Category: Fibromyalgia

  • PEM-safe sleep tools for fibromyalgia and ME/CFS insomnia

    PEM-safe sleep tools for fibromyalgia and ME/CFS insomnia

    If you live with fibromyalgia or ME/CFS, you’ll know that sleep problems aren’t just about struggling to drift off. You might finally fall asleep at 3am only to wake feeling like you haven’t slept at all. Or you collapse into bed exhausted, yet your body refuses to switch off that frustrating “tired but wired” state that so many of us recognise. The sleep disturbance in these conditions runs deeper than ordinary insomnia, and it’s tangled up with pain, nervous system dysregulation, and the ever-present threat of post-exertional malaise.

    Here’s what can make things worse: well-meaning advice designed for otherwise healthy people with insomnia. Standard sleep programmes often encourage restricting time in bed, pushing through daytime tiredness, and increasing activity to “build sleep pressure.” For someone with post-exertional malaise (PEM), following that advice can trigger a crash that sets you back for days or weeks. If you’ve ever felt worse after trying to fix your sleep, you’re not imagining it, and you’re certainly not alone.

    In this guide, we’ll walk through a set of PEM-safe sleep tools that work with your body’s limits instead of against them.

    For a deeper look at how fibromyalgia affects sleep, see What is fibromyalgia? (and what it isn’t).

    This guide takes a different approach. We’ll explore PEM-safe sleep tools that work with your body’s limits rather than against them. You’ll find gentle adaptations from evidence-based insomnia therapies, nervous system calming techniques that don’t require energy you don’t have, and honest information about sleep aids. Nothing here promises a cure, but these supports can make difficult nights a little more manageable.

    Key takeaways

    • PEM changes the rules: Standard insomnia advice assumes you can “push through” tiredness to build sleep drive. With fibromyalgia and ME/CFS, this approach can trigger crashes and worsen symptoms, so everything here is adapted with that in mind.
    • Pacing comes first: Protecting your energy envelope throughout the day is the foundation of better sleep. You can’t optimise nighttime rest if you’re already in energy debt.
    • Borrow gently from CBT-I: Cognitive Behavioural Therapy for Insomnia has helpful elements, particularly the cognitive tools and sleep environment work, but its sleep restriction component isn’t safe for people with PEM.
    • Low-risk supports exist: Nervous system calming techniques, environment adjustments, and certain supplements may help, though evidence varies and nothing works for everyone.
    • Know when to seek help: Persistent sleep problems, suspected sleep disorders, or worsening symptoms warrant a conversation with your GP or specialist.

    Why standard insomnia advice can backfire with PEM

    Cognitive Behavioural Therapy for Insomnia (CBT-I) is the gold-standard treatment for chronic insomnia in the general population. It works remarkably well for many people, and understanding why helps explain why it can be problematic for us.

    Standard CBT-I has four main components. Sleep restriction therapy limits time in bed to match actual sleep time, deliberately inducing mild sleep deprivation to increase “sleep pressure.” Stimulus control asks you to get out of bed after 15-20 minutes of wakefulness and only return when sleepy. Cognitive restructuring addresses unhelpful thoughts about sleep. And sleep hygiene covers the usual advice about caffeine, screens, and bedroom environment.

    The conflict lies primarily with sleep restriction and stimulus control. These techniques require you to intentionally build up tiredness and push through daytime sleepiness to consolidate sleep. For someone without PEM, this creates a temporary dip in daytime function that resolves as sleep improves. For someone with ME/CFS or fibromyalgia with PEM, sleep deprivation is a known crash trigger.

    The 2021 NICE guideline for ME/CFS (NG206) explicitly warns against any programme based on “fixed incremental increases” in activity, and emphasises that rest is “part of all management strategies.” The guideline recognises that people with ME/CFS need daytime rest periods, the opposite of what strict stimulus control demands. Getting in and out of bed repeatedly when you can’t sleep may itself use energy that triggers symptoms.

    This doesn’t mean we should dismiss CBT-I entirely. The cognitive elements addressing anxious thoughts about sleep and reducing the pressure we put on ourselves can be genuinely helpful. The key is knowing what to adapt. We can borrow the gentler tools whilst protecting ourselves from the components that could cause harm. For more on how sleep disruption interacts with symptom flares, see our guide to fibromyalgia sleep flares and PEM.

    PEM-safe sleep tools: foundations for better rest

    These PEM-safe sleep tools for fibromyalgia and ME/CFS insomnia respect your energy limits whilst creating conditions that make sleep more likely.

    Protect your 24-hour energy envelope

    The energy envelope is a core concept from ME/CFS management, now reflected in NICE guidelines. It means staying within your available energy rather than spending more than you have. When you exceed your envelope during the day, you’re more likely to be both exhausted and wired by bedtime and more likely to experience PEM that disrupts sleep for days afterward.

    Practical pacing for better sleep includes planning rest periods throughout the day rather than saving all your rest for nighttime. It means stopping activities before you feel exhausted, and recognising that cognitive and emotional activities use energy too not just physical ones. On days when you’ve had unavoidable exertion, adjusting expectations rather than trying to “catch up” with extra activity can help protect your sleep.

    NICE NG206 recommends agreeing “a sustainable level of activity as the first step, which may mean reducing activity.” This isn’t about being lazy it’s about preventing the boom-and-bust cycles that wreck both daytime function and nighttime rest. Your energy envelope fluctuates, and learning to read your own limits is part of living well with these conditions.

    A softer wind-down routine

    A consistent evening routine signals to your body that sleep is approaching, but with fibromyalgia or ME/CFS, the routine itself needs to be low energy.

    About two hours before bed, begin dimming lights and reducing screen exposure. Blue light suppresses melatonin production by up to 85%, so switching to lamps, candles, or low lighting helps your body’s natural sleep signals emerge. If you need screens, blue light blocking glasses or night mode settings can reduce the impact.

    About one hour before bed, settle into a simple sequence of calming activities. This might include listening to gentle music or an audiobook, very light stretching only if tolerated, a warm drink (not caffeine), or simply sitting quietly. The key is consistency; the same activities in roughly the same order help your nervous system recognise the pattern.

    Avoid anything stimulating during this window: work tasks, difficult conversations, distressing news, or physically demanding activities. Even seemingly passive activities like watching an intense television drama can activate your stress response. Think “boring and gentle” rather than “engaging and interesting.”

    Make the sleep environment kinder

    Your bedroom environment can either support or sabotage sleep. Small adjustments can make a meaningful difference, particularly when you’re managing pain alongside insomnia.

    Temperature matters more than many people realise. Research suggests 15-19°C is optimal for most people, though fibromyalgia can cause temperature sensitivity in both directions. Aim for neutral, neither too hot nor too cold, with layered bedding you can adjust during the night. Breathable natural fibres help regulate temperature better than synthetic materials.

    Darkness supports melatonin production. Blackout curtains, blinds, or a sleep mask can help if light pollution is an issue. If you need to get up during the night, use dim nightlights rather than bright overhead lights to avoid suppressing melatonin.

    Sound management might mean white noise to mask disruptive sounds, earplugs for noise sensitivity, or simply ensuring your bedroom is as quiet as possible. Whatever approach you choose, consistency helps, as the same sounds (or silence) each night builds a sleep association.

    Bedding for pain deserves careful thought. A mattress that provides pressure relief whilst supporting your spine, pillows appropriate for your sleeping position, and positioning aids like a pillow under the knees for back sleepers can all reduce nighttime pain. Weighted blankets have some evidence for calming the nervous system, though they’re not right for everyone.

    Calm pain and symptoms before bed

    Managing pain before bed can prevent it from keeping you awake or waking you through the night. If you take pain medication, timing it appropriately (with your prescriber’s guidance) so it’s working when you’re trying to sleep makes sense.

