Sleep and Insomnia

7 Winter Sleeping Tips for the Number of Days in the Week

cmaynard — Fri, 20 Nov 2009 09:45:27 -0800

November 20, 2009
by: Chris Maynard

Consider these points:

The relationship among pain and sleep has been confirmed in various studies detailing how [url:137,type=|term|,content=|chronic pain|] can make it difficult to sleep and how sleeping problems can exacerbate one’s symptoms.
A past Spine-health poll of nearly 1600 people found that 63.7 percent of people get less than or equal to 6 hours of sleep while only 29.9 percent of responders get the recommended 7-8 hours of sleep.

With this in mind, here are some tricks that I have found successful in getting to [url:161,type=|term|,content=|sleep|] on a more regular schedule. While I’m no chronic pain sufferer, some of these points still apply.

Hit the Hay When Sleepy but Get Up If You Can’t Knock Out

One of my biggest problems in the past has been forcing myself to lay down when I’m not tired, and then staying in bed for hours after failing to fall asleep. What usually happens is that I’ll start thinking too much about things going on in my life or what’s in store for the next day, and become worked up.

As a general rule, get out of bed after 20-30 minutes of failing to fall asleep. Once you get out of bed, engage in an activity that usually makes you tired but does not stimulate your mind too much (such as reading something dense), and do so with the lights dimmed as low as possible. Avoid the bright lights of television or your laptop computer.

In terms of when to go to bed, a big key is getting on a regular schedule that your body is accustomed to, something that has helped me become better at falling asleep around the same time as opposed to the 3-4 hour swings I’ve experienced in the past.

Crack a Window and Infuse Some Cold Air

If you’re like me, the only thing you enjoy about the winter besides the holidays is the cold weather, that is for sleeping and not anything else in the Midwest.

Simply cracking the window the tiniest bit is a great way to make the room temperature colder and to have deeper and more restorative sleeps. Of course, the one bad thing about this tip is that it does not always apply when the weather gets really cold, but it may still be useful for those “fashionably-late” seasons that have been prevalent the last couple of years.

Choose Herbal Tea or a Warm Glass of Milk instead of Caffeine

How some people drink caffeine all day and still get decent sleep is beyond me.

Make a conscious decision to avoid coffee after dinner and expand this to exclude/limit pop and even other stimulants like alcohol and nicotine.

Consider a warm glass of water or milk, which is my preferred choice prior to bed (after briefly putting it in the microwave for 5-10 seconds). If you don’t like milk, be on the lookout for herbal tea the next time you go grocery shopping. A variety of affordable, nighttime tea products exist to help people fall asleep, with sipping these herbal remedies often a great way to relax as well.

Exercise, Just Not Before Bed

Some people who have it made as good sleepers are able to exercise at the gym an hour or two before going to bed, with the [url:157,type=|term|,content=|exercise|] actually making them more tired. For me, exercising a couple of hours before bed usually delays the time I get to bed anywhere from 2-3 hours.

If you have problems sleeping after exercising, try to modify when you work out. Part of this comes back to being on a consistent daily schedule, with exercising early in the morning prior to when most people work often a good start to stimulate the body, which is usually then spent by the end of the night.

For those people who have problems getting up in the morning as a result of falling asleep way too late, try to exercise when you get home from work (around 6-7 p.m.). As it can take anywhere from 4-6 hours for the body to calm down from vigorous activity, this will at least provide you with the necessary time gap if you fall within this crowd of evening exercisers/troubled sleepers.

While many chronic back pain and neck pain sufferers worry that exercising will only exacerbate their pain, the opposite is actually true: remaining inactive is often worse for pain. Engaging in regular exercise, stretching and strengthening programs can promote the body’s natural healing process and make you feel better both physically and mentally.

Forced Worrying

If you’re a bit of a “worry-wart” like me, it can be difficult to get to sleep with so much on the mind. “Forced worrying” is an interesting way to try to ease your concerns and go to bed with a clean slate.

A couple of hours before you go to bed, take 15 minutes or so to write down your worries on a blank sheet of paper. Once done, leave the room where you wrote your worries, which literally symbolizes that you are walking away from your worries for the night.

Remind yourself that you will have plenty of time to address these worries the following day. Now if you find yourself in bed worrying about other things, keep a notebook and pen nearby and write these down as well.

Visualize Something Peaceful and Meditate on that Tranquility

With your mind free of worry, gently close your eyes and think of something tranquil and relaxing.

What this peaceful place exactly is varies from person to person. For me, I like to think of myself out on a boat in the middle of the lake, with a fishing pole in hand and nothing but nature around me.

In a similar light, consider incorporating a sound relaxation machine or even aromatherapy. Also important with this point is your need to associate your bed as a place to rest.

In other words, your bed should not be a place to bring your computer and do work, or to lay back, play video games and become way too stimulated. Be sure to associate your bed as a place to sleep rather than a consortium for thousands of activities.

Remember the MP3s: Mattress, Pillow and Sleeping Position

Last but not least, consider how you are sleeping at night. Personally, I like to sleep on my right hip as my left hip will occasionally flare up and be a bit sensitive when putting my sleeping weight on it.

Ask yourself these questions:
- Does your mattress provide you with enough lumbar support? [url:1325,type=|node|,content=|Check out these mattress guidelines|].
- How does your pillow support your neck? Is it too high or too firm? [url:1329,type=|node|,content=|Remember these rules for buying a pillow|].
- What position are you most comfortable when sleeping? Are you most relaxed on your back, side or curled up? How do you feel when you wake up in the morning as a result of these positions?
If you have certain types of pain, there are a variety of [url:7696,type=|node|,content=|sleeping positions|] that are best for your symptoms.

For example, patients with pain from [url:136,type=|term|,content=|osteoarthritis|] are advised to sleep in the fetal position (on their sides, with knees curled up) while patients with [url:146,type=|term|,content=|degenerative disc disease|] may prefer to sleep on their stomach and those with hip pain may achieve relief by placing a pillow between their knees (something that I didn’t know but will try tonight).

Of course, if sleeping problems and pain persist, they are best treated together. Best of luck in reaching “Golden Slumbers.”

