Can Shiatsu Help Neuropathy Patients Sleep

Today's post from news-medical.net (see link below) looks at a very small study into the effects of shiatsu massage techniques, linked with the brain's cognitive processes, to enable pain sufferers to sleep better. The conclusion is that the results are promising enough to deserve further study. Now the article is aimed at people with chronic muscular-skeletal pain and not nerve pain but the disturbed sleep problem is the same end product and the answers probably lie in the brain's relaxation processes - so any therapy that achieves the right result can be seen as valid. Many neuropathy patients have sleep problems due to pain and the other neuropathic symptoms and it may be worth looking further into alternative therapies which aim to block pain signals in the brain. Acupressure, acupuncture, massage, hypnotherapy may all help to ease the problem and don't need medication to back them up. When the problem is affecting your quality of life, it may be worth exploring other possibilities but we all need to realize that what works for one will not necessarily work for someone else.


Researchers explore shiatsu to help people with chronic pain fall asleep
Published on June 18, 2014

There was a time, back in Nancy Cheyne's youth, when she combined the poise and grace of a ballerina with the daring and grit of a barrel racer. When she wasn't pursuing either of those pastimes, she bred sheepdogs, often spending hours on her feet grooming her furry friends at dog shows.

All that seems like a lifetime ago. After 15 years of living with chronic lower-back pain, Cheyne, 64, can't walk from the disabled parking stall to the elevator at work without stopping for a rest. She eats mostly junk food because it hurts too much to stand over the stove and spends most of her spare time in a recliner with a heating pad.

Despite pain patches and opiates, Cheyne often lies awake at night in the same recliner-sleeping in a bed is like torture-after waking every couple of hours in excruciating pain.

"Pain affects everything I do," says Cheyne. "The chronic ongoing lower-back pain, it's all the time."

Researchers at the University of Alberta are exploring the traditional Japanese massage practice called shiatsu as a potential treatment to help Cheyne and others like her find slumber-and stay asleep. A small pilot study followed nine people living with chronic pain as they self-administered shiatsu pressure techniques on their hands at bedtime.

"We know that sleep involves both physiology and learning. You don't just flip a switch and go to sleep," says Cary Brown, an associate professor of occupational therapy in the Faculty of Rehabilitation Medicine. "What we saw with this pilot is that it appears self-shiatsu may help your body to prepare for sleep and help you stay asleep for longer periods."

For the study, occupational therapy and physical therapy students were taught the basic shiatsu techniques and in turn trained participants, who reported falling asleep faster-sometimes even while administering treatment-and slept longer after two weeks and eight weeks of treatment, compared with a baseline measurement.

Cheyne spent about 10 to 15 minutes every night performing the treatments and found that instead of waking up every 45 or 60 minutes, she could stay asleep for 1.5 to two hours. Given she hasn't felt well rested in more than a decade, every minute counts and she still keeps up her treatments months after the pilot concluded.

"Usually within a few minutes of doing the pressure treatments, I'm gone-asleep," she says. "Sometimes I can't even finish, I just go out."

Results promising, but more study required

Brown cautions it's impossible to draw strong conclusions about the pilot given the small sample size, self-reported nature of the data and limitations in gender; however, she believes the results are promising enough to warrant further study.

Brown also notes there's a difference between people with pain passively going to a therapist versus taking control of their sleep problem in the form of self-administering hand shiatsu, which requires more mental effort-a theory of cognitive attention that she would like to explore further. Hand shiatsu, when self-administered, takes some concentration because our minds cannot focus on two demands at one time, she says, making it less likely that negative thoughts would interfere with sleep.

"One of the barriers to falling asleep for people who have pain is they worry about what's going to happen and while you're laying there you're thinking about all these negative things, it occupies your attention," Brown says. "This relates to research on attention in cognitive theory."

