Sleep Management and Medication Options in Fibromyalgia

Sleep deprivation produces hyperalgesia and allodynia in healthy people, and poor sleepers report more night pain, depression, anxiety and disability. Cognitive behavioral therapy for insomnia is the gold standard, with a review of 14 trials showing an 81% chance of better sleep and improved pain in more than half, but access is limited. Will's service uses a three-week trial of a wearable or phone app to look for patterns in superficial, fragmented sleep with reduced REM and slow wave sleep, before testing sleep hygiene changes, over-the-counter aids or amitriptyline. Seeing the data can persuade reluctant patients to continue a treatment. Medication should come after other strategies. Opioids help only 20 to 30% of patients with chronic pain, and stopping them needs a gradual taper. The 2021 EULAR recommendations give weak support for low-dose amitriptyline, duloxetine and tramadol, while the 2021 NICE guidance advises against opioids and gabapentinoids for chronic pain. He outlines the five rights of prescribing and recent UK data showing more use of amitriptyline, nortriptyline and duloxetine.