0630 A 4-Week Sleep Intervention that Advances and Stabilizes Sleep Timing Leads To Meaningful Improvements in Pain and Physical Function in People With Fibromyalgia

Abstract

Abstract Introduction Fibromyalgia is characterized by chronic widespread pain, mood and sleep disturbance, and affects over 20 million Americans. Pharmacological treatments (antidepressants, antiepileptics, opioids) often have small treatment effects and adverse side-effects. Exercise therapy requires significant patient motivation, and psychotherapy requires specialized personnel. Here we report on a randomized clinical trial in which we tested a 4-week sleep-wake scheduling intervention with either a dim or bright daily 1 hour morning light treatment. Methods Fifty-four adults (52 females, 18-78 years) meeting ACR 2011 diagnostic criteria for fibromyalgia completed a 5-week protocol. In the first week each participant slept at home, ad lib, on their usual sleep schedule. Thereafter, they followed a fixed sleep schedule and a daily 1-hour morning light treatment (randomized to dim or bright light). The sleep schedule advanced each participant’s individual sleep-wake timing by no more than 1 hour, and focused on stabilizing sleep timing. Participants were monitored with wrist actigraphy throughout the study. Outcomes were assessed at baseline, 2 weeks and 4 weeks after the intervention. Results The 4-week intervention resulted in an average 36-minute advance in participants’ sleep timing in both groups (ps<0.001). Night-to-night variability in sleep timing also significantly decreased in both groups (ps<0.01). Pain and physical function improved equally in both groups (Fibromyalgia Impact Questionnaire-Revised, PROMIS Pain intensity, PROMIS Physical Function, ps<0.01). Across both groups, a greater shift in morningness (Owl-Lark score) was associated with a greater reduction in depressive symptoms (PHQ-9; r=-0.45, p<0.001). No significant side effects were reported in either group. Treatment expectations were not significantly correlated with symptom improvement (all rs nonsignificant). Conclusion Results suggest that 4 weeks of an advanced and stabilized sleep schedule can lead to meaningful improvements in pain and physical function in people with fibromyalgia. The addition of a bright vs. dim morning light treatment did not further increase symptom improvement. A reduction in depressive symptoms during the intervention may have contributed to the improvements in pain and physical function. Sleep-wake scheduling should be further explored as a potentially feasible, acceptable and effective adjunctive non-pharmacological treatment for fibromyalgia. Support (If Any) Grant awarded from NINR R21 NR016930.