Click here to listen to episode 71.
We talk about the need for sleep, but there is an irony here for many with fibromyalgia. We don't always believe it, or we may be in such despair that it doesn't appear achievable and sustainable. Today we will continue to look at some unique challenges you are more likely to face living with fibromyalgia.
For those meeting me for the first time, I am Dr. Michael Lenz, a pediatrician, an internist, and a lifestyle medicine physician. I have been a doctor for over 26 years and am the author of Conquering Your Fibromyalgia: Real answers and real solutions to real pain. I blend the best of lifestyle medicine and medical management using an evidence-based approach. Fibromyalgia is complex and, for too long, has been ignored as a real problem, deserving of honest answers and practical solutions for real people struggling with pain, exhaustive fatigue, and debilitating brain fog.
Sleep fragmentation and deprivation impair healthy functioning. We have learned that it occurs with sleep apnea, restless leg syndrome, and innate sleep disruption found in many with fibromyalgia. Weight gain can lead to sleep apnea. What makes it worse for those prone to fibromyalgia is the impact of sleep deprivation on food desire in the human brain. Weight gain can lead to unrefreshing sleep through the development of or worsening sleep apnea.
Understanding how sleep loss and weight gain are connected is essential. A study we will look at sought to tease out the impact of sleep loss and food choices. Food choices are the most critical factors when considering healthy weight loss for the long term. For many, you can recognize the more nutritious food options but still feel the need or desire to do it. This recognition is similar to a smoker recognizing that the healthier option would be not to smoke, but they do it anyways. Why is that?
As we understand more about how behind-the-scenes processing impacts us in our brains, we can work better to prevent this hijacking.
The study called, The impact of sleep deprivation on food desire in the human brain,
sought to test two ideas that central brain mechanisms may lead to weight-promoting food choices following sleep loss. One hypothesis was that failure to recruit brain regions necessary for optimal evaluation of food choices leads to choosing items with greater weight-gain potential. These regions are the anterior cingulate, the lateral orbitofrontal cortex, and the anterior insula. These regions are involved in making decisions. When accessing food choices as being healthy, these are the parts of the brain that say, " Hey, The whole foods plant-based diet is good for me."
A second hypothesis is that excessive reactivity in two brain regions is involved in signaling a higher emotional response and assessing stimuli as more desirable. These areas may motivate the consumption of calorie-dense foods, potentially leading to weight gain. These areas are the amygdala and the ventral striatum. I hear many patients say something like this, "Doc, I know what I should do, but I don't do what I know is good for me." Others may say, "I am an emotional eater." Emotional eating can lead to worse outcomes, shame, and rumination on consistent failures.
To tease this out, they compared the impact of sleep deprivation on activity in these brain regions. The anterior cingulate, the lateral orbitofrontal cortex, and the anterior insula are thought to be involved in contemplating food choices. The other amygdala and ventral striatum are more involved in the emotional, impulsive control of eating. Using special imaging studies known as a functional MRI, which tracks the use of oxygen in parts of the brain, scientists can see which parts of the brain are activated.
What parts of the brain were more and less active with good rest versus sleep deprivation?
Sleep deprivation decreased activity in appetite evaluation regions within the human frontal cortex and insula cortex during food desirability choices, combined with a converse amplification of activity within the amygdala. Sleep deprivation led to a significant increase in amygdala reactivity to food desirability. The findings are impressive and should make us seriously ponder the importance of sleep.
Sleep deprivation leads to reduced activity in the decision-making brain centers. This is similar to the impact of alcohol consumption on decision-making and food choices. Sleep deprivation also leads to more emotional eating.
They also examined whether sleep deprivation triggered increased desirability for high-calorie-density food items. Consistent with their other findings, sleep deprivation significantly increased the proportion of "wanted" food items carrying high-caloric content. These foods have a high immediate dopamine release in the brain leading to a high reward. Not surprisingly, no corresponding differences between the sleep-deprived states were observed for low-calorie items. They had no increased desire for low-calorie density foods that had a lower immediate pleasure.
What impact did this have on the total calorie intake? The calorie content of all wanted items in the sleep-deprived condition was 600 calories more than in the non-sleep-deprived state. In fact, The more calorie-dense food was, the more likely the desire for and the resultant consumption increased after sleep deprivation.
So what are those calorie-dense foods? Common ones include processed and ultra-processed carbs, meats, fried foods, and foods with added salt, sugar, and fat. Food companies don't do you any favors with their marketing of these foods. Many of you may be stuck in the pleasure trap where healthy foods packed full of nutrients but not unnecessary calories are more undesirable. These findings make healthy diet choices and a healthy weight less likely.
These findings support the benefits and the need to do our best to get restorative sleep.
