Sleep apnea also disproportionately affects many patients with chronic pain. In fact, Ms. Cralle says a particular variant of sleep apnea called upper airway resistance syndrome is very common in women with fibromyalgia, and the incidence of RLS has been found to affect 46–80% of patients with fibromyalgia. Diagnosing and treating the sleep disorder has been shown to improve both fatigue and pain in fibromyalgia patients.
To obtain a diagnosis of sleep apnea, Ms. Cralle says patients are given a test called a polysomnogram. Once traditionally offered only in sleep labs, there are now devices that allow patients to test for sleep apnea in the comfort of their own homes.
If a patient is diagnosed with sleep apnea, they are often prescribed continuous positive airway pressure (CPAP) therapy. CPAP patients sleep wearing a small mask that covers the nose and/or mouth and is connected to a shoebox-size machine by a flexible tube. Gentle air pressure continuously flows through the tube, holding the airway open and allowing patients to breathe normally.
Although CPAP is a highly effective treatment, some patients have problems adjusting to sleeping with the CPAP mask.
“Cognitive-behavior treatments have been found to be the most effective way to improve CPAP use and reduce CPAP discontinuation,” Dr. Gentry says.
Nonpharmacologic Treatments for Insomnia
If a sleep study shows that a patient doesn’t have sleep apnea, there is still a lot that can be done to address their insomnia, says Dr. Gentry, who receives many physician referrals for patients suffering from long-term insomnia.
At her offices in Reno, Dr. Gentry uses cognitive-behavior therapy for insomnia (CBT-I) to treat insomnia, a technique the American Academy of Sleep Medicine and the National Institutes of Health recommend as the standard treatment for insomnia. CBT-I, she notes, is different from regular cognitive-behavior therapy, which doesn’t always work for insomnia. However, CBT-I has proved effective in treating patients with comorbid health problems, chronic pain and depression.
Rheumatologists making referrals to sleep specialists should ensure that specialist has been trained in CBT-I. The American Board of Sleep Medicine has a list of specialists trained in this area, as does the Society for Behavioral Sleep Medicine.
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“While sleep medications and antidepressants are commonly used for treatment of insomnia, sleep problems can continue to persist,” Dr. Gentry says. “Typically, it takes three to five sessions with a sleep specialist trained in CBT-I to get to the root causes of a patient’s sleeplessness to effectively treat their insomnia.”