Welcome to the current newsletter issue of Advances in Medicine
(AIM) - Take AIM against pain, brought to you by Dr. Tim Sams
and My Pain Relief Doc - www.mypainreliefdoc.com
Feel free to send me an e-mail with your own thoughts and
experiences. Email: timsams@mypainreliefdoc.com.
* * *
SLEEP
To sleep. To sleep, per chance, to dream. A good night's sleep
and feeling refreshed, the world a little brighter, your stress a
little lighter, your structure a little tighter.
Unless you have chronic pain. The blast of cold, honest reality
is that if you have moderate to severe chronic pain, there may
be no way you can get eight continuous hours of refreshing sleep
daily or even close to daily. There may be no medication or sleep
regimen that will effectively promote sleep for eight hours
consistently. Sleep deprivation will inevitably increase chronic
pain. Good sleep hygiene is absolutely essential to decreasing
pain and increasing your ability to function while improving
your quality of life.
Some technical sleep info to begin with-when you first fall
asleep each day, you proceed through four stages of sleep,
handily referred to as Stages 1-4. After your first 1-4 cycle,
in each successive cycle, you skip the lightest sleep, Stage 1,
and go into rapid eye movement sleep, then into stages 2, 3, and
4. Each cycle takes about 90 minutes-95% of people awakened
during the rapid eye movement stage report they were dreaming.
Most episodes of awakening during the night occur during the
lighter sleep of stage 2, when painful body signals disturb
sleep.
Each of the four stages of sleep is characterized by a
particular brain wave pattern as measured by EEG. Sleep
researchers used to believe that Stage 4, the deepest sleep,
wasn't very important. Then seminal studies in the field
demonstrated that if people were prevented from entering Stage 4
over the course of a night's sleep, they became exhausted,
irritable, mentally confused, and even developed diffuse
myofascial pain, similar to fibromyalgia.
You may not be able to sleep for eight solid hours, but it is
important that you get at least two and preferably three
complete cycles of sleep. You may benefit from taking a
medication like Lunesta, Ambien, Sonata, or Rozerem, especially
no more than a few times a week. Many patients take these
medications every night; perhaps noticing that they become less
effective as tolerance develops. Pain physicians often prescribe
tricyclic type medications, e.g, amitryptaline, desipramine,
imipramine, or doxepin, which are less likely to promote
tolerance or become ineffective over time. Keep in mind that any
medication that knocks you out for eight hours, over weeks or
months, will make you groggy during the day.
Your sleep-wake cycle is determined by the Reticular Activating
System (RAS) in the brain. This system is largely controlled by
the neurotransmitter serotonin. Adequate amounts of serotonin in
the body and the RAS are critical for healthy sleep. People who
are seriously depressed tend to have less serotonin, and thus,
tend to have trouble staying asleep at night. Treating
depression is critical to good sleep hygiene, including
treatment with antidepressants, e.g., the SSRI's like Paxil,
Prozac, Zoloft, or Lexapro. SNRI's like Cymbalta or Effexor
may be used.
Vigorous activity and exercise are important for good sleep
hygiene, also. If you spend half your day or more resting due to
pain, and don't exercise daily, it is no surprise that you are
having trouble sleeping. As people age, even without chronic
pain, they have trouble staying asleep. Pain just makes this
worse. It is absolutely necessary that you exercise during the
day. There is an article available on the home page of
www.MyPainReliefDoc.com that teaches people in pain how to
exercise without increasing pain. Chapters 12 and 13 in ABC's
of Pain Relief and Treatment: Advances, Breakthroughs, and
Choices also reviews strategies for exercise and activity.
The impact of daytime napping on nighttime sleep is highly
equivocal. A short power nap within six hours of morning
awakening is probably just fine, especially if you are active
and/or exercise over the course of the day. A three-hour nap
combined with gross inactivity throughout the day is a recipe
for nighttime sleeplessness. There is a medication called
Provigil that many people in pain take to help increase
wakefulness during the day, stay off the couch, and improve
activity. If you feel lethargic and/or sleepy during the day,
talk to your doctor about Provigil.
Good night, and sleep tite,
Dr. Tim
My Pain Relief Doc
www.mypainreliefdoc.com
Copyright 2007. Dr. Tim Sams and My Pain Relief Doc.
All rights reserved. www.mypainreliefdoc.com
=========================================
You may freely distribute a copy of this newsletter or use it on
your web site or RSS feed, as long as you include the entire
article, along with the web links and copyright information.
Thanks, Dr. Tim
=========================================