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THE PRINCESS, OR PRINCE, AND THE PEA………….
How IC and Overlapping Conditions affect your SLEEP

I was once invited to a "Come as your favorite thing to do" party. I didn't go, but if I had I would have gone in my pajamas. When I met my husband I told him that I was like the princess in the book "The Princess and the Pea." I have had trouble sleeping for most of my life, but never found anything that helped until I was diagnosed with IC.

Sleep (Non-REM & REM)

Sleep is divided into two phases, non-REM (non-rapid eye movement) and REM (rapid eye movement). The first phase of sleep, non-REM, is divided into four stages:
  1. Stage one is the lightest level sleep. During stage one our muscles relax as our temperature drops. We get drowsy and start to drift. During this stage our brain generates fast alpha waves (awake-like brain waves). Jumping, jerking, and a feeling of falling may occur. These activities are called "sleep start."

  2. Stage two is considered a transition stage. Waves of electrical activity in our brains slow down. Our breathing and heart rate also slow down.

  3. Stages three and four are deep sleep. During stage three our brain waves become large, and slow down as they turn into delta waves (slow-wave sleep). Our bodies start to shut out stimulation.

  4. Our deepest sleep, experienced in stage four, is restorative and vital for many body functions to work well, such as the regulation of our various neurotransmitters and hormones (growth hormone for tissue repair), and substances for recharging our immune system (antibody production).

The second phase is REM (rapid eye movement). When this dreaming stage of sleep occurs, our muscles become paralyzed and more relaxed than they are during the deepest levels of non-REM sleep. Our eyes flutter and the depth of our breathing increases. Our heartbeat and blood pressure also rise. There is high electrical activity in our brains, similar to the brain waves when we are awake. During our dream sleep we record our thoughts and events of the day, and place them in a brain file.

According to the Fibromyalgia Network, October 2001 "Sleep Basics", REM begins about 70 to 90 minutes after we go to sleep, lasts about 15 to 30 minutes, and adds up to about 25% of our night's sleep. Normally, we cycle between non-REM and REM four times a night. At first, we spend more time in non-REM sleep. However, we spend more time in REM sleep as the night moves through. As we cycle through these stages our sleep gets deeper.

Sleep Deprivation

Adults are advised to get at least eight hours of sleep a night, but sleep deprivation is normal. Sleep deprivation is actually a clue to certain diseases. Sleep disturbance is one of the first signs of Fibromyalgia (and chronic fatigue syndrome). Sleep disturbance is also a symptom of IC, as well as other painful conditions, such as vulvodynia, migraine headaches and irritable bowel syndrome (IBS).

Sleep disorders that relate to the central nervous system (such as those in FMS) contribute to symptoms. And, although pain increases when sleep decreases, FMS studies show that reducing pain during sleep doesn't necessarily help a FMS patient sleep. Treatment is instead geared towards treating the sleep disorder instead of the pain. Different medications are prescribed for the different causes of sleep disturbance.

Our Circadian Rhythms

Our bodies respond to our circadian rhythm, which is our biological clock. We need to sleep for a certain length of time within a 24-hour cycle in order to function. We experience the most sleepiness during the last hour of our sleep, before we wake up. During this time there is a (circadian) dip in alertness. We feel the least sleepy in the last hour before our (regular) bedtime, because we are programmed to stay awake until we are used to going to bed. When we change our bedtime, or wake up time, from our regular schedule we change our circadian rhythms, which in turn can cause insomnia. Sleep disorders also affect our circadian rhythms.

Sleep Disorders and Disturbances

Much of the following information was printed in the Fibromyalgia Network, October 2001 "Sleep Abnormalities and Treatments"
  • PLMS (periodic limb movement during sleep) is a central nervous system abnormality, which causes alpha wave spikes during sleep. The symptoms of PLMS are uncontrollable limb movement, jerking, tossing and turning. PLMS has a similar alpha wave pattern to that found in FMS patients. It affects more men than women. Tricyclic antidepressants actually worsen this condition. Klonopin and Ambien are prescribed for PLMS, but these medications don't reduce the number of awakenings. PLMS causes fatigue the next day, however, patients who take Trazodone (a med for) need to get about 10 hours of sleep, or reduce the dosage of the medication in order to function well the next day.