    Non-pharmacological options include heat or cold therapy for localised pain, getting into a comfortable position before you settle rather than lying awake shifting, and using relaxation techniques (covered below) that can indirectly reduce pain perception. The goal isn’t eliminating pain for many of us; that’s not realistic, but reducing it enough to let sleep happen.

    Borrowing gently from CBT-I without triggering crashes

    We’ve established that full CBT-I isn’t appropriate when PEM is a factor. But several elements can be safely adapted.

    Cognitive techniques are perhaps the most transferable. Many people with chronic illness develop unhelpful thoughts about sleep: catastrophising about the consequences of a bad night, putting pressure on themselves to fall asleep, or lying awake worrying about symptoms. Working on these thought patterns, perhaps with support from a psychologist familiar with chronic illness, can reduce the mental arousal that keeps us awake.

    Sleep environment optimisation translates directly. Creating positive associations between your bedroom and rest, keeping the room dark and cool, removing distracting electronics, and reserving the bed primarily for sleep and rest (not work or screens) are all compatible with pacing.

    Gentle stimulus control requires significant modification. Rather than getting out of bed and staying active until sleepy, you might simply roll over and rest without pressure, practice breathing exercises whilst lying down, or do a gentle body scan. The goal shifts from “only associate bed with sleep” to “associate bed with rest and calm” recognising that lying quietly has value even without sleep.

    What to avoid: Any fixed schedule that ignores symptom fluctuation. Any instruction to reduce time in bed or push through daytime tiredness.

    For more on how sleep disruption interacts with symptom flares, see our guide to fibromyalgia sleep flares and PEM.

    Any approach that treats rest as something to eliminate. The 2021 NICE ME/CFS guideline is clear that sleep management should be “personalised” and must “take into account the need for rest in the day.”

    If you work with a sleep therapist, explain your condition and PEM clearly. A good practitioner will adapt their approach; one who insists on standard protocols despite your concerns may not be the right fit.

    Nervous-system soothing that respects PEM

    The “tired but wired” state common in fibromyalgia and ME/CFS reflects genuine nervous system dysregulation. Research shows that people with these conditions often have higher sympathetic (stress) activation even during sleep. Calming the nervous system isn’t just about relaxation, it’s about shifting your physiology toward rest.

    Extended exhale breathing is perhaps the most accessible technique. Simply making your out-breath longer than your in-breath activates the parasympathetic (rest and digest) nervous system via the vagus nerve. Try breathing in for 2-4 counts and out for 4-8 counts, whatever feels comfortable. Five minutes of this whilst lying in bed requires minimal energy and can genuinely shift your state. If counting feels effortful, simply focus on a slow, gentle exhale.

    Grounding techniques interrupt anxious thought loops by bringing attention to present moment sensation. The 5-4-3-2-1 technique asks you to notice five things you can see (or remember seeing in your room), four you can feel (the weight of blankets, the pillow beneath your head), three you can hear, two you can smell, and one you can taste. This can be done with eyes closed, entirely from bed, and requires no physical effort.

    A worry pad by the bed gives racing thoughts somewhere to go. When worries surface, jot them down briefly and promise yourself you’ll address them tomorrow. This simple act of externalising concerns can reduce the mental effort of trying to hold onto them and can break the cycle of rumination that keeps the stress response active.

    Self-compassion practice may feel uncomfortable at first, but evidence links self-compassion directly to better sleep. When you notice self-critical thoughts (“Why can’t I just sleep like a normal person?”), try placing a hand on your chest and offering yourself kindness: “This is hard. I’m doing the best I can.” Research shows this kind of supportive self-talk triggers parasympathetic activation and reduces cortisol, the opposite of the stress response that keeps us wired.

    The key with all these techniques is gentleness. If any practice feels like effort or creates frustration, it’s not helping. Start with just one approach, practise it consistently for a few weeks, and add more if it’s working without draining you.

    What about melatonin, magnesium and other sleep aids?

    People with fibromyalgia and ME/CFS often explore supplements and sleep aids, hoping to find something that helps. The evidence is genuinely mixed, and it’s important to approach this area with realistic expectations.

    Melatonin has the most promising evidence for fibromyalgia specifically. Several small studies have found improvements in sleep quality, pain, and quality of life. For ME/CFS, the picture is less clear. A 2021 review found insufficient evidence to recommend it. Some research suggests people with fibromyalgia may have altered melatonin production, which could explain why supplementation helps some people. However, melatonin interacts with numerous medications including anticoagulants, antidepressants, and sedatives, and quality varies between products since supplements aren’t tightly regulated.

    Magnesium has theoretical benefits; it’s involved in muscle relaxation, nervous system function, and sleep regulation, and some studies have found lower levels in people with fibromyalgia. However, the evidence specifically for sleep improvement is limited. Different forms of magnesium have different absorption and effects, and high doses can cause digestive upset. If you’re considering magnesium, discussing it with your GP or pharmacist is sensible, particularly regarding interactions with other medications.

    Other supplements marketed for sleep (valerian, 5-HTP, L-theanine, CBD) have varying and generally weaker evidence. 5-HTP in particular carries significant risks if combined with antidepressants due to the possibility of serotonin syndrome; this combination should be avoided without specialist guidance.

    Pharmaceutical sleep aids require careful consideration. The 2021 NICE guideline for chronic primary pain (NG193) notes that opioids and standard hypnotics are not recommended for fibromyalgia. Low-dose amitriptyline is sometimes prescribed for fibromyalgia with sleep disturbance and may help some people, though it comes with side effects. Any medication decision should be made with your prescriber, considering your full picture.

    The honest summary: no supplement or medication reliably fixes sleep problems in fibromyalgia or ME/CFS. Some people find some things helpful. Many of us are medication sensitive and need to start any new approach at low levels. Nothing replaces the foundations of pacing, environment, and nervous system support, but these additional tools may offer modest benefit for some people when used cautiously.

    When to talk to your GP or specialist

    While this guide offers self-help tools, some situations warrant professional input.

    Consider speaking to your GP if:

    • Your sleep problems persist despite trying these approaches for several weeks
    • You suspect an underlying sleep disorder such as sleep apnoea (loud snoring, gasping awake, excessive daytime sleepiness beyond your usual fatigue)
    • You have symptoms of restless legs syndrome (uncomfortable leg sensations and urge to move, particularly at night)
    • Your sleep difficulties are worsening significantly or affecting your ability to function
    • You’re considering prescription sleep medication or have questions about supplements and interactions
    • You’re experiencing worsening depression or anxiety alongside sleep problems

    Your GP or specialist may offer:

    • Assessment for sleep disorders (potentially including referral for sleep studies)
    • Review of current medications that might be affecting sleep
    • Discussion of medication options appropriate for your conditions
    • Referral to a psychologist experienced in chronic illness for adapted CBT-I
    • Referral to ME/CFS or pain specialist services

    Remember that NICE guidelines emphasise personalised, multimodal approaches. There’s no one-size-fits-all solution, and finding what works often requires patience and professional support.

    Key resources and references

    Disclaimer

    This article provides general information about sleep and chronic illness for educational purposes only. It is not intended as medical advice and should not replace consultation with your GP, specialist, or other qualified healthcare professional. Everyone’s situation is different; what helps one person may not suit another, and some approaches may not be appropriate for your circumstances. Always discuss new supplements or significant changes to your sleep approach with a healthcare provider, particularly if you take other medications or have additional health conditions. If your symptoms are worsening or you’re concerned, please seek professional support.

    Written by Stems From The Gut

    This article was written by someone who lives with fibromyalgia, chronic pain, and gut issues. At Stems From The Gut, we believe in plain-English, evidence-aware information that respects the reality of living with chronic conditions—no toxic positivity, no “just push through” attitudes, and no pretending that simple solutions exist for complex problems. We do our best to align with current clinical guidelines whilst acknowledging their limitations. For more about our approach, see our Authors & Medical Stance page.

