalgia, the American College of Rheumatology, identified 18 separate points on the body called "tender points," by applying pressure with the index, third and fourth fingers of the examiner's hand at nine key bilateral surface sites. These include the side of the hip joint, and buttock and the inside of the knee.
In addition, the patient must complain of widespread pain lasting at a duration of 3 months or more. the pain must be radiating on both sides of the body, and be above and below the waist.
Fibromyalgia and the Polygragh
There is no cure for fibromyalgia. The only relief FM sufferers can hope for is the treatment of their symptoms. Majority of FM patients complain that no matter how long they sleep, it is never restful. Their sleep may be interrupted by frequent awakenings, or they wake up gasping for air, or in pain. Even more common most patients complain of waking up day after day feeling exhausted.
Many of the symptoms that FM patients experience are shared by those with other sleep disorders. As sleep care professionals, we do know the symptoms. Now we must raise awareness to patient and doctors treating FM, that their lack of sleep can be caused by so many factors. Such as, pain, sleep apnea, PLM and bruxism.
But how, (you ask) would a doctor know for sure in a patient complaining of sleep deprivation that their lack of sleep is because of pure fibromyalgia verses fibromyalgia overlap with another sleep disorder?
Here's your answer, "Polysomnography." The polygraph can be used as one of the tools to help doctors battle the problem. In order for you to better understand how fibromyalgia works in sleep. I invite you to come along with me and peek in on the inner workings of the fibromyalgic brain.
I had been working in sleep medicine as a polysomnography technician for only six months when I saw my first client with fibromyalgia. LT was a forty-eight years old female, mildly over-weight and in poor overall health. Her chief complaint was, (Yep you guess it), pain and lack of sleep.
I meticulously place each EEG electrode on her scalp making sure I properly prep and measure each site. I attached two effort belts, one on her chest, the other on her abdomen. Leads where placed near her eyes and chin. Leads where places on her legs, and EKG leads where placed on her chest. A thermistor airfow was placed at her nares and a pulse oximeter probe on her finger. The setup procedure took about an hour, to pass the time away she and I "chatted" about our families and recent news events
Once in bed the client was hooked up to the EEG machine and monitor. She was allowed to watch a little television around 10:30 PM she started getting sleepy. She lets out one big yawn and shuffled between the covers. On the computer screen I notice LT is drifting in and out of sleep (microsleep). She's not totally asleep yet, but her body is relaxing and preparing itself for sleep. It is during this time that her body temperature drops, and her pineal gland at the base of her skull is slowly releasing melatonin in her bloodstream, signaling to her brain that it's time to make that wonderful transition into sleep.
Now this is where the fun for me as a sleep technologist begins. On a computer screen I get to observe all the wonderful electrical activities of the brain. When she was awake I observed those fast, low-voltage type of brain waves called beta waves. But as she closed her eyes, the waves change to a slow-high voltage brain rhythm called alpha waves. Alpha waves danced across the screen for several more minutes, then suddenly right before my eyes the alpha waves were quickly replaced by a new wave pattern called theta. Her mind is no longer thinking about her day, LT has now drifted from a state of conscious wakefulness to that wonderful abyss called stage 1 sleep.
Stage 1 sleep is the lightest stage of sleep. Considered transitional sleep, stage 1 will move LT into a deeper and rewarding sleep state. Her eyes began to roll slightly from side to side, she no longer hear the sounds of cars and trucks passing her window. Or the mild humming noise coming from the fan. But yet if I where to enter her room and lightly touch her arm, she would be easily aroused and not have a sense that she had been sleeping at all.
After 5-7 minutes in stage 1 sleep, LT slowly enters stage 2, during this stage of sleep two identifiable sleep-specific wave forms pop on the screen. Sleep spindles and K-complexes, these are two beautiful wave forms floating across the polygragh. I love vintage cars so every time I look at a sleep spindle, I am reminded of old spoke tires on a ford Model T. K-complexes are quite different then a sleep spindle, it is a super large wave form that appears seconds before a sleep spindle, and looks like the QRS complex on a EKG tracing, with a well delineated negative upward spike which is immediately followed by a positive downward spike. Both of these wave forms appear and disappear across the screen in seconds. LT's legs begins to twitched several times. She now is definitely showing signs of PLM.
15 minutes later she falls into stage 3 sleep or deep sleep. In stage 3 sleep she is not easily aroused. In this stage of sleep between 20-50 percent of the waves are transformed into delta waves. Over size slow tee-pee shape waves ripple across the EEG computer and appear again and again. When all of a sudden (out of the blue) delta waves are constantly being bombarded by alpha waves. Until finally for every delta wave seen an alpha wave intrudes on its territory. LT is no longer asleep, the alpha-delta intrusion causes her eyes to pop open. After twenty minutes staring at the ceiling, she then takes her first bathroom break, why not, her restful sleep has been interrupted.
