TY - JOUR T1 - Sleep as a Window into the World of Fibromyalgia Syndrome JF - The Journal of Rheumatology JO - J Rheumatol SP - 2499 LP - 2500 DO - 10.3899/jrheum.111314 VL - 38 IS - 12 AU - ROBERT JOSEPH THOMAS Y1 - 2011/12/01 UR - http://www.jrheum.org/content/38/12/2499.abstract N2 - One of the most clinically problematic challenges in the management of fibromyalgia syndrome (FM) is the unrefreshing nature of sleep. The problem goes beyond misperceiving the duration or quality of sleep, to a point where patients may feel worse after sleep — a complete loss of the restorative power of sleep. This clinical feature has been associated with changes in sleep that are not readily determined by conventional sleep stages and scoring, but may be identified by a number of complementary analyses. In essence, they all capture in some form the dominance of low amplitude fluctuations in physiological signals during sleep1,2. “Low” is a relative term — pathological sleep, a good example of which is sleep apnea, is dominated by oscillations recurring in nearly every signal trace, every 25–35 seconds. There is a separate set of oscillations at a higher frequency that dominates slow-wave sleep and unfragmented N2 non-rapid eye movement (NREM) sleep, centered on respiration, best seen as strong sinus arrhythmia and breath-to-breath respiratory modulation of blood pressure during periods of stable breathing3.In the electroencephalographic (EEG) … Address correspondence to Dr. Thomas. E-mail: rthomas1{at}bidmc.harvard.edu ER -