Sleep Issues Linked with Chronic Pain

Valerian root photo by oKikos

Valerian root photo by oKikos

Shocker, right? it’s kind of a catch-22. I can’t sleep because I’m in pain, and the fact that I’m not sleeping adds to my pain. I can’t win. According to a study on Arthritis & Rheumatology, researchers found that non-restorative sleep, a type of sleep where a person wakes up feeling unrested no matter how many hours they slept, “was the strongest predictor of new onset WP [widespread pain].”

So this study begs the question, are sleep issues causing widespread pain like that experienced in fibromyalgia? I could go either way with this one. On one hand, when I am exhausted and have insomnia, inevitably I feel terrible in the morning. The thing is, with me, I don’t remember I time when I slept well. From the time I was a young teenager I had trouble falling asleep. The chronic pain came many years later.

We all know sleep is beneficial to your overall health. Getting a good night’s sleep aids in memory recall, as well as mental alertness. When I person has periods no insomnia it can lead to lethargy, irritability, and an increased risk of certain diseases. So let’s get this straight…when you don’t get enough sleep, you become irritable — another shocker.

So what do those of us with sleep issues and autoimmune diseases do? For many of us, pain is adding to sleep issues. My doctor prescribed a muscle relaxer for me to take at night (Flexeril). I also have Xanax to relax. I can tell you that neither one of them help me get to sleep. The Xanax worked for a while, but I think you build up a tolerance to it.

About 9 million U.S. adults use prescription sleep aids to ensure quality rest, according to a recent CDC study. But experts caution that sleeping pills aren’t always effective or safe, and many think their use should be limited.

Tips for Falling Asleep without Medication

Put away the electronics.

I’m guilty of this, and in fact it’s going to be a hard habit to break. When I can’t sleep I am online reading, writing, researching, or just playing stupid online games (Damn, Candy Crush!). It’s best if you put your phone to bed in another room, and turn the laptop off about 30 minutes before you want to fall asleep. The other tough one for me is to shut the television off. Watching TV and playing on the computer actually stimulate the brain. You may start out thinking “oh I’ll just put on this episode of CSI until I fall asleep. Then what happens? Of course you need to know the ending, and if you’re like me, you will finish watching it.

Don’t laugh but I watched someone one of the morning news shows who said that wearing a pair of orange colored glasses an hour before bed with help the body produce it’s own melatonin. Wouldn’t that just freak my family out if I put on some orange goggles at 9pm. I can hear the screams and laughter already!

Limit Your Intake of Caffeine

As someone who suffers from migraines, I only have caffeine when I am suffering with a migraine headache. Otherwise I’ve eliminated it from my diet. I have never been a coffee drinker, but I know plenty of people that don’t even want to be spoken to before their first cup of coffee. Far be it for me to tell them to give that up. There are benefits in limiting you caffeine intake to the morning or early afternoon. Skip the caffeine full soda with dinner as caffeine in the evening can definitely mess with your sleep. Caffeine stimulated the nervous system. Maybe you’ve even tried one of those energy drinks full of caffeine to get you through an afternoon or work or classes. While it’s true that caffeine affects some people more than others, a good rule of them is not to drink anything with caffeine after 3pm.

A Hot Shower

I always thought there was nothing more relaxing than a hot bath (and I still find it relaxing), but research shows that when you come out of a warm shower into a cooler bedroom, your body temperature will drop. That drop in temperature signals your body that it’s time to rest, slowing down essential metabolic functions including heart rate, breathing, and digestion. The problem with the bath, for me, is that I like it super hot to help with muscle stiffness and pain. This can actually backfire on the relaxation end and make you feel more energetic.

Progressive Muscle Relaxation
Developed in 1915, this technique will never get old. “Progressive muscle relaxation is a relaxation in exercise where you systematically tense and then relax all the muscle groups of your body,” according to the clinical director of UPenn Medicine’s Behavioral Sleep Medicine Program Phil Gehrman, Ph.D., told Everyday Health.

The exercise generally starts with you lying down and taking a few deep breaths. First tense your toes and hold then in that tensed position for a few moments, then relax the toes. You will feel a greater awareness of the muscles in you toes as you release the tension. Continue this working up your body with the calves, thighs, buttocks, abdominals, hands, arms, and even your face. Plan to take a full 5-10 minutes to complete the progressive muscle relaxation technique.

I’ll be honest and tell you that even though this is a very effective technique, when I was pregnant, my husband, who played college football, tried to talk me through a progressive relaxation session to help me sleep. He said they used it to clear their minds before a football game. Just a small note that I found it easier to talk myself through it. Listening to my husband trying to sound soothing and calm made me laugh so hard that tears were coming down my face. The harder I tried to relax, the more I’d laugh at him, which he didn’t appreciate (but it was hysterical)

Meditate
Similar, to progressive muscle relaxation, meditation works by bringing awareness to the stress in your body and letting it go.  Focus on your breathing, feeling your belly rise and fall with each breath. As your worries and issues from the day come to mind, let them go and come back to your breathing. It helps me to focus on a two-syllable word like serene or tranquil so I can breathe in during the first syllable and breath out during the second.

There are many online tips for meditation. This is one I like from the Huffington Post.

Consider a Supplement
While natural supplements aren’t regulated by the FDA, they can be effective in helping you fall asleep. The most popular supplement is Melatonin, which can be an extremely effect sleep aid. One thing to note about melatonin, is that instead of taking it right before bed, try taking it an hour or two before bedtime. During this time the body creates it’s own melatonin as you wind down from the day. Adding the supplement will help keep that circadian rhythm.

