Almost all patients with pain suffer from
sleep problems and the resulting daytime sleepiness and fatigue. Ron, a
forty-one-year-old former professional soccer player, said he had not
slept more than 2 or 3 hours a night for weeks. While that sounds
exaggerated, I’m sure he was basing that on the way he felt each day:
fatigued, weary, and irritable with an inability to concentrate or be
productive at work. Ron wanted relief—now. But before he could begin to
sleep well, I explained that he had to deal with his pain problem. As
you probably know, if you are in pain at night, it is virtually
impossible to relax and sleep well.
last step in your Pain-Free program, I want to help you solve the
problem of pain interfering with your sleep. I’ll explain how
inflammation and obesity are both linked to quite serious sleep
disorders such as obstructive sleep apnea (OSA), a problem in
which the person literally stops breathing many times throughout the
night. OSA is increasingly common among many overweight patients who
also suffer with pain.
lack of sleep is now thought to decrease the level of serotonin in the
body (a brain neurotransmitter that contributes to a relaxed mental
state and also plays a role in the pain that you feel), I will unravel
these findings so you can see how the sleep-pain-inflammation puzzle
fits together—especially in your situation. Finally, I want you to
sleep—tonight! So I’ll suggest some helpful, practical sleep strategies
that have worked for my patients and will help you relax your mind and
body, ease your pain, and finally get healing sleep.
century ago, Americans used to sleep an average of 10 hours each night.
But that was before Thomas Edison perfected the incandescent lightbulb
in 1880. Since then, the number of hours Americans sleep has greatly
declined. When you add the addictive power of television, home video,
and high-speed Internet, is it any wonder that the average American
today only sleeps 6½ hours? According to the National Sleep Foundation,
the proportion of adults in the United States sleeping less than seven
hours per night has increased from 16 to 37 percent over the past forty
years. Not only can lack of sleep put undue stress on the body, it can
result in physiological changes that increase your pain, affect your
cognitive skills and job performance, increase inflammation in the
body, and even seriously disrupt your breathing at night.
The Stages of Sleep
STAGE 1: Light sleep
STAGE 2: Moderate sleep
STAGE 3 AND 4: Deep sleep, called delta sleep
STAGE 5: REM (rapid eye movement) sleep, the dream stage
Increases in Pain and Moodiness
different pain ailments are associated with sleep disturbances. But
researchers are not certain if the sleep problem causes the increase in
pain or if the pain itself causes the sleep disorder.
are five stages of sleep (see sidebar, above). REM (rapid eye movement)
sleep, during which we dream, is associated with psychological
well-being and feeling refreshed upon awakening. People who are
deprived of REM sleep complain of irritability and moodiness. Stages 3
and 4 appear to be the most important for physical recovery. If sleep
disturbances occur during these stages, you will wake up feeling tired and may complain of muscular aches and pains.
twenty years ago, scientists in Toronto, Canada, discovered that
patients with fibromyalgia syndrome had stages of sleep that were
contaminated by an “alpha rhythm,” the normal brainwave of a person who
is awake—not asleep. In the study, researchers showed that
healthy volunteers deprived of delta sleep (the deepest stage of sleep)
by being exposed to noise, also developed periods of deep sleep mixed
with alpha waves, again like those brainwaves seen in wakeful states.
Interestingly, when deprived of delta sleep, these people experienced
musculoskeletal discomfort and mood symptoms similar to those of the
patients with fibromyalgia. These findings suggest that this sleep
interruption itself may have contributed to the achiness or pain and
mood symptoms. Your body needs deep sleep to repair itself.
sleep also leads to lower levels of serotonin in the body. Serotonin is
a naturally occurring neurotransmitter (brain chemical) that is
associated with a calming, anxiety-reducing feeling in the body. When
serotonin is depleted from lack of sleep, the result is an increase in sensitivity to pain,
as well as increased feelings of anxiety, malaise, and even depression.
There are also studies showing that a decrease in serotonin triggers an
increase in appetite, particularly for carbohydrates such as candy,
pastries, and other baked goods.
