Tag: CBT-I

  • 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 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.