We may be prescribed drugs for our Fibromyalgia and/or CFS which could, in reality, worsen our symptoms by interfering with Stage IV (delta wave) sleep.

Stage IV is that part of the sleep cycle when the brain helps repair the daily wear and tear of the body. If it is disturbed (and therefore shortened), we awake stiff, sore, and/or without feeling refreshed. Most of the Fibromyalgia research indicates that Stage IV sleep is implicated in causing and/or influencing our symptoms.

Every competant CFS and FMS doctor addresses "the sleep problem" and generally discourages the use of Stage IV-disturbing drugs. However, along with those specialists, if one goes to a doctor who knows nothing about Fibromyalgia or CFS, but who feels compelled to treat the sleep problem and pain the only way he/she knows, the patient may inadvertently be prescribed drugs which worsen Fibromyalgia/CFS.
Sort of a Catch-22. There are many other diseases/syndromes that are best treated with some of these medications which disturb Stage IV sleep. If that is the case for you, perhaps a discussion with your doctor should be initiated that addresses this. For instance: "Since I need NSAIDs for my osteoarthritis and they can interfere with Stage IV sleep, is there some other way we can treat the OA and some other way we can promote Stage IV sleep?"

This whole issue is very uncomfortable for everyone. I am not making any judgments about using these drugs. That is an issue strictly between you and your doctor.

The Central Nervous System (CNS) Depressants - which include all the benzodiazepines, skeletal muscle relaxants, and narcotics - may create clinical depression by themselves. This becomes very important to remember when we have received mutltiple CNS depressant prescriptions, i.e., a benzodiazepine for sleep, an opiate for pain, and a muscle relaxant for spasms. While there is undoubtedly a medical necessity for such combinations, we must be aware that if depression becomes more of a problem, our prescriptions must be re-evaluated.

Here are the results of some major searching to help folks understand those drugs and how they influence Stage IV sleep. Since I first researched and compiled the list in early 1998, it has stood the test of time. The results have not changed.

What has changed over the years is that research has shown that people who use potentially physically and psychologically addicting drugs for chronic pain situations have been shown to not get the "high" that recreational users get. Additionally, people who use mood-altering drugs for chronic pain situations usually use the least amount necessary to break the cycle of pain - again, totally unlike recreational drug users. Therefore, though we may become physically addicted to such a drug, withdrawal is usually less of a problem since we are not psychologically addicted.

(However, the possibility of a chronic pain patient becoming both physically and psychologically addicted to their mood-altering prescriptions cannot be ignored or considered "impossible." One only has to read the various online newsgroups with an objective eye to find folks who are obviously psychologically addicted to narcotics and other mood-altering drugs by their exhibiting true drug-seeking behavior. Unfortunately for the majority of chronic pain patients, such obvious substance abusers within our ranks lessens our credibility with the medical community.)

I offer the list below in order that we can make informed choices in our medcial care. If the drug or its classification you're taking isn't listed here, it probably doesn't interfere with Stage IV sleep.

Barbiturates decrease the amount of time spent in Stage III sleep and are major CNS depressants.

Benzodiazepines increase the length of Stage I sleep at the expense of Stage IV sleep, i.e., none or little Stage IV sleep is obtained. Xanax apparently is the exception because it doesn't disturb Stage IV.
Klonopin a member of a class of drugs known to block the adverse effects of circulating cytokines. Klonopin is also used for sleep and to treat brain injury (especially temporal lobe injury) which often is common in CFS. It is also known to increase beta wave activity in the brain during the day time and may promote development of sleep spindles at night and therefore improve the quality of sleep. However, Klonopin is still a benzodiazepine and its potential disadvantages vs. benefits should be discussed with one's doctor.

Opiates/Narcotics: Stage IV sleep is disturbed.

Muscle Relaxants (Soma, Skelaxin, Robaxin): Apparently don't disturb Stage IV. However, in physical dependency, they may well disturb Stage IV.

NSAIDs cause sleep disturbances by decreasing melatonin synthesis. Tylenol apparently is okay.

Drugs which disturb Stage IV Sleep