Another herbal supplement option is valerian root. A few small studies have given inconclusive results, according to the Office of Dietary Supplements of the National Institutes of Health. That being said, there are a lot of people online that swear by valerian root.

Don’t forget there is also Sleepy Time tea, and other brand that help promote a good night’s sleep with herbs like valerian root in it. I’m not sure the teas work for me, but I really enjoy the taste of it, and I figure it can’t hurt.

Feedback Welcome

Let me know if any of these tips work for you. I’m always looking for new ways to fall asleep with medication, so please feel free to comment on this post with your ideas or email me to autoimmunemama@gmail.com. I’m off to try the progressive relaxation sans the husband. Perhaps it won’t be as funny this time around.

Here’s to a good night’s sleep to all!

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Lots of Drama on Valentine’s Day

Photo by Hathuyanna

Photo by Hathuyanna

Valentine’s Day has never been much of a big deal to me. I scheduled doctor’s appointments and hair cuts for the kids. We got pizza and watched a movie together. We watched Wall-E, which might possibly be the most boring movie I’ve ever seen.

We ended up with about 13 inches of snow and there is a huge shortage of salt in the area, so everyone is freaking out. It’s getting all sorts of media coverage. I didn’t even attempt to shovel the snow after a night of crazy loud sleeting. I knew it would be too heavy for me.

The night turned dramatic a few minutes ago with my youngest daughter. We laughed at something she said, which resulted in tears and theatrics with statements like, “My heart is broken and I just don’t know if there is anything you can do to fix it” and “No one in this family loves me.” She has a flair for drama — my own little Sophia Lauren.

The good news about today was that some of the intense pain in my hands was gone. I still have the numbness and my lower back aches, but it’s a huge step up from the pain I was in earlier in the week. My swelling has gone down quite a bit. Tonight I’m doing a lot of research on sleep, more specifically non-restorative sleep. I can’t be alone in feeling like I can sleep all night and still wake up exhausted and unrefreshed.

While sleep has been in issue for me as long as I can remember, it wasn’t until lately that I have a whole new level of exhaustion. There are many days where I can’t make it through without a nap — again, it’s a blessing that I work from home, as that might be difficult in an office. I’m not only trying learn about the stages of sleep (which will make for another blog post), but different ways to get more quality sleep.

I don’t know if you’ve tried sleep medications, either over-the-counter or prescription, but with most of them, I wake up in more of a fog than usual. I think I’ve touched on my issues with Ambien in previous blog post. I have not remembered shopping sprees on Ebay (very happy that even on meds I’m a bargain shopper) and I’ve made several phone calls and written emails that I don’t have a single memory of in the morning.

Needless to say, I need help in the area of sleep. With my rheumatologist mentioning the possibility of starting Lyrica, he did also mention that it would help me relax at night. Perhaps an added bonus. Have any of you on Lyrica seen a benefit in your quality of sleep? I’d be really interested to hear how it has affected others.

We did have a Twitter comment asking about Orencia. For any other readers on Orencia for their rheumatoid arthritis, how long did it take to begin feeling a difference? Feel free to comment here or on our Autoimmune Mama Facebook page.

Sleep and Autoimmune Diseases

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It’s no secret that one thing people with autoimmune diseases like rheumatoid arthritis, lupus, and fibromyalgia need is sleep. But for many of us who suffer from these diseases, that can be much more difficult than it sounds. Johns Hopkins’ Rheumatoid Arthritis treatment information page says rheumatoid arthritis  patients “often need over ten hours of sleep a night, or eight hours a night and a two-hour nap during the day.”

Seriously? A 10 hours of sleep a night? That would be a dream. Between not being able to fall asleep and waking up in pain one or more times each night, I’d be lucky to say I get 6 hours of sleep each night. I do have the luxury of napping during the week on most days and that keeps me going, but I can’t help but wonder what it would be like to fall asleep and wake up feeling refreshed.

I wake up exhausted, no matter how many hours of sleep I have had. My rheumatologist reminds me at every visit that sleep deprivation can lower resistance and increase flares in patients with autoimmune issues. I’m not arguing that. I’m just saying sleep eludes me most of the time.

I’ve tried tea that is supposed to help you sleep, natural remedies like valerian root and melatonin. I’ve always used over-the-counter drugs to help you sleep, as well as prescription drugs like Ambien and Lunesta. While I do have an active prescription for Ambien, I don’t use it that often. If I’ve had three or four nights with very little sleep, I will break down an take one. The problem I have (well, one of them) is that I wake up even more groggy than usual. I won’t even get into the numerous phone conversations and online shopping excursions I’ve had on Ambien, which I have no recollection of.

I get made fun of for my morning or afternoon naps, but I honestly don’t know how I could make it through without them. I don’t have a normal tired feeling. It’s possible that people who don’t suffer from autoimmune issues don’t understand our kind of exhaustion. I’m not just tired, I am ready to fall over and can’t keep my eyes open.

I’ve had the privilege of connecting with a lot of new people through this blog and I’m wondering what you do to help with sleep. I’d also like to hear if you wake up with a numb sort of pain. This is new for me in the past month or so. I wake up and my whole arm is numb, but it hurts terribly. I’ve had the “maybe you’re sleeping on it wrong” suggestions, but it’s not that. It’s a stiffness through the elbow that causes a pain down through my fingers. I am basically unable to use the arm for at least the first 20-30 minutes of my day. Is this common?

As always, I’d love to hear from you. If you have any great ideas to help me (and other readers) fall asleep, please share. Knowledge is power and there is strength in numbers. It’s important to gain strength from others fighting the same fight.