SLEEP DISTURBANCE PLAYS A PROMINENT ROLE IN FIBROMYALGIA. THE MAJORITY OF FIBROMYALGIA PATIENTS EXPERIENCING SOME SLEEP PROBLEMS. FATIGUE, TIREDNESS AND INSOMNIA WERE INCLUDED IN THE 2010 DIAGNOSTIC CRITERIA FOR FIBROMYALGIA.POOR SLEEP QUALITY HAS BEEN SHOWN TO BE ASSOCIATED WITH PAIN IN THESE PATIENTS. THE DIAGNOSIS OF FIBROMYALGIA INCREASES THE CHANCE OF PERSISTENT PAIN (E. G. CHRONIC DAILY HEADACHE, MIGRAINE), MORNING STIFFNESS, FATIGUE, SLEEP DISTURBANCES (E. G. DIFFICULTIES IN FALLING OR STAYING ASLEEP, EARLY MORNING AWAKENINGS, NON-RESTORATIVE SLEEP AND RESTLESS LEGS SYNDROME), ANXIETY DISORDERS, MOOD DISORDERS, IRRITABLE BOWEL SYNDROME AND IRRITABLE BLADDER. GENETIC AND NEUROENDOCRINE FACTORS LIKE SEROTONIN ABNORMALITIES MAY PLAY A ROLE IN THE PATHOGENESIS OF PAIN, MOOD DISORDERS AND NON-RESTORATIVE SLEEP IN FIBROMYALGIA.THESE PATIENTS ALSO HAVE SIGNIFICANTLY LONGER SLEEP LATENCIES, INCREASED AROUSALS, DECREASED SLOW WAVE SLEEP, REM AND TOTAL SLEEP TIME.THE FIRST STEP IN MANAGEMENT OF FIBROMYALGIA IS THE DIAGNOSIS OF ANY UNDERLYING DISORDERS AND OBTAINING THE PATIENT’S SLEEP HISTORY. NON-PHARMACOLOGICAL MANAGEMENT INCLUDE EDUCATION ABOUT SLEEP HYGIENE, INCREASING DAYTIME PHYSICAL ACTIVITY, ELIMINATION OF ANY PHYSICAL FACTORS THAT INTERFERE WITH SLEEP, GOING TO BED AND WAKING UP AT THE SAME TIMES EVERY DAY, AND AVOIDING ANY FOODS OR MEDICATIONS THAT MAY ADVERSELY AFFECT SLEEP.PHYSICAL METHODS, SUCH AS ULTRASOUND MAY INCREASE SLOW WAVE SLEEP AND DECREASE THE PERCENTAGE OF STAGE I SLEEP AND REDUCE FATIGUE, PAIN AND THE NUMBER OF TENDER POINTS. TRANS-CRANIAL DIRECT CURRENT STIMULATION OF THE PRIMARY MOTOR CORTEX MAY DECREASE PAIN AND IMPROVE SLEEP QUALITY.SELECTIVE SEROTONIN REUPTAKE INHIBITORS AND TRICYCLIC ANTIDEPRESSANTS FOR TREATMENT OF COMORBID MOOD DISORDERS MAY BE USEFUL BUT WORSEN RESTLESS LEG SYNDROME. MEDICATIONS LIKE PREGABALIN, DULOXETINE AND MILNACIPRAN IMPROVE SLEEP QUALITY IN FIBROMYALGIA PATIENTS. OTHER DRUGS SUCH AS AMITRIPTYLINE, TRAZODONE AND GABAPENTIN MAY ALSO POSITIVELY INFLUENCE SLEEP. SODIUM OXYBAT, THE SODIUM SALT OF GAMMA-HYDROXY-BUTYRATE INCREASES SLOW WAVE SLEEP, DECREASE SLEEP FRAGMENTATION, REDUCE PAIN AND FATIGUE AND IMPROVE THE QUALITY OF LIFE. DOPAMINE AGONISTS CAN IMPROVE SLEEP DISTURBANCES IN FIBROMYALGIA PATIENTS WITH CONCOMITANT RESTLESS LEG SYNDROME.