Monthly Archives: October 2009

Sleep and Chronic Pain

How Chronic Pain and Sleep Interact

Do you know someone who suffers from chronic pain?  It may be back pain, headaches, pelvic pain, fibromyalgia . . . many types of pain sufferers also experience sleep disruption.  Unfortunately, people can get into a cycle in which pain disrupts their sleep, and insufficient sleep makes pain worse.  This may seem logical, but let’s look more specifically at pain and sleep interactions.

A few chronic pain conditions are known for sleep disruption.  One of them is fibromyalgia.  70% of fibromyalgia patients have sleep complaints, and one study found that 27 of 28 had sleep-disordered breathing.  When the breathing was treated with CPAP, patients had a 23-47% improvement in symptoms.  80% of cluster headache patients are found to have obstructive sleep apnea.  For those patients who experience insomnia due to pain, it’s been shown that Cognitive-Behavioral Treatment (CBT-I) will improve their sleep, and may slightly decrease pain.

How to Minimize the Effect of Chronic Pain on Sleep

When people are in pain and their sleep is disrupted, they may feel like they need to catch some ZZZs whenever they can, even during the day. 

  • As best you can, maintain the difference between daytime activity and nighttime rest.  Stay awake and engaged during the day, and be sure to get bright light, preferably outside.  During the night, keep lights out, and minimize your activity.  This will help consolidate your sleep in the night. 
  • If you need to rest or lay down because of pain do so somewhere other than your bed or bedroom.  Make yourself a comfortable spot in the living room, maybe an easy chair or day bed.  This maintains a strong association of your bed as someplace to sleep. 
  • Get tested for sleep disorders if necessary, especially as discussed above. 
  • If you are taking prescription pain medications, be aware that some of them can cause sleep disruption.  You may want to ask your prescribing doctor to review your medications, and switch them if appropriate.

Optimal Sleep

The Most Common Sleep Problem

Once again, in 2008, insufficient sleep was the most common sleep problem in America.   More than 47% of adults and 57% of children get less than the recommended amount of sleep each night.   This chronic partial sleep deprivation can have global health effects, some of which we’ve discussed in past newsletters.   Here are some of the effects:

    – appetite regulating hormones leptin and ghrelin are disordered, causing increased hunger, increased appetite for high caloric, high fat and simple carbohydrate foods, and weight gain
    – physical agility, coordination and reaction time are impaired, contributing to drowsy driving auto accidents
    – irritability and mood impairment increases
    – memory, concentration and creative problem solving are impaired

The Optimal Sleep Test

We’re raising awareness of insufficient sleep by sponsoring The Optimal Sleep Test.   Sleep optimization is done by researchers to determine how much sleep is ideal.   During sleep optimization participants spend much more time in bed and allow themselves to sleep as long as they can, and wake on their own without an alarm.   Participants will commonly sleep hours extra for the first couple weeks, and then their sleep will settle into a regular nightly amount.

To do The Optimal Sleep Test:
1. Start at the beginning of your weekend, and continue for at least 5 nights.
2. Set your bedtime close to your regular bedtime, maybe 30 minutes earlier.
3. Make your room as dark and quiet as possible, consider turning down phone ringers or other sounds that may disturb you.
4. Allow yourself to sleep as late as possible in the morning, waking without an alarm.
5. At the end evaluate the symptoms above and see how they’ve improved.

You may find that the added sleep benefits you to the point that it is worth having fewer active hours in exchange for feeling better during the time that you are awake!

Prevent Drowsy Driving

Planning ahead before driving will help you reduce your risk of drowsy driving. Get adequate sleep the night before. Try to travel long distances with a companion who can take turns driving and can help you stay alert with some good conversation. Plan enough time so you can take plenty of breaks – at least every 2 hours or 100 miles on long trips. Avoid alcohol and sedating medications while driving.

While you are driving if you are yawning, constantly blinking, or find your head nodding those are signs that you are drowsy. Mentally you may not remember driving the last few miles, you may feel irritable, or experience wandering, dream-like thoughts. You may drift in your lane or even hit the side rumble strip.

