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Wed, Nov. 20

Studies show a link between sleep disorders and fibromyalgia

Dear Dr. Rosenberg:

I have fibromyalgia and chronic fatigue syndrome. My husband says I snore and sometimes I even wake myself up from snoring. I read in Prevention Magazine that there may be some relationship between sleep and fibromyalgia. Is this true?

A: Yes, it is true. One of the characteristic findings of fibromyalgia is that most patients feel they sleep poorly. They complain about feeling fatigued when they awaken. Until recently, we attributed the disruption of sleep to pain. However, recent studies have shown that a disproportionate number of fibromyal-gia patients may have a breathing-related sleep disorder. Several studies have shown a particular form of breathing abnormality called upper airway resistance syndrome. In this condition, the airway does not close completely, but closes enough to require an increased effort to breathe. This results in repetitive, short arousals from sleep, all night long. When patients with this disorder were studied and treated with CPAP or oral dental appliances to keep their airways open, their pain levels dropped significantly and their daytime fatigue improved.

Dear Dr. Rosenberg:

I have been feeling sleepy and fatigued for about 2 months. I am 64 years old and attributed this to my age. Recently, I have noticed that heartburn wakes me up 2 to 3 times a week. I have been using Tums for some time now. Do you think there could be a relationship between heartburn and waking up in the middle of the night?

A: Yes. What you are describing is referred to as Nocturnal GERD, or nighttime heartburn. A recent study in the Journal of Clinical Sleep Medicine showed that these episodes may be very disruptive to sleep. In fact, 90 percent of these episodes caused brief and frequent arousals from sleep, of which the subject had no recollection in the morning. These subjects evidenced fatigue and sleepiness. You should mention this to your primary care provider.

Dear Dr. Rosenberg:

I had a sleep study performed and was diagnosed with sleep apnea. I was then asked to return to the sleep lab for a second study to determine the level of CPAP required in order to treat this condition. I was surprised when a third study was requested. Apparently, I have what they call "complex sleep apnea," which requires a different type of machine other than a CPAP. What is this condition and why couldn't they get it right in the first place?

A: Complex sleep apnea is a newly described form of sleep apnea. Basically, about 10 to 15 percent of patients, when placed on CPAP, have episodes in which they stop breathing, and make no effort to breathe. It is as if they forget to take a breath. These events are called central sleep apneas, as opposed to the more common obstructive sleep apneas. Central apneas turn out to be just as disruptive to sleep as obstructive apneas and cannot be treated with CPAP alone.

There is a new form of treatment for complex sleep apnea called adaptive servo ventilation. It is not unusual to have to return to the sleep lab for a third study with this new device. It is a small unit that delivers pressure, just like CPAP. However, it eliminates both types of breathing-related sleep abnormalities - central and obstructive apneas. Most of the research on this new machine is from Mayo Clinic. This is probably what you will be treated with when you return for your third study.

Dear Dr. Rosenberg:

I have had epilepsy for 10 years. Recently my seizures have not been well controlled with my medications. My husband came with me to my last doctor's appointment and mentioned that I snore. Now my neurologist would like me to get a sleep study. He told us there may be a relationship between snoring and the increase in seizure activity. What do you think?

A: I think your neurologist is on to something. Recent studies have shown a remarkable increase in the incidence of sleep apnea in epileptic patients who are not responding to their medication. In fact, in one study, a third of patients with treatment-resistant seizures were found to have sleep apnea. More importantly, there was a 45 percent reduction in seizure frequency when their sleep apnea was treated. I most definitely agree with your physician's advice to obtain a sleep study. If in fact you have sleep apnea, then, with CPAP treatments, you may be able to avoid additional medications.

Dr. Rosenberg will answer questions by incorporating them in future columns. Contact him at or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Dr., Prescott Valley, AZ 86314.

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