Today's #Sleeptember FACT --- The relationship between insomnia and back pain

If you have chronic back pain and have experienced insomnia in the past, you might be interested to learn that a study in Israel in 2014 points to increases in insomnia as predictive of future back pain.

#SLEEPTEMBER

The study followed 2,000 healthy subjects over a 3-year period and it was determined that a whopping 40 percent of the insomniacs in the group were to go on to suffer from back pain at the end of the study period. Interestingly, the reverse has not yet been found to be true: people with chronic back pain are not shown to be more likely to develop chronic insomnia as a result.

What might be at the root of the relationship between insomnia and chronic back pain? Stress hormones. Your body should not be processing a lot of stress hormones while you sleep, but if it does, it can lead not only to poor sleep in the form of insomnia, but also changes in pain processing that may actually elevate pain levels.

Just one more argument for reducing the stress in your life so that you can achieve quality sleep and live pain free. 

Study link: "Increased Insomnia Symptoms Predict the Onset of Back Pain among Employed Adults." Agmon M and Armon G; Landau R (editor). PLoS One. 2014; 9(8): e103591. Published online 2014 Aug 1. doi:  10.1371/journal.pone.0103591

Sleep Hygiene Tip of the Week || What about those sugarplums anyway? Will eating sugar hurt my sleep?

"Sugarplums," artist unknown.

Sugarplums are actually not fairies, as commonly assumed by fans of the ballet. They are a kind of confection made either of dried fruit (plum) and sugar, or a sugary gelatin confection shaped like a plum and colored purple.

They are an old-fashioned treat that probably isn't consumed as much anymore as was done in the old days. But sugarplums are also a more generalized reference to all things sugary and sweet and enjoyed at the holidays. This can include candy canes, butterscotches, ribbon candies, Turkish delight, pralines, penuche, divinity fudge, white almond bark... ANY candy, really, that is not made of chocolate.

Okay, so it's the holidays, and that means these foods enter into our diets more frequently for a temporary (let's hope!) time in our lives as part of the festivities. And that's okay. But consuming lots of sugary treats will have an impact on your ability to sleep well, so it's a good idea to know what to expect before you launch into a bowl of eggnog taffy or those leftover gumdrops from last night's gingerbread house party right before you go to bed.

What goes up must come down 
Sugary foods eaten right before bedtime can drastically increase, then decrease your blood glucose levels, as your body is forced to release hormones to establish balances between blood sugar and insulin. This swing in hormone release can impair sleep, which is a body process that relies upon, among other things, a balance in your blood chemistry. You may find you have early-night insomnia, for instance, or you wake up an hour or so after falling asleep; this can be due to glucose regulation and even the "crash" (or withdrawal) that comes after consuming a lot of sugar. (This also holds for alcohol "nightcaps.")

This is not the same thing as being "hyperactive." Remember the old days when people said kids who were hyperactive at bedtime probably just ate a bunch of sugar? Not really true. Sugary foods will spike your energy levels briefly but what follows is a downward spiral of energy leading to sleepiness. Here's a great article at Slumberwise which illustrates the sugar-sleep paradox.

Carbo loading
Sugary foods, by the way, are carbohydrate in nature. Other carbohydrates that aren't sugary include foods like rice, bananas, bread, pasta and warm milk, which could actually make you feel more sleepy afterward than straight-up sugary foods might. The body processes these kinds of carbs more slowly than pure sugar (and its cousins, honey, corn syrup, and the like), so you may only feel the hypoglycemic (blood sugar crash) after-effect and not the initial rise in energy (hyperglycemia, or blood sugar high) like you might after eating a candy cane. These carbs inspire your brain to send messages to your digestive system to slow down for the purpose of starting the sleeping process. If you want to sleep, this is not really a problem; however, if you're working the night shift, then you might want to avoid these foods in order to stay alert on the job.