Decreases in Alertness and Performance
only is sleep deprivation associated with increased pain or decreased
pain tolerance, it causes changes in other mental functioning. If you
are sleepy during the day, this can lower your concentration and lessen
your short-term memory. Your energy, productivity, and attention to
detail are all compromised. Some patients who suffer with night after
night of sleep loss because of pain often ask if they have attention
deficit disorder (ADD), a problem that is associated with an inability
to focus or pay attention, and sometimes with impulsive behaviors.
instance, perhaps this is coincidence, but I find it unsurprising that
both the Chernobyl and Three Mile Island nuclear disasters occurred in
the early morning hours, when the body wants and needs sleep. And while
most people think that a captain’s drunkenness caused the Exxon Valdez oil spill, the National Commission on Sleep Disorders says otherwise. The real problem may have been the severe fatigue of the ship’s third mate, who was in charge at the time of the accident.
that involve total concentration, such as driving a car, are much
riskier because of the tendency for a sleep-deprived person’s attention
to wander without diversion or constant stimulation. I find it
interesting that the National Commission on Sleep Disorders concluded
that drunk driving causes fewer fatalities than does sleepiness. In
fact, the National Sleep Foundation estimates that 100,000 traffic
accidents and 1,500 fatalities occur each year due to driver fatigue.
Studies reveal that the day following the switch to daylight savings
time, when an hour of sleep is lost, traffic accidents increase by 7 percent. When we later gain the hour back going off daylight savings, we see the opposite—a 7 percent decrease in traffic accidents.
Increases in Appetite and Weight
A recent study of healthy volunteers in the medical journal Sleep
found that those who slept 2 to 4 hours a night were over 200 percent
more likely to be obese than those volunteers who got 7 hours of sleep.
In fact, one study found, just a 16-minute loss of sleep per night also
increased the risk of obesity.
indicate that sleep loss lowers the level of leptin, a hormone that
stimulates metabolism and decreases hunger. Sleep loss or shorter hours
of sleep appear to boost the concentration of the hormone ghrelin,
which increases hunger.
In a study of
middle-aged women, researchers concluded that weight gain was related
to the amount of sleep each night. This study started about twenty
years ago when more than 68,000 women were asked every two years about
their sleep patterns as well as their weight. After sixteen years, the
findings revealed that those women who slept 5 hours or less each night
weighed 5.4 pounds more than the women who slept 7 hours. The
researchers thought that the women who slept less were not only
threatened by weight gain but by obesity, as well. For instance, women
who slept 5 or less hours per night were 15 percent more likely to
become obese than were women who slept 7 hours each night.
line with these studies, there is increasing evidence that people who
sleep less than 6 or 7 hours a night have a higher risk for diabetes.
Researchers at the University of Chicago found that losing just 3 to 4
hours of sleep over a period of several days is enough to trigger
metabolic changes that are consistent with a prediabetic state. The
body’s ability to keep blood glucose at an even
level declines significantly. This may be because sleep deficit affects
the immune function of the body. In one study, scientists found that a
45 percent reduction in total sleep time resulted in a nearly 30
percent reduction in cellular immunity. Getting quality sleep is now
considered a basic defense mechanism to staying healthy and preventing
Reductions in Levels of Human Growth Hormone
now know that as deep sleep decreases, so does the secretion of human
growth hormone. By the time a person is thirty-five, this can decrease
by as much as 75 percent. Studies have shown that this hormone
deficiency can lead to obesity, loss of muscle mass, and a reduced
capacity to exercise.
We want to do
everything in our power to promote deep sleep and the production of
growth hormone, so overweight baby boomers with chronic pain can lose
weight, reduce inflammation and pain, and be active again.
Inflammation and Obstructive Sleep Apnea (OSA)
you lose sleep (even just an hour a night), pro-inflammatory chemicals
are markedly increased in the body, resulting in pain. Now some experts
believe that there is a possible link between OSA and inflammation.
is caused by the vibration of the soft parts of the throat while
breathing in and out during sleep. OSA involves periods of
breath-holding while snoring. The periods of stopped breathing are
called apneas, which are caused by obstruction of the upper airway.
Apneas may be interrupted by a brief arousal that does not awaken you
completely—you often do not even realize that your sleep was disturbed.
Yet if your sleep was measured in a sleep disorders laboratory,
technicians would record changes in the brain waves that are
characteristic of the arousals.
sleep apnea results in low oxygen levels in the blood, because the
blockages prevent air from getting to the lungs. The low oxygen levels
also affect brain and heart function. OSA is more common than asthma in
adults, and up to two-thirds of the people who have obstructive sleep
apnea are overweight.
For those who have
OSA, elevated levels of pro-inflammatory markers in the body can
directly worsen of the problem. Those with more than twenty apneas
(complete obstructions) per hour of sleep may have a greater risk of
dying from cardiac rhythm and rate disturbances, and complications of
high blood pressure such as stroke and heart attacks, than do people with fewer apneas.
Common Symptoms of Obstructive Sleep Apnea
• Morning headaches
• High blood pressure
• Dry mouth
• Sore throat upon awakening
• Concentration problems
• Memory failure
• Excessive daytime sleepiness
• Restless sleep (increased movements)
• Choking sensations
• Frequent awakenings
• Irregular heart rhythm