Insomnia and Chronic Pain

Someone recently contacted me to ask about how she can get involved in a sleep study to help with her insomnia and chronic pain. I thought I would share our Q&A with everyone in case others are going through the same thing:

Q: How does one go about becoming a part of a sleep study? As a chronic pain sufferer, insomnia has plagued my life for the past 7 years. I would be very interested in your reply and I have ordered your book. I look forward to yet another approach, perhaps this will aid me!

A: First of all I want to thank you for your post. Chronic pain is an area that I have had some experience with in my clinical practice, and it is an exceptionally difficult area for sleep.

About 35-40% of those with pain issues actually have different brain waves associated with deep sleep than people without pain. The difference is that their deep sleep is lighter than others. It is called alpha delta sleep. This means more arousals, lighter sleep, and more difficulty staying asleep, for some.

Medications can be both helpful and harmful to sleep (both sleep meds and pain meds) and should be reviewed by your doctor. We have had luck with some insomnia meds (Ambien CR, klonipin, and I think Rozerem would work but I have no experience with it) but the program in my book, especially the 28 night program, should be an excellent adjunct to any formal diagnostic sleep study and therapy.

In addition you should know that many folks with pain also have an underlying sleep disorder and when we fix that the pain GETS BETTER!!!! Of course we cannot promise this, but it has happened on numerous occasions.

If you are looking to get a sleep study, based on pure insomnia most clinicians are not going to be favorable about this because insomniacs do not sleep, much less in a lab with 27 wires attached to their heads!

I would say for sure you should contact a sleep specialist (someone who is board certified in sleep medicine -- I can help you find one if you need me to) and see where they want to help.

If you feel that there are other sufferers here please bring them into the conversation as well.

Dr. Mike PhD

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• Cupping: Alternative Therapy to Treat Chronic Pain
• Sleep and Chronic Illness

Technorati Tags: sleep, chronic pain, Sleep Doctor

Sleep Facts

I recently came across a great list of sleep facts on the Pieces of Phour blog, and thought I would share it with you all. (The list was originated by Australia's The National Sleep Research Project.)

Before I launch into some selections from the list, here are my additions to the sleep trivia collection. Interestingly enough, one of these facts is about Australians and sleep.

The following 5 facts are all taken from my book, Good Night: The Sleep Doctor's 4-Week Program to Better Sleep and Better Health:

1. 75% of people in Portugal stay up past midnight, the highest percentage of any country.
2. 7 of the top 10 nocturnal areas are in Asia, led by Taiwan, where 69% turn in after midnight.
3. The Japanese sleep less than anyone else on the planet, with 41% snoozing just 6 hours or less each night.
4. Australians go to bed the earliest and sleep the longest. In a poll, nearly one-quarter of Australians say they go to bed by 10 p.m., and 31% said they average more than 9 hours of sleep every night. (Perhaps all this beauty rest is why Australians are so successful in Hollywood!)
5. One of the loudest snores recorded in Guiness World Records was 93 decibels (120db is a jet engine), by Kare Walkert of Kumla, Sweden, in 1993.

Now, onto the other list:

20 FACTS ABOUT SLEEP YOU PROBABLY DIDN'T KNOW... (OR WERE TOO TIRED TO THINK ABOUT)

(Short version, taken from the original 40-item list.)