Nighttime bathroom breaks
One of the things that happens when your blood sugar is out of whack is that your body will try to eliminate the excess sugar. Dr. Lynn Maarouf, RD and diabetes education director at the Stark Diabetes Center in Galveston points out that “any time your blood sugar is really high, your kidneys try to get rid of it by urinating, so you are probably getting up and going to bathroom all night long -- and not sleeping well.” This isn't true only for diabetics, but for prediabetics and healthy individuals who have consumed a large amount of sugar in one sitting. That is what the body's filtration system does: it kicks out the excess waste products through urination and/or bowel movement, both which should be more active processes during the day, but not so much at night.

If you are needing to use the restroom all night, you should probably mention this to your primary care physician so they can look for reasons as to why this is happening. It could just be a temporary imbalance in processes brought on by increased sugar intake, but it could also be a sign of metabolic dysfunction or something else entirely, like sleep apnea, which causes the body to frequently arouse due to lack of oxygen, which sends signals to the bladder to be emptied upon awakening.

Here's a great article on sugar intake and sleep quality worth checking out if you are concerned about the possibility of developing or aggravating a diabetic condition.

How to achieve sweet dream
So what does one do with all these wonderful sugarplums winking at us at our neighborhood party, the office kitchen or the family gathering by candlelight? If you already have a known metabolic condition, you know the answer is to stick to the healthy stuff. But if you don't, and you need to get a good night's sleep after the party is over, try to limit yourself to a few sugary treats and break up the sugar infusion with some crudite or a small protein bite in between to keep your blood sugar on an even keel. Drinking water in between also helps you to avoid the sugar-insulin rollercoaster ride by helping you to avoid dehydration, which concentrates your blood sugar and makes you hyperglycemic.

Whatever you do, be prepared. If all else fails, you might not get all your winks that night, and remember, if you're a believer in the fat man... Santa does see you when you're sleeping, and he knows when you're awake...

MONSTERS OF SLEEP || Sleep Disorders 101: Night Terrors

If you are the parent of a child who experiences night terrors, you know these are no ordinary nightmares. It will seem as if your child has suddenly become possessed! Your child, in the throes of a night terror, might suddenly bolt upright, shout and scream in defense and be utterly inconsolable regardless your efforts to calm them. Their breathing may be rapid, their heart pounding out of their chest, and they may be sweating, thrashing around for several minutes until they finally calm down and return to sleep. 

Night terrors can often leave parents nearly as traumatized as it seems their child is during an episode. Usually the child going through a night terror isn't even aware that you are trying to calm them down, and when you ask them the next day about their nightmares, you discover they have absolutely no memory of them.

That's because night terrors are not nightmares at all, but a disruption to sleep that occurs during transitional sleep between deep Stage 3 sleep and lighter REM or non-REM stages. 

Night terrors occur during the first three hours of the night. These passages between sleep stages are smooth, but they can lead to stress responses in the child. Children's bodies and brains are still developing, and changes in growth hormones and other brain chemistry might be at work at this time. Thus, this physical (not emotional) expression of fear, caused by the sudden release of stress hormones into the bloodstream, can panic the child, leading to a full-blown, dramatic episode of terror. 

Anyone who has witnessed a child in the middle of a night terror knows to put the emphasis on the word Terror, as this is an extremely accurate representation of what happens. 

Dreams and nightmares, on the other hand, are the fodder of REM (rapid eye movement) sleep and never happen in deep Stage 3 sleep. Consider this: during REM sleep, the body is more or less paralyzed from the neck down as part of the brain's effort to keep one from acting out the compelling content of dreams. If your child is terrified in the night but does not move about, and the episode occurs later in the night, they might be having a nightmare. You also might have better luck consoling them, and they stand a good chance of remember the content of their bad dream in the morning because in REM sleep, visual imagery is processed and remembered. In stage 3 sleep there is no imagery for the brain to process.

The good news? Night terrors are actually normal and do not suggest any underlying medical condition. Kids grow out of them, thankfully, so parents can hope for more peaceful nights as their children age.

Insomnia Central || Can Insomnia Lead to High Blood Pressure?