More on This Topic:

[url:1318,type=|node|]
[url:17141,type=|node|]
[url:1321,type=|node|]
[url:1320,type=|node|]
[url:1317,type=|node|]
[url:6599,type=|node|]

Move More, Sleep Better and Longer

Carolyn — Wed, 18 Jun 2008 16:27:00 -0700

June 18, 2008
by: Sylvia Marten

(Spine-Health.com) -- New research presented at the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS) shows that “an acute session of moderate aerobic exercise, but not heavy aerobic or moderate strength exercises” can improve the amount and quality of [url:161,type=|term|,content=|sleep|] for people with insomnia (without resorting to pharmaceutical sleep-aids).

What exactly does "acute" mean in this context? Merriam-Webster defines acute as “having a sudden onset, sharp rise, and short course”, so “moderate, but not heavy, aerobic exercise” is like a brisk 20-30 minute walk.

In this new research, 36 patients, all with primary chronic insomnia, were divided into four groups:

Moderate aerobic exercise (e.g. walking)
Intense aerobic exercise (e.g. running)
Moderate strength exercise (e.g. pilates)
A control group (no exercise)

Of the above 4 groups, the moderate aerobic exercise group (exercise walking) showed the most sleep improvements:

54% reduction in time it takes to fall asleep
36% less awake time during the night
37% increase in total sleep time

These findings highlight the importance of moderate physical exercise to help treat insomnia.

In general, about 30 percent of adults are thought to have symptoms of insomnia. It is more common among elderly people, women, and [url:1318,type=|node|,content=|those suffering from a pain condition|].

Source: American Academy of Sleep Medicine, http://www.aasmnet.org/Articles.aspx?id=926

Back Pain and Holiday Blues: 18 Tips to Reduce Your Holiday Stress

spine-health — Fri, 07 Dec 2007 13:00:24 -0800

December 7, 2007
by: Sylvia Marten

Ah yes, the holidays are upon us once again, and with them the holiday blues. Not everyone is in festive spirits, especially those of us with chronic pain. Often, chronic back pain leads to [url:138,type=|term|,content=|depression|], and alternately depression can worsen physical pain. The added anxiety and stress of all the holiday planning and expectations can intensify feelings of sadness. Travel blues may factor into the equation too - vacation blues catch us off guard as we're taken away from our normal routines and pain management support like special [url:158,type=|term|,content=|ergonomic chairs|] and [url:161,type=|term|,content=|mattresses|]. Even if it's just a temporary bout of the holiday blues, that doesn't mean you have to simply accept it. Here are some things you can do to reduce your holiday stress.

Talk with friends on the phone, or over coffee.
Talk with other people who suffer from back pain or chronic pain on the Spine-Health.com forums:

See your family doctor or psychiatrist - you may have a physiological disorder that requires antidepressants.
Improve your diet and exercise regularly, at least on non-party days. Don't stress about weight gain at the big family gathering or work holiday party. Having food you enjoy and chatting with friends releases endorphines. Live a little! On other days, make sure that you eat in moderation and get at least a half hour of cardiovascular exercise, even if that means nothing more than taking a walk. If you have difficulty with certain types of exercises due to back or neck pain, try these [url:1183,type=|node|,content=|exercise tips for people with back pain|].
Seek sunshine - the real thing is best, but if it's dark and dreary outside, spend a few extra dollars and get yourself some full spectrum lighting.
Set realistic goals and don't be the ultimate people-pleaser. Decide what's important and don't overextend yourself.
Plan a small gathering of friends or neighbors such as a dinner or wine party.
Read these Spine-Health.com articles:

[url:1079,type=|node|]
[url:6615,type=|node|]
[url:1081,type=|node|]

Make sure your plans move you toward your goal, and celebrate even minor achievements.
Cook, buy yourself some new music and/or new books to have on hand. (no depressing music!)
Go to a museum or concert.
Plan a short trip to a place you enjoy, either by yourself or with a good friend, and don't forget to take along these [url:1107,type=|node|,content=|pain-free travel tips|].
Rent movies from your local movie store or an online DVD rental company.
Hug somebody! This is no joke, hugging has positive and real physical benefits. The BBC even published the results of a study stating that hugs increase oxytocin and reduce blood pressure in women.
Meditate. According to researchers at James Cook University in North Queensland, Australia, meditation offers similar mood benefits to running or other physical exercise. If your pain restricts you from strenuous exercise, consider meditation. Don't know how? You can learn to meditate.
Go ergonomic. If you're at home, it makes sense to have [url:158,type=|term|,content=|ergonomic seating|] available. If you're going to sit and watch TV, eat dinner or pay bills, do everything you can to reduce your pain by giving your back the proper support. [url:170,type=|term|,content=|Pain management|] is a key component in managing depression during the holidays as well as throughout the year.
[url:1927,type=|node|,content=|Get enough sleep|]. Yes, you have to get to the store, wrap those gifts, bake that cake, etc...but sleep deprivation is a big contributor to depression. Be disciplined - go to bed and get 6 to 8 hours of sleep! If you have difficulty sleeping due to chronic pain, you might want to check out our articles on the [url:1315,type=|node|,content=|best mattresses for back pain|].
Clean up the house and get organized. A clean space can make you feel better about any other holiday projects you have going on.

BONUS "BEAT THE HOLIDAY BLUES" TIP:

Honor your own feelings. While nobody wants to feel depressed, recognizing your sadness can mean that something isn't working in your life the way that you would like it to. If it's something you want to change, hey, it's almost time for those New Year's resolutions, right? Pay attention to what your body is telling you, and if necessary, seek the help you need.

Top 12 Tips for Buying a New Mattress

Thu, 18 Oct 2007 12:12:59 -0700

October 18, 2007
by: Sylvia Marten

Any [url:1325,type=|node|,content=|mattress|] that helps you sleep comfortably and wake up feeling refreshed, without pain and stiffness, is the best mattress for you. There is no single mattress that works for all people. You should choose the mattress that provides adequate support and meets your standards for comfort and allows you to get a good night's [url:161,type=|term|,content=|sleep|].