  • Fibromyalgia body clock

    Fibromyalgia body clock

    If you live with fibromyalgia, it can feel as though your body clock has a mind of its own. Many people talk about a “fibromyalgia body clock” that runs on a completely different timetable to everyone else. Not very helpful when your body seems to be running on a completely different timetable to everyone else.

    This is not another generic list of sleep tips. Instead, we are zooming in on your body clock, your circadian rhythm, and looking at how timing (when you sleep, wake, move and see light) can gently support pain, fatigue and brain fog alongside everything else you are already doing. We will also be honest about what the research actually shows, and where we are still making educated guesses.

    What you will take away from this

    Fibromyalgia seems to mess with the body clock in ways that matter. When your sleep and wake rhythms get disturbed, pain, fatigue and mood often spiral. The strongest signal from the research is not about magic gadgets or expensive supplements; it is about regularity. When you wake up and the difference between your daytime and nighttime patterns seems to matter more than chasing perfect sleep.

    Tools like CBT-I (cognitive behavioural therapy for insomnia), morning light and low dose melatonin can help some people feel more in control, but they sit alongside everything else. They are adjuncts, not cures.

    If you also have ME/CFS or clear post exertional malaise, pacing and energy envelope management stay front and centre. Any timing tweaks need to work around that reality, not override it.

    Here is the reassuring bit: you do not need perfect routines. Tiny, sustainable shifts in timing can still make a difference when you are working with what your body can actually manage right now.

    Meet your body clock (and why it matters for fibro)

    Deep inside your brain, in a tiny cluster of cells in the hypothalamus, sits your master clock. It keeps roughly twenty four hour time, responds to light (especially in the morning), and helps coordinate hormones like cortisol and melatonin. It also influences body temperature, gut motility, immune signalling and even how you process pain.

    Most people’s internal clocks naturally run a touch later than twenty four hours. Without something to anchor them, they gradually drift later and later. For many of us, that anchor is morning light plus a fairly consistent wake up time.

    In fibromyalgia and related pain conditions, several studies have noticed a familiar pattern. People are more likely to prefer evenings, describe themselves as “night owls”, show bigger day to day swings in when they fall asleep and wake up, and have altered rhythms of melatonin and cortisol. That does not prove cause and effect, but it fits what many people with fibromyalgia describe: days and nights gradually sliding out of sync, pain and fatigue flaring when sleep becomes chaotic.

    What research actually says about the fibromyalgia body clock

    The evidence base is still small, but a few themes are emerging that can help us make better informed guesses.

    Morning light and a fixed wake time

    In one four week trial, people with fibromyalgia were divided into two groups. One group had bright morning light therapy, the other dimmer light. Both groups were also given a stable wake up time and some simple advice about bedtime.

    Both groups improved. Pain, mood, day to day function and sleep quality all got better, and the bright light group did not clearly outperform the dim light group. The researchers concluded that regular sleep and wake timing was probably doing most of the heavy lifting, rather than the intensity of the light itself.

    Melatonin: modest help, not a miracle

    Some older trials in fibromyalgia, and newer work in mixed chronic pain groups, suggest melatonin can modestly improve sleep quality and slightly reduce pain scores for some people, especially over the first few weeks. The effects often fade after about six weeks, though. Doses and formulations vary wildly from study to study – anywhere from one to ten milligrams, immediate release or slow release. We still do not have clear long term safety data or a single “best” dose.

    There is also one small trial in ME/CFS that used one milligram of melatonin plus zinc over sixteen weeks and found improvements in fatigue and quality of life. Promising, but not yet replicated.

    Melatonin is not suitable for everyone, particularly if you take several other medicines or live with epilepsy, bipolar disorder or more complex health conditions. It can cause morning grogginess, vivid dreams and, less commonly, mood changes. In the UK it is usually prescription only, which is another reason to talk it through with your GP or pain clinic first rather than experimenting on your own.

    CBT-I for insomnia

    For people with fibromyalgia who also have clear insomnia, CBT-I – a structured talking therapy focused on sleep patterns, thoughts and behaviours around sleep tends to outperform generic “sleep hygiene” advice. It also does better than standard CBT for pain when the main target is broken sleep.

    Improvements in pain and mood tend to be smaller than the sleep gains, but they can still be meaningful for some people.

    NICE does not currently recommend melatonin or light boxes specifically for fibromyalgia because the evidence is limited. Instead, guidance leans towards multimodal care: pacing, gentle movement within limits, psychological support where appropriate, and CBT-I for those with true insomnia.

    The big idea: give your body clock a daily anchor

    The most realistic change most of us can make is not fancy or expensive. It is about giving your fibromyalgia body clock a few consistent time signals every day, so it knows what counts as day and what counts as night.

    Those anchors might be getting up at roughly the same time most days, seeing natural light not too long after waking, keeping most of your eating, movement and social contact in the daytime, and making your evenings visibly and sensibly “quieter” with softer light and less stimulation.

    You do not need to hit all of these. Even one or two clear anchors, done gently and consistently, can start nudging your system in a kinder direction.

    Step 1: Choose a realistic wake up window

    For many people with fibromyalgia, especially those without post exertional malaise, the single most powerful shift is choosing a regular wake up time and sticking to it on most days.

    If your current pattern is all over the place, it is usually unhelpful to suddenly decide you will get up at seven every morning. Instead, look back over the last week and notice when you naturally wake if nobody is forcing you. Use that as your starting point. If you tend to wake somewhere around half past eight or nine, choose a half hour window in that range and aim to be out of bed within that window on most days.

    If you also live with ME/CFS or clear post exertional crashes, your anchor might need to be softer and later. The aim is gentle regularity, not dragging yourself out of bed in the middle of a crash just to “protect your rhythm”. You can always experiment with edging your window earlier by fifteen or thirty minutes once things feel more stable.

    Step 2: Use light as your “on switch” gently

    Light is the main signal for your master clock, but you do not need specialist equipment to begin with. If you can, open the curtains soon after you wake and spend ten to twenty minutes near a window with a drink. On better days you might manage to step outside, even if it is just onto a balcony or front step.

    If mornings are your worst time and you tend to wake very late, start from where you are rather than where you think you “should” be. If you usually first see daylight at one in the afternoon, aim to see it at half twelve for a week, then experiment with shifting that earlier in small steps – only if your body tolerates it.

    Some people use a bright light box, particularly in winter. These can be helpful in conditions like seasonal affective disorder. In fibromyalgia, though, the best evidence so far suggests that having a regular morning light routine mattered more than hitting a particular brightness. You can treat any gadget as a possible helper, not a cure.

    If you have a history of bipolar disorder, significant eye disease or you take medicines that make your skin or eyes more sensitive to light, speak to your doctor before using a light box.

    Step 3: Create quiet cues for “night mode”

    Evenings are about giving your brain clear signals that it is time to wind down. This does not require a long complicated routine, it is more about drawing a line between “day” and “evening”.

    That might look like switching from the main ceiling lights to lamps about an hour before bed, choosing lower stimulus activities such as an audiobook, podcast, familiar television or a paper book instead of fast scrolling, and keeping your largest meals earlier in the evening so you are not trying to sleep on a very full stomach.

    Some people with insomnia find blue blocking glasses helpful for a couple of hours before bed, especially if they use screens a lot. Most of the research for these is in general insomnia rather than fibromyalgia specifically, but they are relatively low risk and not usually expensive if you want to try them. Using the night mode or warm colour settings on your phone, tablet or laptop is a simple, free step in the same direction.

    If you already have a basic wind down routine, you do not need to add lots of extra steps. The main thing is that your brain can tell, most nights, when day has ended and night has begun.