Once in bed, her sleep debt built up from her arousal causes her to fall quickly back into stage 1 sleep again. Throughout the night she will repeatedly travel up and down the stages of sleep, never reaching stage 4 or REM sleep because of alpha-delta intrusion and PLM. This constant interruption in her sleep can hamper the proper release of serotonin, (which is necessary for the activation of an important immune system cell called "natural killer cells")# and growth hormones that aide in rebuilding damage cells. LT's sleep test ends at 6:00 AM, she had several complaints from being tired, to increase pain, to being unhappy. these are all typical complaints of a FM sufferer.
A trained and experienced polysomnographic technologist then analyzed and scored LT's sleep data. The report indicated she had frequent leg movements in stage 1 and 2 sleep, consistent with the disorder premature leg movement (PLM), along with frequent arousals and alpha-delta intrusion.
A month later, a follow-up phone call was conducted by the sleep center. Therapy for LT included low dose anti-depressant, physical fitness training and benzodiazepines such as clonazepam which help in promoting better sleep, by relaxing skeletal muscles and reducing her premature leg movements. Every fibromyalgia patient is different and may require a different individualized treatment, (some patients may suffer from sleep apnea or bruxism.) But, for LT these combination of treatment seemed to help and she was happy with the outcome.
I hope this small glimpse into fibromyalgia will help explain why patients need and will benefit from a sleep center. Precise diagnosis is essential to establish the existence of fibromyalgia and distinguish this disease from other sleep disorders. Once the diagnosis is made, a multifaceted approach is then required to ensure healing and restful sleep.
The consequences of fibromyalgia can be significant for those affected as well as bed partners and family members. Although many patients try to self-manage their lack of sleep, most will eventually seek treatment if symptoms are progressive and/or unrelenting. I extend this one challenge to every doctor and that is to ask their fibromyalgia patient one question, "How are you sleeping?"
Shirise J. Wilson is a health professional and founder of cpapcompare.com, where you can find great information on snoring and sleep apnea products. Here newest ebook is FREE.
This ebook could save your life. Discover the Insider Secrets of How to Stop Your Snoring in the Privacy and Comfort of Your Own Home...The ebook is FREE. http://cpapcompare.com/STOPSNORING!!.html
Your Kidney Function Really Matters: A Lighter Look at What You Need to Know to Prevent Adverse Dru
When you (or loved ones) are taking prescription or over the counter medications...there is a lot you should be worried about, and a lot that your pharmacist may not be telling you.
Seroquel Side Effects: Effects of Seroquel Worth the Risk?
Seroquel is an atypical antipsychotic drug that is used to treat hallucinations, delusions and confusion caused by psychotic conditions such as bipolar disorder and schizophrenia. Atypical antipsychotics are not SSRIs (selective serotonin reuptake inhibitors) or benzodiazepines. Atypical antipsychotics like Seroquel affect only certain parts of the brain, blocking the input of serotonin, dopamine, norepinephrine, histamine, and muscarine. The benefit to atypical antipsychotics is that they are non-habit forming and are not as frequently abused as normal antipsychotics.
4 Reasons Why You Should Use Canadian Pharmacies
Let's face it: purchasing prescription drugs in the U.S. can be a costly undertaking. By filling your prescriptions online through Canadian pharmacies, your savings can be substantial. Here's why you should consider having your drugs shipped to your home from Canada:
rX My Heart and Hope to Die
This must be a mistake! How could his drug costs rise from $150 a month to $1101 in just three weeks? My hands shook while I read the pharmacy bill.
Bextra Recall: Lawyer Says Help Is On The Way
By now, you have probably heard of the prescription drug Bextra. You may not know, however, why that a recall is in order. The reason is quite simple. The FDA has asked Pfizer to withdraw Bextra from the market because of increased risks of heart attack and stroke.
Death by Fluoride
A wee bit of fluoride makes teeth and dentists happy, we're told. Dr. Happy Tooth's smiley face turns into a frown when his favorite decay buster is busted as a killer. Anything in large doses kills, bristles Drill & Fill, DDS, even Dihydrogen Monoxide, they often tease. Ha, ha, get it ? water ? H2O. Stop picking on fluoride, they say, you make us look bad.
Anxiety Management With Prescription BuSpar: Don?t Worry, Be Happy
We've all had one of those weeks: the washing machine overflows, the dog forgets his housetraining and the toddler her toilet training, the boss is going through a divorce and making everyone miserable. And you feel like you just don't know how to handle it all.
What Not to Tell Your Doctor?
