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Lifestyle & Exercise > November 2002
THE PRINCESS, OR PRINCE,
AND THE PEA
SLEEP, PART TWO
It's common for
IC patients to wake up with nocturia (a strong and /or painful urge
to urinate many times during the night), and not be able to go back
to sleep. Knowing that you have to get up for work or an early appointment
can make it even more difficult to go back to sleep. Consequently,
sleeping late helps make up for lost sleep during the night. However,
medications are often necessary in order to help you get back to sleep,
or even sleep through bladder interruptions during the night.
Medications used by IC
patients for sleep
The tricyclic antidepressant, amitriptyline (Elavil) is one of the
most common medications taken for IC and fibromyalgia (FMS). (Antidepressants
taken in low doses are helpful to many chronic pain patients.) Amitriptyline
is actually made of five different medications, including an antihistamine
and an analgesic. The different medications seem to help with the
different symptoms of IC, including nocturia.
is a tricyclic antidepressant that interferes with the re-uptake
of serotonin by the presynaptic neurons. In other words, it helps
to reduce symptoms by changing the levels of norepinephrine and
serotonin in the synapse, therefore blocking pain messages to the
Some IC patients use over-the counter Benadryl to aid sleep. Benadryl
may be helpful to the bladder because it helps to block mast cell
secretion, which stimulates swelling in the tissues of the bladder.
(IC patients should not take antihistamines that contain decongestants.)
hydroxyzine (Atarax or Vistaril), however, is considered the most
effective in this category. It is often prescribed to IC patients
to decrease pain and frequency. It counteracts allergic reactions
and helps to block the neurotransmitter acetylcholine, as well as
anxiety. Hydroxyzine helps patients with allergies, migraines and
irritable bowel syndrome (IBS). It is thought to be most effective
after taken a few months. Because of its sedating effects, hydroxyzine
is taken at night to encourage sleep.
The sleep medications called "hypnotics" are the most
prescribed for sleep problems. Hypnotics are used to assist the
sleep in stage two of sleep (see our last column, The
Princess and the Pea.), which is the transition stage to deep
sleep. Hypnotics help to reduce the time it takes to fall asleep.
They also increase the amount of time spent in sleep.
is a nonbenzodiazepine hypnotic that is sometimes prescribed to
IC and FMS patients for occasional use. Ambien works fast and has
a relatively short duration, therefore it must be taken before bedtime
when patients have at least 7 or 8 hours to sleep. Unlike some other
hypnotics, Ambien doesn't help prevent the number of awakenings
during the night. It also does not have muscle relaxant properties.
After discontinuing Ambien (when taken on a nightly basis, for the
prescribed length of a time), there may be a rebound effect of insomnia.
Ativan (lorazepam) has a sedating effect because it is a benzodiazepine
(a particular type of hypnotic). The calming effects of Ativan help
with the pain and anxiety caused by IC. Ativan is very addictive
and usually prescribed only for occasional use.
Pillows & Sleep Positions
It's best to sleep on a bed that is not too hard so your muscles
can rest comfortably, and "let go." However, you should
avoid a bed that is too soft and, or uneven. A sagging bed bends
your back in compromising positions, especially when sleeping on
your stomach. Your muscles also have to work hard while they try
to find the right support needed for relaxation.
are rated by their contour-ability, different types of mattresses
contour the body differently. The popular memory foam, which is
pressure-sensitive, reacts to your body weight and temperature,
and molds to your shape and position. This may help some patients,
but others may find that this type of foam lacks the support and
structure needed for muscles to "let go." As a matter
of fact, some experts believe that memory foam causes more problems
when it molds to an existing tension pattern in the body. Pillowing
(using pillows) is a better way of giving your body the proper support
and structure needed for a comfortable night's sleep, and rested
muscles in the morning.
on your stomach
Sleeping on your stomach adds to low back, hip and neck pain. If
you have to sleep on your stomach, place a flat pad or pillow under
your stomach to support your low back and hips. (IC patients often
need to sleep on their stomachs and place their fists into the pressure
points along their pubic bone in front of their bladder to relieve
on your side
If you sleep on your side, place a baby pillow between your knees.
A standard size pillow will put too much pressure on your hips.
