PA_MaryAnne :
Good evening everyone and welcome to our Online Chat with Brenda Murdough MSN, RN-C, Military/Veterans Initiative Coordinator, American Pain Foundation. We’re glad you could join us! The topic for this evening will be "Catch Your ZZZ's - Release Your Pain – The Importance of Sleep in the Battle Against Chronic Pain."

Brenda currently serves as the American Pain Foundation Coordinator of the Military/Veterans Initiative where she advocates for the pain management needs of veterans, military and their caregivers.

In this position she provides information, education, resources and support to members of the military and veterans’ community that are affected by pain, doing outreach and collaboration with other organizations, and developing and supervising staff to assist with this work.
Brenda is also a pain management nurse specialist at the Cheshire Medical Center in Keene, N.H., where her duties include all aspects of patient care in the peri-anesthesia/pain management care setting including assessment, intervention, education and support of patients and families regarding Pain management and peri-anesthesia procedures.

A member of the American Society for Pain Management Nursing, Brenda earned her nursing diploma from the Albert Einstein School of Nursing in Philadelphia, Pa., a Bachelor of Science, Management, degree from Keene State College in Keene, N.H. and a Master of Science, Nursing Education degree from Rivier College in Nashua, N.H.

Ms. Murdough will be giving a short presentation followed by a question and answer period. Please remember that this is a protocol chat.

In order to give everyone a turn, anyone with a question or a comment will just type a "?" for question or a "!" for a comment and wait to be called upon.

Now, I’d like to hand over the chat to Brenda for her presentation! GA, Brenda.

Bmurdough:
Hi all - I want to thank you for joining our discussion this evening. I know time is limited, so I’ll be giving just a few brief comments about sleep, some helpful tips to improve your sleep, instructions for a relaxation technique that might be helpful, and a few resources for additional information. Then we can have questions and discussion. No napping during this part.

Let’s define what sleep is - it isn’t just resting. It is an unconscious but arousable state. So laying in bed watching TV or reading doesn’t count, even though that may be relaxing or comfortable.

Sleep is essential for all of your body’s functions to remain healthy and working properly, particularly your immune response and your cellular regeneration and repair. A lot is going on within your body while you sleep.

But one of sleep’s primary roles is its restorative function. Muscles relax and rest. Blood flow improves. Nerves are quieted. Cellular repair takes place. Your immune system works during this time to fight disease and repair cells and tissues.

There are several stages of sleep within a 1 ½ hour cycle. It is essential that complete cycles which include all of the stages occur for restful, restorative sleep. Also, we need at least 3, but more likely 4-5 of these complete cycles every night to be well rested.

So, by now you’re maybe thinking - sleep for 1 ½ hours straight and do it 4-5 times a night? 8-8.4 hours of sleep a night - I wish. I’ll never be rested! But we’ll get to that.
So what happens if we don’t get enough sleep? Well, you all can tell me – you know. Sleep debt disrupts our body’s natural rhythm or circadian rhythm - our natural clock or cycle. The restorative function of sleep is disrupted and optimal health is threatened.

We feel sluggish, tired, and irritable, achy and sensitive. Our judgment is off and our coordination is affected.

It effects us emotionally and socially - we don’t feel like doing our regular daily activities, we feel weak and maybe depressed. We are less active and don’t feel like socializing with our family or friends - we just want to sleep.

Does this sound a little like how a bad pain day makes you feel?

So now you have daily pain and no sleep and all of the effects of one are compounded by the other. This is one reason why sleep is so important in a complete plan of care. It refreshes you for the fight. And if you don’t get enough, it can make the battle against chronic pain seem that much more difficult.

So what can we do to try to improve the quality and quantity of our sleep?

Avoid substances that can disrupt your sleep cycle. They include caffeine - yes that after dinner cappuccino, tea, cola and chocolate. Smoking or nicotine can affect sleep. Alcohol, although at first may help you to fall asleep, disrupts the sleep cycle and awakening occurs. Avoid these for several hours before sleep.

Maintain a regular bed and wake time, when possible - this promotes your body’s natural chemistry and circadian rhythm.