That being said, there are a ton of advertising claims being made by mattress companies and it's hard to choose which is right for you. To help you get started, here are some things to keep in mind when buying a new mattress:

Research online before going shopping. Two helpful resources that provide information (but don't sell mattresses) are the Spine-health.com Sleep Health Center and Better Sleep websites.
Talk to your doctor. If you have a health condition, talk to your doctor or physical therapist about what he or she recommends. Keep in mind that doctors are not sleep experts, but they know your medical condition and symptoms and will probably have some good advice from that point of view.
Firm mattresses aren't always better for your back. Think twice before buying a hard or firm mattress. There is a difference between firm support and firm feel. You want firm support with a comfortable feel (comfortable will be defined by your personal preference. Research has shown that the [url:1310,type=|node|,content=|best mattress for low back pain|] is a medium firm mattress rather than a firm mattress.
Pillow tops aren't for everyone. Very light-weight people don't need big thick pillow top mattresses because they don't weigh enough to compress the foam to even touch the underlying coils/support system. On the flip side, larger/heavier people do tend to feel more comfortable with a little extra cushion to help buffer thems from the coils.
Adjustable beds are a great option, especially if you find you are more comfortable sitting in a recliner than lying down. They allow you to elevate your head and knees slightly to relieve pressure on the lower back. You can also create the same effect using pillows rather than an adjustable bed.
Ask about money-back guarantees. If you think you'll like a memory foam mattress but aren't quite sure, try the Tempurpedic brand as they typically offer a 30-day money-back guarantee. If you don't like it within the first 30 days, you're probably not going to change your mind so send it back.
Ask about "comfort guarantees" BEFORE you buy. Many states still allow retailers to give what's called a comfort guarantee. Ask for it BEFORE you buy, and be sure you understand the details – if you're required to pay shipping, if it includes a money-back guarantee or exchange, time frames, etc.
Check the warranty. A good mattress will have a minimum of a 10 year FULL replacement or NON prorated warranty.
Protect your investment. Always get some kind of water proof mattress protector. Stains will void your warranty.
Take it for a test drive. When shopping for a mattress, try to lie on the mattress for at least 10 to 15 minutes. Don't feel self conscious or let the sales person hurry you along – it's a big purchase, and if you don't try it for at least 10 minutes you're not going to get a real feel for it. That being, said it's at all uncomfortable you can rule that one out pretty much right away.
Check out all the options and variations. Give yourself a comfort test if the salesperson doesn't offer you one. Ask to try a firm, a plush, and a pillowtop in the same brand quality and price point of each other. Lay on each one for 10-15 minutes. When you find the most comfortable one ask to see more of that kind.
Shop at a real mattress store, not a furniture store or department store. The salespeople at a mattress store usually have more training on the whole subject of sleep. Try to find a store that carries several major brands, such as Sealy, Serta, Simmons, and Tempurpedic. Remember it's your mattress, your back, and your money, so it's worth the time to research it and get the best that you can. That being said you don't have to spend a fortune either – mattresses are often on sale, and the price, frames and delivery fees are often negotiable.

Sources:

[url:1315,type=|node|,content=|Choosing the Best Mattress for Low Back Pain|]
Sleep Discussion Board

Posted by: Stephanie

Unusual Office Chair Solutions

Mon, 08 Oct 2007 18:29:35 -0700

October 8, 2007
by: Sylvia Marten

Many people feel very uncomfortable in their office chair. And there are lots of good office chair reviews if you're looking for a new option. But what if the problem is not your specific [url:1106,type=|node|,content=|office chair|] but the fact that you're sitting on one at all? If this may be true for you, then here are some office chair alternatives to consider.

Stand up desk

For people who really feel uncomfortable sitting at a desk all day, one solution is not to sit – but rather stand up and work. Just get a desk that is a comfortable height for you to work at while standing.

Other guidelines:

Put your foot up on a footrail or some type of footrest so you can put rest one foot higher than the other and easily shift your body weight from one leg to the other.
Use some type of seat as well. Using a stool affords you the most options, as you can sit fully or just sit partially by leaning forward while sitting with your weight distributed between your seat and your foot on the floor.

A side benefit that some people find from working standing up is that they feel more energized and are more productive working while standing up. My first boss told me to stand up when making important phone calls because then you sound more positive and motivated. Also, if you're someone who likes to move around a lot (aka you fidget when sitting still), then standing up while working makes it easier to pace while doing certain tasks, such as talking on the phone.

Add a podium

If working full time at a stand up desk isn't for you, consider adding a podium, lectern or stand up desk in your work area and just do certain tasks while standing, like reading or talking on the phone. This way you can move between your regular desk and your standup area and get some variety in your positions during the workday.

Walking desk

[url:6601,type=|node|,content=|We've talked about walking desks/treadmill desks|] before. The idea is that you walk very slowly on a treadmill while working standing up. Personally I'm not a big fan of this idea – I like to keep the workout and the work separate. But I can see how this idea would make sense in certain situations, and some people say it works for them.

Exercise ball

The main benefit here is that [url:1706,type=|node|,content=|sitting on an exercise ball|] is active – your body is constantly making minor adjustments to remain balanced on the ball - and this requires your core body muscles, your abs and large lower back muscles, to work to hold the body upright and balanced on the ball. And because there is not back as on an office chair, it's hard to slump or slouch, which encourages good posture.

Until your core muscles get strong enough to support you and sitting on the exercise ball feels comfortable, it is often a good idea to not have the ball fully inflated so that it is more stable, and start out by sitting on it for only a little while at a time (e.g. 10 to 20 minutes) and gradually work up to several hours at a time. You can buy a ball with sand at the bottom of it if you're concerned about it rolling away every time you stand up (a good idea for people who get up a lot at work).

Other factors to note: This is one of the least expensive office chair options, usually around 15 - $30. However, many people find that they also sit in a regular office chair for at least part of the day.

Balance stool

A balance stool the same general idea as an exercise ball – forcing you to sit with good posture (as you're not able to slump or slouch) and many versions, such as the Swopper, encourage active sitting as they bounce up and down and side to side, making your core muscles work in order to stay balanced on it. Compared to the exercise ball, a balance stool looks slightly less unconventional and stays in one place.

