Drugs That Make Rheumatoid Arthritis Worse - And What To Do About It

To cure Rheumatoid Arthritis it is very important to do everything perfectly 'right'. However, many RA sufferers are inadvertently making their RA worse because of a lack of information or by not fully understanding the underlying cause of this disease. So today, to help you on your path to wellness, I would like to warn you about two types of drugs that can make your Rheumatoid Arthritis worse in the long run and give you some simple tools so that you can protect yourself from this problem.

The two drugs that I will discuss below can both have the effect of upsetting your digestive system in the worst possible way. These drugs create turmoil on the healthy bacteria in your intestines (which are called 'probiotics' by the supplement companies) and damage your intestinal wall leading to poor absorption of nutrients and a concept known as 'leaky gut' by Naturopaths. 'Leaky Gut' is actually a descriptive term for having holes in your intestinal wall, which then allows large foreign molecules to enter your blood. These foreign proteins entering your blood can trigger a state of 'molecular mimicry' and result in your body attacking it's own joints in a state of innocent confusion. Quite literally, by having a depleted intestinal environment you will experience worsened symptoms of RA.

So, we need to look at the following two drugs very seriously! Let us first look at Non Steroidal Anti-Inflammatory Drugs (NSAID's)

NSAID's

There are a large range NSAID's that are commonly used to treat arthritis. Research has shown that most of these drugs actually contribute to 'leaky gut' and thus perpetuate Rheumatoid Arthritis through the mechanisms I have described above. The offenders include all the common brands like Advil, Motrin, Naprosyn and so on, with the only exceptions being aspirin and nabumetone (Relafen). [1] It has been shown that these drugs can increase intestinal permeability (holes in the intestinal wall) within 24 hours [2]

My personal experience matches these findings. The first medication I took for my RA was one of the leading NSAID brands. It was fantastic at relieving my pain for about 2 weeks. As time wore on the effects of the drug diminished and so after about 3 weeks I decided to see how I felt once I stopped taking the drug. After stopping this medication I felt about twice as bad as what I was before I started taking it. Looking back I believe that my intestinal wall took a battering during this time, which in turn led to increased swelling and pain.

I learnt most about my body and my food intolerances by remaining off these drugs. These drugs interfere with the critically important communication that occurs, via pain levels, from eating a food and monitoring its effect on your body. By cutting out the pain with a drug I was losing all the information I needed to create a diet free of offending foods.

Since NSAID's are common and are available over the counter we think that they can't be too harmful for us. It couldn't be further from the truth. If you are stuck at the moment on these drugs due to persistent pain levels then that's OK - pain relief and protection from joint damage in the short term is obviously of paramount importance - but I'll show you below some great ways to offset the long term effects whilst you wean yourself off these drugs.

But first, lets look at another drug that is wreaking havoc on your insides:

ANTIBIOTICS

To start our discussion of antibiotics and their effect on the body, we first need to talk about something a little unusual - your intestinal bacteria...

In an ideal state of health you would have between 2-4 pounds of bacteria living inside your intestines in numbers upwards of 40 Trillion. This may sound like the premise of a horror film, but don't freak out, the vast majority of organisms living in there are helpful, or at least not harmful, to our lives. Beneficial Bacteria (also called Probiotics or Microflora) are the good bacteria that live inside us with the majority found between the end of the small intestine and the distal colon. These tiny organisms are absolutely imperative to our health and we should really think of this big mass of mini life as a vital organ like a lung or a kidney.

The many important functions that our bacteria perform for us includes killing harmful bacteria, killing fungus (also known as candida), and building B vitamins for the rest of our body to use. They also help our bodies produce enzymes, help to change the acidity within our cells and play an important role in the development of the immune system by maintaining a constant dialog with our internal bodies through the surface of the gut. Our microflora also influences many of our hormones. So this healthy bacteria is very important stuff.

The word 'biotic' means 'pertaining to life'. Hence a probiotic is literally pro life. Poor eating habits, stress and antibiotics ('anti-life') sometimes found in animal foods can wreak havoc on the good bacteria, allowing bad bacteria to multiply. Taking prescription antibiotics for a long period of time is catastrophic to your internal health. Doses of antibiotics not only kill the nasties, but also kill the good, innocent civilians in your stomach as well. A lack of healthy intestinal flora is a serious concern. I believe the cause of my RA was due mostly to taking antibiotics for years to combat some persistent acne. I blindly took these antibiotics from my late teens through into my early 20's without too much of a thought, other than 'gee, my skin looks good!'. I wish I had some idea of the bigger picture. Little did I know that I was creating an environment where I was wiping out my healthy bacteria, thus allowing unwanted pathogens to thrive. Pioneering orthomolecular researcher Dr F. R. Klenner says RA sufferers have a 'shortage of B vitamins'. [3] Since B-Vitamins are manufactured by your healthy bacteria it stands to reason that if you've killed all your bacteria you'd be short of B-Vitamins!

