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Lifestyle & Exercise > September 2002
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:
- 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."
- Stage two is
considered a transition stage. Waves of electrical activity in our
brains slow down. Our breathing and heart rate also slow down.
- 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.
- 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.
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).
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
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.
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.
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:
causes one trouble falling asleep. Trazodone is usually prescribed
to reduce the time required to fall asleep.
causes one to wake up several times during the night.
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.
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).
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.
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
- Alpha EEG
- 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
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.
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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