Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Waking Up To Insomnia

To sleep perchance to dream.

One cannot emphasize enough the importance of sleep in reducing the severity of chronic pain. Sleep has been shown in fibromyalgia studies to be so important in reducing the pain fibromyalgia patients experience. The lack of sleep appears to contribute to the misery restless legs syndrome (RLS) patients experience.

Insomnia affects 10% to 20% of the United States population. Among the elderly, the percentage of those affected is 47%. For the year 2007, it is estimated the cost of treating insomnia was approximately $100 billion!

We have all seen the television commercials. Will (legal) pills allow us to enter this wonderful dream world, where a spaceman, a beaver and Mr. Lincoln all join us in the breakfast nook?

There are several classes of medications for insomnia:

1. Benzodiazepines such as Restoril or Valium are effective in putting patients to sleep and keeping them asleep, and they are relatively inexpensive. However, such drugs can have a hangover effect, and a significant addiction potential. Patients also develop tolerance to these drugs.

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2. The so-called non-benzodiazepine hypnotic drugs have the advantage of not causing withdrawal, not causing tolerance. These drugs include all the names you have seen parading across your television screens during Katie Couric: Ambien, Sonata, and Lunesta. Unfortunately, they are not without risk: In 2006, the United States Food and Drug Administration (FDA) warned of severe allergic reaction potential with these drugs; the FDA also warned of complex sleep-related behavior such as sleep driving, making phone calls and preparing and eating food while asleep. At the very least, these medications make for a fascinating alibi.

3. Melatonin receptor agonists. In the United States, Rozerem is available. This is an interesting drug, in that it produces no apparent risk of abuse/addiction in dosages up to 20 times the recommended therapeutic dose.

4. Anti-histamines such as Benadryl.

In my opinion, Rozerem appears to be the safer of the drugs discussed above. But I try to encourage my patients to practice good sleep hygiene, as a way of minimizing the use of medications. Even over-the-counter Benadryl is not without risk: I have seen several patients present with the inability to urinate due to Benadryl; this and many other sedating drugs can cause urinary retention---which can be a significant problem in those patients who already have troubles due, for example, to an enlarged prostate.

Good sleep hygiene is so simple, and yet so difficult.

Because it involves changing habits.

Good sleep hygiene involves not having a television in the bedroom; this is noisy and gives unnecessary stimulation just at the time when a person should be winding down. Save the bedroom for sleep. However, intimacy is allowed!

Good sleep hygiene involves not spending the last couple of hours in front of a computer monitor, as many researchers feel the light from the screen stimulates certain biochemicals in the brain, lessening the amount of melatonin and therefore making sleep more difficult. (Remember, Rozerem helps the melatonin system to help us sleep).

Good sleep hygiene involves not eating late at night, as this can cause reflux and gas and affect sleep. In particular, avoid eating or drinking things with caffeine-an old reliable STIMULANT found in chocolate and many sodas, in addition to, of course, coffee.

Good sleep hygiene involves sleeping in a room as dark as possible. Again, the melatonin thing.

Sleep lessens pain. It makes us feel refreshed. It lets us dream again.

You don't have to be a Shakespearean scholar to appreciate, "To sleep perchance to dream".

 

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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