Thursday, June 16, 2011

Insomnia and Pain.

The sleep cycle is composed of 4 stages. Stage 1 is light sleep, Stage 4 is a deep sleep. Stage 4 is the most restful/restorative sleep. After Stage 4 we enter REM Sleep (Rapid eye Movement). This is the stage in which we dream. At night we go through this roughly 90 minute cycle multiple times spending less time in stages 3-4 and more time in REM sleep. How often one wakes up throughout the night varies by person and is not harmful unless it causes daytime sleepiness.

Pain can cause difficulty falling asleep and frequent awakenings throughout the night. This often limits the depth of the sleep cycle preventing the restful/restorative sleep and causing someone to wake up feeling tired despite having "slept" all night. Pain leads to decreased activity during the day which also hampers stage 3 and 4 restful sleep. For the patient in pain, less restful sleep causes more pain/anxiety/stress/depressed mood and less ability to cope with their pain.

Treatment for insomnia due to pain involves treating the pain, but also limiting factors that can make sleeping difficult for someone without pain. See "Rules for Sleep" and "Eating for Insomniacs" in future blog posts.

Monday, June 6, 2011

Depression and Anxiety.

Depression/Anxiety and pain often go hand-in-hand.  This is because pain will make you feel sad.  Sadness may also manifest physically as pain.  When you are hurting, you are not going to want to be active and do the things you enjoy.  If this is repeated continually, it will cause you to feel depressed.  As the depression worsens, prolonged immobility will cause your pain to flare up with the slightest activity.  The increased pain will make the depression worse and the depression, both directly and indirectly, will make the pain worse. That is why it is paramount to address and treat psychological disturbances when pain becomes chronic.
Lifestyle modifications are important to consider in the management of pain.  As already stated, stopping smoking is always a good first step.  A well balanced diet will also ensure that your nutritional and caloric demands are optimized.   Finally, minimizing caffeine and alcohol intake will also aide in your nutritional recovery.
Exercise has a crucial role in the treatment of pain.  It is important to differentiate regular exercise from therapeutic exercise.  Often people engage in sport-specific play, warm-up, stretch, and have a cool down periods.  Weight lifting and cardio focused programs also help in aerobic conditioning, toning & strengthening.  Albeit important for a healthy overall lifestyle, this differs from formal therapy programs that focus on back/neck exercises, postural training, and core strengthening.  In a formal PT program, your therapist may also utilize modalities that further facilitate pain relief.  This includes things such as massage, cold/hot packs, TENS units, and many more.  Your doctor and therapist will work together also to educate you on body mechanics and a proper home exercise program.