Tag: fibromyalgia fatigue

  • 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 Sleep and Flares: How Bad Nights Turn Up Pain and PEM

    Fibromyalgia Sleep and Flares: How Bad Nights Turn Up Pain and PEM

    You know the pattern if fibromyalgia sleep flares are part of your life. A night spent tossing and turning, staring at the ceiling, or waking every hour. Then morning arrives, and with it comes pain that feels sharper, brain fog that is thicker, and a flu like exhaustion that sits heavy in your bones. It is not your imagination, and it is not weakness. There is a real, measurable connection between broken sleep and the worsening of fibromyalgia symptoms.

    This post builds on an earlier piece about why sleep itself feels so disrupted when you have fibromyalgia. Here, we’re looking at fibromyalgia sleep flares, what happens after a bad night, why pain and fatigue spike, how this connects to post-exertional symptom worsening, and what you can do to navigate the next day without making things worse.

    The reassuring news is that you are not imagining the link between rough nights and rough days. Research shows that poor sleep leaves the nervous system more sensitive to pain, and for people with ME or CFS or Long COVID overlap, inadequate rest can be one of the triggers that tips you into post exertional malaise. Understanding this cycle can help you approach bad nights with self compassion rather than self blame.

    Why a Bad Night Can Make Fibromyalgia Sleep Flares Worse

    When you do not get enough good quality sleep, especially deep, restorative sleep, your nervous system does not get the chance to reset properly. Think of it like a smoke alarm that has become too sensitive. It starts going off at the smallest whiff of toast, not because there is a real fire, but because its threshold has been turned down too low. That is essentially what happens with pain processing when sleep is disrupted.

    In fibromyalgia, this is part of something called nociplastic pain or central sensitisation. Your nervous system has become over protective, and it amplifies pain signals that might feel mild or even go unnoticed in someone without chronic pain. It is not all in your head. It is your alarm system working overtime, trying to keep you safe but actually causing more distress. Poor sleep makes this hypersensitivity worse, because sleep is when the nervous system usually does its housekeeping and turns down the volume on threat detection.

    The good news is that a few bad nights usually cause a temporary spike in symptoms, not a permanent worsening. Your pain threshold might drop for a day or two, making everything feel more intense, but this does not mean you have lost ground forever. Your body is responding to a stressor, in this case lack of sleep, and once you get a bit more rest, things often settle back towards your baseline. It is uncomfortable and exhausting, but it is not a sign that you are failing or that your condition is spiralling out of control.

    Sleep, Flares and PEM or PESE: When Exhaustion Becomes a Crash

    In fibromyalgia, people often talk about flares. These are periods when pain, fatigue, brain fog and other symptoms ramp up significantly and stick around for days or even weeks. They are not random. They are usually triggered by something, whether that is physical over exertion, emotional stress, illness, or broken sleep. A flare can feel like your body has suddenly turned the difficulty dial right up on everything.

    For people who also have ME or CFS or Long COVID, there is an additional layer called post exertional malaise, also called post exertional symptom exacerbation. This is when symptoms get noticeably worse after doing too much. It is not just feeling tired in the moment, but experiencing a delayed crash that can last for days. Too much does not only mean exercise. It can include mental effort, emotional stress, travel, or simply not getting enough sleep for several nights in a row.

    This is where it gets tricky. Broken sleep can act as one of several stressors that push you over the edge into a flare or a PEM episode. Imagine your energy and symptom tolerance as a budget. You might cope reasonably well with one stressor, such as a bad night, or a busy day, or an argument with a friend. When two or three pile up, you hit your limit. A fibromyalgia sleep flare up followed by trying to keep up with your normal routine can be the combination that tips you into a crash.

    It is important to understand that taking care of your sleep is one supportive pillar among others. Pacing, managing stress and supporting your nervous system are also important, but sleep on its own is not a cure. Improving your sleep will not make fibromyalgia or PEM disappear, but it can help reduce the frequency and intensity of flares by keeping one major stressor more under control.

    Planning for After a Bad Night: Pacing, Not Punishment

    After a terrible night, the instinct is often to push through. You feel as if you have lost time, so you need to catch up. There is a to do list staring at you, responsibilities that will not wait, and a nagging voice saying you should be able to manage if you just try harder. But here is the truth. Pushing through after a bad night is one of the quickest ways to trigger a worse flare. Your body is already running on empty, and asking it to perform at full capacity is like trying to sprint on a sprained ankle.

    A more sustainable approach is to think of your days using a simple traffic light system.

    On red days, when you have had a very bad night and feel dreadful, you go into a gentler mode. This means fewer tasks, more rest breaks, and letting go of anything that is not essential. It is not giving up. It is strategic energy management.

    On amber days, when you have had an ok night and feel wobbly but functional, you keep the essentials but drop the non essentials and add extra breaks throughout the day.

