The chicken or the egg?

This question about what comes first. The onset of chronic pain (and/or other conditions) from sleep disturbance or the relevance of sleep disturbance due to chronic pain?

Here’s some of what we know about sleep …

Sleep complaints are present in 67-88% of chronic pain disorders and at least 50% of individuals with insomnia – the most commonly diagnosed disorder of sleep impairment – suffer from chronic pain. Further, both chronic pain and sleep disturbances share an array of physical and mental health comorbidities, such as obesity, type 2 diabetes and depression.” 1

One study found that “women who endorse frequent, “sleep problems,” defined as frequently difficult falling asleep or having a sleep disorder, were significantly more likely to develop fibromyalgia 10 years later.” 2

Also, in another how “sleep disturbance temporally preceded increases in pain, … in “temporomandibular disorder (TMD).” 3

Similar research is being conducted in terms of cancer pain, for depression, PTSD and ageing (including Alzheimer’s and dementia).

I knew poor sleep to be a contributing factor for people who live with chronic pain. What I didn’t know was how it affects not only physical health but mental health.

What’s piqued my interest is in new studies where a trend has emerged suggesting that sleep disturbance may be a stronger predictor for pain than pain of sleep disturbance.” 4

…several longitudinal studies convincingly demonstrate that insomnia symptoms significantly increase the risk of developing future chronic pain disorders in previously pain-free individuals, whereas existing pain is not a strong predictor of new incident cases of insomnia.” 5

Not just a stronger predictor for pain, but also in terms of mental health conditions.

This bidirectionality or said another way, “what came first, the chicken or the egg?”

Lots of studies to examine obviously, but here’s one on the positive side “Quality sleep has also been shown to predict chronic widespread pain symptom resolution over 15 months.” 6

Researchers will continue to find out more and doctors will refer out to specialists in many areas. Pretty much the gold standard for treating insomnia now is CBTi or Cognitive Behavioral Therapy for Insomnia.

Yet, there are things you can learn to do for yourself, that will help.

Curious about this? Exploring some practices, tools and gaining resources that can support you in getting a better night’s sleep. What stress and the nervous system have to do with sleep? Or how you might find rest during the day?

I’m offering a 4-week workshop starting Feb. 16th at 7:30pm ET.

You’ll have some time and space to explore, experience what might be helpful for you all in the comfort of your own home. Online. Change into some comfy clothes, grab a warm cup of herbal tea and join in. Anyone can follow along. We’ll be rolling on the floor a little, expending energy maybe by rocking and swaying, taking some breaths together. And learning “all the things your parents/doctors/friends/colleagues never told you… about sleep.” There’s a lot more to it than just laying your head down on a pillow, each night.

References:

  1. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-1552. doi:10.1016/j.jpain.2013.08.007
  2. Mork PJ, Nilsen TI. Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway. Arthritis Rheum. 2012 Jan;64(1):281-4. doi: 10.1002/art.33346. PMID: 22081440.
  3. Quartana PJ, Wickwire EM, Klick B, Grace E, Smith MT. Naturalistic changes in insomnia symptoms and pain in temporomandibular joint disorder: a cross-lagged panel analysis. Pain. 2010 May;149(2):325-331. doi: 10.1016/j.pain.2010.02.029. Epub 2010 Mar 31. PMID: 20359824.
  4. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-1552. doi:10.1016/j.jpain.2013.08.007
  5. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-1552. doi:10.1016/j.jpain.2013.08.007
  6. K. A. Davies, G. J. Macfarlane, B. I. Nicholl, C. Dickens, R. Morriss, D. Ray, J. McBeth Restorative sleep predicts the resolution of chronic widespread pain: results from the EPIFUND study. Rheumatology (Oxford) 2008 Dec; 47(12): 1809–1813. doi: 10.1093/rheumatology/ken389

You’re not sleeping either?

woman in red long sleeve shirt sitting on chair while leaning on laptop
Photo by Andrea Piacquadio on Pexels.com

Did you know “chronic insomnia is highly prevalent and affects approximately 30% of the general population?” 1

Or, that “approximately 40% of adults with insomnia also have a diagnosable psychiatric disorder – most notably depression?” 2

That “sleep complaints are present in 67-88% of chronic pain disorders?” 3

I was aware of the third statistic, that sleep can be a contributing factor for people living with chronic pain. But why my interest in sleep, generally? I had (mostly) been a good sleeper yet started to experience disruptions to my sleep patterns over the past few years. Along came menopause and similar to many others I found myself in a cycle of wakefulness around 2, 3, 4 in the morning and went looking for solutions.

Last fall, however, something else happened. On a Facebook page I belong to, the subject of sleep was brought up. Well, the lack thereof.