I don't mean to add more guilt or frustration to living with fibromyalgia, but I hope this gives you a better understanding. Having this insight can, at a minimum, make us understand our susceptibilities. In sports, a scouting report of the other team is done to understand their vulnerabilities. Good teams will do a scouting report on themselves to build awareness of their weaknesses. Similarly, knowing that sleep deprivation leads to poor food choices and resultant weight gain, leading to possible problems such as sleep apnea. These foods also give a feeling of short-term energy but are energy-depleting and can cause fibromyalgia-related problems like IBS and migraines. Poor energy makes it harder to get the consistent activity needed to appease the fibromyalgia dragon. Most people have experienced emotional eating, but those with fibromyalgia are much more likely to consume higher calorie-dense foods and lower consumption of fruits, vegetables, whole grains, legumes, nuts, and seeds. The average person consumes about seven servings of fruits and vegetables a week. However, the average person with fibromyalgia consumes half that amount. This insight helps you understand why. Education is so important. In the short term, what do you do with this information? There are many actions you can take. Make good sleep a priority. It is vitally important. Seek diagnosis and treatment for health conditions that cause unrestful sleep. Also, don't sabotage yourself by bringing calorie-dense foods into your home. It is like having cigarettes around for someone intent on quitting. Like food, cigarettes offer short-term benefits but severe long-term consequences. Sleep deprivation is a driver of cigarette consumption and poor food choices.
But what else might be happening for those struggling but are likely oblivious to it because it is all you know? It would be nice to be able to snap your fingers and sleep well, waking up rested and restored.
You are likely aware that sleeping better would help you, but getting good sleep can be incredibly difficult if you have fibromyalgia.
Additionally, it is even more challenging if you are one of the estimated 50% of those with fibromyalgia who also have ADHD.
Why is that? One reason is that many with ADHD have RLS and PLMD. And whether or not they have these, those with ADHD are likelier to have their sleep schedules flipped than neurotypical people. Instead of sleeping deeper the first part of the night and lighter the second, they are more likely to have light sleep and difficulty falling asleep until finally achieving deep sleep around 4 AM but then difficulty waking up to start the day. They are also more likely to wake up later, but due to school or work schedules need multiple alarms or people to wake them up and start the day with lackluster energy.
Some may say, " I don't like to sleep." And what does someone think if they don't like to do something objectively good for them?
"sleep is a waste of time."
"I don't need a lot of sleep."
It's just too hard to get sleep."
During the day, you likely have a busy life to keep your brain and mind occupied. At night time, it may feel like it is the only time you get to explore the tasks that you love. You may override your sleep drive with these dopamine-releasing activities.
Also, If you have ADHD, you are more likely to have so many more thoughts going through your mind than a non-ADHD person. Some of these thoughts may be pleasant, positive, or creative thoughts. Often, they are harmful. People with ADHD tend to have a prefrontal cortex that is less involved in the deep contemplation of ideas. Instead, the emotion center is used. This center, known as the amygdala, is involved in the brain's alarm system. Unfortunately, this system is more quickly and easily activated. More intense negative emotions can worsen fibro symptoms. This can result in feeling much more overwhelmed. The second question of the second part of the fibromyalgia questionnaire asks, how overwhelmed do you feel from 0, never, to 10 all the time?
You can get into a downward spiraling rumination loop that can be like quicksand that is hard to get out of. The flight or fight response is activated, sabotaging good sleep. If you fall asleep in fear, anger, or frustration, you are more likely to wake during the night and have a more challenging time self-soothing back to sleep.
For those living with PTSD, reliving trauma can rev up intense emotions while hoping for restorative sleep. Many with PTSD have ADHD. Treatment with psychotherapy and stimulant medication can help improve sleep in those with both by allowing one to focus on less disruptive and harmful thoughts and more on mindful meditative, calming thoughts.
For many with ADHD alone, treatment with a stimulant covering up to bedtime is beneficial for winding down and sleep initiation. It may seem counterintuitive because you may wonder why to give a stimulant to calm down. Still, it is essential to remember that the ADHD brain doesn't lack attention but has too much attention to many different stimuli and thoughts.
Here are some key take-home points for you to remember from this week's episode.
Sleep is vital for many reasons, but one is the impact of poor sleep on our ability to assess and make good food choices.
Poor sleep allows the emotion-based part of the brain, known as the amygdala, to become overly activated. The part of the brain involved in deeper contemplation of food choices, known as the prefrontal cortex, becomes less involved with our food decisions. These lead to increased consumption of calorie-dense but nutritionally poor food, which can lead to weight gain and worsening fibro symptoms.
If you have ADHD and fibro, the emotional part of the brain is more involved in general, contributing to the challenges needed to overcome. ADHD also can interfere with the ability to wind down before bed and keep a consistent bedtime routine, further aggravating fibro.
We will talk more about sleep hygiene in an upcoming episode. Still, recognizing and treating underlying conditions will smooth the rugged upward path many with fibro are left to navigate.
Thanks for listening, and I hope you have gained insights into understanding fibromyalgia. If you have any questions or topics you would like covered in future episodes, please email me. If you have enjoyed the podcast, the biggest compliment you can give is to hit the like or follow button, leave a 5-star rating, review, and share with others. That way, more people struggling with fibro can find the podcast more easily and gain the insights you have discovered.
Until Next week, go Team Fibro.