Most balance stools are in the price range of $200 - $700. Ikea offers a similar option that is similar but less expensive at around $50.

Kneeling chair

A kneeling chair is actually a bit of a misnomer, because you're not really kneeling while on the chair, just sitting while angled forward with some of your bodyweight supported by your shins. Your shins provide stability, but the body is still sitting, not kneeling. The design of the chair is intended to:

Reduce some of the strain placed on the lower back when sitting in conventional, right angle office chairs – the idea is that sitting while tilted forward slightly places the spine in a more neutral position.
Encourage good posture by sliding the hips forward so that your weight is distributed between your pelvis and knees/shins, which reduces spinal compression, and therefore reduces the stress and tension in the lower back and leg muscles.

The result is an office chair that makes sitting in the proper position feel comfortable and effortless. As with all chairs, be sure to get one that allows you to adjust the height and angle. Some versions are on casters, if you need to move around, and some have a bit of lumbar back support for when you want to lean back a little.

Recliner

Many people with back pain feel much more comfortable sitting in a reclining position than sitting upright. In a survey on Spine-health.com, we found that 72% of people with back pain felt less pain when lying down or reclining (N = 1368). If you are one of these people and have the option, then working while sitting in a recliner, with feet propped up on an ottoman or attached footrest, then using some type of laptop stand with your recliner may be a good option.

For the inexpensive route, you can use a lap desk – a wood or other type of solid top and beanbag cushion on the bottom – and work on it with your laptop and a wireless mouse.

If you're working for longer periods, then I would recommend using a laptop stand that lets you use a separate keyboard and ergonomically positioned wireless mouse. There is a huge variety of recliners and laptop stands – some very elaborate ones, and there's bound to be a setup that will suit your needs.

Personally, I think sitting in a recliner would be way too comfortable and relaxing – I'm pretty sure I'd be dozing within minutes. Standing or active sitting are definitely better options for me.

Final thoughts

No matter what you choose, there is nothing better than getting up regularly during the day to stretch and walk around. If price is an issue, remember that all the above options are available for much less via Craigslist and EBay, as a lot of people seem to buy these new but end up reselling them without using them much.

Of course this is not a comprehensive list, just a few ideas to get you thinking about alternatives. Have you found something that works well for you? Please let us know. (No sales pitches please.)

More reading:

OSH Answers – Working in a Sitting Position – Alternatives
[url:6660,type=|node|,content=|Is Your Job Aging You? Computer Users Beware|]
[url:1106,type=|node|,content=|Reducing Back Pain While Sitting in Office Chairs|]
Stand Up Desk – CNN Money Magazine

11 Unconventional Sleep Tips: How to Get to Sleep and Stay Asleep

spine-health — Mon, 20 Aug 2007 18:16:11 -0700

August 8, 2007
by: Stephanie

I have a lifelong difficulty with falling asleep at night and then -- even more problematic -- staying asleep. I don’t have a medical cause for insomnia or any sleep disorders, just a brain that likes to go into overdrive when my body finally has a chance to lie down and rest.

More Mattress/Sleep Info:

[url:1325,type=|node|,content=|Mattress Guidelines for Sleep|]

[url:1315,type=|node|,content=|Mattresses for Low Back Pain|]

[url:1329,type=|node|,content=|Pillow Comfort |]

Sleep Problem Forums

I’ve looked to the Internet for sleep advice, but I’ve mainly just found lists with sleep tips so obvious it’s painful -- like “avoid coffee in the evening” and “make your room dark”. It’s taken me a bit of trial and error, but finally I’ve found a number of things that really do work in helping me [url:1927,type=|node|,content=|get to sleep|] and stay asleep long enough to get enough deep restorative sleep to wake up feel rested and refreshed in the morning. For me, the following has worked well. I call these [url:161,type=|term|,content=|sleep tips|] unconventional because I haven’t seen them in the typical sources -- in fact, I often see the just the opposite recommended.

Nap every single day
Contrary to all the sleep sources that say to avoid napping during the day in order to sleep better at night, I believe it is actually a good idea to nap every day. But in order to make this work it is vital to stick to three rules:
1. Nap regularly
2. Keep it short, and
3. Make it in the early afternoon
1) By napping at the same time every day, your body will start to regulate itself to want to nap at that time and it will become easier to fall asleep quickly and take an efficient nap; 2) Keep it short – only nap for about 20 minutes. This length of time, a power nap, is just enough to make you feel refreshed and mentally more alert but doesn’t allow you to go into a deep sleep (which would interfere with falling asleep at night), and; 3) Make sure to nap in the early afternoon – preferably about 20 to 30 minutes after lunch, which is when your body is naturally inclined to feel sleepy, and early enough in the day to not interfere with falling asleep at night.
Avoid taking a hot bath
There is a lot of advice that says take a hot bath right before bed to relax yourself, but since the body needs to lower its temperature in order to fall asleep a hot bath will actually keep you up. If you find a hot bath very relaxing, enjoy it about 2 hours before your bedtime so that your body has enough time to cool down. Make sure to give your body at least an hour to cool down after a bath and prior to going to bed.
Make your room colder
Similar to the point above, your body needs to cool down in order to fall asleep and stay asleep, so do what you can to make your room cool. For me, a cool bedroom has the added benefit of nestling into a heavy comforter, and I find the heavy warmth on top of me very soothing.
Exercise intensely
Don’t just “exercise”, but do so intensely, to the point of feeling physical exhaustion. At the end of the day, this is probably the single best thing for helping induce deep, restorative sleep. When I say “intensely”, I mean intense relative to your capability. For some this may mean running 5 miles, for others it may mean a brisk 20 minute walk that elevates the heart rate. Physical tiredness is absolutely essential to getting a good night’s sleep.