    What about melatonin, light boxes and other circadian “hacks”?

    For adults, small doses of melatonin, often in the one to three milligram range, can shift the body clock slightly earlier if taken at the right time, usually one to two hours before your intended bedtime. In some fibromyalgia and chronic pain studies, this has led to better sleep and modest reductions in pain in the short term.

    At the same time, it is not a cure for fibromyalgia, and it is not right for everyone. It can cause grogginess, vivid dreams and occasionally changes in mood, and it can interact with other medicines. Because melatonin is prescription only for adults in the UK, it is best thought of as something to explore with your GP or pain team as a time limited trial, not something you put yourself on indefinitely.

    Bright light therapy boxes sit in a similar category. They can be helpful in certain circadian rhythm disorders and seasonal affective disorder, but in fibromyalgia the clearest message so far is that a regular morning routine matters more than a particular lux number. For people with ME/CFS we do not yet have strong evidence that bright light therapy improves post exertional symptoms or core fatigue, and it is not a specific NICE recommendation. If you do experiment, it is wise to start gently and keep an eye on boom and bust patterns, where a brief improvement leads to a big uptick in activity and then a crash.

    Blue blocking glasses and software night modes fall into the “low risk helper” category. They can make it easier for some people to fall asleep and stay asleep, especially in our very screen heavy evenings, but they are unlikely to transform fibromyalgia on their own.

    If you live with PEM or ME/CFS as well as fibro

    Many people reading this sit somewhere on a fibromyalgia ME/CFS Long Covid overlap. You might recognise delayed crashes after effort, have very limited energy to spare, or face days when getting out of bed at all feels like climbing a mountain.

    In that context, pacing and energy envelope management remain non negotiable. Any body clock work needs to be gentle enough that it does not trigger post exertional malaise. It is completely fine if your wake window is later than average, if it has to flex on crash days, or if family, caring roles or appointments mean your timing is far from textbook.

    A useful way to picture this is to imagine body clock work as sandpaper rather than a hammer. You are smoothing out a few rough edges, not remodelling the whole structure. If any suggestion in this article feels as though it would tip you into a crash, it is simply not the right step for you at the moment.

    Making this doable when you are already exhausted

    When you are dealing with chronic pain, fatigue and brain fog, even small changes can feel like a lot. It helps to treat this as a series of tiny experiments rather than a big lifestyle overhaul.

    You might begin with one simple anchor, such as opening the curtains within fifteen minutes of waking most days, or sitting in your usual spot by a window with a drink for ten minutes. Set a reminder on your phone, or leave a note where you will see it, so you do not have to hold it in your head.

    On more difficult days, the only realistic goal might be to keep today’s wake time within an hour of yesterday’s, if that is possible. If you share a home, you could ask a partner, family member or housemate to help with easy cues, opening the curtains or switching to lamps in the evening at an agreed time.

    If a week or two goes off track, that is not failure. It is simply information about what your body and life are like at the moment. You can always restart from where you are, not where you were.

    When to talk to your GP or specialist

    Self help changes can be useful, but they are not a substitute for proper assessment. It is worth speaking to your GP or specialist if you have had very little sleep for months despite trying basic changes, if someone has noticed loud snoring, gasping or pauses in your breathing at night, if you wake unrefreshed with morning headaches, or if your mood has dropped very low or you are having thoughts of self harm.

    It is also sensible to get medical advice before using melatonin or bright light therapy if you have a history of bipolar disorder or psychosis, or if you are already taking several medicines that make you drowsy.

    In that appointment, you can ask about referral options for services that offer CBT-I, whether melatonin might have a role in your specific case, and whether any of your current medicines might be making your body clock later or your sleep worse.

    Next read: Pain and crashes fit together; have a look at our guide to fibromyalgia and sleep.

    Key resources and references

    If you would like to read more or share information with your GP, these are good starting points:

    NICE guideline NG193 on chronic primary pain in over sixteens, which includes fibromyalgia.

    The Royal College of Physicians guidance on diagnosing fibromyalgia.

    The Burgess trial on morning light and stabilising sleep and wake timing in fibromyalgia.

    The DREAM-CP trial led by Galley and colleagues, looking at modified release melatonin in severe chronic pain.

    Recent reviews of CBT-I in people who have both fibromyalgia and insomnia.

    Disclaimer

    This article offers general information about fibromyalgia, sleep and circadian rhythms. It is not a substitute for individual medical advice. If you are experiencing chronic pain, fatigue or other worrying symptoms, please speak with your GP or a relevant specialist. Everyone’s situation is different, and what helps one person may not be right for another.

    Written by Stems From The Gut

    Created by someone living with fibromyalgia, chronic pain and messy gut issues. I write in plain English to help you feel more informed and less alone. You can read more about how we use evidence on the Authors and Medical Stance page.

  • Fibromyalgia and Sleep: Can Fixing Your Sleep Really Help Pain and Exhaustion?

    Fibromyalgia and Sleep: Can Fixing Your Sleep Really Help Pain and Exhaustion?

    If you’re living with fibromyalgia, fibromyalgia sleep can feel like an impossible puzzle. You’re beyond exhausted. Bone-deep, all-the-time exhaustedYet when you finally climb into bed, sleep won’t come. Or it does come, but you wake every hour, or you sleep through the night only to feel like you haven’t slept at all. Meanwhile, the pain keeps humming away in the background, or gets worse the moment you lie down.

    In this guide, we’ll look at fibromyalgia and sleep, why nights can be so broken, and what genuinely helps. If you’re not sure whether your symptoms fit fibromyalgia, start with What Is Fibromyalgia? (And What It Isn’t).

    If you’re living with fibromyalgia and sleep feels like an impossible puzzle, you’re far from alone. Poor sleep is one of the most common and frustrating symptoms people with fibromyalgia face. And it’s not just about feeling tired. Broken sleep can intensify pain, worsen brain fog, and leave you feeling utterly depleted before the day’s even started.

    Quick takeaways

    • Poor sleep can increase pain sensitivity, fatigue, and brain fog in fibromyalgia
    • Fixing sleep” doesn’t cure fibromyalgia — but it can reduce symptom intensity and improve coping
    • The best improvements often come from gentle consistency, not forcing strict routines
    • If you also experience PEM/PESE, pacing and sleep need to work together (not against each other)

    The good news? While there’s no magic cure, there are evidence-informed strategies that can genuinely help. Improving your sleep won’t make fibromyalgia disappear, but it can ease the pain-fatigue-insomnia cycle enough to give you a bit more breathing room. Let’s look at what’s actually going on with fibromyalgia and sleep, and what you can realistically do about it.

    Key takeaways

    • Fibromyalgia doesn’t just cause pain – it also disrupts how your nervous system regulates sleep, leaving many people “tired but wired”.
    • Poor sleep and fibromyalgia pain fuel each other; improving sleep usually won’t cure fibromyalgia, but it can make pain, fatigue and brain fog easier to live with.
    • The strongest evidence supports a regular wake-up time, morning light, and CBT-I (a structured talking therapy for insomnia).
    • Tools like melatonin, light therapy lamps and sleep hygiene tweaks can be helpful adjuncts, ideally used alongside pacing and nervous-system-friendly routines.

    Why can’t I sleep with fibromyalgia?

    Fibromyalgia affects the way your nervous system processes pain signals. In simple terms, your pain “volume” is turned up too high: signals that wouldn’t normally register as painful get amplified, and signals that are painful feel even more intense. This heightened sensitivity doesn’t just affect pain—it affects your entire nervous system, including the systems that regulate sleep.

