Fibromyalgia is a pain amplification syndrome produced by persistent afferent sensory stimulation and manifested as a central sensitization syndrome. Multiple studies including neuroimaging studies have consistently shown that fibromyalgia syndrome (FM) pain emanates from changes in the brain and spinal cord using the same mechanism that makes sunburnt skin sensitive to light touch. The role of sleep in the etiopathogenesis of fibromyalgia is underscored by the fact that up to 90% of FM patients have non-restorative sleep. The sleep disturbance should be investigated to ascertain whether periodic limb movement syndrome, sleep apnea, bruxism or acid reflux disease is present. FM is modified by hormonal, cytokine, neurotransmitter, and autonomic influences. The overwhelming majority with FM have sleep disorders, with the alpha-delta abnormality being the principal pathology. Managing sleep pathology in FM appropriately ameliorates the symptoms and signs of the syndrome more than almost any other intervention.