1. The record for the longest period without sleep is 18 days, 21 hours, 40 minutes during a rocking chair marathon. The record holder reported hallucinations, paranoia, blurred vision, slurred speech and memory and concentration lapses.
2. Anything less than five minutes to fall asleep at night means you're sleep deprived. The ideal is between 10 and 15 minutes, meaning you're still tired enough to sleep deeply, but not so exhausted you feel sleepy by day.
3. A new baby typically results in 400-750 hours lost sleep for parents in the first year.
4. One of the best predictors of insomnia later in life is the development of bad habits from having sleep disturbed by young children.
5. The continuous brain recordings that led to the discovery of REM (rapid eye-movement) sleep were not done until 1953, partly because the scientists involved were concerned about wasting paper.
6. REM dreams are characterised by bizarre plots, but non-REM dreams are repetitive and thought-like, with little imagery -- obsessively returning to a suspicion you left your mobile phone somewhere, for example.
7. Some scientists believe we dream to fix experiences in long-term memory, that is, we dream about things worth remembering. Others reckon we dream about things worth forgetting -- to eliminate overlapping memories that would otherwise clog up our brains.
8. Scientists have not been able to explain a 1998 study showing a bright light shone on the backs of human knees can reset the brain's sleep-wake clock.
9. British Ministry of Defence researchers have been able to reset soldiers' body clocks so they can go without sleep for up to 36 hrs. Tiny optical fibres embedded in special spectacles project a ring of bright white light (with a spectrum identical to a sunrise) around the edge of soldiers' retinas, fooling them into thinking they have just woken up. The system was first used on US pilots during the bombing of Kosovo.
10. Seventeen hours of sustained wakefulness leads to a decrease in performance equivalent to a blood alcohol-level of 0.05%.
11. The 1989 Exxon Valdez oil spill off Alaska, the Challenger space shuttle disaster and the Chernobyl nuclear accident have all been attributed to human errors in which sleep-deprivation played a role.
12. Exposure to noise at night can suppress immune function even if the sleeper doesn't wake. Unfamiliar noise, and noise during the first and last two hours of sleep, has the greatest disruptive effect on the sleep cycle.
13. The "natural alarm clock" which enables some people to wake up more or less when they want to is caused by a burst of the stress hormone adrenocorticotropin. Researchers say this reflects an unconscious anticipation of the stress of waking up.
14. After five nights of partial sleep deprivation, three drinks will have the same effect on your body as six would when you've slept enough.


15. Ducks at risk of attack by predators are able to balance the need for sleep and survival, keeping one half of the brain awake while the other slips into sleep mode.
16. Feeling tired can feel normal after a short time. Those deliberately deprived of sleep for research initially noticed greatly the effects on their alertness, mood and physical performance, but the awareness dropped off after the first few days.
17. Diaries from the pre-electric-light-globe Victorian era show adults slept nine to 10 hours a night with periods of rest changing with the seasons in line with sunrise and sunsets.
18. As a group, 18 to 24 year-olds deprived of sleep suffer more from impaired performance than older adults.
19. Experts say one of the most alluring sleep distractions is the 24-hour accessibility of the internet.
20. The extra-hour of sleep received when clocks are put back at the start of daylight in Canada has been found to coincide with a fall in the number of road accidents.

Related Topics:

• Is Your Child Sleep Deprived?
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Santa and Sleep Disorders

I came across this really clever post over at Breath Spa for Kids, entitled "Is Santa at Risk for Sleep Disorders?", and wanted to share it with all of you. It's a list of sleep disorders that Santa may have, based on what we know about him.

My two additions to the list would be:

Santa could have psychophysiologic insomnia due to the anxiety he likely has from checking his list multiple times to make sure he know who is naughty and who is nice.

1. In addition, he could very well be a short sleeper, where he only needs 4 hours of sleep a night -- which would allow him to go on his merry way delivering toys to all the good little girls and boys.

Here's Breath Spa's original post:

"Santa Claus is a popular and successful figure but that can't insulate him from the risk of sleep disorders. Particularly during the obligations and convivialities of a busy and bon viveur festive season.

"Read through the following statements that each describe a sleep disorder that may affect Santa because of his lifestyle. Which of the following statements is true?

1. Santa is at risk for shift work disorder from staying in work to supervise the delivery logistics for the gifts leading up to Christmas.
2. Santa is at risk for sleep-disordered breathing if he has reflux that troubles him, related to his high-frequency, high-volume festive food intake.
   
3. Santa is at risk for mouth-breathing because of the rapid changes of temperature to which he is exposed in different climates and with his constant changes from outdoors to the indoor environment. Mouth-breathing is related to snoring.
4. Santa is at risk for obstructive sleep apnoea because he is obese.
5. Santa is at risk for all of the above.
   

"Santa should consult his GP or family doctor if he is aware of any sleep disturbance or if Mrs Santa has mentioned any such to him. If Santa interacts with the public or carries on delivering when he has a sleep disorder he may constitute a public health menace."

This blogger is right -- driving that sleigh when Santa's over-tired could lead to microsleeps, which could lead to accidents. Mercedes is developing a car that can keep drivers awake -- maybe Santa should call and put in a request for a custom-made safety sleigh.

Related Topics:

• Tips for Letting Your Kids in on the Santa Secret
• Alternative Treatments for Insomnia

Technorati Tags: sleep doctor, santa, insomnia, sleep apnea

Holiday Blues

The holidays can be rough on many people. This Washington Post article, which quotes Dr. Eric Hollander, director of the Compulsive, Impulsive and Anxiety Disorder Program at the Mount Sinai School of Medicine in New York City, makes suggestions for coping with the stress, sadness, and irregular sleep patterns some experience around this time of year:

"Maintaining healthful lifestyle patterns and getting together with others is especially important during the holidays," said Hollander.