[Update June 18, 2008] [url:7277,type=|node|,content=|New research|] presented at the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS) shows that “an acute session of moderate aerobic exercise, but not heavy aerobic or moderate strength exercises” can improve the amount and quality of sleep for people with insomnia (without resorting to pharmaceutical sleep-aids).
[url:7277,type=|node|,content=|See "Move More, Sleep Better and Longer" for details.|]
Limit red wine
I can drink a few beers or glasses of white wine and sleep fine, but when it comes to red wine any more than one single solitary glass and I'm in for a poor night's sleep. Drinking more than one glass of red wine is a sure-fire way to wake me up after a few hour's of sleep and make it impossible to get back to sleep. This started after I turned 30 (although I don’ t know why this is).
Get out in the sunlight soon after waking up in the morning
When you wake up, don’t lounge around in bed. Don’t even stay inside. If possible, get out in the morning sun soon after getting up. The bright sunlight (or any bright light) tells your body’s natural biological clock that its time to wake up, and that same clock will then be set to tell your body its time to go to sleep about 14 to 16 hours hours later.
Don’t watch TV
Avoid watching TV (or looking at a computer screen) at least 30 minutes before you go to bed. Many sources of sleep advice say to watch TV or do something similar like surfing the Internet to wind down before bed, but I think this is bad advice. Watching TV and going online are both mentally and visually stimulating. It may feel physically restful, but these activities stimulate the brain instead of helping the brain wind down enough to fall into sleep.
Block out noise
White noise is restful, and even more importantly, it means that I won’t be woken up with every little thump that the house makes. A fan is ideal because it does double duty of providing consistent soft background noise as well as keeping my room cool. White noise machines are also available. I got one from Radio Shack for about $20 that allows you to pick from sounds such as rain, babbling brook, and or a train (no whistles, just the wheels on the track).
Find a bedtime ritual that works for you
Warm milk? Yech. A cup of herbal tea? No thank you. These are commonly advised to help you rest and fall asleep. I say find the routine that works for you - whatever it is - and just do it every night. For me, it’s the simple act of shutting the house down. Turning off all the lights, picking up stray toys, reviewing the schedule for the next day, planning breakfast for the morning rush, and locking each door. Feeling organized about the house helps me feel less anxious. This simple routine tells my body that its time to close down for the day, and it really does help. Find what helps you feel less anxious at the end of the day and incorporate into a nightly ritual.
Do what it takes to manage stress in your life
At some points in our lives we are burdened by a great deal of stress. It may be chronic pain or other health condition, a family or work situation, financial stress, or all combined. And the stressful situation may well be unavoidable. But do what you can to take some control over the stress. There are so many ways to do this -- I encourage you to try some and just keep trying until you find what works for you. Simple meditation works best for me. It forces my mind to focus on something, thereby freeing up all the clutter to float to the surface, be recognized, and be gone. For others it is guided imagery, either with the help of a professional or with CD’s, regular massage, yoga or tai chi, calming music, or a therapeutic run or bike ride after work. We all have different preferences -- try one that sounds appealing, but if you find it difficult to stick with it, then try a different one.
Keep pen and notebook next to your bed
Often when I’m lying in bed, or even while I’m sleeping, I’ll think of a new idea for work. Or I’ll remember something important that I forgot to do during the day. Rather than try to remember it, which causes anxiety (which is stimulating) I write it down so it exists on paper and doesn’t have to stay in my head. And if I keep a notebook for these things right next to my bed I find I’m more likely to write it down.

For those who are curious, I have tried sleep medications, biofeedback, and many other sleep aids as well, but the above combination has worked the best. I think the bottom line is to re-condition yourself to positively associate the process of going to bed with sleep, which ultimately is an act of letting go -- and to get your brain to stop stressing.

The preceding tips worked perfectly for me and I hope will give you at least some ideas of what will work for you, too. What do you think? Do you have a tip that didn’t make my list? Let us know in the comments.

Sweet Dreams!

Posted by: Stephanie

Additional resources:

[url:6589,type=|node|,content=|How to Power Nap at Work|]
[url:1318,type=|node|,content=|Breaking the Cycle of Chronic Pain and Insomnia|]
Dr. Orman’s Guide to Better Sleep
[url:161,type=|term|,content=|Sleep Health Hub|]

Lyrica Helps with Restorative Sleep

spine-health — Mon, 02 Jul 2007 14:26:41 -0700

July 2, 2007
by: Stephanie

Just read about an interesting study that showed that Lyrica (pregabalin) helped the participants get more restorative sleep, not just fall asleep faster. Thanks to Dr. Steven Poceta, a neurologist, who explains on his Revolution Health blog:

"Slow wave sleep is deep—hard to wake up from—it is highly conserved and the first to recover after sleep deprivation, and it is the stage in which growth hormone is secreted in children. Slow wave sleep seems to diminish as we age. In some ways, slow wave sleep is the “holy grail” of sleep disorders. Getting more of it is always better (more restorative), just like getting younger."

He also hypothesizes that Lyrica's ability to increase slow wave sleep may explain its effect on helping people with fibromyalgia pain.

As those with [url:137,type=|term|,content=|chronic back pain|] know all too well, the problem isn't just getting to sleep but staying asleep long enough to wake up restored and refreshed.

Let's hope that the scientific community continues to produce and refine agents that will help people with chronic pain get sleep in long enough stretches - true restorative sleep - in order to help them heal.

Posted by: Stephanie

Additional reading:

[url:1318,type=|node|]
[url:6629,type=|node|]

38 Questions to Ask Your Surgeon Before Having Back Surgery

Thu, 28 Jun 2007 18:02:14 -0700

June 28, 2007
by: Stephanie

Surgery Videos

This subject comes up a lot in our forums - "I'm considering surgery, what questions should I ask my surgeon?" From articles on Spine-health.com and contributions from our discussion forum members, we've compiled a list that you can print up and take with you to your consultation. Good luck!