    Non-restorative sleep and frequent waking

    Many people with fibromyalgia describe their sleep as “light” or “unrefreshing.” You might spend eight hours in bed but wake feeling as though you’ve had three. Research shows that people with fibromyalgia often spend less time in the deeper, restorative stages of sleep. Instead, sleep is fragmented: you wake repeatedly (even if you don’t fully remember it), and your brain doesn’t get the sustained rest it needs to repair and reset.

    This isn’t just “bad sleep”—it’s a feature of how fibromyalgia affects your nervous system. The same heightened sensitivity that amplifies pain signals can also keep your brain in a state of hyperarousal, making it harder to relax into deep sleep.

    The vicious circle: pain, fatigue, and broken sleep

    Here’s where things get particularly frustrating. Poor sleep makes pain worse. When you don’t sleep well, your pain threshold drops, meaning you feel pain more intensely the next day. That increased pain then makes it harder to sleep the following night. Add in the exhaustion (fibromyalgia fatigue is profound and doesn’t respond to a simple early night), and you’re stuck in a cycle that feels impossible to break.

    Brain fog, low mood, and heightened stress responses all feed into this loop as well. It’s no wonder so many people with fibromyalgia feel utterly trapped by their sleep problems.

    Your body clock and fibromyalgia

    Your circadian rhythm—your internal body clock—helps regulate when you feel alert and when you feel sleepy. It’s driven by light exposure, meal times, activity, and routine. When fibromyalgia disrupts your sleep, it can also throw your circadian rhythm out of sync.

    Irregular sleep and wake times, staying in dim indoor light all day (because you’re too exhausted to go out), and crashing into bed at wildly different times can all confuse your body clock. Once your rhythm is disrupted, it becomes even harder to fall asleep at night and wake feeling rested in the morning—even if you’re desperate for rest.

    What actually helps? Evidence-informed strategies for fibromyalgia and sleep

    There’s no single “fix” for fibromyalgia insomnia, but several approaches have good evidence behind them. The aim isn’t perfection—it’s small, sustainable improvements that ease the cycle over time.

    Sleep-wake regularity: your body clock’s best friend

    One of the most helpful things you can do is work with your body clock rather than against it. This means:

    • A consistent wake-up time, even on weekends. Yes, even when you’ve slept terribly. This is hard, but it’s one of the most powerful tools for resetting your circadian rhythm. Your wake-up time anchors your body clock far more than your bedtime does.
    • Morning light exposure as soon as you can manage it. Natural daylight (even on a cloudy day) signals to your brain that it’s daytime, which helps regulate the release of melatonin later in the evening. If getting outside feels impossible, sitting near a window with your morning tea can help. Light therapy lamps are another option, though it’s worth discussing these with your GP first, especially if you have eye problems, take photosensitising medication, or have a history of bipolar or manic episodes.
    • A wind-down routine in the evening. This doesn’t need to be elaborate—20–30 minutes of dimmer lighting, something calming (reading, gentle stretching, breathing exercises), and stepping away from bright screens can signal to your body that sleep is approaching.

    This won’t work overnight, but over a few weeks, many people find their sleep becomes a little more predictable.

    CBT-I: one of the best-supported approaches for chronic insomnia

    Cognitive behavioural therapy for insomnia (CBT-I) is a structured, evidence-based approach specifically designed to tackle long-term sleep problems. It’s recommended by NICE (the National Institute for Health and Care Excellence) as a first-line treatment for chronic insomnia, including for people living with persistent pain conditions like fibromyalgia.

    CBT-I isn’t about “thinking positive” or forcing yourself to relax. Instead, it focuses on changing the thoughts and behaviours that keep insomnia going. This might include:

    • Stimulus control: retraining your brain to associate bed with sleep (not frustration, scrolling, or lying awake for hours).
    • Sleep restriction (more accurately called “sleep consolidation”): spending less time in bed initially to build up sleep pressure, then gradually expanding your sleep window as your sleep improves. This sounds counterintuitive but can be very effective.
    • Addressing unhelpful thoughts about sleep, such as catastrophising about how awful tomorrow will be if you don’t sleep tonight.

    CBT-I is usually delivered over several weeks by a trained therapist, though online CBT-I programmes (such as Sleepio, available on the NHS in some areas) can also be helpful. It’s not a quick fix, and it requires some effort, but many people with fibromyalgia find it genuinely improves their sleep quality over time.

    Pacing and energy management during the day

    How you manage your energy during the day has a direct impact on your sleep at night. If you push through on a “good” day and do far too much, you’re likely to crash hard afterwards—and that crash often includes worse pain and even more disrupted sleep.

    Pacing means finding a sustainable rhythm of activity and rest that doesn’t tip you into a flare. It’s not about doing nothing; it’s about doing enough, consistently, without overdoing it. Some gentle structure to your day—regular meal times, short rests, a bit of movement within your limits—can also help support your circadian rhythm and make it easier to wind down in the evening.

    There’s no “push through it” here. Pacing is about respecting your body’s limits and working with them, not fighting against them.

    Gentle movement within your limits

    Movement can help with both pain and sleep, but it needs to be the right kind of movement. This isn’t about graded exercise programmes or forcing yourself to hit step targets. For people with fibromyalgia, overdoing exercise often backfires, leaving you in more pain and even more exhausted.

    Instead, think: gentle stretching, short walks, seated exercises, or anything that feels manageable without triggering a flare. Even five or ten minutes of gentle movement during the day can help. Some people find that a bit of movement in the morning supports their body clock, while others prefer a gentle stretch in the evening as part of their wind-down routine.

    The key is listening to your body. If something leaves you feeling worse, pull back.

    Adjuncts and support tools: helpful, but not magic bullets

    Morning light and evening dim lighting

    Alongside a regular wake-up time, getting bright light in the morning and reducing bright light in the evening can help recalibrate your circadian rhythm. You don’t need expensive equipment—natural daylight is best, but if you’re housebound or it’s winter, a light therapy lamp (around 10,000 lux) used for 20–30 minutes in the morning may help. Speak to your GP before starting light therapy, especially if you have eye conditions, take photosensitising medicines, or have a history of bipolar or manic episodes.

    In the evening, dimming the lights and reducing screen time in the hour or two before bed gives your brain a chance to start producing melatonin naturally.

    Melatonin: a short-term adjunct, not a cure

    Melatonin is a hormone that helps regulate your sleep-wake cycle, and some people with fibromyalgia find that a low dose (around 1–3 mg) taken an hour or so before bed helps them fall asleep more easily. Small studies suggest melatonin may also have mild pain-relieving effects in chronic pain conditions, though the evidence is still emerging. Studies in chronic pain, including fibromyalgia, are still small and short term, and in the UK melatonin isn’t usually prescribed specifically for fibromyalgia on the NHS – it’s more of a case-by-case, off-label discussion with your doctor.

    However, melatonin isn’t a cure for fibromyalgia or fibromyalgia insomnia. It’s best used as a short-term tool to help reset your sleep pattern, ideally alongside the behavioural strategies above. It can cause daytime grogginess in some people and may interact with other medications, so it’s important to discuss it with your GP or specialist before trying it.

    Sleep hygiene basics

    You’ve probably heard of sleep hygiene: keeping your bedroom cool, dark, and quiet; avoiding caffeine late in the day; not using your bed for scrolling or working. These things can help, but they’re not usually enough on their own—especially when you’re dealing with fibromyalgia pain at night.

    Still, they’re worth getting right. Small adjustments like blackout curtains, a supportive pillow, or a notebook by the bed (for writing down worries so they’re not spinning in your head at 2 a.m.) can make a difference when combined with the bigger strategies.