The pilot was an attempt to explore low-cost, unintimidating alternatives to drugs to help people with chronic pain fall asleep, noting medication is seldom recommended for long-term use. Brown collaborated on the project with shiatsu therapist Leisa Bellmore of the Artists' Health Centre at Toronto Western Hospital and U of A colleague Geoff Bostick.

For patients suffering from chronic pain due to low-back and other musculoskeletal injuries, the only thing that matters is finding results that work, Brown says. Not only does sleep deprivation lower a person's pain threshold, it also affects their health, from increased risk of obesity, diabetes, cardiovascular disease and traffic accidents.

More research is needed in foundational areas to break the cycle, she adds.

"If you have insomnia, you face a higher risk of experiencing chronic pain. If you have chronic pain, you're not going to get as much sleep."
 
Source:University of Alberta

http://www.news-medical.net/news/20140618/Researchers-explore-shiatsu-to-help-people-with-chronic-pain-fall-asleep.aspx

Can Poor Sleep Patterns Cause Chronic Pain In Older People

Today's article from sciencedaily.com (see link below) looks at the link between restless and disturbed sleep patterns and chronic pain, especially amongst older people. I think almost everybody living with chronic pain can identify with that. A bad night's sleep almost always results in more pain in the morning. Whether it's the pain that causes the poor sleep, or the other way around, is the question.
 

Could Restless Sleep Cause Widespread Pain in Older People? 
Date:
February 13, 2014
Source:
Wiley
 
Summary:
Researchers in the U.K. report that non-restorative sleep is the strongest, independent predictor of widespread pain onset among adults over the age of 50. According to the study anxiety, memory impairment, and poor physical health among older adults may also increase the risk of developing widespread pain. Muscle, bone and nerve (musculoskeletal) pain is more prevalent as people age, with up to 80% of people 65 years of age and older experiencing daily pain. Widespread pain that affects multiple areas of the body —- the hallmark feature of fibromyalgia —- affects 15% of women and 10% of men over age 50 according to previous studies.

Researchers in the U.K. report that non-restorative sleep is the strongest, independent predictor of widespread pain onset among adults over the age of 50. According to the study published in Arthritis & Rheumatology (formerly Arthritis & Rheumatism), a journal of the American College of Rheumatology (ACR), anxiety, memory impairment, and poor physical health among older adults may also increase the risk of developing widespread pain.

Muscle, bone and nerve (musculoskeletal) pain is more prevalent as people age, with up to 80% of people 65 years of age and older experiencing daily pain. Widespread pain that affects multiple areas of the body -- the hallmark feature of fibromyalgia -- affects 15% of women and 10% of men over age 50 according to previous studies.

Led by Dr. John McBeth from the Arthritis Research UK Primary Care Centre, Keele University in Staffordshire, this newly published population-based prospective study identified factors that increase the risk of the development of widespread pain in older adults. The team collected data on pain, psychological and physical health, lifestyle and demographic information from 4326 adults over the age of 50 who were free of widespread pain at the start of the study (1562 subjects reported no pain and 2764 had some pain). These participants were followed up three years later for the development of widespread pain.

Results show that at follow-up, 800 (19%) reported new widespread pain. The development of new widespread pain was greater in those with some pain at the start of the study; 679 (25%) of those with some pain and 121 (8%) of those with no pain at the start developed new widespread pain at three year follow-up.

Analyses determined that pain status, anxiety, physical health-related quality of life, cognitive complaint and non-restorative sleep were associated with increased risk of widespread pain development, after adjusting for osteoarthritis (OA). Increasing age was associated with a decreased likelihood of the development of widespread pain.

"While OA is linked to new onset of widespread pain, our findings also found that poor sleep, cognition, and physical and psychological health may increase pain risk," concludes Dr. McBeth. "Combined interventions that treat both site-specific and widespread pain are needed for older adults."

Story Source:

The above story is based on materials provided by Wiley. Note: Materials may be edited for content and length.