Questions before you decide to have the surgery

What type of surgery are you recommending? Why?
What is the source of the pain that is being addressed? How do you know this? (Exploratory back surgery is not done).
Please explain the procedure - at a very high level/with some detail/in great detail. The amount of information depends on your personal preference – some want to know everything, some not so much! To actually see the surgery (animated – no gore) – view our [url:204,type=|term|,content=|Spine surgery animated videos|].
What are my non-surgical options?
What is the natural course of my condition if it is not surgically addressed?
What would you recommend if this were your friend/wife/sister/daughter etc…?
How long will the surgery take?
What are side effects, potential risks and complications?
Please explain the risks and how they relate to me personally. For example, chances of having a non fusion if you are overweight, a smoker, risks if have a grade 3 spondy, etc.
What if you get in there and see something different than you expected?
Do I need to donate my own blood? If yes, why? For most types of [url:165,type=|term|,content=|back surgery|], blood does not need to be donated ahead of time.
Do you perform the whole procedure? Will any students/other surgeons be doing any parts of the operation? If yes, who are they and what are their qualifications? Some surgeons only do a small part of the operation, others do the whole thing. If another surgeon is required, e.g. a vascular surgeon, their role is important and it would be good to know their qualifications..
Who else will assist you in the operation? What is their background and qualifications?
What are the long-term consequences of the proposed procedure? E.g. will the operation ever need to be re-done? If it is a fusion, will it lead to degeneration at other levels of the spine?)

Questions about the surgeon

How many times have you done this procedure? In general, when it comes to surgery "practice makes perfect", so more is better. (However, if the doctor is recommending something that is not often done, such as multi-level fusions, more would not necessarily be better.)
Are you board eligible or board certified? You can usually look on the wall and see a certificate.
Are you fellowship trained in spine surgery? This is more important if the surgery is a fusion, artificial disc replacement, or other more extensive procedure.
If I want to get a second opinion, who would you recommend? (Someone not in the same practice)
Statistically the success rate for this type of surgery is _%. What is your personal success rate, and how many of this type of surgery have you done?
Can I talk to other patients who have had a similar procedure?

Any defensiveness on the part of the surgeon when you ask these types of questions may be a red flag. A surgeon with good results and appropriate qualifications will not be threatened by these types of questions and will respect your attention to these matters.

Questions about what to expect after the surgery

What kind of pain should I expect after the surgery and for how long?
How long is the hospital stay?
May a family member spend the night with me in the hospital?
How do you manage the pain in the hospital?
Which pain medications will I be sent home with? What are possible side effects of these prescriptions? E.g. Constipation, drowsiness, etc.
Will you know before the surgery if I will need a backbrace afterwards? If so, will I be fitted for one before the surgery?
Who can I call if I have questions after the surgery? What is the process for communication?
How often will I see you after my surgery?
What symptoms would warrant a call to your office?
What symptoms would warrant immediate medical attention?
What limitations will I have after surgery and for how long?
How long will I be out of work? School? Whatever...
What kind of help will I need when I return home?
When can I drive again?
When can I resume normal (light) household chores?
What expectations do you have for my recovery?
When is it safe for my spouse and I to have sexual relations again?
How soon after the surgery can I start physical therapy?

Good luck with your decision and your recovery!

Posted by: Stephanie

More resources:

[url:1457,type=|node|,content=|Practical Advice for Recovering from Back Surgery|]
[url:1536,type=|node|,content=|Preventing Constipation after Back Surgery|]
[url:1547,type=|node|,content=|How to Select a Spine Surgeon|]
[url:6592,type=|node|,content=|How to help your surgeon help you|]
[url:6591,type=|node|,content=|Back Surgery Postop Recovery Tips|]
[url:6593,type=|node|,content=|Top 10 Reasons to Run from your Surgeon|]

Chronic Back Pain and Wandering the Halls at 2:00 am

Tue, 26 Jun 2007 16:29:55 -0700

June 26, 2007
by: Stephanie

Two-thirds of Spine-health.com's visitors report having sleep problems, but ... so what? Spending the long nighttime hours wincing in pain while wandering from bed, to recliner, to couch, to simply roaming the house, and finally back to bed for one last short bit of sleep. That's the real story. Exhausting. Makes me tired just reading about it.

Recent excerpts from our message board explain the real challenges of sleep problems due to chronic pain:

Can't fall asleep

CindyS: "I have a difficult time falling asleep because I just can't get comfortable. [url:2205,type=|node|,content=|Neuropathy|] in my leg drives me crazy when I am lying down."

Dilauro: "Biggest problem I have going to sleep is getting comfortable with my legs. From my hips down I get various degrees of numbness and stabbing pain. The symptoms have been identified as being RLS (Restless Leg Syndrome). In the past year, I've spent about half of the time sleeping on a couch with my legs hanging of the edge (this made sleeping a lot better)… I can sleep for about 4 hours, but then my legs start to bother me."

Can't stay asleep

CindyS: "…my [url:912,type=|node|,content=|neck pain|] makes it impossible to stay in one position, so once I finally do doze off to lala land, I wake up and then can't go back to sleep… I generally move from bed to couch to recliner to bed, and I am usually able to sleep for a little while in each location, but then when I change positions, I'm awake again... During the day I am busy enough to keep my mind off of it, but night time is the worst."

Virg: "When my back is at its worst, nothing and I mean NOTHING really helps me to get a good night's sleep. Lortabs, flexeril, nada. I would go to sleep but it was not a deep and restful sleep. .. I always wake craving a few more hours of shuteye even though there are tons of things I want to accomplish during my day."

ErinM: "I was fine until after I got off the narcotics. Then I could actually feel everything. I went for a good six months fighting [url:1318,type=|node|,content=|insomnia|], due to pain I could not sleep more than an hour or two and then wake up."

Dilauro: "Then there are other nights where I just have to get up of bed and walk around, watch TV, get on the computer for couple of hours. Warm milk doesn't help, De-Caf tea does not help , a glass of port or wine helps get me back to sleep but doesn't keep me sleeping… I am happy with 4 hours of sleep, that's a gem."

Mwebb40: "I have two things working against me...I am starting menopause, so I deal with the night sweats and hot flashes. Once those wake me up, then I cannot get back to sleep. I will sleep a total of 6 hours in about 3 days, which with two small kids is not a good thing. Then, if I don't get a good nights sleep, my pain is worse and my numbness in my right leg is less tolerable…I am due to go back to work (after being off for six months) on July 1. I am an RN and need to sleep!! I have an 8 year old and a 4 year old. Life is challenging to say the least right now....sleep would definitely help!"

