Fibromyalgia and Sleep

Sleep Quality

One of the core features of FMS is poor-quality sleep. 74 This may be assessed on a 100-mm linear scale with "sleep is no problem" at one extreme and "sleep is a major problem" at the other extreme. The patient is asked "how much of a problem has sleep been in the past week." Such a score can be incorporated into instruments such as the CLINHAQ. Similar scales can rate sleep quality, number of awakenings, and quality of restedness on awakening in the morning. Information in regard to abnormalities with sleep also can be derived from other instruments, such as the Symptom Clock List-90 (SCL-90) using items 44,64, and 66.

Sleep Physiology

There has been extensive research into characterization of EEG patterns during both rapid and nonrapid eye movement sleep, using polysomnography, in FMS patients.71 These abnormalities remain a source of ongoing research, and no standard technique or analysis of the resultant EEG has been universally accepted outside the research laboratory.


Fatigue is one of the core features of FMS, both generalized and localized, and measurement of this variable is important in both the clinic and research settings. The patient's fatigue over a defined period of time, usually in the week before assessment, can be ascertained using a 100-mm linear VAS with a statement such as "fatigue is no problem" at one end and "fatigue is a major problem" at the other end. The Multidimensional Assessment of Fatigue is a 16-item instrument developed by Belza.12. to provide more information about the fatigue symptom.

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