I was curious if it was only menopausal women who were struggling with sleep, so I created a random poll. Within an hour or so, there were hundreds of responses.

  • 404 responses
  • 74 comments about issues with sleep.
  • 224 neither menopausal or perimenopausal
  • 95 perimenopausal
  • 51 menopausal
  • 34 ‘other reasons’

Clearly a problem for many but I was surprised to learn that it wasn’t only my age group challenged by this issue. The poll wasn’t scientific and could just reflect the ages of people in the Facebook group. Yet, wow!

Of course people will at times need specific diagnosis, treatment and care from healthcare professionals. Yet, digging into some of the research and after some of the behavioral or environmental factors are addressed with general sleep hygiene information, a lot of what affects sleep has to do with stress and the nervous system (and other systems… circadian, homeostasis, etc.). Which you can learn to influence and modulate.

Would you be interested in exploring this thing called sleep? Safely, gently, with compassion and care you’ll get to experience and learn what might be helpful for you. In your own home, cozy in your pajamas … having some time and space to do so.

A 4-week workshop Rest & Restore: Strategies for Sleep starts Feb 16th!

What are the many factors or contributors that affect sleep? What does the research tell us? What can you do during the day, that will affect your sleep at night? What can you do when waking up from sleep? How might you find some rest in the day, if your sleep wasn’t that great?

If you’d like to join in, registration is now open.

I’ve tried to make it affordable at just $20 each week. If finances are really tight, reach out to me at info@yogatoolsforlife.com. If finances are plentiful, please reach out as well and look to sponsor someone else.

I’d love for you to join in. Experience and learn what might can be helpful, for you.

References:

1. Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007;3(5 Suppl):S7-S10.

2. Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007;3(5 Suppl):S7-S10.

3. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-1552. doi:10.1016/j.jpain.2013.08.007

Just, Calm Down

It was probably my first year as a yoga teacher, 10 years ago now, when I had a student in my class I so clearly recall would get up and leave as soon as it was time for Savasana. I’ve been trying to remember what I offered her in terms of advice but it escapes me now. Likely, I didn’t have much to offer. Yet I did empathize and understand why she left, unable to stay in this ‘corpse pose’ as it’s often called.

Ask the same of people when they are told to “just” sit still and meditate. Particularly if they’re experiencing anxiety, or high levels of stress and notice what happens.

Or telling a young child having a full-blown meltdown to “just” calm down.

The last thing anyone can do in these moments is calm down. There are likely to be many reasons for the state in which people find themselves and can’t calm themselves, but the ‘state’ is the important piece.

If someone is in a state of arousal, a natural nervous system response, telling them to do the opposite may not be helpful. It might add to the stress or leave them feeling ashamed about not being able to control their emotions or behavior. All this movement, powerful breathwork (sobbing), yelling, screaming, stomping of feet, tossing and turning the body in an attempt to express feelings and emotions going on inside (insert here: toddler meltdown).

There are some ways, practices or movements that enable calming down or a relaxation response. But it might be something just the opposite that’s needed to even begin this shift. Maybe what was needed, in this particular situation, is a mobilized response. We need both… to survive and engage in the wide variety of experience life is going to throw our way.

Recognizing the state is the first piece. Having some tools and options to choose from that might be helpful to you in the moment, could be a good thing to practice.

Today, I would have a few suggestions should this person turn up in my yoga class and find it a struggle being in corpse pose.

I’m kicking off a workshop in February all about SLEEP. Deep rest. How one might get to a place of settling in… for the night. Or for Savasana. Or if you’re having a hard time with routine, uncertainty, stress in these days you might find it helpful as well. I’d love for you to join in so stay tuned here, or you can sign up at yogatoolsforlife.com.

It turns out – we are adaptable!

We are adaptable

Tissue can change. Your brain can change.

brain

This provides HOPE to anyone living with pain, chronic pain, limitation to mobility or perhaps psychological pain (or unease) from the stress, anxiety, depression, insomnia that often accompany physical pain. All of which are common problems affecting a large proportion of our 21st Century population.

Pain science

The experience of pain doesn’t necessarily correlate with the state of our tissue.

You may see some awful looking images on an x-ray and yet not experience pain. You may experience pain, though not even have the limb that pains you (phantom limb pain).

Which doesn’t mean it’s all in your head but that pain is indeed, very complex

Neuroplasticity

Contrary to our understanding up to about the year 2002, our brain can change

This is revolutionary in terms of we can keep learning, and also how we can change behavior and adapt.  Most important, how your pain can change.

What does this have to do with how well you can or cannot move? The fact that you have persistent pain or not? Why it flares up?

Explore this (somewhat new) information and learn simple things you can use throughout your day that are most likely to help, according to the latest research.