Krazigirl: "I typically ‘sleep' about 5-6 hours / night. Not a bad number, BUT it is never a rested sleep. I wake up every morning feeling like I never went to sleep, or like I caught a short nap. Then, when I wake up, the pain is worse than it was before I went to bed. When I'm not on painkillers before bed, typically I toss and turn all night, waking every couple of hours from sharp pains or throbbing aches."

Some things do help

Krazigirl: "Typically sleep is more restful if I exercise the night before. Swimming, [url:1196,type=|node|,content=|elliptical|], or things of that nature that won't irritate my back too much, but wear me out enough to make me sleep soundly. BUT the hard part is getting to the gym because I'm already hurting and don't want to hurt more- so I avoid working out- so it is a vicious cycle."

Bion: "Lying awake counting sheep is definitely for the birds and does not work; rather than do this I get up, make myself a hot cup of Milo and come to our study where I spend a couple of hours on the computer before trying out the sleep routine again. I find the no TV rule to be a bit of an old wives tale, for if I lie on our recliner in our lounge in the middle of the night, watching TV, this can happily set me off to sleep at times, but it's not always the answer."

Ddenn65: "I take Lunesta for sleep. I can sleep 4 hours, up to 5 1/2 on a good night. It isn't a bad medicine. It works fast."

ErinM: "Airborne PM if I feel really jittery helps me, it is a hot drink. So during the colder months I loved it before bed. No caffeine after 2pm has helped me as well. Also the fact that I can actually exercise really helps once you get past the holy-crap-my-muscles-hurt-stage. Now I don't get sore muscles, and it just plain expends some energy and is helping my over all recovery. [url:1349,type=|node|,content=|Yoga|] has helped me to center myself, learn to relax some, and gain flexibility, which also combats muscle soreness"

And in one sentence ...

CindyS: "Ahhh, sleep. I can't remember the last time I had a good night's sleep."

My take: Those with such chronic pain often find that sleep is impossible. For me, this signals the reality of the pain – if you're up half the night, you can't be "faking" or exaggerating the pain – it must be bad.

Posted by: Stephanie

More Reading: [url:1318,type=|node|,content=|Breaking the cycle of chronic pain and insomnia|]

Disrupted Sleep Makes Chronic Pain Worse

spine-health — Tue, 22 May 2007 14:03:47 -0700

May 22, 2007
by: Stephanie

A new study indicates that frequently interrupted sleep can make one more susceptible to pain by altering the body's natural systems that regulate and control pain and can even lead to spontaneous painful symptoms.

The study included 32 healthy women who were studied for seven nights. The women were assigned to one of three groups: a control group that slept undisturbed; a group that was woken up eight times during the night;and a third group that went to bed later than usual. On the sixth night, the women in the latter two groups underwent 36 hours of total sleep deprivation, followed by an 11-hour recovery sleep.

During the study, researchers tested the women's pain thresholds and pain inhibition. The women in the group that had been woken up eight times during the night showed an increase in spontaneous pain, while those in the other two groups did not, showing that [url:1318,type=|node|,content=|disrupted sleep|] impairs natural pain control mechanisms that are thought to play a key role in the development, maintenance, and exacerbation of [url:137,type=|term|].

Conclusion: For those with chronic pain, getting continuous, undisturbed sleep is key to controlling the pain.

SOURCE: American Academy of Sleep Medicine, news release, April 1, 2007

Posted by: Stephanie Burke

More information

[url:1318,type=|node|,content=|Breaking the cycle of chronic pain and insomnia|]
National Sleep Foundation

How to Power Nap at Work

spine-health — Mon, 09 Apr 2007 17:52:34 -0700

April 9, 2007
by: Sylvia Marten

What do Leonardo da Vinci, Albert Einstein and Thomas Edison all have in common? They've all made important contributions to the advancement of mankind, they're all distinguished in their respective fields, and they were all avid power nappers.

More and more employees are spending a significant part of their afternoon staring blankly at the computer screen, or pinching themselves to stay awake during an afternoon staff meeting.

A Spine-health.com reader poll revealed that 63% of people are getting 6 hours or less of sleep at night, which, according to James Maas, author Power Sleep, is at least 1.5 hours fewer than they need.

What's the solution? Power napping.
Twenty minutes of sleep in the afternoon recharges your body and mind and provides the extra push required to have a successful, productive day; pleasing both you and your employer.

What is a power nap?
"A power nap is defined as a short nap during the day of about 20-30 minutes duration," says William Deardorff, Medical Advisor for Spine-health.com. "This results in a winding down of activity in the brain's prefrontal cortex. The short duration of a power nap prevents the person's brain from entering slow-wave (deeper) sleep. Waking up after being in this deeper state of sleep can result in a sleep inertia causing you to feel heavy, sluggish and groggy."

"Power naps have recently been studied more extensively by researchers and found to yield many benefits such as a boost in productivity at work, lower stress, improved ability to concentrate, and enhanced mood. Researchers at the Salk Institute for Biological Studies found that with a nap, brain activity stays high throughout the day; but without a nap, brain activity declines over the course of a day," says Dr. Deardorff.

"You must sleep sometime between lunch and dinner… Don't think you will be doing less work because you sleep during the day. That's a foolish notion held by people who have no imaginations. You will be able to accomplish more. You get two days in one -- well, at least one and a half, I’m sure."
Winston Churchill

Some of the main benefits of power napping include improving alertness and memory retention, sharpening motor skills and increasing stamina. NASA sleep researchers have found that a nap of just 26 minutes can boost performance by 34 percent. Another NASA study found that napping significantly increases “working memory”, the ability to focus attention on one task while holding other tasks in memory, which is critical when performing complex work.

So how do you know if power napping is right for you? If you find that you're always drowsy on the ride home from work, or you lack energy during the afternoon, you're probably an ideal candidate for power napping.

In addition to overall performance, power naps are especially beneficial for individuals who engage in high pressure situations where they have to be "on", such as:

Important presentations
Meetings with clients
Scholastic exams
Long drives or commutes
Competitive sports
Complex problem solving

Whether you need to gain a competitive edge, or even if you just feel like you're not making the most of your day — power napping is right for you.

