|
Exercise is more effective if done in the late afternoon or evening. If you absolutely can’t do it then, exercising earlier in the day is better than not exercising at all, but you will probably need to exercise longer for the same effect. Some patients find that exercise provides an immediate benefit, making them feel more alert and comfortable for several hours. If you experience this effect, you may want to try exercising three times a day instead of just once. Patients who can do this are the ones most likely to eventually be able to get off medication. Exercise seems not to work through conditioning of muscles but rather through a direct, possibly hormonal effect on pain and sleep. Patients who have been exercising regularly and then miss a day usually find that their fibromyalgia symptoms are significantly worse the next day. Avoid physical and emotional stressExercise is an indispensable component of successful treatment, but too much physical activity of the wrong kind can precipitate a relapse. Rather than doing housecleaning, yard work, or other physical activity all on one day, break up the task so that you do a half hour or an hour every day until it is done. While it is difficult to learn to do this, it is essential that you be able to sense when you have reached your limit and stop. You need to be able to say no to family and friends when you are not up to some outing or other activity. Don’t take on extra stressful responsibilities if you don’t have to. If you have ongoing problems with depression or anxiety, consider seeking help for them from your family doctor or psychiatrist in an attempt to lower your overall stress level. Relaxation techniques or a chronic pain program can also help lower your stress level. Fibromyalgia patients must learn to manage their physical and emotional resources. Treat other sleep disordersSeveral other sleep disorders besides insomnia may aggravate fibromyalgia. Almost half of men with fibromyalgia and some women have obstructive sleep apnea. In this condition the patient snores loudly and has periodic pauses in breathing after which he starts breathing again with a snort. Periodic limb movements of sleep is a condition in which patients twitch every 30 to 90 seconds for long periods during the night. Patients may be completely unaware of either of these conditions until the spouse complains. Not only will it be difficult to get fibromyalgia symptoms to improve without treating these disorders, but if sleep apnea is left untreated it may lead to accidental death or injury as well as early strokes or heart attacks. Other common sources of repeated sleep disturbance are a spouse’s snoring and young children. If the spouse drinks alcohol in the evenings, eats dairy products, or is overweight, then avoidance of alcohol after supper, dairy at all times or weight loss will most likely eliminate snoring. Sleeping propped up on the side will often help. At the very least, the patient can wear earplugs. Children are harder to put off but fortunately most soon outgrow their need for care at night. It is important to avoid prescription tranquilizers and sleeping medications especially of the benzodiazepine group. While these may help you get to sleep, they suppress deep sleep and therefore often make fibromyalgia worse! Alcohol and narcotic pain medicationsTaken in the evenings they have the same effect on deep sleep and should be avoided. Try not to exercise just before bed, as this may make it harder to fall asleep. Patients with fibromyalgia should probably give up caffeine completely as even one cup in the morning can sometimes disrupt sleep at night and may also directly increase muscle pain and headaches. If you are drinking more than a cup a day you should gradually taper yourself off caffeine-containing beverages over two weeks or so to minimize caffeine withdrawal symptoms such as headaches. It is also helpful to refrain from protein consumption in the evening. Support and educationFor best results, you need to be actively involved in your treatment and to have as clear an understanding of this complicated disorder as possible. I recommend that you keep this handy and re-read it periodically. Patients with fibromyalgia often elicit less sympathy and support from family, friends, and employers than they deserve because of the lack of outward evidence of disease. Many patients have been told by other physicians that there is nothing wrong with them or that it is “all in your head” which can be very demoralizing. For these reasons, and just because it is good to know that you are not alone, I strongly encourage attending support group meetings. There are local chapters in most areas now of the Fibromyalgia Network. This organization produces an excellent newsletter which is well worth getting. Here’s how to contact them: Fibromyalgia Network5700 Stockdale Hwy, Suite 100 Info line: 1-805-631-1950 from 10am-2pm Pacific Time ConclusionWith a little work, most patients can make it to the point where they feel good most of the time. Even with good results from treatment however brief relapses are common, perhaps caused by staying up as little as one hour late one evening, skipping exercise, a disruption in your routine, increased stress, a storm front moving in, or often for no apparent reason. You will do best if you “give in to it” when this happens and try to get extra rest. Ibuprofen or naproxen and hot baths may help at these times, but are only to be used temporarily. If at all possible, try not to stop exercising when this happens, even if you have to back off on the amount a little. Once you have had a period of feeling relatively well, it should always be possible to get you back to that point again by trying to identify what derailed you and correcting the problem. David Nye, MD
|
