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:
- 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).
- 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.
- 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).
- 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.
- 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.
- Get outside (or near a window) in the morning, even for five minutes. Your body clock will thank you.
- 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
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.