Journal Reference:
John McBeth, Rosie J Lacey, Ross Wilkie. Predictors of new onset widespread pain in older adults Results from the prospective population-based NorStOP study. Arthritis & Rheumatology, 2013; DOI: 10.1002/art.38284

http://www.sciencedaily.com/releases/2014/02/140213083711.htm

Neuropathy And Sleep Deprivation

Today's short article from neuropathy.org talks about something that affects a great many people with neuropathy and that is problems with sleeping. Being woken up by the tingling, or the pain can be really depressing, especially if it happens regularly and the knock-on effects on your daily life can lead to all sorts of problems. Most people find one or another strategy to help them get through the night but when the symptoms strike, it's almost impossible to ignore them. The article tries to give some advice.

Is Neuropathy Affecting Your Sleep?
By Leslie MacGregor Levine

Editor’s note: This is the second in a series of articles aimed at helping you better understand the link between anxiety, depression, sleep disturbances, and neuropathy.

Insomnia (or sleep disturbances) affects up to 50 percent of the general population.¹ It may take several forms: difficulty falling asleep at night, waking up too early in the morning, waking up frequently throughout the night; and generally poor sleep. In addition, people with insomnia can also develop ‘daytime’ symptoms—such as daytime sleepiness, fatigue, depressed mood, lack of energy, impaired cognition, memory problems, irritability, and decreased alertness and concentration—that, over time, takes a toll on relationships, productivity at work, and overall health and wellbeing.

The Link Between Neuropathy and Sleep
Neuropathy can impact sleep in a number of ways. For some, the neuropathy symptoms may cause the sleep disturbances (e.g., neuropathic pain makes it difficult to fall asleep or stay asleep; abnormal sensations or hypersensitivity to touch, particularly in the feet and legs makes it difficult to fall asleep). With daytime distractions (e.g., work, friends, family, hobbies, etc.) at a minimum during the evening hours leading to bedtime, many patients will find themselves focusing more on the pain; and, so many report that their perception of the pain actually increases when attempting to fall asleep and this delays falling asleep. For others, the neuropathy symptoms may be made worse by sleep disturbances (e.g., sleep deprivation can lower your pain threshold and pain tolerance and make the existing neuropathic pain feel worse).

Managing Sleep Disturbances and Neuropathy
People who sleep poorly are also susceptible to depression and other mood disorders, changes in eating, decrease in physical activity, and an overall decline in health. Compounded with neuropathy, this becomes a vicious cycle.
Improving Daytime Habits and Bedtime Routines to Improve Sleep
When dealing with neuropathy, you may find yourself thinking your insomnia is the least of your problems. But, the compounding effects of neuropathy and sleep disturbances require that you address both head on. Start by tracking your symptoms and sleep patterns, and then making healthy changes to your daytime habits and bedtime routine:

- Keep a regular sleep/wake schedule;

- Develop a bedtime ritual (e.g., taking a warm bath, reading light material);

- Limit or eliminate caffeine four to six hours before bed and minimize daytime use;

- Avoid smoking, especially near bedtime or if you awake in the middle of the night;

- Avoid alcohol and heavy meals before you go to bed;

- Turn off your TV, smartphone, iPad, and computer a few hours before your bedtime;

- Adopt relaxation techniques to help induce sleep (e.g., give yourself an extra hour before bed to relax and unwind and time to write down worries and plans for the following day; meditation ; deep breathing exercises); and

- Create a comfortable sleeping environment (e.g., make sure your bedroom is dark, quiet, and well-ventilated; use bed and pillows that are comfortable; elevate the bed sheets so that it is not in direct contact with your legs and feet).
Seeking Your Doctor’s Help to Address Sleep Disturbances
If sleep problems persist and interfere with your ability to function, it may be time to consult your doctor. You will want to describe your sleep symptoms; effects of sleep symptoms on your daily activities and neuropathy; medication history (because many prescription medications can also affect the quality of your sleep, including some herbal remedies).