"Insomnia" by Gabriel Ward. Courtesy DeviantArt.

It's not a stretch to imagine that suffering from chronic insomnia can eventually lead to the development of hypertension. When you are staring at the alarm clock, counting the minutes that have passed while you have remained impossibly awake, it seems like common sense that the stress of this hypervigilant behavior alone could lead to high blood pressure.

Recent research continues to show measurable correlations between behaviors of insomnia and high blood pressure. But how might insomnia physiologically  lead to high blood pressure?

During the process of sleeping, your blood pressure falls to a consistent low until you wake up again. (The exception is during REM sleep, but if you have insomnia, your odds of experiencing REM are very low.)

While at rest, your heart should be working at an easy-to-manage default pace while the remainder of your systems repair, restore, and rejuvenate themselves overnight. Most active processes, like digestion, slow down in order to allow the sleep process to work its healing magic.

Unless, of course, you can't sleep through the night.

Insomnia is defined here as the inability to fall asleep or to stay asleep for the full night, even when given the perfect opportunity to do so. If you have insomnia, this means you are either never fully falling asleep, or you are moving from sleep to wakefulness all night, leading to sleep fragmentation.

Did you know that every arousal sets off a chain reaction of chemical processes in your body? This flood of various hormones into your bloodstream, including stress hormones like cortisol, can disrupt your ability to maintain sleep. Higher cortisol results in lower melatonin and higher adrenaline. You need melatonin to maintain sleep, while adrenaline is all about alertness.

One night of insomnia may have very little long-term impact on your health; the human body is resilient and can recover from brief, temporary episodes of sleeplessness. But if you go through a stretch of weeks or months of insomnia, the constant presence of these stress hormones in your blood during sleep can negatively impact other processes, leading to problems with insulin sensitivity, vascular chemistry, and systemic inflammation. So, not only are you not sleeping, but you are also opening the doorway to potential disease onset.

Add to this the fact that insomnia is frequently caused by the emotional stress in everyday life (not just Big Picture stress like divorce, but day-to-day stress like coping with moody teenagers), and you can see how stress can lead to these same uninvited hormones hijacking your systems even while you are not sleeping.

Research confirms that people with chronic insomnia experience chemical and process imbalances throughout their body not only during the day, but at night as well. These processes include higher frequency brain activation, abnormal hormone levels, higher metabolism, elevated heart rate, and more activity coming from the sympathetic ("fight or flight") nervous system, regardless the time of day.

It's as if the body and brain never get a chance to rest. 

What about that eight or so hours of sleep at night that your body needs to repair itself at the cellular level? What about that eight or so hours of sleep at night that the brain needs to synthesize the information and experiences of the day?

Sleep is necessary to give all of your organs the rest they require to function optimally. This includes your heart. These lost hours of sleep are, in essence, holding your organs hostage to stress. Over time, this stress to your system will result in, among other things, higher blood pressure, as the hormones in your bloodstream will gradually alter the default mechanics of your heart. When your heart is fueled regularly by high octane cortisol, day and night, it will not be able to avoid wokring on overdrive even while at rest. This leads to oxidative stress over time and a worn-out ticker.

If you are concerned about long-term insomnia and its potential negative impact on your blood pressure, please consult your physician to identify the root cause of both your insomnia and to identify whether you might have hypertension. Treating insomnia may likely benefit both conditions.


Sources: 
The relationship of sleep duration and insomnia to risk of hypertension incidence: a meta-analysis of prospective cohort studies. Meng L, Zheng Y, Hui R. Hypertension Research (2013) 36, 985–995; DOI:10.1038/hr.2013.70; published online 5 September 2013.

Insomnia linked to hypertension. Henry Ford Health System via ScienceDaily. Retrieved April 24, 2014 from www.sciencedaily.com/releases/2012/06/120606142706.htm

Do Insomnia Complaints Cause Hypertension or Cardiovascular Disease? Phillips B, Mannino DM. Journal of Clinical Sleep Medicine. Aug 15, 2007; 3(5): 489–494.