Establish a regular bedtime routine. Remember when you used to put your kids to bed with a bath, a story and lights out? Well, a warm bath, light reading, relaxing music or mediation is a good practice for adults, too.

Try “black out” curtains, eye shades, ear plugs or ‘white noise” such as a water fall or rain CD.

Be sure to have a comfortable pillow and mattress, supporting any painful extremities.

Create a quite, dark, temperature appropriate room. Cool temperatures may be painful for some persons and too warm may be painful for others.

Exercise is a helpful component for pain management, but avoid this before bed time. Exceptions are Yoga or other stretching or relaxation exercises that may promote sleep.

Avoid stimulating activities such as violent TV, controversial discussions or doing your taxes before bedtime.

Use relaxation techniques such as soft music, aromatherapy, progressive muscle relaxation, guided or visual imagery and focused breathing to help you to fall asleep.

And, one tip especially for women who are approaching menopause, the number one complaint in this group is….no, not hot flashes…but insomnia. So if you feel this might be contributing to your sleep problems, be sure to discuss this with your health care provider.

Keep a diary, like a pain diary except for sleep, to take to your next appointment so you can share it with your practitioner to see if a medication for sleep might be indicated. Always consult your health care provider before adding any medications to your regime as they may interact with those you already take.

Possible resources for information are:
The National Institute of Health-National Center on Sleep Research www.nhlbi.nih.gov/about/ncsd/

The National Sleep Foundation www.sleepfoundation.org

Here’s a quick Mini Relaxation Breathing Exercise you can try tonight. Remember that you cannot breathe deeply while holding in your stomach, so relax.

Begin to inhale, very slowly through your nose, counting one, two, three, four as you do this.

Pause for a few seconds. Then exhale slowly, counting four, three, two, one. Repeat several times.

You may close your eyes to better visualize the air moving slowly in and slowly out. Think abut dropping your shoulders into a relaxed position as you exhale out, releasing the tension. Repeat for several times.

Ok - Time to wake up… I’ve given you a few ideas about sleep to consider so now let’s hear from you - we often learn best from sharing our experiences. I welcome your comments, suggestions and questions. /end

PA_MaryAnne:
Very good! We're going ahead with our Q&A portion now. PA Carolina will call on you in turn. I believe Finesse has the first one.

Finesse1:
Awake here. Great ideas. Totally agree with the menopause thing. I tend to "sleep" for 1 1/2 hours at a time. But feel exhausted. Sorry. I go back to sleep but never feel like I actually slept. Any ideas?

Bmurdough:
Yes, the menopause is a shocker. We always think of hot flashes, but insomnia can be very bothersome. You may not be completing a full sleep cycle or you may have some other problem where you aren't sleeping soundly. You can consult your health care provider if you don't feel rested after a nights sleep. /end

Ozzy37:
Can people with R.S.D go into remission? /end

Bmurdough:
I'm not sure it's called remission, but there may be times when the RSD is not as bothersome, depending on what else is going on with your health. /end

Judychunk:
How does changing our medications effect sleep? It seems like every time I get put on a new med I can't sleep.

Bmurdough:
Medications certainly can affect the quality of your sleep and if it becomes problematic, speak with your prescriber about this.

Judychunk:
I have and they say it just part of the process/end

Bmurdough:
Many meds interact with one another, so look at all the meds you take for possible interactions that might affect sleep. /end

Babsiel:
What do you do if the spasms keep you waking up all night WITH sleep med AND muscle relaxer? end

Bmurdough:
Try the Sleep diary and keep track of the meds you take before sleep and when you wake up and bring it with you to your next office visit to review so they can maybe suggest another option. Certainly some progressive muscles relaxation techniques are helpful and maybe some of the previously mentioned ideas to promote sleep. /end

Jubedo:
What's the difference between diabetic neuropathy and RSD? /end

Bmurdough:
Diabetic neuropathy is caused by damage to nerves from blood sugar that is too high over time. RSD - we aren't always sure of the cause- maybe trauma, surgery, a fall or some other event triggers it- but the cause is not well understood. /end

KenyonD:
Any additional advice or suggestions for those with Sleep Apnea and utilize a CPAP? In addition, what if an occasional cigar with a glass of wine does calm and relax you after a long stressful day? end

Bmurdough:
Sleep apnea needs to evaluated by a physician who specializes in this area as it can be a very dangerous condition- and follow their suggestions. A glass of wine and cigar are probably ok - just not too close to bed time...