    Practical tips you can try: small steps, realistic goals

    If you’re reading this and feeling overwhelmed, start small. Here are a few manageable things you can try:

    1. Pick one wake-up time and stick to it for two weeks, even after a bad night. Set an alarm, get up, and get some light (natural or from a lamp).
    2. Create a simple wind-down routine: 20–30 minutes before bed, dim the lights, put your phone in another room, and do something genuinely calming. Reading, gentle stretching, or listening to an audiobook all work.
    3. Keep a sleep and pain diary for a week or two. Note your bedtime, wake time, how you slept, and your pain levels. Patterns often emerge that can help you spot what’s helping (or hindering).
    4. Pace your daytime activity. Don’t try to “make up for lost time” on good days. Spread tasks out, rest before you’re desperate, and give yourself permission to do less.
    5. Try a “brain dump” before bed: write down anything that’s worrying you or that you need to remember. Getting it out of your head and onto paper can reduce the mental chatter that keeps you awake.
    6. Get outside (or near a window) in the morning, even for five minutes. Your body clock will thank you.
    7. Talk to your GP or a sleep specialist if insomnia is severely affecting your quality of life. CBT-I, referrals to pain management services, or adjustments to your medication may all be options worth exploring.

    Even small improvements in sleep can start to ease the pain-fatigue cycle. It won’t happen overnight, but over weeks and months, many people find that their pain becomes a little more manageable, their energy improves slightly, and the whole picture feels a bit less impossible.

    Bringing it together

    Fibromyalgia and sleep are deeply intertwined. The same nervous system changes that amplify pain also disrupt your ability to get restorative rest, creating a vicious circle that’s exhausting to live with. But while there’s no magic cure, there are evidence-informed strategies that can help.

    Working with your circadian rhythm, exploring CBT-I, pacing your activity, and making small, sustainable changes to your sleep habits can all contribute to breaking the cycle. Adjuncts like morning light, melatonin (if appropriate), and good sleep hygiene can support these bigger strategies, though they’re not enough on their own.

    The goal isn’t perfect sleep—it’s better sleep. And better sleep, even in small increments, can make fibromyalgia a little easier to live with.

    FAQ: Fibromyalgia and sleep

    Why can’t I sleep with fibromyalgia, even when I’m exhausted?
    Fibromyalgia affects your nervous system’s ability to regulate pain, stress, and sleep. Even when you’re exhausted, your brain may be in a state of hyperarousal, making it difficult to relax into deep sleep. Pain at night, heightened sensitivity, and a disrupted circadian rhythm all contribute to this frustrating “tired but wired” feeling.

    Can improving my sleep reduce fibromyalgia pain?
    Yes, to some extent. Better sleep won’t cure fibromyalgia, but it can help reduce pain intensity, improve your pain threshold, and ease other symptoms like fatigue and brain fog. Sleep and pain are closely linked, so working on one often helps the other.

    Is CBT-I effective for fibromyalgia insomnia?
    CBT-I (cognitive behavioural therapy for insomnia) has good evidence for treating chronic insomnia, including in people with long-term pain. It won’t work for everyone, and it requires commitment, but many people with fibromyalgia find it improves their sleep quality and reduces the impact of insomnia over time.

    Should I take melatonin for fibromyalgia sleep problems?
    Melatonin can help some people with sleep onset, and there’s early evidence it may have mild pain-relieving effects in chronic pain. However, it’s not a cure and works best as a short-term adjunct alongside behavioural strategies. Always discuss melatonin with your GP first, as it can cause side effects and may interact with other medications.

    Disclaimer: This article is for general information only and is not a substitute for individual medical advice. Always speak to your own doctor or specialist before making changes to your medication, diet, supplements, or activity levels.

    Next read: When you’re ready, learn how bad nights can tip you into crashes in Fibromyalgia Sleep and Flares: How Bad Nights Turn Up Pain and PEM

    Key resources & references

    NHS – Fibromyalgia overview

    NICE guidance on chronic primary pain (NG193)

    NICE guidance on ME/CFS: diagnosis and management (NG206)

    Versus Arthritis – Fibromyalgia

    Fibromyalgia Action UK (FMA UK)

    Written by Stems From The Gut
    Created by someone living with fibromyalgia, chronic pain and messy gut issues. I write in plain English to help you feel more informed and less alone. You can read more about who we are and how we use evidence on the Authors & Medical Stance page.

  • What Is Fibromyalgia? (And What It Isn’t)

    What Is Fibromyalgia? (And What It Isn’t)

    Why this question matters

    You’ve been living with pain for months, maybe years. It shifts around your body – your neck one day, your hips the next, your hands the day after that. You’re exhausted in a way that sleep doesn’t touch. Your brain feels thick and foggy. You’ve had blood tests, scans, referrals. Everything comes back “normal”.

    And yet you’re not fine. Not remotely.

    Maybe your GP has mentioned fibromyalgia. Maybe you’ve typed “chronic widespread pain” or “what is fibromyalgia” into Google at 2am, trying to make sense of it all. Maybe someone has suggested it’s stress, or that you just need to get fitter, and a small part of you is wondering if they’re right.

    Here’s the thing: fibromyalgia is real. It’s recognised by the NHS, by NICE guidelines, and by pain specialists across the UK. The pain you feel isn’t imagined, it isn’t weakness, and it isn’t your fault.

    So what is fibromyalgia – and just as importantly, what isn’t it?

    What is fibromyalgia? A plain-language definition

    Fibromyalgia is a long-term pain condition where your nervous system becomes oversensitive to pain signals. It’s as if the volume knob on your pain system has been turned up too high. Sensations that wouldn’t usually hurt – a light touch, everyday movement, even the weight of clothing or bedding – can feel painful, uncomfortable or strangely “too much”.

    Medically, fibromyalgia sits under the umbrella of chronic widespread pain. That means pain affecting several parts of the body (both sides, above and below the waist) for at least three months. In current NICE guidance it’s grouped within chronic primary pain – pain that has become a condition in its own right, rather than being explained by obvious joint damage, inflammation or a single injury.

    In fibromyalgia, your brain, spinal cord and nerves process information differently. The alarm system is on a hair trigger. That doesn’t make the pain any less real. It simply means the main issue sits in how the nervous system works, rather than in something that shows up on a scan or a standard blood test.

    This isn’t about “thinking yourself into pain”. The system that’s meant to protect you has become over-protective. Once those pathways are reinforced over months or years, they can be very persistent.

    How fibromyalgia feels in real life

    Fibromyalgia almost never shows up as “just aches”. It usually arrives as a cluster of symptoms that don’t fit neatly into a single box.

    The pain itself often feels deep and muscular, as though you’ve done a tough workout you never actually did. It can feel like joint pain even when the joints themselves aren’t inflamed or damaged. Some people describe burning, shooting or stabbing sensations. Others notice that even a hug, a waistband, or lying on one side in bed feels surprisingly sore. The pattern shifts: shoulders might be worst one week, lower back or hips the next, or sometimes it seems to be everywhere at once.

    Then there’s the fatigue – not just feeling tired, but a bone-deep exhaustion that doesn’t lift with a lie-in. People say it’s like waking every day with only 10% battery, no matter how early they went to bed.

    Sleep itself is usually part of the problem. Many people fall asleep only to wake repeatedly, or sleep through the night but wake feeling completely unrefreshed. Doctors call this non-restorative sleep: your brain never quite drops into the deeper, restorative stages often enough, so you wake feeling as if you’ve barely slept at all.

    “Fibro fog” adds another layer. Losing words mid-sentence. Walking into a room and immediately forgetting why. Reading the same paragraph three times and still not taking it in. Mixing up dates, names or simple tasks you’d normally do on autopilot. It’s frightening, especially when you worry about things like dementia, but in fibromyalgia it’s usually part of the wider picture of chronic pain, poor sleep and a constantly over-busy nervous system.

    Many people with fibromyalgia also notice their senses feel dialled up. Background noise in a café, bright lights in a supermarket, strong smells or changes in temperature can all feel overwhelming. IBS-type gut symptoms, bladder urgency, headaches or migraines, dizziness, restless legs and muscle twitches are common travelling companions.