Support your spine by placing a flat pillow or pad between your
waist and armpit. (Special sleeping pads will be available soon
on our new website, www.new-pattern.com.) Hug a standard size pillow
to relieve neck and shoulder pain. Keeping the rib cage wide, instead
of collapsed, can also assist fuller breathing.
problems during sleep
sinus pain and migraine headaches can be caused by toxins in pillows
and linens. It's important to use pillows and linens made of natural
materials. The Vermont Country
Store sells a pillow made of 100% pesticide-free cotton. It is
very supportive and comfortable. See resources at the end of this
Patients who experience
nasal congestion (sinus blockage) may become "mouth breathers."
Mouth breathing is shallow, and not as deep and restorative as nasal
breathing. Mouth breathing can also become a habit and can cause waking
and self-hypnosis may help you to fall back asleep. According to the
Fibromyalgia Network, April 2002,
Relaxation Breathing, relaxation breathing exercises can be used to
quiet your sympathetic nervous system by restoring your heart rate
to a more normal rhythm. Breathing exercises improve the blood flow
to your muscles, and help them to relax when you close your eyes,
encouraging them to get that heavy feeling.
Vermont Country Store
It's helpful to
eat at the same time every night, but eating heavy meals close to
bedtime can interfere with sleep. On the other hand, going to bed
hungry can also have a negative effect on sleep.
The foods that
are the most irritating are acidic, spicy, gassy and fatty foods.
They cause indigestion and acid reflux (the acidic and spicy foods
affect IC), and can interfere with quality of sleep. Elevating the
head of your bed four to six inches helps with acid reflux. Acid reflux
often accompanies IBS and can be a side effect of some medications,
such amitriptyline (Elavil). When amitriptyline relaxes the colon
the valves to the esophagus can also relax and allow the contents
of the stomach to travel upward.
Limit your coffee
and tea intake to the morning, or before mid-day to avoid awakenings
during the night. Interestingly enough, the neurotransmitter tyrosine,
found in chocolate, red wine and aged cheese, etc. (which most IC
patients must avoid) can cause heart palpitations during the night.
MSG (monosodium glutamate) also interferes with sleep. MSG is broken
down into an excitatory amino acid that affects the central nervous
system (CNS). It can increase pain in patients with IC, FMS, migraines
and other chronic pain conditions. MSG is also listed on labels as
gelatin, hydrolyzed vegetable protein, textured protein, and yeast
extract. The artificial sweetener, aspartame (Nutrasweet) has a similar
effect on the CNS.
near bedtime can interfere with the second half of your night's sleep,
when sleep gets deeper. Alcohol must leave your body before you experience
quality of sleep. When it begins to leave your body, REM (dream state)
sleep interferes with deep sleep and can cause strange dreams.
Sleep and Hunger
With IC, there
is often reduced physical activity and weight gain, partly due to
medications that increase appetite and cause edema (smaller doses
cause less weight gain). Now, researchers have found that lack of
sleep is a powerful appetite stimulant. Evidently, lack of sleep creates
changes in the body's levels of leptin and cortisol. These hormones
regulate hunger. When patients (in a study) got enough sleep their
insulin and blood sugar levels returned to normal. FMS patients often
have hypoglycemia (low blood sugar).
It's best to exercise
in the late afternoon. Mornings are usually not an ideal time because
so many patients experience stiffness, and the bladder is most active
from 9:00 am to 1:00 am. Exercising with stiff muscles and joints
can lead to injury, and some patients experience bladder pain when
they exercise during the morning and early afternoon. Another good
reason to exercise in the afternoon is to release the day's tension.
However, exercising in the evening can be too stimulating. It's important
to have three hours of down time before bed.
Gaye is an author and IC patient & support group leader who
has been involved in IC work for years. In 1990 she published
"Stretch Into a Better Shape" and produced a stretching
and exercise video for IC patients in 1993. She is a specialist
in Aston-Patterning movement and muscle re-education.
over ten years of clinical and health care management position.
He is currently the Administrator of Maison Hospitaliere, located
in New Orleans. Andrew holds a Ph.D. in Special Education, a
M.A. of Health Adminstration, M.A. of Clinical Psychology.
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