Upon evaluation of your neuropathy and sleep problems (as well as ruling out other causes of sleep disturbances), your doctor will review:
Self-help techniques—These are techniques you can adopt (as described above) if you are not already incorporating them to address your insomnia;
Non-pharmacological treatments—These include cognitive behavioral therapy, relaxation techniques, stress management, and acupuncture that can help improve sleep disturbances. They are preferred to prescription sleep medications which can lead to sleepiness during the day, can cause dependency, and come with side effects;
Pharmacological treatments—These are used as a last resort and should only be used for short periods of time especially when the insomnia is chronic. Sometimes, medicines used to reduce pain or aid sleep can affect your sleep.

- Over-the-counter pain medications—For mild pain, over-the-counter pain medications (e.g., Tylenol, Advil) may suffice. Some over-the-counter pain medications also have an antihistamine to help with sleep (e.g., Advil PM or Tylenol PM).²

- Prescription medications—For more severe or chronic pain, your doctor may recommend prescription pain medications (e.g., ultram, opioids such as oxycodone, hydrocodone bitartrate and acetaminophen, codeine, and morphine). Other drugs can also help with pain, such as some antidepressants and anticonvulsants. To help with sleep, your doctor might recommend drugs typically prescribed for anxiety, called benzodiazepines (e.g., lorazepam, clonazepam, triazolam). Your doctor may also consider nonbenzodiazepine hypnotics that are particularly helpful for sleep and appear to be better for longer-term use than benzodiazepines (e.g., zolpidem, eszopiclone, zaleplon).³

Poor sleep, depressed mood, and anxiety can complicate your (and your doctor’s) efforts to manage neuropathic pain. The key is to recognize this triad and partner with your doctor to find the right treatments and approaches that work best for you.

References:
1. Mai E. and Buysse D.J. Insomnia: Prevalence, Impact, Pathogenesis, Differential Diagnosis, and Evaluation. Sleep Med Clin. 2008;3(2):167-174

2. - 3. http://www.webmd.com/pain-management/features/arthritis-aches-keeping-you-up?page=3 (Accessed November 17, 2011).

http://www.neuropathy.org/site/News2?page=NewsArticle&id=8145

SLEEP SELECTIVELY STORES USEFUL MEMORIES

After a good night's sleep, people remember information better when they know it will be useful in the future, according to a new study in the Feb. 2 issue of The Journal of Neuroscience. The findings suggest that the brain evaluates memories during sleep and preferentially retains the ones that are most relevant

;

Humans take in large amounts of information every day. Most is encoded into memories by the brain and initially stored, but the majority of information is quickly forgotten. In this study, a team of researchers led by Jan Born, PhD, of the University of Lübeck in Germany set out to determine how the brain decides what to keep and what to forget.

"Our results show that memory consolidation during sleep indeed involves a basic selection process that determines which of the many pieces of the day's information is sent to long-term storage," Born said. "Our findings also indicate that information relevant for future demands is selected foremost for storage."

The researchers set up two experiments to test memory retrieval in a total of 191 volunteers. In the first experiment, people were asked to learn 40 pairs of words. Participants in the second experiment played a card game where they matched pictures of animals and objects -- similar to the game Concentration -- and also practiced sequences of finger taps.

In both groups, half the volunteers were told immediately following the tasks that they would be tested in 10 hours. In fact, all participants were later tested on how well they recalled their tasks.

Some, but not all, of the volunteers were allowed to sleep between the time they learned the tasks and the tests. As the authors expected, the people who slept performed better than those who didn't. But more importantly, only the people who slept and knew a test was coming had substantially improved memory recall.

The researchers also recorded electroencephalograms (EEG) from the individuals who were allowed to sleep. They found an increase in brain activity during deep or "slow wave" sleep when the volunteers knew they would be tested for memory recall.

"The more slow wave activity the sleeping participants had, the better their memory was during the recall test 10 hours later," Born said. Scientists have long thought that sleep is important in memory consolidation. The authors suggest that the brain's prefrontal cortex "tags" memories deemed relevant while awake and the hippocampus consolidates these memories during sleep.