So How Can You Combat The Effects Of NSAID's and Antibiotics?

Without the correct approach, the challenge to uphold our intestinal health can be a difficult one. You have a leaky gut, a depleted mucosal lining and a shortage of healthy bacteria to rectify. Trust me, you never 'accidentally' fix these without knowing how to, since they don't teach you this stuff in high school (and they don't teach Rheumatologists this stuff at College either unfortunately). However, once you are shown how then it can be understood and followed easily and excellent results can be achieved in a short period of time.

How to replenish your good bacteria?

Well, many companies sell probiotics in bottles which enable you to supplement your supply of good bacteria via capsules. But there is a better and more effective way than this, which is to feed the existing bacteria with their favorite foods which allows their populations to grow naturally, rather than trying to add new guys to the mix. From my own experimentation, I have found that this is the best way to go and it's far cheaper. Let's feed the good bacteria and let them multiply! God knows you've been starving them to death up until this point!

So what do your bacteria want to eat? Good bacteria love fiber. The partially digested remnants of our meals, after arrival in our large intestines, become the foods for our microflora. Each species of bacteria survives best on specific kinds of nutrients. Friendly bacteria love all kinds of plant-food remnants, especially fiber from green leafy vegetables, whilst pathogens thrive when the diet is low in plant foods and high in animal products and processed foods.

What we eat determines the predominance of the bacteria species that will live in our gut. By changing from a diet based on processed foods and animal products to plant foods, you can suppress the growth of harmful bacteria and stimulate those that are beneficial fairly quickly. Major alterations in the microflora take place within one to two weeks of dietary intervention [4] As a treat to your little guys, good bacteria also love raw garlic, raw onion and artichoke.

How to re-establish your mucosal lining?

Eat brown rice. Avoid dairy products like the plague. (In fact, I might send you a whole email about dairy products down the track to give you the full picture. You won't believe the lies we get told about dairy over the years!)

How to heal your leaky gut for Rheumatoid Arthritis?

Think of your intestinal wall like a skin. When you stop irritating it with the wrong foods then it will heal, like any wound on your exterior. So you can replenish your gut flora, heal your mucosal lining and repair your leaky gut all by minimising your intake of meat and dairy products and increase your intake of fiber-rich foods. In particular, eat green leaves, raw garlic, raw onion and artichoke which will replenish your bacteria even faster. Eat brown rice to help heal your mucosal wall. (Avoid white rice, which is junk food compared to brown rice since it has been stripped of most of it's nutrients).

You will make some humble progress on this natural Rheumatoid Arthritis Treatment and help combat the negative internal effects of the drugs.

Remember, your health is your responsibility and consult your doctor before making any changes to your medication. I am not a medical doctor (but I do have a PhD in results!)

Of several remedies, the physician should choose the least sensational - Hippocrates

Your Partner in Healing,

Clint Paddison

Previous RA sufferer, author of the 'Clint's Cure to Rheumatoid Arthritis' program.

Restore Your Health!

References:

[1] Baillieres Clin Rheumatol 10:165, 1996

[2] R.T.Jenkins et al Oxford JournalsMedicine Rheumatology Volume26, Issue2Pp. 103-107

[3] 'A Clinical Guide to Vitamin C', Frederick R. Klenner, M.D

[4] Clin Res 29:754, 1981

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Main Rheumatoid Arthritis Symptoms

Did you know that low back pain is one of the earliest symptoms of arthritis? People over 60 arthritis is the most common cause of low back pain. Osteoarthritis and Rheumatoid Arthritis are the two most common forms of arthritis. Here are the main rheumatoid arthritis symptoms.

Hand and feet joint stiffness in the morning is the main symptom. Often the stiffness will last for more than an hour and the swelling and pain will last more than six weeks. Another common symptom is that rheumatoid is symmetrical so if it's your hands then both will hurt. Tiredness and fever are also a symptoms. Pea sized nodules can sometimes be felt under the skin.

Anemia, fluid accumulation on the ankles and behind the knees, and loss of appetite may be symptomatic of rheumatoid arthritis. In children chills, shaking, and a pink rash can occur.

