New research reveals that greater frequency and duration of daytime napping are associated with more severe symptomatology in patients with fibromyalgia.
According to the study results, published in BMC Musculoskeletal Disorders (2015 Feb 7;16:13. doi: 10.1186/ s12891-015-0464-y), the majority of participants reported using daytime napping as a strategy for coping with poor sleep and fibromyalgia symptoms. “Participants who regularly took a daytime nap were found to have a higher number of comorbidities, increased levels of pain, fatigue, sleep problems, memory difficulties and mood disturbance in comparison to participants with fibromyalgia who napped less regularly or not at all,” reported Alice Theadom, PhD, senior research fellow at the National Institute for Stroke and Applied Neurosciences, in Auckland, New Zealand.
Whereas previous research has shown sleep to be problematic for people with fibromyalgia, uncertainty remains over whether daytime napping is a beneficial or detrimental coping strategy.
“We found that poor sleep has been linked to poorer outcomes, and we found associations between difficulty falling asleep or waking up during the night with greater levels of pain and fatigue and other symptoms in this condition,” Dr. Theadom stated. “What we were looking at specifically in this study, however, was the impact of how people use daytime naps as a way of managing feelings of fatigue or tiredness during the day.”
An online questionnaire of 1,044 adults who reported napping on a daily basis showed that 18.9% napped in the morning of a typical weekday, 58.8% napped in the afternoon and 25% napped in the evening. It was also revealed that 86.5% of participants found themselves taking a nap without intending to, Dr. Theadom reported.
“Daytime napping was significantly associated with higher levels of pain, feelings of low mood and anxiety, and people feeling more fatigued, as well as memory difficulties and difficulty sleeping at night,” she said. “So daytime napping seemed to be linked to quite a range of symptoms.”
Daytime napping was also associated with a high rate of comorbid conditions, including arthritis (20%), irritable bowel syndrome (15%) and asthma (13%). Of those surveyed, 5.1% reported a psychiatric condition and 11.2% had depression, Dr. Theadom said. Finally, the duration of naps was found to have an influence on the impact of symptoms.
Those who engaged in daytime naps for longer than 30 minutes had greater memory difficulties and levels of depression than those who napped for shorter periods (P<0.010).
The most common reasons for taking a nap included tiredness/exhaustion (94.1%), feeling unwell (67.2%), catching up from the previous night’s poor sleep (59.6%), headache (42.6%) and pain (26.2%).
Although studies of people unaffected by a medical condition have shown a direct correlation between duration of napping and performance outcomes, Dr. Theadom stressed that the data for those with fibromyalgia remain inconclusive. Further research is needed, she said, to understand whether daytime napping is detrimental to symptom severity or whether it can be recommended as a strategy to manage symptoms.
“It’s really important that we try to unpick this so we can make fruitful recommendations to patients who are experiencing difficulties in fatigue,” Dr. Theadom concluded. “We need to provide guidelines so that patients know whether to use the daytime nap or not, and if so, for how long and when.”
“Fibromyalgia is a disorder not only about pain,” said Stuart Silverman, MD, FACP, FACR, former medical director and founder of the multidisciplinary outpatient Fibromyalgia and Chronic Pain Program at Cedars-Sinai in Los Angeles, “but about fatigue, sleep, cognitive dysfunction and also irritable bowel and irritable bladder. People who have more severe fibromyalgia, in terms of decreased functioning, also have more pain, more fatigue, more cognitive problems and more sleep disorders. This study is reinforcing our concept of fibromyalgia as a multisymptom illness. It is more than pain.”