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THE PRINCESS, OR PRINCE, AND THE PEA………….
SLEEP, PART TWO

• Medications Used
  
• Mattresses, Pillows & Sleep Positions
  
• Breathing Problems During Sleep
  
• Diet and Sleep
  
• Lack of Sleep & Hunger
  
• Exercise and Sleep
  

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

Antidepressants
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.

Amitriptyline 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 brain.

Antihistamines
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.)

The antihistamine 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.

Hypnotics
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.

Ambien (zolpidem) 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.
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Antianxiety Medications
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.

Mattresses, Pillows & Sleep Positions

Mattresses and Sleep
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.

Although mattresses 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.

Sleeping 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 pain.)

Sleeping 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.

Breathing problems during sleep

Breathing problems, 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 column.

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 episodes.

Breathing exercises 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.

Resource: The Vermont Country Store
1-802-362-8440

Diet and sleep

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.

Drinking alcohol 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.

Lack of 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).

Exercise and sleep

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.