Rheumatoid arthritis is painful. How this occurs isn't really understood. It's known that cartilage itself doest not cause the pain because there is no nerves to transmit pain signals. It is caused by the irritation of the tissues around the joints. Treatment with NSAIDs helps reduce pain because it stops the production of prostaglandins.

The type of pain rheumatoid arthritis causes can be a result of many conditions including fibromyalgia, chronic fatigue syndrome, autoimmune diseases, and injuries or infection.

How arthritis acts can be very unpredictable and very cyclic. It can stay for awhile then disappear only to reappear. No matter how mild your symptoms if they last for more than 6 weeks they should be checked by a doctor. If they are severe they should be checked much sooner.

More than 7 million Americans suffer from this type of arthritis. In fact it is the most common type affecting 1 in every 5 people in every age group.

The most recognizable symptom of rheumatoid arthritis is the symmetrical way of the pain. Two hands, two knees, two hips, two ankles. In the hands it often affects the proximal interphalagneal and metacarpal phalangeal joints, wrists, and elbows.

One distinction between osteoarthritis and rheumatoid arthritis is that the later can affect your entire body and it can make you feel tired and sick all over. The body's immune system begins attacking the body mistaking it's own tissue for an invasive body.

It sends special white blood cells combined with cytokines which are a toxic chemical to destroy the foreign material. But the trouble is that foreign material is your own body materials.

The reason for this form of arthritis is still not understood and research continues on. One very scary concern with this arthritis is its ability to affect your internal organs like skin, spleen, blood vessels, heart, muscles, and lungs. And the damage causes is irreversible.

Rheumatoid arthritis is diagnosed by a rheumatologist by establish at least 6 weeks of joint pain and inflammation combined with the symptoms. There are also some blood tests that can help. And MRI can be helpful too.

Although there is no cure there are enough treatments available that combined correctly can provide relief and improved quality of life. There's no reason to suffer anymore!

What is Rheumatoid Arthritis?

Rheumatoid arthritis is a systemic autoimmune disease. It is not caused by old age, years of hard work, or injury. In fact, the true cause remains unknown. In this disease, a person's immune system attacks the synovial membranes that cover the joints, causing pain, swelling, heat, and eventual deterioration of the joints.

This disease can onset at any age. When it occurs in children, it is called juvenile rheumatoid arthritis. This form is rarer than adult onset rheumatoid arthritis. When the disease occurs in adults, it occurs more often in women than in men. Rheumatoid arthritis is a chronic disease that progresses over a person's lifetime. Currently there is no cure. Although the cause is unknown, the disease is known to have a strong hereditary component. Prior infections are also suspected to play a roll in the development of this disease.

Symptoms of this disease include pain, swelling, and stiffness in multiple joints. Usually the smaller joints of the body are affected, including the finger and wrist joints, the foot and ankle joints, and the joints in the cervical spine (the neck). Larger joints can also be affected, especially as the disease progresses. Joints on both sides of the body are usually affected, and multiple joints are affected, not just one or two.

When joint swelling occurs, the joints become enlarged and warm to the touch. They may appear red in color. Stiffness is present in the affected joints, especially in the morning. A person may feel stiffness in the joints for an hour or more after getting out of bed in the morning. This makes movement difficult until the stiffness wears off. Other common symptoms a person may experience include fatigue, dry eyes, and skin lesions.

As rheumatoid arthritis progresses, joint deformities may occur. The knuckles of the fingers may deteriorate, causing the tendons of the finger muscles to pull the fingers toward the little finger side of the hands. This deformity is called ulnar drift. Another deformity that can occur is Boutonniere deformity, in which the small joints of the finger deform in a way to appear that the finger is permanently pushing down on a flat surface. The middle joint is flexed and the far joint is extended. A third deformity that can occur is swan neck deformity, where the joints deform in a way that causes the finger to take the shape of a swan's neck. The middle joint is extended and the far joint is flexed.

This disease is diagnosed through physical examination and blood tests. A positive indicator for rheumatoid arthritis is the presence of the rheumatoid factor in the blood. However, the absence of this factor does not mean that a person does not have rheumatoid arthritis. Other substances in the blood and physical symptoms are also used to diagnose this disease. It can take several months and several rounds of tests before the diagnosis of rheumatoid arthritis is determined, as the early symptoms are similar to several other conditions.

Treatment for rheumatoid arthritis includes medications, regular exercise and weight loss, rest, adaptations to protect deteriorating joints, and other interventions such as physical and occupational therapies. Numerous diets and supplements exist to treat this condition as well.