Gilles Einstein, PhD, an expert in memory at Furman University, said the new findings help explain why you are more likely to remember a conversation about impending road construction than chitchat about yesterday's weather. "These results suggest that sleep is critical to this memory enhancement," said Einstein, who was unaffiliated with the study. "This benefit extends to both declarative memories (memory for a road detour) and procedural memories (memory for a new dance step)."

The research was supported by the German Research Foundation.

Link Between Poor Sleep And Suicide

Today's post from medicinenet.com (see link below) looks at the serious problem of sleep-deprivation and the effect it can have on your mental health. People living with neuropathy very often have disturbed sleep patterns. For some reason that nobody seems to be sure of, neuropathy symptoms can flare up during the night and pains in legs and feet can seriously affect your quality of life. It's logical really that prolonged lack of quality sleep will leave you drained during the day. Over a period of time that lack of energy and constant tiredness can lead to depression. If this is the case with you and you feel yourself being impacted by this, don't hesitate to contact your doctor and get help and advice but remember, sleeping tablets may not be the answer because the symptoms will continue despite being masked by the drugs. One thing is sure, don't ignore it and hope it will go away; make sure your medical professionals are aware of the problem.
 

Study Hints at Link Between Poor Sleep, Suicide Risk
By Tara Haelle HealthDay Reporter WEDNESDAY, Aug. 13, 2014 (HealthDay News) 
  
Sleeping difficulties may increase the risk of suicide in older adults even when other symptoms of depression aren't present, a new study suggests.

The study focused on adults 65 and older, and poor sleep included difficulty falling or staying asleep, waking up early in the morning, experiencing daytime sleepiness and not feeling fully rested after a night's sleep.

"These findings suggest that sleep disturbances stand alone as a valid risk factor -- independent of depressed mood -- and worthy of focus as a potential [suicide] risk factor, screening and intervention tool," said lead researcher Rebecca Bernert, an instructor of psychiatry at Stanford University School of Medicine. "Compared to many other known suicide risk factors, sleep disturbances are arguably less stigmatizing and may be undone, and are highly treatable."

Among the 20 study participants who died by suicide, 19 were men. The researchers randomly matched these 20 people to 400 living participants based on shared age, sex and location, and then compared their sleep quality and depression scores.

The study couldn't prove that sleeping problems cause suicidal thoughts or attempts, nor could it explain why the link may exist. But, Bernert said, it's likely that poor sleep affects the ability to regulate moods.

"The idea is simple: when we sleep poorly, it impacts how we feel and the way in which we manage our emotions, as well as decision-making," Bernert said. Past research has shown that fragmented sleep can result in more intense negative emotions, impaired judgment and difficulty managing fear or anger.

Those who reported having poor sleep quality at the start of the study had 40 percent greater odds of dying by suicide during the next 10 years before depression symptoms had been considered. Even after making calculations to remove the effects of depression symptoms, the odds of dying by suicide were 30 percent higher for those reporting poorer sleep quality, the study authors said.

Also, those who reported not feeling well-rested after sleeping had twice the odds of dying by suicide compared to those not reporting sleeping problems, even after symptoms of depression had been considered. And sleep disturbances better predicted who died by suicide over a decade than depression symptoms did, the study authors reported in the Aug. 13 online edition of JAMA Psychiatry.

The researchers used two separate questionnaires, one on sleep quality and one on depression symptoms, for their calculations.

Yet William Kohler, medical director of the Florida Sleep Institute in Spring Hill, Fla., said he's skeptical about how well the researchers could completely account for depression symptoms since they are so similar to the symptoms of poor sleep.

"We have to ask what's the cart and what's the horse because it's not common to be really sleep-deprived and then be wide-eyed and bushy-tailed and positive about things," Kohler said.