    Taken together, it can feel as if your whole system is turned up too loud.

    How is fibromyalgia diagnosed?

    There isn’t a single blood test, scan or “marker” that diagnoses fibromyalgia. That doesn’t mean it’s vague or made up – it means diagnosis is based on patterns rather than one lab result.

    In practice, a diagnosis usually comes from three strands woven together:

    Your story and symptoms. Your clinician will listen for pain affecting multiple areas of the body for at least three months, alongside things like fatigue, unrefreshing sleep and brain fog.

    A physical examination. Your GP or specialist will check painful areas, look at how the pain is distributed and make sure there are no obvious signs of joint inflammation, neurological disease or another clear explanation that would point in a different direction.

    Tests to rule out other conditions. Blood tests help exclude things like thyroid disease, inflammatory arthritis, anaemia or vitamin deficiencies.

    Normal blood tests do not mean the pain is “just anxiety” or “in your head”. They simply show that those particular problems aren’t present.

    Some GPs are confident diagnosing fibromyalgia themselves; others refer on to rheumatology or pain clinics. Whichever route you take, a good diagnosis should feel like someone has finally joined the dots with you – not like you’re being dismissed.

    What fibromyalgia isn’t

    Because fibromyalgia doesn’t show up clearly on standard tests, a lot of myths have grown around it.

    It isn’t “all in your head”.
    The brain and nervous system are central to fibromyalgia, but that doesn’t make the pain imaginary. Brain imaging studies show differences in how people with fibromyalgia process pain and sensory information. The pain is real; the wiring just works differently.

    It isn’t classic arthritis.
    Fibromyalgia doesn’t damage or deform your joints or bones. You can absolutely feel joint pain, stiffness and aching, but if you have visible swelling, warmth or deformity in a joint, that needs separate assessment. Some people live with both fibromyalgia and an inflammatory or mechanical joint problem – but they’re not the same condition.

    It isn’t laziness or a lack of fitness.
    Most people with fibromyalgia have pushed through for a long time before anyone names what’s going on. Chronic pain naturally leads people to move less, which can cause deconditioning over time – but that’s a consequence, not the root cause. You didn’t bring this on yourself by being “unfit”.

    It isn’t simply stress or depression.
    Stress and mood absolutely influence pain, and long-term pain feeds anxiety and low mood in very understandable ways. But fibromyalgia isn’t just “stress in disguise”. It’s better understood as a condition of nervous-system sensitisation, sometimes with mood and stress layered on top, rather than as a purely psychological problem.

    Why does fibromyalgia happen?

    The honest answer is that we don’t yet have a single, simple explanation. Fibromyalgia seems to develop from a combination of factors that add up over time.

    There may be a genetic vulnerability – fibromyalgia and related pain conditions run in families. On top of that, many people develop central sensitisation: over months or years, the nervous system becomes more and more protective, until it starts reacting as if everyday sensations are dangerous.

    There’s usually a trigger, or a cluster of triggers. For some people, fibromyalgia appears after a physical injury, an operation, an infection or a period of severe illness. For others, it follows a stretch of intense life stress – bereavement, relationship breakdown, work pressure – or a long spell of poor sleep and burnout. In many cases, several of these threads are tangled together.

    Hormones seem to play a role too. Fibromyalgia is more common in women, and some people notice their symptoms fluctuate with their menstrual cycle or around perimenopause and menopause. That doesn’t mean oestrogen changes are the whole story, but they’re likely part of it.

    There’s also growing interest in gut–immune–nervous system connections. Many people with fibromyalgia also live with IBS-type gut symptoms, and research is exploring whether changes in the gut microbiome and low-grade inflammation might interact with the pain system. At the moment, it’s safer to describe these as possible contributors rather than simple causes or cures.

    What we know with confidence is that fibromyalgia is a real neurobiological condition that emerges from a mix of biology, life events and environment. It’s not about being weak, negative or somehow failing to cope.

    How is fibromyalgia treated? A realistic overview

    There is no quick cure for fibromyalgia. Anyone promising to “fix” it in a month with a single supplement, boot camp or detox is overselling. But that doesn’t mean there’s nothing to be done.

    Most people who find a better balance with fibromyalgia do so through a combination of approaches that gradually turn the nervous system’s volume down and make life more liveable. The aim is “better and more manageable”, not perfection.

    Understanding and validation.
    Simply having a clear explanation – “this is fibromyalgia; this is how it works” – is surprisingly powerful. Knowing that your pain comes from nervous-system sensitivity rather than hidden damage can reduce some of the fear and confusion that automatically dial pain up. Being believed matters too. A GP or specialist who says, “Yes, this is real and it’s tough, but there are things we can try,” makes a huge difference.

    Pacing rather than boom-and-bust.
    Many people with fibromyalgia recognise the boom-and-bust pattern: a slightly better day appears, you rush to catch up on everything, and then you crash hard for days afterwards. Pacing is about stepping off that rollercoaster. It means spreading activity more evenly, building in rest before you’re desperate for it, and working out what feels like a sustainable “baseline” level of activity for you right now. From there, you can experiment with very gentle increases.

    If you notice post-exertional malaise (PEM) – where even modest physical or mental activity makes you significantly worse for a day or more – the approach needs to be especially cautious, more akin to ME/CFS-style pacing than to classic graded exercise. The key is respecting the limits your body currently has, not pushing through them because you “should” be able to.

    Sleep support.
    Non-restorative sleep is such a core piece of fibromyalgia that any improvement here tends to ripple out into pain, fatigue and brain fog. Helpful strategies include keeping a fairly consistent wake-up time (even after a bad night), getting some daylight soon after waking, creating a short wind-down routine in the evening and looking at anything else that might be disrupting sleep – from medication timing and pain to worries that hit hardest at 2am.

    Cognitive behavioural therapy for insomnia (CBT-I) is one of the most evidence-based treatments for long-term sleep problems, and it can be adapted for people with chronic pain. It doesn’t suit everyone, and it does require some effort, but for some people it makes a real difference to sleep quality over weeks and months.

    Movement within your limits.
    Movement helps pain, mood, sleep and general health – but only if it’s done in a way that your system can tolerate. For fibromyalgia, “no pain, no gain” is usually the wrong approach. For some people, helpful movement looks like short, gentle walks, stretches or water-based exercise. For others, especially when symptoms are severe, it might start with very small, structured movements around the house or in a chair.

    The key is to work with your body, not against it: start low, go slow, and watch how your symptoms respond over the next 24–72 hours rather than just in the moment.

    Emotional and psychological support.
    Living with long-term pain is emotionally hard work. Therapies such as CBT or acceptance and commitment therapy (ACT) can help people find ways to live alongside symptoms, reduce the intensity of distress, and make room for things that still matter to them. That doesn’t mean your pain is “just psychological”. It means your brain, body and emotions are all connected – and if one part is under constant strain, it’s helpful to support the others.

    Medication – where it fits, and where it doesn’t.
    Medicines sometimes take the edge off fibromyalgia symptoms, especially when used alongside the approaches above, but they’re rarely a complete solution on their own.

    In NICE guidance for chronic primary pain, the main medicines considered are certain antidepressants, such as amitriptyline or duloxetine. These are used at lower doses than for depression and may help calm overactive pain pathways and sometimes improve sleep.

    Other medicines, such as pregabalin or gabapentin, are generally reserved for people who also have clear nerve-type pain or another neuropathic pain condition, and usually under specialist advice. NICE is cautious about starting these purely for chronic primary pain.

    On the other hand, long-term opioids (like codeine or tramadol), benzodiazepines, and using paracetamol or NSAIDs as stand-alone treatments are not recommended for chronic primary pain in general. They may still have a role for other conditions you might also have – for example inflammatory arthritis – but they’re not good long-term tools for fibromyalgia-type pain on their own.