When treating rheumatoid arthritis, a person should work with a rheumatologist, a doctor who specializes in the treatment of arthritis. If a rheumatologist is not available in a person's area or insurance plan, a person should seek a doctor who has experience in arthritis treatment. A person should always discuss new medications and nutritional supplements with this doctor before trying them, as medication reactions are quite common and treatment setbacks might occur if medications and supplements interact. One example involves nutritional supplements that are designed to remove excess fluid from a person's system. These supplements work well in reducing swelling, but may also remove medications that are designed to build up in a person's system over time. The therapeutic effects of the medication may be reduced or eliminated entirely by the supplement. Therefore, while supplements may be effective and valuable in the treatment of rheumatoid arthritis, a person should always check with his or her doctor before trying a new one.

The progressive joint changes that occur in rheumatoid arthritis may force a person to make lifestyle changes to compensate for activities they can no longer do the same way. Energy conservation, joint protection, and work simplification techniques can help a person adapt activities so that he or she can still do what needs to be done in a day. Please refer to additional articles in this series for descriptions of these techniques.

Real Help for Rheumatoid Arthritis

Rheumatoid Arthritis is a crippling inflammatory condition that causes deterioration of the joints, especially of the hands, feet and knees. It generally affects both sides of the body simultaneously. Persons can be known to be fine one day in an area, yet be troubled by that joint the next day. Now there is real help with alternative healing methods.

The symptoms of rheumatoid arthritis are varied:

-aching and stiffness in a joint

-loss of range of motion in the affected joint

-the muscles near the joint are weakened

-joint deformity as the joint deteriorates

-rheumatoid nodules that form under the skin near the joint

Rheumatoid arthritis is an autoimmune disease resulting from a weakened immune system, resulting in the tissues and joints being attacked by the persons own body. If left untreated the joint breaks down and becomes destroyed over time. The need for joint replacement surgery is about the only thing that a person can do if this happens.

Alternative medicine for rheumatitis can help to rebuild and restore damaged joints and also remove the pain of inflammation that is caused by too much arachidonic acid in the body. A small change in diet, according to Dr. Floyd Chilton in his book entitled "Winning the War Within" which includes a minimum of 4 to 5 servings of the right seafood or cold water fish a week, along with enough omega 3 oil;(at least 600mg.) and 600 mg. to 1000 mg. borage oil per day will help eradicate this debilitating condition. The condition, if left untreated, will only get worse. Joints will continue to deteriorate until bone is touching bone; the pain becoming unbearable.

Fortunately there is real help out there for arthritis sufferers. As you can see, there are many natural food supplements that can help with this condition and perhaps leave you pain free.

Arthritis Inflammation Symptoms, Treatments

When you suffer from arthritis, you experience severe inflammation in your one or more joints. Injuries, fractures, dislocations and the resurfacing of old injuries are the factors that can lead to joint inflammation.

While injuries and infection may trigger inflammation, the most common cause is arthritis. There are hundred kinds of arthritis but not all types cause inflammation. The most common arthritis types associated with inflammation include:

Rheumatoid Arthritis
It is an autoimmune disease in which the body's immune system attacks the joints causing painful inflammation in joints. The most common symptoms are joint pain, swelling, stiffness, tiredness, depression, and anaemia. Some patients also develop flu-like symptoms, such as feeling ill, feeling hot and sweating.

Some less common symptoms of rheumatoid arthritis include inflammation in the eyes, rheumatoid nodules and weight loss. In rare cases inflammation may occur in other body parts, namely lungs and blood vessels and the membrane around your heart.

The initial treatment options available for rheumatoid arthritis are physical therapies and anti-rheumatic drugs- painkillers (analgesics), non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs) and steroids.

In cases where body joints give severe pain, stiffness and immobility replacement surgeries like knee replacement hip replacement may be needed.

Psoriatic Arthritis
This arthritic condition causes painful inflammation in and around body joints and tendons. Symptoms of this condition include inflammation in your spine (spondylitis) causing stiffness in back or neck, swelling in and around your fingers or toes (dactylitis), buttock pain, inflammation where tendons attach to bone (enthesitis) causing pain and swelling in your heels, knee, hip bones and chest.

NSAIDs and DMARDs are most often used to treat psoriatic arthritis. In very rare occasions, surgery is used to repair damaged tendon. The joint that has been long damaged by inflammation is best treated with joint replacement surgery.

Gouty Arthritis
Gout is considered as the most painful form of inflammatory arthritis. The symptoms of gout are caused by abnormally high level of uric acid that builds up and forms crystals in the joints, which can lead to recurring attacks of joint inflammation. Gout most commonly affects the small joint at the base of the big toe but it affects other joints as well, including the ankles, knees, fingers, wrists, and elbows.