"We know that sleep disturbance causes depressive symptoms, such as lack of energy, lack of interest in things one enjoys and feeling a little down the next day, so I'm not sure how they would separate that out," he added.

Separating them out is what the researchers said they attempted to do.

"Sleep disturbances and suicidal ideation are both symptoms -- among a constellation of symptoms -- of depression, which is why it is crucial to disentangle them as risk factors and the way in which they may interact to increase risk," Bernert said. "It is important to note that suicide is the tragic outcome of multiple, often interacting risk factors and medical conditions."

Approximately 12 out of every 100,000 people die by suicide each year in the United States. Individuals thinking about suicide can reach a nearby certified crisis center by calling the National Suicide Prevention Lifeline at 1-800-273-TALK.

The U.S. Substance Abuse and Mental Health Services Administration ranks sleep difficulties as one of the top 10 warning signs of suicide. Past studies have linked insomnia, nightmares and overall poor sleep quality to an increased risk of suicidal thoughts and attempted suicide. But those studies did not usually control for depression.

This new study differs from past research because of its size, length and focus on older Americans. The researchers tracked more than 14,000 adults, aged 65 and older, for 10 years. The adults assessed their sleep quality and depression symptoms six times during that decade.

Bernert said she and her colleagues are now investigating why the link between poor sleep and suicide might exist.

The U.S. Centers for Disease Control and Prevention and the U.S. National Institutes of Health contributed funding for the study.

http://www.medicinenet.com/script/main/art.asp?articlekey=180048

SEVERITY OF SLEEP APNEA IMPACTS RISK OF RESISTANT HIGH BLOOD PRESSURE

A new study shows a strong association between severe, untreated obstructive sleep apnea and the risk of elevated blood pressure despite the use of high blood pressure medications.

The study involved patients who had cardiovascular risk factors or established heart disease and moderate or severe obstructive sleep apnea. Among participants prescribed at least three antihypertensives including a diuretic, resistant elevated blood pressure was more prevalent in those with severe sleep apnea (58.3 %) compared with moderate sleep apnea (28.6%). Further analysis found that the odds of resistant elevated blood pressure were four times higher in participants with severe, untreated obstructive sleep apnea even after adjusting for potential confounders such as body mass index, smoking status, diabetes mellitus, and cardiovascular disease (adjusted odds ratio = 4.12).

"Our findings suggest that severe obstructive sleep apnea contributes to poor blood pressure control despite aggressive medication use," said first author Dr. Harneet Walia, assistant professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. "This is an important finding from a clinical perspective as poor blood pressure control in patients taking multiple antihypertensive medications makes them particularly vulnerable to increased cardiovascular risk."

Study results are published in the Aug. 15 issue of the Journal of Clinical Sleep Medicine, which is published by the American Academy of Sleep Medicine.

"High blood pressure that is resistant to treatment with medications is a strong warning sign for the presence of obstructive sleep apnea, a chronic disease that increases the risk for heart disease and stroke," said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler. "Over one-third of patients with hypertension and nearly eight out of 10 patients with treatment resistant hypertension have obstructive sleep apnea. People who have high blood pressure should talk to a doctor about their risk for sleep apnea."

Data were analyzed from the baseline examination of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a four-site randomized controlled trial comprising patients with moderate to severe OSA who were under cardiovascular disease management. The analysis involved 284 participants, of which 73 were prescribed an intensive antihypertensive regimen.

"Even under the close care of a cardiologist following national guidelines for treatment of cardiovascular risk and comprehensive medication regimens, severe levels of obstructive sleep apnea versus a moderate level of OSA appear to be contributing to suboptimal blood pressure control," said Walia.

According to the Centers for Disease Control and Prevention, about 36 million American adults with high blood pressure don't have it under control. The American Academy of Sleep Medicine reports that approximately 80 percent of people with drug-resistant high blood pressure have obstructive sleep apnea, which involves repetitive episodes of complete or partial upper airway obstruction occurring during sleep despite an ongoing effort to breathe.