  • RLS (restless leg syndrome) is considered a cousin of PLMS, and people who have one condition often have both conditions. RLS causes alpha waves like PLMS. RLS usually occurs in the evening, but can occur while sitting during the day. There is the need to move around, which controls the symptoms. Being still causes built-up muscle tension and symptoms in the legs. The stillness during sleep also causes symptoms.

    RLS is common in FMS patients. Klonopin and Ambien are prescribed for RLS, but don't reduce the number of awakenings. RLS worsens during pregnancy, menopause, and during the menstrual cycle. Symptoms are described as feeling as if one's legs are cut off at top of thighs, as well as painful quivering sensations. Some IC patients also experience a strange weak related feeling in their bladder, pelvic floor and abdomen. RLS causes fatigue the next day.

  • Insomnia is defined as having trouble falling asleep and staying asleep, but there are different types of insomnia. Insomnia can cause muscle soreness and discomfort in anyone, but especially in those with FMS (and probably many IC patients). Women suffer with insomnia more than men, and the effects of insomnia are greater in women. Insomnia has three main forms:

    • Sleep onset insomnia causes one trouble falling asleep. Trazodone is usually prescribed to reduce the time required to fall asleep.

    • Maintenance insomnia causes one to wake up several times during the night.

    • Early morning insomnia causes one to wake up too early, and not be able to fall back to sleep. Sometimes this problem is diagnosed as depression before a patient is properly diagnosed with another cause, such as IC or FMS.


    Insomnia patterns, such as maintenance insomnia caused by a medical problem, are sometimes defined as multiple awakenings. According to FMS specialist, Devin Starlanyl M.D., there is a type of insomnia called compulsive urination insomnia. This insomnia is common in patients with FMS (many FMS patients have a condition called "irritable bladder") and myofascial pain syndrome (MPS).

  • Compulsive urination insomnia causes one to get up to urinate so she, or he can go back to sleep. This need is caused by a small amount of urine, which irritates the bladder, and creates the pressure that keeps one up and going to the bathroom (so she, or he won't have to get up later). The two most common sleep complaints among FMS patients are sore muscles, and sensitivity to any amount of fullness in their bladders.

  • Nocturia, which is a hallmark of IC, is a sleep disorder that causes multiple awakenings. Nocturia wakes one up with a strong, and/or painful urge to urinate many times during the night. Lack of sleep in IC patients is solely blamed on nocturia. (As far as I know, there haven't been sleep studies on IC patients to understand their sleep patterns.) Vulvodynia, irritable bowel syndrome (IBS), migraine headaches, and acid reflux are other medical problems that cause insomnia patterns.

  • Alpha EEG Sleep Anomaly - Alpha wave sleep disturbances are common in patients with FMS and/or myofascial pain syndrome (MPS). Delta sleep is interrupted when alpha waves intrude. Alpha waves can wake patients up, or just prevent them from getting a good quality of sleep, which usually results in more pain. K-alpha waves, which mainly occur during stage two sleep, create poking sensations. Experts believe that K-alpha waves also contribute to GI (gastrointestinal) problems and cause muscle pain. This sleep anomaly affects mostly women FMS patients. Although K-alpha is similar to PLMS, it may not be caused by the same mechanism. Ambien usually helps patients with K-alpha sleep disturbance.

  • Phasic alpha sleep disturbance occurs in episodes during stages three and four sleep (deep sleep). Phasic alpha often exists with K-alpha disturbances, and also causes muscle pain and stiffness. Although both phasic alpha and K-alpha waves are common in FMS, phasic waves are more common. These waves interfere with restorative sleep, which contributes to FMS symptoms (and probably IC symptoms too).

  • Sleep apnea, which supposedly affects mostly men, is now believed to affect many women too. Sleep apnea causes one to stop breathing while snoring. It fatigue the next day, and is dangerous. Both sleep apnea and snoring can cause headaches and trouble breathing.

  • RSD (reflex sympathetic dystrophy) is another condition that sometimes occurs with FMS. RSD interferes with sleep, is brought on by an injury, and manifests during or after the injury. RSD can last a long time and lead to a chronic pain pattern, because it alters the central nervous system. The pain of RSD has been compared to the pain of IC, because it can interfere with the quality of sleep and keep the sufferer up at night. The nerve-pain agent, Neurontin, is often prescribed as treatment.

Refer to our next column, Sleep, Part Two, for more information on medications, diet, exercise, beds, menopause, dreams and more.

 

About The Authors:
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.

Andrew has 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.

They welcome your comments and feedback on their articles at: The Sandlers


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