Symptoms of gout usually include intensely painful and swollen joints, redness and warmth on the affected joint and red or purple skin around the joint.

Treating the gout usually involves either anti-inflammatory drugs or steroids that can help reduce the pain and inflammation of gout attacks. Some certain medications decrease the level of uric acid in the bloodstream. Many gout patients turn to natural methods to reduce the risk of future gout attacks. In order to prevent gout flares you should modify your diets- avoid overindulgence in meat, seafood and alcohol; and drink more water- consume beverages that contain more water. Losing weight, following a moderate exercise regimen and taking supplements can be of great help.

Systemic Lupus Erythematosus (SLE)
Also referred to as Lupus, it is an autoimmune disease in which the body's natural defense system attacks healthy body cells and tissues. This inappropriate response of body's immune system causes inflammation which in turn leads to pain, swelling and tissue damage throughout the body.

Some lupus sufferers develop only mild symptoms, including tiredness, joint pain, swelling (arthritis) and fever. In some cases skin rash, hair loss and mouth sores can also occur. The times when symptoms get worse the patients may experience problems with the heart, kidneys, blood cells, lungs, or nervous system.

Lupus can be best treated by taking nonsteroidal anti-inflammatory drugs and applying medicated cream for rashes. Taking proper rest, avoiding the sun and regular exercise can help you cope with the condition.

Managing Rheumatoid Arthritis - Five Steps to Manage RA Pain

To avoid preventable joint strain and added rheumatoid arthritis discomfort, try to follow these five useful steps. Remember, Rheumatoid Arthritis is an incurable disease, its not going to disappear, its not going to get better However, it can be managed effectively.

Step One: Mobilize every joint throughout its complete pain-free range of movement at least one time a day

This will help you keep liberty of movement in your joints. The volume you're able to Mobilize every joint devoid of rheumatoid arthritis pain may change daily be careful not to do too much. Keep activities gradual and smooth abrupt jerking or bending can cause pain your joints.

Steer clear of leaving your joints in the same position for a lengthy amount of time. Don't allow your joints the possibility to grow to be rigid, keep them mobile. After writing or doing handiwork, loosen your hold every 10 to 15 minutes, or as soon as your hand feels tired. On lengthy car journeys, exit the car, relax and walk about at least each hour. During watching tv, stand up and move around every half an hour.

Step Two: Try to understand and have respect for your rheumatoid arthritis discomfort

Understand the differences involving the common soreness of rheumatoid arthritis and the tenderness from overworking a joint. By knowing the movement that overworked a joint, you can keep away from continuing that motion. Pain that remains for more than an hour following an activity may suggest that the activity was too demanding. Consider ways that you can change the activity.

Exert yourself at a steady, careful pace and steer clear of hurrying. Rest before you become tired or in pain. Switch between easier or more difficult activities all through the day. And make use of occasional relaxation breaks.

Step Three: Use sensible body mechanics

The way you posture your body greatly changes how much stress you place on your joints. True body mechanics enable you to use your body more effectively and save energy. When you're sitting down, the correct height for a working surface is 2 inches lower than your cocked elbow.

If you type at a computer for extended lengths of time and your chair doesn't boast arms, think about using wrist or forearm supports. An angled working area for reading and writing is more helpful on your neckline. When you're standing, the height of your working area should allow you to work in comfort without lowering the head. To pick up objects from the floor,lower yourself by bending your knees and hips.

Hold weighty items close to your body, sustaining the load on your forearms, and keep up good balance. Poor posture creates uneven load distribution and can stress your ligaments and muscles.

Step Four: Be sensible how you use your hands

You use your fingers in several daily pastimes. Demanding positions and techniques may intensify the threat of pain. You can complete most tasks in more helpful ways with the aim to put a reduced amount of deforming pressures on your joints.

Keep away from situations that bend your other fingers in the direction of your little finger. As an example, steer clear of tasks that need stressful or lengthy gripping or clamping. Finger movements should be in the direction of your thumb when feasible. Avoid forming a clenched fist. Use utensils with ergonomically formed handles, that yield them more helpful to clutch.

Step Five: Make use of the strongest joint available for the task

Save your less strong joints for the particular tasks which only they can carry out. During the day, choose large joints. For example, hold objects with your palm wide open, distributing the burden equally above your forearm. Slide items across a counter instead of lifting them. When opening cabinets or weighty doors, use a strap that you can draw with your wrist or forearm to lower strains on your fingers.

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.

Conclusion

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?"