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Marshall James Nev, PLC | Sleep and Pain in Richmond

Lexington-Richmond Headache Clinic
Marshall James Ney, DMD, FAAOP
Fellow American Academy of Oral Facial Pain

527 W. Main St.
Richmond, 40475
(859) 623-3761

Sleep and Pain
 

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Without good quality sleep, you will not get out of pain. Having pain while you are sleeping creates a condition called Alpha-Delta sleep. This produces a night of non-restorative sleep. You go to bed tired and awaken just as tired.

  1. Quality sleep is not just the number of hours you spend in bed, but also:
    • the length of time it takes you to fall asleep and
    • the number of times your sleep gets interrupted.
      Interrupted means anything from
      • getting up to go to the bathroom to
      • simply awakening, knowing you're awake, and going back to sleep.
  2. Also, dreaming plays an important role in sleep. A lot of dreaming means you are in a light stage of sleep and this appears to be bad for patients suffering from headache and neck pain.

Learn More

sleep1_364x200.jpgLet's take a walk through the sleep maze and see what good sleep and bad sleep is. After all, without good sleep, you will not get out of pain. In particular, let's talk about how sleep and pain are related under the following topics:

The Power of Sleep

When you’re scrambling to meet the demands of modern life, cutting back on sleep can seem like the only answer. How else are you going to get through your never-ending to-do list or make time for a little fun? Sure, a solid eight hours of totally uninterrupted sleep sounds great, but who can afford to spend so much time sleeping? The truth is you can’t afford not to. If you want to manage your pain, you have to look at your sleep.

Sleep consists of a series of distinct cycles and stages that restore and refresh your body and mind. Even minimal sleep loss takes a toll on your mood, energy, efficiency, and ability to handle stress. If you want to feel your best, stay healthy, and perform to your potential, sleep is a necessity, not a luxury. You want to learn what happens when you’re sleeping, how to determine your nightly sleep needs, and what you can do to bounce back from chronic sleep loss and get on a healthy sleep schedule.

At night you may think that you would rather stay up to watch TV, read a book, or do anything that sounds more interesting then going to sleep. In the morning, however, if you have not had a enough sleep or had enough good quality of sleep, you may want to sleep another hour. Your quality of sleep, which is also determined by the number of times you awoke and how much you dreamed, directly affects pain and the quality of your waking life. Your mental sharpness, productivity, emotional balance, creativity, physical vitality, and even your weight are ALL tied to how well you sleep! No other activity delivers so many benefits with so little effort.

So... sleep isn’t just when your body and brain shut off. When you sleep, your brain stays busy, overseeing many biological maintenance tasks to keep you running in top condition and prepare you for the day ahead. Without enough uninterrupted restorative sleep, you’re running a high octane car on low octane gas.

How Sleep Affects Pain

For many of us, poor sleep translates into pain. The good news is that you don’t have to choose between being healthy and being productive. As you start getting the sleep you need, your energy and efficiency will go up and your pain level should go down if we have correctly identified other factors contributing to your headache and neck pain. In fact, when you manage your pain and you get a good night of sleep, you'll find that you actually get more done during the day than when you were skimping on sleep and sleeping poorly.

Sleep Myths

Don't get caught by these six sleep myths:

Myth 1

Getting just 1 hour less sleep per night won’t affect your daytime functioning.
You may not be noticeably sleepy during the day. But even slightly less sleep can affect your ability to think properly and respond quickly, and compromise your cardiovascular health, energy balance, and ability to fight infections.

Myth 2

Your body adjusts quickly to different sleep schedules.
Most people can reset their biological clock, but only with appropriately timed cues. Even then, however, we can do it only 1–2 hours per day at best. Consequently, it can take more than a week to adjust after switching to the night shift or traveling across one or more time zones.

Myth 3

Extra sleep at night can cure you of problems with excessive daytime fatigue.
Not only is the quantity of sleep important but also the quality of sleep. You may sleep 8 or 9 hours a night but not feel well rested when you wake up because the quality of your sleep is poor. Some things that affect the quality of your sleep include awakening one or more times during the night, eating too close to bedtime, and dreaming too much.

Myth 4

You can make up for lost sleep during the week by sleeping more on the weekends.
Although this sleeping pattern will help relieve part of a sleep debt, it is not enough. Furthermore, sleeping later on the weekends can affect your biological clock and make it much harder to go to sleep at the right time on Sunday night and get up early on Monday morning.

Myth 5

It is ok to lie in bed after you awaken.
Actually, NO IT IS NOT. When you awaken from sleep in the morning you are coming out of your last REM period where the muscles have been paralyzed. It is best if you get out of bed immediately upon awakening and take a hot shower.