He suggests making a special effort to get as much sunlight as possible, exercise regularly, eat a healthful diet, and keep up social connections during the holiday season. Eating a healthy diet goes a long way toward sleeping well, especially during the holiday season. If you eat well, you can sleep well.

Sleep-friendly foods may help you relax and fall asleep, but don't view them as "sleeping pills." All the sleep-friendly foods in the world won't help much if you are working until midnight, chugging coffee, and thinking constantly about the next day's work.

Assuming you aren't doing any of that, foods that may help promote sleep as part of a healthy diet and lifestyle include the following:

The Sleep Doctor's Sleep-Friendly Shopping List
(Feel free to print this and put it on your refrigerator if you need to!)

• tuna
• halibut
• pumpkin
• artichokes
• avocados
• almonds
• eggs
• bok choy
• peaches
• walnuts
• apricots
• oats
• asparagus
• potatoes
• buckwheat
• bananas

These foods contain generous supplies of the vitamins, minerals, fats, and proteins necessary for proper functioning of our nervous, muscular, metabolic, skeletal, and hormonal systems. Important nutrients include calcium, magnesium, selenium, zinc, omega fatty acids, amino acids to build proteins, vitamins C, E, and B-complex, and iron (especially for premenopausal women).

If you have been running around with your family or getting ready for guests and have not had time to eat at night, a light snack may allow you to fall asleep more easily.

Carbohydrates and dairy products have been shown to
help decrease the time it takes to fall asleep. I have several examples of appropriate bedtime snacks (including my own personal favorites) in my book Good Night.

You'll notice that hot toddies and egg nog aren't on the shopping list above.

Regarding alcohol: Alcohol is a depressant. Although it may help you fall asleep, as your body clears it from your system while you are sleeping, you will have a withdrawal that can cause symptoms like nightmares, sweats, and a headache.

If you're going to drink socially, try drinking one glass of water for every alcoholic beverage you drink to reduce these effects.

Finally -- make the time for sleep and naps, if you can. But if you find yourself sleeping too much or feeling unusually depressed, do call a doctor or a hotline for help. The number for the National Suicide Prevention Lifeline is 1-800-273-8255. Here is their MySpace page.

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• 13 Healthy Habits to Improve Your Life
• Eating for Everyday Wellness

Technorati Tags: sleep doctor, holiday stress, nutrition, wellness

Jessica Simpson's Psychophysiological Insomnia

Maybe Renee Zellweger should seek sleep advice from a fellow celebrity: Jessica Simpson has found a way to beat the insomnia that's been plaguing her lately -- by sleeping on the floor.

"It's more of a mental thing. I tell myself, 'I cannot fall asleep, there's no way if I get into bed right now I'm gonna fall asleep.' I end up just laying on the floor and falling asleep," Simpson says.

"That's the advice I've gotten -- don't ever get into bed until you know that it's time to go to sleep, or else you'll lay there and that's when you start tossing and turning... I'll start thinking about what I wanna dream about... It's called lucid dreaming. I'm a little sexually frustrated right now, so if you tell yourself what you're gonna dream about then you can have a really great dream."

In truth when someone cannot fall asleep in their bed but can fall asleep elsewhere, it is called Psychophysiological Insomnia.

This is a situation where there is a large mental component (the Psycho part -- not that she is psycho -- this is VERY common) and a physical component that has to do with the inability to relax certain muscle groups.

Jessica is also correct to not get in bed when you are not tired, because alltrying to sleep when you're not ready does is increase autonomic arousal-- basically, just frustrating yourself. Then you'll never fall asleep.

As for lucid dreaming, this is another very interesting topic. It is the situation where people are aware that they are dreaming and can "order up" whomever or whatever they want in their dreams. So if she is sexually frustrated, it is quite possible to order whomever she wants. In many cases people can reach orgasm in these lucid dreams.

If Jessica is interested in supplementing her floor-sleeping method, I would be happy to send her a copy of my book, Good Night, and my SoundSleep meditation CD. Here's my email.

Related Topics:

• Insomnia: Alternative Medicine Popular
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Technorati Tags: jessica simpson, insomnia, sleep doctor