If you experience any of these symptoms Stop and Rest! Even a twenty minute nap can hold drowsiness off for a while. You can also use the alerting effects of caffeine. A good plan is to pull over, drink a caffeinated drink and take a 20 minute nap. Because it takes about 30 minutes to feel the effects of caffeine this plan will provide the benefits of both the nap and caffeine. (Be aware that caffeine is less effective in people who regularly drink a lot of it).

Although it is just the end of October, soon the winter holidays will be in full swing. Let’s help make this a happy holiday season for everyone by getting enough sleep to be a safe driver, and making other arrangements when those holiday festivities cut our sleep short!

Drowsy Driving

Have you heard the buzz about drowsy driving? Sleep experts are now estimating that drowsy driving accounts for over 100,000 accidents each year, and causes 1550 deaths! The number of fatigue-related accidents may actually be much higher than this estimate because is it so difficult to detect. Fatigue-related accidents usually occur with a driver who is alone, driving at night, during the mid-afternoon lull, or at another time they are usually asleep. As opposed to a drunk driver, the drowsy driver will not swerve, apply the brakes or take any action to avoid the accident. They can’t, because they are asleep!

In 2005 the National Sleep Foundation conducted a large poll about drowsy driving. 60% of drivers said they had driven while drowsy, and an amazing 37% admitted to falling asleep at the wheel in the last year. Personally, these are alarming statistics to remember whenever I get on the road.

You are at risk if you have been awake for greater than 16 or 17 hours, are chronically sleep deprived, or have had a sleepless night. If you have an untreated sleep disorder such as sleep apnea you are also at risk. Some groups are more at risk than others, including men aged 25 and younger, shift workers, commercial drivers, business travelers, those who drive at night, and anyone who has worked 60 hours in a week.

Next Monday’s blog post will be filled with strategies to avoid drowsy driving, so check back then.

Sleep Habits for Immune Health

There are many ways that healthy sleep supports a healthy immune system. And remember, our immune system is constantly working to rid our bodies of foreign bacteria and abnormal cells. These abnormal cells can become cancerous, so it is important that our immune system weeds them out. To strengthen your immune system:
1. Be sure to get adequate rest most nights.
2. Sleep in accordance with the natural light-dark cycle. When the light bulb was invented and became widely available it significantly changed our way of life. Occasionally think to yourself “Would I be up right now if there was no electricity and light?” This question can help you stay in sync with natural light-dark cycles.
3. The techniques and skills we’ve discussed in this blog will help a cancer patient sleep better. Those include making the bedroom a good sleep environment, keeping a regular schedule, etc. (Past issues of the more comprehensive e-newsletters can be found on the website at http://naturalsleepmedicine.net/news_letters_page.html).

Sleep and Cancer

In honor of October being Breast Cancer Awareness Month, let’s look at the connection between sleep and cancer. This is a complex issue, as getting poor sleep increases the risk of cancer, and sleep in cancer patients is disturbed. Let’s look at each situation more closely.

Poor Sleep Increases the Risk of Cancer
In the last ten years research has been done looking at the life-long sleep histories of breast cancer patients. It’s been found that being awake at night (usually for shift work) increases the risk of developing cancer. This is thought to be because the light suppresses melatonin, which is highest during the dark night. In turn, when melatonin is low estrogen levels are increased, thus increasing risk of breast cancer. Colo-rectal cancer is also increased in women who have done shift work for 15 years or more. In addition to melatonin, cortisol patterns are irregular when a person is not sleeping well. Cortisol is important for our immune system.

It’s not only shift workers who suffer increased risk of cancer. Among physically active women, those who sleep less than 7 hours per night have a 47% increased risk of cancer compared to those who sleep more.

Sleep in Cancer Patients is Disrupted
Cancer patients experience sleep problems at a high rate. About 30-50% have insomnia, which worsens with repeat courses of chemotherapy. They also experience irregular sleep-wake patterns.