For many years since medicine has been established as an ethical profession and gained widespread credence people have believed that they could and should tell their doctor everything even remotely pertinent to their health and that it was held in the strictest confidence. Furthermore, how can the physician make accurate judgments when important or significant information is missing? This system worked very well until relatively recently but there now exists a breach of this confidence that people should know about and this breach has developed from the advent of third party investigations into people's backgrounds. Your medical records are no longer confidential because you are forced to reveal them. Let us look at some scenarios.
CRP And Your Heart
Monitoring your CRP level is vitally important because it is one of the best indicators of heart disease. C-Reactive Protein has proven to be one of the best indicators of looming Heart disease.
Three Questions People Are Asking About Health Care in America
Q. Why is there so may uninsured people in America?
Thimerosal: Autism and Mercury Poisoning Side Effects?
Thimerosal is a preservative that is added to vaccines (has been since the 1930s) that is almost half (49.6% by weight) mercury. Preservatives are added to vaccines to prevent bacteria and fungi from growing. These vaccines include antivenins, skin test antigens, ophthalmic and nasal products. Thimerosal preserved vaccines have been given to children as well as adults.
Living Migraine Free
Don't treat your migraines, prevent them. A life without migraines is obtainable, I know. I was a migraine sufferer for 12 years and have been treating... preventing them for my patients for 15 years. The 95+% success rate achieved at my office comes from a combination of research, common sense and the hard work of my patients.
The Lower Cost Prescription Drug Alternative
Today in the United States, there are hundreds of thousands of people who do not have and cannot afford adequate health care coverage. Sadly, many must pay out of pocket for medical treatment of any kind, not to mention much needed prescriptions. These expenses can add up quickly and are usually very costly. Consumers often find themselves cutting back on other expenses, in order to pay for medical procedures and medication. Oftentimes they are forced to go without.
The Neurological Exam: Evaluating the Master Organ
How does a mind contemplate itself? That's a philosophical question I'll leave to minds smarter than mine, but what I can tell you is how to examine the brain and other parts of the nervous system.
New Company Helps Another Medical Condition Become: ?Acceptable? Dinner Conversation
Recently once taboo subjects like plastic surgery have become acceptable dinner conversation. Medical conditions are no longer whispered to friends, but have instead become part of the dinner table conversation with full blown discussions on Botox, erectile dysfunction and the feared colonoscopy. However recently there is a new kid on the block, well maybe not so new, it's actually plain old heel pain. You might ask why is this happening? Why is it so important now? After all heel pain for the most part won't kill you.
Accutane Side Effects Lawyer: Hair Loss, Depression, Suicide
You probably know the drug isotretinoin by its trade name, accutane. Accutane is a powerful drug often used to treat acne. Unlike other acne treatments, which are simply antibacterial agents, accutane actually changes the composition of the skin. Accutane causes skin to produce less oil, which almost always results in a reduction of acne. Accutane is very powerful and effective, but this comes with some very dangerous side effects that everybody should be aware of. If used or administered improperly, accutane can do more harm than good.
Stevens Johnson Syndrome (SJS) is a severe and deadly allergic reaction to certain drugs, some proscription and some over the counter, which causes the severe burning of skin and mucosal membranes from the inside out. 15% of people who develop Stevens Johnson Syndrome will die as a direct result. Many drugs which have been known to cause SJS do not have warning labels notifying users about the very real danger of Stevens Johnson Syndrome. If you or a loved one has SJS, a Stevens Johnson Syndrome lawyer can help you receive financial compensation.
Modern Medicine Has Extended Life - BUT 9 Out of 10 People Say Its a Miserable Extension!
Sit down in a quiet place alone and take a minute to notice how you really feel inside and out? Would you consider yourself in good health or living a slow death you call life? As you sit quietly observing yourself, pay attention to the signs and symptoms of your body. Notice the things you've been ignoring such as a low-grade headache that rarely ceases, aching joints, slightly blurred vision, a bulging stomach, sagging chin, no zest for life or maybe a definite feeling of being bone tired and constantly in pain somewhere.
Interactive Technology in Healthcare Education
Healthcare professionals are under pressure to remember, utilize and absorb vast amounts of new or changing information in increasing volume. This surge has led to new and improved computer-based tools for many healthcare activities and to an explosion in the marketplace of tools used in instruction and education of healthcare workers. This article explains the use of interactive technology in healthcare and how this benefits instruction and education of healthcare professionals.
Medical Billing Specialist
As Pres. Bush was touring the Midwest, shortly before he was re-elected as President, and even after, he spoke of medical reform centering on liability costs. He called it "defensive medicine." Searching for a good medical billing specialist who is familiar with reliable electronic medical record systems is quite possibly one of the best defensive medicines that consumers and practices can employ. I say that because small practices spend an average of $150,000 per year in liability costs. That may include insurance or even law suits. Consumers may also have to fit the liability bill if things get ugly.
|home | site map|