Sleep Disturbance in a Selection of Medical Disorders

Not only may this EEG pattern be indicative of nonrestorative sleep, it may also be related to pain sensations. Three of six healthy, non-FM subjects underwent a sleep deprivation induction trial marked by the presentation of auditory stimuli during delta sleep (24). As a result, they experienced greater muscular ten- 

In a study examining pulmonary function, Sergi et al. (29) reported an increased incidence of periodic breathing in FM patients relative to normal controls, due to decreased transfer factors for carbon monoxide. The authors conclude that this may account for the daytime sequelae of FM patients, as opposed to the changes in sleep architecture reported above. 

Further sleep disturbance in FM may be related to increased incidence of periodic limb movements in sleep, restless legs syndrome, or the presence of comorbid depression. Consequently, given that a number of factors contribute to the sleep disturbance in FM, it would appear prudent to undertake a multifactorial approach to best understand sleep complaints and daytime symptoms of FM patients. Consistent with this notion, the interaction between psychological variables, such as cognitive appraisals of pain and sleep, as well as emotional reactions ought to be more carefully examined to best understand this complex syndrome. 

Pharmacotherapy. Despite the ambiguity around FM, antidepressants are a reasonable pharmacological candidate for treating FM for the following reasons (a) depression is thought to mediate depressive symptoms (b) as noted above, serotonin may underlie the pathophysiology of FM and (c) tricyclic antidepressants tend to be efficacious in treating pain (39). Data from meta-analytic 

Perhaps the role of cognitive-behavioral treatments ought to be tested, as both depression and chronic pain tend to be responsive to cognitive and behavioral interventions. To our knowledge, very few, if any, treatments have studied the combined effects of pharmacotherapy and behavioral or physical therapies. Given the complex nature of FM, a multifactorial approach may be the most effective (40) and an important area to explore with more scientific rigor. 

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