“Despite the fact that people spend one-third of their lives asleep, the function of sleep is unclear and the mechanisms underlying its capacities for physical and mental restoration are poorly understood,�?says Dianne Lorton, Ph.D., of Sun Health Research Institute of Sun City, AZ.* Adding that sleep involves a complex “cross-talk�?between the brain and the immune system, more specifically your glial cells that produce immune substances called cytokines to regulate your sleep and wake periods.

Most people think their brain controls their sleep. While this is technically correct, the glial cells from your immune system and not your neurons, are in charge of orchestrating sleep. More than 70% of the cells in your brain and spinal cord are made up of glia, but only in the past 15 years did scientists begin to realize that these cells were not just innocent bystanders in the development of chronic pain or sleep disorders. As you will read in the January 2008 Journal, researchers are getting closer to understanding how glia might be the cause of chronic pain conditions like FM. Their role in sleep is less understood, but the cytokines they produce are being investigated in connection with sleep disorders.

Interleukin-1, interleukin-6, and tumor necrosis factor (TNF) are three cytokines known to induce sleep. In fact, the production of these cytokines is elevated during infections, physical trauma, or sustained stress to make a person sleepy so their body can recover faster. However, a disruption of their production could lead to sleep disorders and daytime fatigue. In fact, Lorton notes that an elevation in daytime interleukin-6 has been proposed as the cause of the debilitating fatigue of chronic fatigue syndrome and FM.

* Lorton D, et al. NeuroImmunoModulation 13:357-74, 2006.

 

The hypothalamus in the brain produces corticotropin releasing hormone (CRH) that is known to disrupt sleep and increase the “fight or flight�?stress response actions of the sympathetic nervous system. The latter effect is thought by some to be partially responsible for the pain in FM patients. A 50% increase of CRH in the spinal fluid was found in both men and women with FM.¹ The higher the CRH, the greater the patient’s pain, sympathetic system activity, and depressive symptoms. However, patients with higher CRH values did not have greater fatigue scores.

What does this mean in terms of sleep? CRH given during the night to healthy middle-aged men caused sleep disruptions (e.g., insomnia-like symptoms).² In addition, elevated CRH is also believed to decrease the deep-level restorative stages of sleep as well as REM sleep needed for next-day memory and thinking processes.³

FM patients with higher levels of CRH also had more symptoms of depression. Novel drugs that block the action of CRH (CRH-antagonists) are being tested in Europe to treat forms of depression that do not respond to traditional serotonin-boosting medications. As for the enhanced sympathetic nervous system activity, this could alter blood flow to the muscles and increase muscular pain. Why the CRH levels did not correlate with the fatigue scores is a mystery, but this was a small study. The manner in which CRH is linked to pain certainly needs to be explored in greater depth.

1. McLean SA, et al. Neuropsychopharm 31:2776-82, 2006.
2. Vgontzas AN, et al. J Clin Endocrinol Metab 86:1489-95, 2001.
3. Cauter E, et al. JAMA 284:861-8, 2000.

 

If the shorter daylight hours have left you feeling blue, ask your doctor about seasonal affective disorder (SAD). The October 2006 eNews Alert described for Members the symptoms, diagnosis, and treatment options for SAD, and a link to an article reprint is provided for you below in case you missed it. The good news is that you have survived the shortest day of the year (December 22nd) and the symptoms of SAD are often gone by the end of March.

When the days are shorter, people are at increased risk of developing vitamin D deficiency. Talk to your doctor about taking 400 to 800 IU of vitamin D per day, particularly if you live in the northern latitudes. This supplementation also helps to lift depressed feelings that tend to occur during the winter months. Another option might be to visit a tanning salon two or three times a week to make up for the loss of sun exposure and the ultraviolet (UV) rays that help your skin make vitamin D. In the October 2007 Journal, research showed that exposure to UV produces a relaxing effect on people, and there is some evidence to indicate that it reduces FM pain. However, be careful not to overdo it and follow the safety precautions mentioned in the last Journal.

Click here to download the SAD article - PDF*

 

January of 2008 marks 20 years of serving fibromyalgia (FM) and chronic fatigue syndrome patients with information and support. Personal computers, or PCs, were still a novelty and the Internet did not exist. Long-distance phone calls were outrageously expensive and the monthly bill for our toll-free line (which was set up in 1993) was ten times what it is today. First-class postage for a letter-sized envelope was 19¢. Those were the days when everyone relied upon the postal system to communicate with others and to pay their bills using a check rather than a debit card or online bill pay.

The diagnostic criteria for FM was published two years after the first issue of Fibromyalgia Network, which at the time was just a newsletter and not a full-color journal. Much has changed in the field of FM research. The National Institutes of Health did not spend a penny to study FM until 1994, but now its yearly budget is close to $10 million. Covering FM research and treatment news was relatively easy because only a handful of studies were published on the condition each month and about half of them could be ignored because they implied that the symptoms were “all in the head.�?/STRONG>

FM Network hosted its first information booth at the 1991 annual meeting of the American College of Rheumatology (ACR). Just seeing the word “fibromyalgia�?on our sign brought out the worst in some rheumatologists who came up to the booth, insisting that FM was not real and expressing disgust with our efforts to legitimize the illness. What could we have been thinking?

Look for short articles on the major milestones in the areas of research and treatment for FM in upcoming eNews Alerts and the Fibromyalgia Network Journal. As little as three years ago, who would have thought that a drug would receive approval specifically to treat FM? By the end of 2008, there will be three drugs approved to ease your symptoms and make life easier!

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Fibromyalgia Network ... Helping Patients Since 1988

PO Box 31750 | Tucson, AZ 85751-1750 | (800) 853-2929 | www.fmnetnews.com 

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I have been a member for awhile now and have enjoyed learning about ways to cope with, and helpful hints dealing with, FM.

I am so glad they are available and the newsletter if free!

Of course I also joined as a member getting the magazine in the mail. It is full of wonderful information!

Thank you so much for the information.