    On green days, when you have had a better night, you can consider doing a little bit more, but still within your limits. It is not about making up for lost time.

    Scaling down your plans after a bad night is not laziness or failure. It is wise self management. You are working with your body rather than against it, and that gives you the best chance of avoiding a full flare or a PEM crash. The goal is not perfection. It is to avoid the boom and bust cycle where you overdo it, crash hard, recover a little, then overdo it again.

    Tiny Tweaks That Help You Survive the Day After

    You do not need a long list of complicated strategies to get through the day after a bad night. Pick one or two small adjustments that feel realistic for your life, and be gentle with yourself. Perfection is not the goal. The aim is to get through the day without making things worse.

    If you wake up feeling wired and exhausted, a quieter, lower stimulation morning can help. This might mean softer lighting, less noise and simpler tasks that do not demand much decision making. Your nervous system is already overwhelmed, so you do not need to add more demand first thing.

    Gentle movement or stretching can help if it feels tolerable, with the emphasis on gentle. This is not about making up for lost time or forcing yourself through a workout. It is about moving in a way that feels supportive, such as a slow walk around the house or some careful stretches in bed. If movement makes you feel worse, rest is absolutely fine too.

    Steady meals and snacks can make a real difference. When you are exhausted, it is tempting to skip meals or survive on sugar and caffeine, but this can leave you even more shaky and foggy. Easy, nourishing food, nothing fancy, can help stabilise your energy without adding to your load.

    It also helps to think realistically about naps. For some people, a short nap earlier in the day, perhaps twenty to thirty minutes before mid afternoon, can take the edge off without ruining night time sleep. For others, naps make falling asleep at night harder. If naps do not work for you, quiet rest or just lying down with your eyes closed can still give your body some recovery time. There is no single right way here. It is about noticing what your body responds to.

    Protecting Future Nights Without Perfectionism

    The goal here is not perfect sleep every single night. That is not realistic for anyone, especially for people living with fibromyalgia or ME or CFS. The aim is to gently shift the odds in your favour, so you have fewer bad nights and the bad nights you do have feel a little less intense.

    Gentle and realistic sleep protecting habits can help. A wind down routine that does not require lots of energy, perhaps dimming lights, putting your phone away and doing something calm, can signal to your nervous system that it is time to move towards rest. Roughly regular bedtimes and wake times, when life allows, can help stabilise your body clock. The key word is roughly. It has to be flexible enough to allow for the realities of chronic illness.

    What does not help is self criticism. Telling yourself that you have failed at sleep only adds stress to a nervous system that is already overloaded. You are doing your best in difficult circumstances, and some nights will simply be rough whatever you do. That is not your fault. The kinder you can be to yourself about sleep, acknowledging that it is hard, that you are trying, and that progress is not linear, the less emotional stress you add to the physical challenge.

    When to Talk to a Doctor About Your Sleep

    Having fibromyalgia, ME or CFS or Long COVID does not protect you from other sleep disorders, and sometimes what feels like typical fibromyalgia sleep may have an additional, treatable cause. It is worth speaking to a GP or sleep specialist if you notice certain signs.

    Very loud snoring, choking sounds, gasping for air, or long pauses in breathing during sleep can be signs of sleep apnoea, which is surprisingly common and can be treated. Uncomfortable sensations in your legs, such as crawling, tingling or an urge to move, or kicking during sleep, might point to restless legs syndrome or periodic limb movement disorder. Both have treatment options.

    If you are experiencing very low mood, high anxiety or any thoughts of self harm, it is vital to reach out for support. Chronic sleep deprivation can worsen mental health, and you deserve help to navigate that.

    Taking a short symptom diary, even just a few days, can make medical appointments more productive. Note when you go to bed, when you wake, how many times you wake during the night, and how you feel the next day. It does not need to be complicated. Rough notes on your phone are absolutely fine.

    You Are Not Lazy: It Is a Real, Rough Cycle

    Needing a quieter day after terrible sleep is not a character flaw. It is a sign that your body is working incredibly hard to manage a complex and exhausting condition. You are not lazy for resting after a bad night. You are being sensible. You are not weak for struggling with pain and fog when you are sleep deprived. You are human, and your nervous system is behaving in exactly the way science says it will in these circumstances.

    The key idea to take away is this. Bad nights can turn up pain and worsen post exertional symptoms, but you are not powerless. Pacing, tiny adjustments and self compassion can soften the impact over time. You will not eliminate bad nights altogether, and you will not always get it right. But every time you choose to scale back after a rough night instead of pushing through, you are breaking the boom and bust cycle a little more.

    If you would like to explore more about fibromyalgia and sleep, or dive deeper into pacing and energy management, there are other posts on this site that may help. Take what is useful, leave what is not, and remember that you are doing better than you think.

    Next read: What is fibromyalgia? (And what it isn’t)

    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.

  • 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.