How long should you nap?
The main goal of a power nap is to reap the energizing, refreshing benefits of sleep in the least amount of time, which for most people is 20 to 30 minutes. This allows the body to complete two sleep cycles, providing rest and relaxation for the mind and body, but avoiding the deep slow wave sleep cycles.

Waking up between 30 and 60 minutes of sleep will usually produce sleep inertia -- an undesirable effect that makes it hard to focus both mentally and visually. It's very important that you avoid waking up during this time frame and allot the right amount of time for your power nap.

Of course, a longer nap of one to two hours is a great luxury, allowing you to complete an entire sleep cycle by reaching your deep sleep and REM stages. This type of restorative nap is difficult to attain during the workweek, however, and is best left as a weekend indulgence.

Keep in mind that the precise timing of sleep cycles can vary from person to person, so you may want to test out a few different length naps in order to find out what works best for you.

Tips for getting the best power nap at work
Once you lay your head down for a nap, the worst thing to do is start stressing -- this will waste time and defeats the purpose of getting the most rest in the least amount of time. To help you get the most of your power nap time, we suggest trying a few of the following tips.

First and foremost: don’t put your job in jeopardy
At many companies, sleeping on the job is a firing offense. If you work in an anti-nap environment do not simply put your head down on the keyboard and doze off. If you’re thoughtful about staying within the bounds of what’s allowed at your company, however, power naps should still be possible --for example, most employers won’t mind if you nap during your coffee break or lunch break, and it may be possible for you to nap just before or after work. Increasingly (albeit slowly), more employers are allowing or even promoting naptime during work. Some more progressive companies already have a nap-friendly policy or even a room outfitted for napping.

Get comfortable
Most sleeping difficulties are psychosomatic, not physical, so if you're having trouble falling asleep, consider reevaluating the environment you're sleeping in. An environment conducive to napping is quiet, dark and free from interruptions. If you sleep on a floor at work, keep a mat (like a yoga mat that rolls up) at work, and possibly a pillow and blanket, if that makes you more comfortable. Other tools of the trade to consider – eye shades, ipod or walkman with restful music, or specific MP3 files designed to help you wind down and fall asleep.

Eat right
Avoid consuming caffeine, fat, carbohydrates or sugar in the hours before your nap as these foods make it harder to get to sleep. Instead, try to consume protein and calcium. In an ideal scenario drinking a glass of warm milk about an hour before you plan to nap will encourage you to sleep.

Wake up on time
Plan the length of your nap and set an alarm for your desired awakening time. If you do not have access to a formal alarm clock consider using the sleep timer on your cell phone or downloading an alarm clock program to your computer. If you struggle with waking up after even short naps, you might consider taking a "caffeine nap." Being late is a sure way to put an end to your power naps.

Make it routine
Don’t lose heart if you don’t fall asleep right away the first time you try to nap. You can train your body to be ready to sleep - sleeping at the same time of day, for the same amount of time, and in the same place will signal to your body that its time to rest and rejuvenate with some power shuteye.

Don’t feel guilty
Napping is great for your health and productivity. But even though most of us know this, we often still feel as though we are wasting time. This feeling of guilt only impedes successful power napping. Instead, make an effort to "recognize that you're not being lazy; napping will make you more productive and more alert after you wake up."

Where are the best places to take a power nap?
For most people, this is probably the single most difficult challenge. Where to nap at work? Remember, the more isolated and relaxing the location, the greater chance you'll quickly fall asleep.

If, like most of us, you work at a place that doesn’t have a room labeled “Nap room”, you something in this list may work for you:

In your office. This is obviously the best spot – if you have an office, you’re way ahead of the game. Put “do not interrupt” on your phone, close your door, and get comfortable.
In a conference or break room. It’s best if you can reserve the room so you won’t get interrupted during your nap.
In the library or a book store. These are some of the best quiet places to nap. Simply head on over to the closest library or book store during your coffee break or lunch break. Same goes for a quiet coffee shop, and this has the added advantage of being able to enjoy a coffee after your refreshing nap!
Department stores. Some department stores have suites fully equipped with comfortable couches and chairs. The Nordstrom near me has two beautiful rest areas right near the women’s bathroom. If you don’t mind sleeping where strangers might come and go, this could work for you.
On a couch or reclining chair. Some employers make couches available in certain spaces, such as the restroom, break room, lunch room, or even a pumping room for nursing mothers.
In a parked car. This may sound crazy, but most cars are actually a pretty comfortable spot to nap. If it’s safe, you can power nap in your car during lunch in your company parking lot. Or, pull into a safe parking lot on your commute home, lock the doors, turn on some relaxing music, and get 15 minutes of powerful rest before heading home to enjoy your post-work day.
On the bus or train. For many of us, the sensation of moving is a total sedative, making the after work commute an ideal time to sleep. You can create a feeling of isolation if you put on headphones or earplugs.
As a passenger in your carpool. If carpooling is an option, see if your carpool partner would mind you driving into work and letting you be the passenger on the drive home everyday. This way you can get in a quick nap before arriving home. Again, headphones or earplugs might help, freeing up the driver to listen to the radio, crack gum or talk on the phone without bothering you.

When more attractive options run out but you desperately need a few minutes of shuteye, sit in a bathroom stall, cross your forearms over your knees, and put your head down to rest. It doesn’t sound appealing, but you’d be surprised how many people do it. A full power nap may not be possible here, but even closing your eyes to unwind can be productive. Experts advise "a brief rest has the benefit of reducing stress and helping you relax a little, which can give you more energy to complete the tasks of your day."

Basically any place where you can put your head down, stay safe, not cause a distraction to others and remain undisturbed is an acceptable place to power nap.

If you’d like to be as creative, productive and accomplished as Thomas Edison at work --or if you’d just like to feel better and have more energy in the afternoon and evening -- it’s absolutely worth it to give power napping a try.

Additional resources

Check out these links for more information on power napping and sleep deprivation:

[url:161,type=|term|,content=|The Keys to Better Sleep|]
Snooze, You Win
Sleep Benefits: Power Napping for Increased Productivity, Stress Relief & Health
Sleep Stages
Scientists Finding Out What Losing Sleep Does to a Body
How to Power Nap