Myth 6

Time in bed equals hours of sleep.
No. As we mentioned before it is the quantity AND quality of sleep that matters.

Desirable quantity of sleep: 7.5 - 9.0 Hours
Recommended quality of sleep:

  1. Going to sleep within 5-10 minutes of lying down
  2. No awakenings
  3. Little if any dreaming
  4. No pain while you are sleeping

If any the above quantity and quality of your sleep is not happening, you have a good chance of staying in pain.

How Many Hours of Sleep Do I Need?

Average Sleep Needs

Age

Newborns (0 to 2 months)
Infants (3 months to 1 year)
Toddlers (1 to 3 years)
Preschoolers (3 to 5 years)
School-aged children (5 to 12 years)
Teens and preteens (12 to 18 years)
Adults (18+ years)

12-18
14-15
12-14
11-13
10-11
8.5-10
7.5-9

According to the National Institute of Health, the average adult sleeps less than 7 hours per night. In today’s fast-paced society, 6 or 7 hours of sleep may sound pretty good. In reality, it’s a recipe for chronic sleep deprivation.

While sleep requirements vary slightly from person to person, most healthy adults need between 7.5 to 9 hours of sleep per night to function at their best. Children and teens need even more. And despite the notions that sleep needs decrease with age, older people still need at least 7.5 to 8 hours of sleep. Since older adults often have trouble sleeping this long at night, daytime naps can help fill in the gap.

However, if you sleep too much during the day, this will satisfy your sleep requirements and you will get sleep interruptions during the night.

Consequently, what can be good for the general public may not be good for the patient in pain. I tell my patients that a short power nap sitting up in a chair, can be great. You get a little rest, and your jaw drops down, so you will be much less likely to clench or grind.

Sleep needs and peak performance
There is a big difference between the amount of sleep you can get by on and the amount you need to function optimally. Just because you’re able to operate on 6 hours of sleep doesn’t mean you wouldn’t feel a lot better and get more done if you spent an extra hour or two in bed. The best way to figure out if you’re meeting your sleep needs is to evaluate how you feel as you go about your day. If you’re logging enough sleep hours, you’ll feel energetic and alert all day long, from the moment you wake up until your regular bedtime.

Think six hours of sleep is enough?
Think again. Researchers at the University of California, San Francisco discovered that some people have a gene that enables them to do well on 6 hours of sleep a night. But the gene is very rare, appearing in less than 3% of the population. For the other 97% of us, six hours doesn’t come close to cutting it.

Sleep Deprivation and Lack of Sleep

If you’re getting less than eight hours of sleep each night, chances are you’re sleep deprived. What’s more, you probably have no idea just how much lack of sleep is affecting you.

How is it possible to be sleep deprived without knowing it? Most of the signs of sleep deprivation are much more subtle than falling face first into your dinner plate. Furthermore, if you’ve made a habit of skimping on sleep, you may not even remember what it feels like to be wide-awake, fully alert, and firing on all cylinders. It feels normal to get sleepy when you’re in a boring meeting, struggle through the afternoon slump, or doze off after dinner. But the truth is that it’s only “normal” if you’re sleep deprived. And this is if you are just sleep deprived. If you are in pain, you can multiply these feelings by 10!

You may be sleep deprived if you:

  • Need an alarm clock in order to wake up on time
  • Rely on the snooze button
  • Have a hard time getting out of bed in the morning
  • Feel sluggish in the afternoon
  • Get sleepy in meetings, lectures, or warm rooms
  • Get drowsy after heavy meals or when driving
  • Need to nap to get through the day
  • Fall asleep while watching TV or relaxing in the evening
  • Feel the need to sleep in on weekends
  • Fall asleep within five minutes of going to bed

While it may seem like losing sleep isn’t such a big deal, sleep deprivation has a wide range of negative effects that go way beyond daytime drowsiness. In addition to not helping you manage your pain, lack of enough sleep without interruptions will also cause:

  • Moodiness and irritability
  • Reduced creativity and problem-solving skills
  • Inability to cope with stress
  • Reduced immunity; frequent colds and infections
  • Concentration and memory problems
  • Weight gain
  • Impaired motor skills and increased risk of accidents
  • Difficulty making decisions
  • Increased risk of diabetes, heart disease, and other health problems

So... Is lack of sleep affecting your performance?
Lack of sleep affects your judgment, coordination, and reaction times. In fact, sleep deprivation can affect you just as much as being drunk. You can tell how lack of sleep is affecting your performance by. playing this BBC Sheep game after a good night's sleep and when you haven't slept enough. It's fun! It will give you an idea about how well rested you really are.

