Dr. Jacob Teitelbaum's Column
...expert advice on CFS, Fibromyalgia and other Health Topics.
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Monday, October 10th, 2011:
What's New in S.H.I.N.E. — Part 2: More on SleepWhat's New in S.H.I.N.E. — Part 1: Sleep
by Jacob Teitelbaum MD
Getting a Great Night's Sleep
In this multi-part series, I am reviewing the elements of the SHINE protocol for CFS and fibromyalgia: Sleep, Hormones, Infections, Nutritional Supplements and Exercise — I'm reviewing the basics and also discussing new developments in treatment for each of the five elements.
In part 1, I looked at natural remedies for sleep. In part 2, below, I continue talking about sleep, first looking at "sleep hygiene" (daily habits that can help or harm sleep), and then at how to effectively use multiple, low-dose medications to treat the sleep problems that are so common in CFS/FM.
Good Sleep Hygiene
A number of daily and nightly habits will enhance your ability to fall asleep:
- Hot bath. Take a hot bath before bed.
- Cool room. Keep your bedroom cool.
- Caffeine-free. Don't consume caffeine after 4:00 pm.
- Alcohol early. Don't consume alcohol near bedtime.
- Snack to snooze. Have a light high-protein snack before bedtime. Hunger and hypoglycemia (low blood sugar) cause insomnia in all animals, and humans are no exception. Eat a 1-2 oz. high-protein snack at bedtime to see if this helps sleep (a hard-boiled egg, nuts, cheese, turkey or other meat).
- Bedroom, not office. Don't use your bedroom for problem solving or work.
- Ignore the clock. Put the bedroom clock out of arm's reach and facing away from you, so you can't see it. Looking at the clock frequently aggravates sleep problems — and it's frustrating!
- Solve snoring. If your partner snores, sleep in a separate bedroom (after tucking in or being tucked in by your partner). Or get a good pair of earplugs and use them. The wax plugs that mold to the shape of the ear are often best.
- Better bladder control. If you frequently wake up to urinate during the night, don't drink a lot of fluids near bedtime. Unfortunately most pain patients wake up during the night because of the pain or because their sleep center isn't working properly. Because they also have a full bladder, they think they're waking up because they have to urinate. But this is not the case. They are waking up because of their pain syndrome. The following is a simple way to remedy this problem:
If and when you wake up during the night and notice your bladder is full, just talk to it (in your mind, so your spouse won't think you're nuts). Say, "Nighttime is for sleeping. We will go to the bathroom in the morning, when it is time to wake up." Then roll over and go back to sleep. If you still have to urinate five minutes later, go to the bathroom. Most of you will find that your bladder will happily go back to sleep — and when you wake up in the morning you won't even have to urinate as badly as you did when you woke up in the middle of the night.
I much prefer natural remedies to prescription medications. But the sleep disorder in CFS/FMS patients may be too severe to be dealt with by natural remedies alone. However, even if you are someone who needs prescription sleep aids, adding natural remedies can be very helpful and usually decreases the amount of medication that you will need, resulting in fewer side effects. In addition, once you come off the sleep medications (usually after 9 to 18 months, although they can be used indefinitely if needed) you may find that all you require are the natural remedies. But whatever treatments you use, it's important that they not only increase the duration of sleep but also maintain or improve the deep stages (stages 3 and 4) of sleep. Unfortunately, most sleeping pills in common use (for example, Dalmane, Halcion and Valium) may actually worsen the quality of sleep by increasing the amount of light stage sleep (especially stage 2), and decreasing the stages of deep sleep. You want to be certain that the treatments and medications you use leave you feeling better the next day, not worse.
There are several approaches to sleep when treating pain patients. Some doctors prefer to use a single medication or treatment, and push it up to its maximum level. If that works, great. If not, they stop it and switch to another medication. Other doctors prefer to use low doses of many different treatments together until the patient is getting good, solid sleep regularly. I strongly prefer the latter approach. Most of a medication's benefits occur at low doses and most of the side effects at high doses. In addition, if you combine low doses of a few different sleep aids, each of them will be cleared out of your body by morning — so you won't be hung over. Meanwhile, the effective blood levels that you have during the middle of the night from each treatment are cumulative, and will keep you asleep for eight to nine hours of solid sleep each night without waking or hangover. To see which medications I recommend for sleep, scroll down to the sleep section (page 4) of our SHINE treatment protocol document (a 46-page pdf file).
Used with permission from Dr Jacob Teitelbaum's free newsletters-available at www.Vitality101.com
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