Fibromyalgia and Insomnia: Recent Study Offers Help and Hope Elisabeth Deffner A new study may offer hope to fibromyalgia patients who suffer from insomnia. Principal investigator Dr. Jack Edinger, clinical professor of psychiatry at Duke University and senior psychologist at the Durham VA Medical Center, has been involved in insomnia treatment since 1982, and has published the results of several insomnia studies. But this one was unique. For the first time, Edinger studied insomniacs who have fibromyalgia. Though the final results of the study will not be determined until around the end of the year, Edinger has already noticed something positive. "I think we can say that we can improve the sleep for these folks, the ones who do have insomnia complaints," he says. "Whether or not that has spin-off for other important fibromyalgia symptoms—we just haven’t gotten there in the data yet. I hope it does." Data was collected from 48 fibromyalgia patients who were randomly assigned to one of three different treatment groups: one in which individuals recorded information about their sleep, pain, and quality of life; one in which they also received instruction in "sleep hygiene" (limiting caffeine and alcohol intake, exercising regularly, maintaining a comfortable bedroom environment, and so on); and one on in which they received cognitive-behavioral insomnia therapy. Cognitive-behavioral therapy, or CBT, included two major components: sleep education and the establishment of a set behavior regimen. Members of this third group learned about sleep requirements, and the fact that each person has a unique sleep requirement; the effects of aging on sleep; and the primary factors that contribute to a good night’s sleep. Their required behavior regimen forced them to practice good sleep habits, like establishing a standardized wake-up time, avoiding daytime naps, getting out of bed if they couldn’t fall asleep, and restricting their time in bed to an individually tailored amount (the individual’s unique sleep requirement plus 30 minutes). In addition to filling out questionnaires about their fibromyalgia pain and their quality of life, members of this group kept a sleep journal in which they recorded when they went to bed, when they woke up, and when they got out of bed. "When people develop insomnia, they typically do not accept it passively; they do something about it," says Edinger. "They think about it [and] do something [logical] about it, [like] sleep in on weekends or take a nap. All these make sense, but [it’s] actually the opposite of what they need to do. They just perpetuate the problem instead of solve it. "The regimen we follow is designed to set the stage for predictable and reliable sleep to return. [Insomniacs] can’t wait till their sleep gets better to change their habits; they have to change their habits first and wait for sleep to catch them." The CBT patients met weekly with a therapist for six weeks, and the study followed them for up to six months of treatment. Because of the need for face-to-face interaction with the study team, all participants live within commuting distance of Duke University in North Carolina. Final results, to be determined by early 2004, will demonstrate how much CBT was able to improve participants’ insomnia.