    Medication is very individual: what helps one person does little for another, and side effects often limit what’s realistic. The goal is to find the smallest effective dose of the simplest regimen that gives you some relief without too many downsides, and to combine that with non-drug strategies.

    Can fibromyalgia get better?

    Fibromyalgia doesn’t follow a single script. Some people find their symptoms are fairly steady over time. Others notice waves and phases – better stretches followed by flares. A smaller group see quite marked improvement over the years.

    It isn’t always relentlessly downhill. With the right mix of pacing, sleep support, movement within limits, emotional support and, where appropriate, medication, many people find that their pain becomes less overwhelming, crashes become less intense or less frequent, and life starts to feel a little more spacious again.

    You may not get back to how things were before fibromyalgia appeared. But it’s entirely reasonable to hope for more good days, shorter flares, and a life that feels more like yours again, rather than something ruled entirely by pain.

    Quick answers to common questions

    Is fibromyalgia real?
    Yes. It’s recognised by the NHS, by NICE, and by pain specialists and researchers worldwide. Studies show measurable differences in how people with fibromyalgia process pain and sensory information.

    Is fibromyalgia an autoimmune disease?
    At the moment, fibromyalgia isn’t classed as an autoimmune disease. Classic autoimmune illnesses involve the immune system directly attacking tissues, which isn’t what we see in fibromyalgia. It’s better thought of as a condition of nervous-system sensitisation, although there may be some immune and inflammatory involvement that researchers are still unpicking.

    Can fibromyalgia be cured?
    There’s currently no cure. But symptoms can be reduced and better managed with the right mix of self-management, medical support and time. The focus is on improving quality of life rather than chasing a complete disappearance of every symptom.

    Will exercise help, or make me worse?
    It depends very much on how it’s done and on whether you also experience post-exertional malaise. Gentle, well-paced movement within your limits helps some people over time. For others, especially where activity reliably causes big delayed crashes, the priority is careful pacing and energy management first, with tiny movement experiments built in very gradually.

    Is fibromyalgia connected to gut health or hormones?
    Both seem to be part of the wider picture. Many people with fibromyalgia have IBS-type symptoms, and hormonal changes (for example around perimenopause) can influence how symptoms feel. Supporting gut health and hormone balance can help as part of a bigger plan, but they’re unlikely to be magic bullets on their own.

    Disclaimer: This article provides general information about fibromyalgia and is not a substitute for individual medical advice. If you’re experiencing chronic pain, fatigue or other worrying symptoms, please speak with your GP or a specialist. Everyone’s situation is different, and what works for one person may not work for another.

    Next read: If you’d like to understand why sleep is such a big deal in fibromyalgia, read our guide to fibromyalgia and sleep

    Key resources & references

    Written by Stems From The Gut
    Created by someone living with fibromyalgia, chronic pain and messy gut issues. I write in plain English to help you feel more informed and less alone. You can read more about who we are and how we use evidence on the Authors & Medical Stance page.

  • Welcome to the Stems From The Gut blog

    Welcome to the Stems From The Gut blog

    Living with fibromyalgia or chronic primary pain can feel like navigating a fog with no map. One day you’re managing; the next you’re flaring and can’t remember why. Your GP might have given you a diagnosis, but not much explanation. Online, you either find miracle cures that don’t work or complicated research you can’t make sense of when you’re exhausted.

    That’s where Stems From The Gut comes in. This is a fibromyalgia chronic pain blog that explains the science behind your symptoms in plain English, without over-promising or overselling. It’s here to help you understand what’s happening in your body – especially the gut–brain connection – so you can make informed choices that actually fit your life.

    You’re not looking for another person telling you to “just try harder”. You’re looking for realistic, evidence-informed support. That’s exactly what you’ll find here.

    What you’ll find on this fibromyalgia chronic pain blog

    This blog focuses on fibromyalgia and chronic primary pain, plus overlapping conditions like ME/CFS and Long COVID. The posts cover the topics that actually matter when you’re living with these conditions:

    Sleep and circadian rhythm. Why your sleep is disrupted, how that affects pain and fatigue, and what might genuinely help without requiring heroic effort.

    Gut health and the gut–brain–immune connection. How your digestive system, nervous system and immune system talk to each other, and why that matters for fibromyalgia symptoms. This isn’t about promising gut-healing cures; it’s about understanding the biology so you can make sense of your experience.

    Flares, pacing and nervous-system support. How to recognise your patterns, work with your limits instead of fighting them, and manage the boom-and-bust cycle that so many of us fall into. No graded exercise plans, no “push through the wall” advice – just pacing that respects post-exertional symptom worsening.

    Gentle lifestyle ideas that respect energy limits. Small, practical adjustments to movement, food, rest and routine – things you can actually do when you’re already exhausted.

    Everything is written with the understanding that you’re managing a real, physical condition. Not “all in your head”, not something you can positive-think your way out of.

    Who this is for (and who it isn’t for)

    This blog is for you if you’re tired of feeling dismissed. If you want explanations that respect both the science and your lived experience. If you’re fed up with conflicting advice that ignores how severe your fatigue or pain actually is.

    It’s for people who want plain-English help understanding fibromyalgia, chronic pain and why their body responds the way it does – without the hype or the judgement.

    It isn’t the right blog if you’re looking for quick miracle cures, or if you want someone to tell you that you just need to exercise more and think positive. Those approaches don’t work for fibromyalgia and chronic primary pain, and this blog won’t pretend they do.

    How we talk about evidence and safety

    Every post on Stems From The Gut is evidence-informed and, where relevant, aligned with NICE guidelines and current research. That means the information you read here is based on what the science actually says – not exaggerated, not twisted to sell you something.

    At the same time, this blog is honest about uncertainty. Fibromyalgia research is still developing, and there’s a lot we don’t know yet. When the evidence is unclear or mixed, the posts will tell you that.

    This is general information, not personal medical advice. It can’t replace speaking with your GP or specialist, and you should always check any changes to your routine or treatment with your own doctor first. But it can help you have more informed conversations with them.

    Where to start

    If you’re new here, you can read more on the About page to learn about the story and aims behind Stems From The Gut. It explains why this blog exists and what it’s trying to do.

    Head to the Articles page to browse posts on fibromyalgia, sleep, flares, gut–brain topics and more. Start wherever feels most relevant to what you’re dealing with right now. You don’t need to read everything at once – come back when you have the energy.

    A gentle closing note

    Living with fibromyalgia or chronic pain doesn’t mean you’re lazy, weak or failing. It means you’re managing a complex, often invisible condition that affects multiple systems in your body. That takes enormous effort, even when no one else can see it.

    This blog is here to help you feel a little less alone, and a bit more equipped to understand what’s happening. One small step at a time, at your own pace.

    If you’re not sure where to begin, start with the basics below, or browse everything on the Articles page.

    Where to Start

    • Begin with our overview: What Is Fibromyalgia? (And What It Isn’t)
    • Then explore Fibromyalgia and Sleep: Can Fixing Your Sleep Really Help Pain and Exhaustion?
    • When you’re ready, read Fibromyalgia Sleep and Flares: How Bad Nights Turn Up Pain and PEM to understand why bad nights can trigger crashes

    Key resources & references

    NHS – Fibromyalgia overview

    NICE guidance on chronic primary pain (NG193)

    NICE guidance on ME/CFS: diagnosis and management (NG206)

    Versus Arthritis – Fibromyalgia

    Fibromyalgia Action UK (FMA UK)

    Written by Stems From The Gut
    Created by someone living with fibromyalgia, chronic pain and messy gut issues. I write in plain English to help you feel more informed and less alone. You can read more about who we are and how we use evidence on the Authors & Medical Stance page.