Katie Marie:
Are you saying that if we can sleep for 1 1/2 hours at a time -several times a night that we are actually getting enough restorative sleep - even though one wakes up feeling tired - and therefore, don't stress about waking up and going back to sleep several times during the night? / ga

Bmurdough:
I think that if you are sleeping for 1-1/2 hours you may be completing a sleep cycle, but it isn't only quantity, it is the quality of sleep- so you may not be sleeping soundly. If you do not feel rested, then you might need to explore this further /end

Ozzy37:
Are there any studies going on in the Charlotte N.C? END

Bmurdough:
I'm not aware of any, but you can check out the Clinical Trials highlight on our main web page. And also ask at any major medical centers in your area /end

Dlkeil:
I sleep for only 2 hours at a time, and then I go back to sleep and sometimes I wake up 2 hours later again, but feeling as though I slept a lifetime. Does that deep sleep for short time do any good? I have RSD and can only sleep for 1.5 to 2 hours at a crack--no matter what I do. If I take meds to sleep, I can’t work in the morning. /end

Bmurdough:
It sounds like you're getting some good quality sleep during those two hours that you do sleep - certainly enough time to complete a cycle - So if you feel that you're rested, go with that. /end

Finesse1:
How can you tell what the best bed is for you? I know I need a new one & it's a lot of money to spend, but an important investment. Any suggestions? /ga

Bmurdough:
Yes, absolutely try a mattress out before you buy it- Go to a showroom that has several different styles that you can try- see if they have a return policy for maybe the first 30 days- some folks do. /end

Nam-ma:
I awake every hour on the hour every night and it feels as if I have been asleep for 8 hrs I am wide awake, but yet I am so tired each morning, I have been on most of the sleep meds with no results, any suggestions /ga

Bmurdough:
Any idea what’s waking you up? Is it pain or something else? g/a

Nam-ma:
No idea, maybe stress and pain/ga

Bmurdough:
Stress certainly can affect sleep, and your age alone with all of those other things I mentioned before. So, maybe try to add some of the non medicine techniques and then speak again with your provider. You might need a different kind of medication - not necessarily a sleep med. end

Katie Marie:
What do you mean by if you don't feel rested you need to explore this further? What can one do to get a quality sleep? - I know my waking up is when my pain level gets too high. I wake up burning up (one of the side effects of my pain. /ga

Bmurdough:
I mean that the quality of your sleep may not be good even if you feel that you sleep enough time. You might not be sleeping soundly. If pain wakes you up, perhaps a long acting medication is something that you can talk with your prescriber about so it doesn't wear off while you sleep./end

Gootes:
REM sleep is important

Bmurdough:
Absolutely

Judychunk:
When you don't get quality sleep at night, should you try to sleep in the daytime or try to stay awake till bedtime again? The pain level is much higher during the day when I try to stay up all day, then when I do go to bed I have muscle spasms, etc. & severe pain. /end

Bmurdough:
A nap can help to repair a sleep deficit, and keep your pain level lower. Just limit the time to maybe 1-2 hours and then have a wake period before bedtime. /end

PA_Carolina1:
Thank you all so much for coming tonight. We will have a transcript of this chat on the discussion boards in about an hour and also available on our website later this week. We would love to have you all participate in our boards and chats. We have daily chat Monday-Friday 11:00a.m. EST. Plus evenings. Mondays at 9:00p.m. EST and Wednesdays at 7:00p.m. EST. We have a great group of very supportive folks here and we will be having more special chats as well.

PA_MaryAnne:
Thank you so much Brenda for your time and expertise this evening! Please tell us you'll come back and soon!!??