Stages of Sleep: REM and non-REM

All sleep is not created equal. Sleep unfolds in a series of recurring sleep stages that are very different from one another in terms of what’s happening beneath the surface. From deep sleep to dreaming sleep, they are all vital for your body and mind. Each stage of sleep plays a different part in preparing you for the day ahead.

There are two main types of sleep:

  • Non-REM (NREM) sleep consists of four stages of sleep, each deeper than the last.
  • REM (Rapid Eye Movement) sleep is when you do most active dreaming. Your eyes actually move back and forth during this stage, which is why it is called Rapid Eye Movement sleep.

Stages of Sleep: REM & Non-REM

Let's see how these types of sleep show up in the stages of sleep:

Non-REM Sleep

  • Stage 1 (Transition to sleep) – Stage 1 lasts about five minutes. Eyes move slowly under the eyelids, muscle activity slows down, and you are easily awakened.
  • Stage 2 (Light sleep) – This is the first stage of true sleep, lasting from 10 to 25 minutes. Eye movement stops, heart rate slows, and body temperature decreases.
  • Stage 3 (Deep sleep) – You’re difficult to awaken, and if you are awakened, you do not adjust immediately and often feel groggy and disoriented for several minutes.
  • Stage 4 (More intense deep sleep) – The deepest stage of sleep. Brain waves are extremely slow. Blood flow is directed away from the brain and towards the muscles, restoring physical energy. This is one of the reasons that in treating a muscle related headache or neck pain that good quality deep sleep (stages 3 and 4)

REM sleep (Dream sleep)
About 70 to 90 minutes after falling asleep, you enter REM sleep, where dreaming occurs. Eyes move rapidly. Breathing is shallow. Heart rate and blood pressure increase. Arm and leg muscles are paralyzed. REM sleep occurs more in the early morning hours.

The sleep cycle: Understanding the architecture of sleep

You may think that once you go to bed, you soon fall into a deep sleep that lasts for most of the night, progressing back into light sleep in the morning when it’s time to wake up. In reality, the sleep cycle is a lot more complicated.

When you chart the sleep stages over the course of the night, the result looks like a city skyline. This is why it is called "sleep architecture"!

During the night, your sleep follows a predictable pattern, moving back and forth between restorative sleep (deep sleep) and more alert stages and dreaming (REM sleep). Together, the stages of REM and non-REM sleep form a complete sleep cycle that repeats until you wake up.

The amount of time you spend in each stage of sleep changes as the night progresses. For example, most deep sleep occurs in the first half of the night. Later in the night, your REM sleep stages become longer, alternating with light Stage 2 sleep. This is why if you are sensitive to waking up in the middle of the night, it is probably in the early morning hours, not immediately after going to bed.

Having a hard time getting up? Take advantage of the 90-minute sleep cycle.

Even if you’ve enjoyed a full night’s sleep, getting out of bed isn’t easy if your alarm goes off when you’re in the middle of the deeper stages of sleep (especially stages 3 and 4). If you want to make mornings less painful, set a wake-up time that’s a multiple of 90 minutes, the length of the average sleep cycle.

For example, if you go to bed at 10 p.m., set your alarm for 5:30 (a total of 7 1/2 hours of sleep) instead of 6:00 or 6:30. You’ll feel more refreshed at 5:30 than you will with another 30 to 60 minutes of sleep, because you’re getting up when your body and brain are already close to wakefulness.

Your longest REM period is the last REM period, and your brain is almost awake. So when you wake up within 60 minutes of the time you need to get up, do get up right away. You will feel better and your chance of getting back into pain will be much less.

The importance of deep sleep and REM sleep

Getting good, restorative sleep is not just a matter of spending enough hours in bed. The amount of time you spend in each of the stages of sleep matters. A normal adult spends approximately 50 percent of total sleep time in stage 2 sleep, 20 percent in REM sleep, and 30 percent in the remaining stages, including deep sleep.

Each stage of sleep in the sleep cycle offers benefits to the sleeper. However, deep sleep (stages 3 and 4) and REM sleep are particularly important.

Deep sleep

The most damaging effects of sleep deprivation and pain are from inadequate deep sleep. Deep sleep is a time when the body repairs itself and builds up energy for the day ahead. It plays a major role in maintaining your health, stimulating growth and development, repairing muscles and tissues, and boosting your immune system. In order to wake up energized and refreshed, getting quality deep sleep is key!