Progressive Muscle Relaxation for Sleep

Many people in my sleep clinic report lying in bed unable to sleep, having insomnia. This happens either at the beginning or middle of the night. For people who are thinking a lot, the Gratitude Meditation from last week can be helpful.

Another technique to help you fall asleep is called Progressive Muscle Relaxation. I recommend this for the people who report tossing and turning in bed. The benefit of Progressive Muscle Relaxation is that it both occupies the mind and relaxes the body. Below are the instructions, you can use this natural technique whatever time you are awake in bed.

  1. Starting with your toes, tighten a muscle group for a count of 8, then relax it fully, allowing those muscles to feel heavy and sink into the bed.
  2. Focus your mind on clenching your muscles and slowly counting. Gently turn away other thoughts.
  3. Next, slowly move up to the next muscle group, your calves. Repeat.
  4. Continue moving up your body through legs, abdomen, bottom, hands, arms, back, jaw, face.
  5. Be sure to continue breathing regularly during this practice.

People regularly find that they are asleep before they complete the entire sequence.

Gratitude Meditation for Sleep

On Thursday after my presentation a woman shared with me her lovely gratitude practice that she uses to go to sleep. I wanted to share it with you.

Each night after getting into bed she does this meditation until she is asleep. One by one, she slowly thinks of each person in her life, and thanks them for the ways they have helped her.

Research has been done recently on the practice of gratitude and how it affects health. Gratitude strengthens the immune system, decreases heart disease risk, and motivates you to take good care of yourself by exercising and getting regular check-ups. This emerging field is called ‘postive psychology.’

In my clinic, many people describe lying in bed at night worrying, thinking about their ‘to-do’ list or otherwise problem solving. These thoughts are stressful, and prevent them from sleeping. Doing this gratitude meditation can be a better way to engage your mind that is actually sleep-promoting. If you are stuck thinking in the night, try this and let me know how it works!

Sleep Health Education in Seattle

Many people need more information and inspiration to improve their sleep. This fall I’ll be giving sleep health talks to many groups of people around Seattle.  Here is a short listing of educational talks coming up.  If you would like to schedule a sleep presentation for your group just email or phone.

“Sleep Well, Succeed in School”
Seattle Academy October 19, 2009
Not open to the public

Many children have sleep problems, and their mood and performance suffers.
Come learn about common pediatric sleep problems, how they influence your child, and what you can do to ensure your child gets healthy sleep.

Join Dr. Catherine Darley, ND from The Institute of Naturopathic Sleep Medicine as she discusses:
normal sleep in children
the changes in sleep timing that teens experience
the effects of insufficient sleep, the most common sleep problem
sleep disordered breathing in children
steps to take at home to improve your child’s sleep
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“Optimizing Work Performance – The Sleep Connection”
October 20, 2009 noon -1pm
City of Seattle
Open to city employees

Join Dr. Darley to learn about how good sleep health can improve your job performance. Objectives for this one hour “Lunch and Learn” are:
Understand the ways poor sleep interferes with mental, physical and emotional performance
Understand the most prevalent sleep disorders, including insufficient sleep
Learn ways to improve sleep
There will be time for discussion and to answer questions.
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“Sleep Apnea and it’s Consequences”
November 10, 2009 7 – 8pm
King County Medical Assistants Association
Continuing Education event, open to members

Sleep apnea is a common sleep breathing disorder which affects both men and women. It is important to recognize and treat effectively because it significantly increases cardiovascular disease. Dr. Darley will discuss sleep apnea, it’s mechanism and it’s effects on overall health. We’ll also discuss current treatment options and issues.
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“Sleep and Mental Health: A Dynamic Interplay”
Continuing Education event for the Seattle Counselors Association (SCA)
February 19, 2010
Open to SCA members and visitors

Dr. Darley will discuss the dynamic interplay between sleep and mental health. We’ll look in depth at a few conditions, including ADHD, anxiety, and depression. The second half of the presentation will include screening questions for counselors to use in assessing whether sleep may be a contributing factor. We’ll also discuss the effects of pharmaceuticals, over the counter medications, and supplements. There will be ample time for questions and discussion.