If you are in pain while you are sleeping, you will have what we call Alpha Delta Sleep. This is one of the worst things to happen. Not only are you not getting enough deep sleep but it is corrupted by pain! You will feel exhausted in the morning.

Factors that can lead to poor or inadequate deep sleep include:

  • Being awakened during the night. (by outside noise, for example, or in order to care for a crying baby)
  • Awakening on your own, for no reason or because you are in pain.
  • Working night shifts or swing shifts. Getting quality deep sleep during the day can be difficult, due to light and excess noise. (Blame Thomas Edison!)
  • Smoking or drinking in the evening. Substances like alcohol and nicotine can disrupt deep sleep. It’s best to limit them before bed.

REM sleep

Just as deep sleep renews the body, REM sleep renews the mind. REM sleep plays a key role in learning and memory. During REM sleep, your brain consolidates and processes the information you’ve learned during the day, forms neural connections that strengthen memory, and replenishes its supply of neurotransmitters, including feel-good chemicals such as serotonin and dopamine that boost your mood during the day.

Improving your overall sleep will also increase your REM sleep. If you aren’t getting enough deep sleep, your body will try to make it up first, at the expense of REM sleep.

Medication can change the amounts of your REM and Deep Sleep. Narcotic and valium type drugs will lengthen stage 2 sleep at the expense of REM and Deep Sleep.

The medications we usually give will increase REM by not allowing you to interrupt your sleep and will deepen your sleep.

Tips for getting good sleep, night after night

Do you feel like no matter how much you sleep, you still wake up exhausted? Learn how to maximize your sleep quality and sleep well every night by following a regular sleep-wake schedule, developing a relaxing bedtime routine, and improving your sleep environment. You can learn more by reading Tips for Getting Better Sleep: How to Sleep Well Every Night.

Paying Off Your Sleep Debt

Sleep debt is the difference between the amount of sleep you need and the hours you actually get. Every time you sacrifice on sleep, you add to the debt. Eventually, the debt will have to be repaid. It won’t go away on its own. If you lose an hour of sleep, you must make up that extra hour somewhere down the line in order to bring your “account” back into balance.

Sleeping in on the weekends isn’t enough!

Many of us try to repay our sleep debt by sleeping in on the weekends. But as it turns out, bouncing back from chronic lack of sleep isn’t that easy. One or two solid nights of sleep aren’t enough to pay off a long-term debt. While extra sleep can give you a temporary boost (for example, you may feel great on Monday morning after a relaxing weekend), your performance and energy will drop back down as the day wears on.

Here are some tips for getting sleep and staying out of sleep debt. With a little effort and planning, you can get back on track.

  • Aim for at least 8 hours of sleep every night. Make sure you don’t fall farther in debt by blocking off a minimum of 8 hours for sleep each night. Consistency is the key.
  • Settle short-term sleep debt with an extra hour or two per night. If you lost 10 hours of sleep, pay the debt back in nightly one or two-hour installments.
  • Look at your pain diary: Record when you go to bed, when you get up, your total hours of sleep, and how you feel during the day. As you keep track of your sleep, you’ll discover your natural patterns and get to know your sleep needs.
  • Take a sleep vacation to pay off a long-term sleep debt. Pick a two-week period when you have a flexible schedule. Go to bed at the same time every night and allow yourself to sleep until you wake up naturally. No alarm clocks! If you continue to keep the same bedtime and wake up naturally, you’ll eventually dig your way out of debt and arrive at the sleep schedule that’s ideal for you.
  • Make sleep a priority. Just as you schedule time for work and other commitments, you should schedule enough time for sleep. Instead of cutting back on sleep in order to tackle the rest of your daily tasks, put sleep at the top of your to-do list.

For the pain patient, here are your rules:

  1. If we have given you something for sleep take it on time; on time may be different for everyone. The sleep notations in your pain diary will tell.
  2. If you are awakening throughout the night slowly increase your sleep medication until you sleep without interruptions and do not dream much.
  3. Limit your naps to power naps sitting up in a chair.
  4. As soon as you awaken in the morning, get right out of bed and into a hot shower.
  5. Keep pets out of the bedroom (children too).
  6. If you must watch TV in the bedroom, set a sleep timer so that the TV will not play all night.
  7. If your bed partner snores, look into options that can quiet or eliminating snoring. You may want to read about sleep apnea.

I know this has been a long lesson on sleep, but it is the way we like to treat pain - by educating you, the patient, as to what is wrong. Once you learn to diagnose and treat your own pain, you won't need us! However, we are here if you do.

—Dr. Ney

 

 
 
Richmond Dentist | Sleep and Pain. Marshall James Ney is a Richmond Dentist.