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Popular Sleep Myths.....

1) Sleeping is a passive activity...
Whilst most of us think of sleeping as a rest period when we 'shut-down', our brains are actually in an active state during sleep & go through complex sequences of events whilst our bodies remain inactive.

2) Short naps during the day are a waste of time...
Daytime napping is often viewed negatively in many Western cultures. Whilst taking a short rest may be considered lazy, it can actually improve work performance. Bill Clinton, John F Kennedy & Albert Einstein all took daytime naps!

3) You need 8 hours sleep to function at your best...
There's no magic number when it comes to hours of sleep required. Though adults need, on average, 7-8 hours sleep each night, scientific studies have shown that we don't all have the same amount of sleep time required in order to function at optimum levels. Genetics may play a part in explaining why some people can survive on far less sleep than others.

4) Alcohol calms you down, enabling you to sleep better...
A glass of wine or two may make you feel more tired and therefore fall asleep faster, but you'll end up having more broken sleep patterns and waking up during the night.

5) It's fine to fall asleep in front of the TV...
The artificial light from TV, computer & smartphone screens can lessen our body's production of melotonin. This hormone, which helps to promote sleep, is triggered by darkness. Furthermore, our circadian rhythms- the bodily cycle that responds to daylight & darkness & helps us sleep- are disturbed by artificial light.

6) Sleeping in at the weekend helps you catch up on on lost sleep...
Sleep 'bingeing' at the weekend actually upsets your consistent sleep patterns & makes it harder to get refreshing sleep. By sleeping in very late on the weekend, your body will not sleep well that night, therefore setting you up in a 'no-sleep' cycle for the week ahead.

7) Teenagers sleep too much & are lazy...
Many of us may have experienced battling with teenagers to get out of bed in the morning & leave their cosy beds. Research shows that there are body clock changes occurring during adolescence, meaning that teenagers need at least around 9-10 hours sleep each night, as opposed to the average 7-8 hours required by most adults.

And finally...

8) Counting sheep can help you fall asleep...
The famous myth that conjuring up images of endless sheep & counting them helps promote sleep has been around for many years. However, a study at the UK's Oxford University Department of Experimental Psychology actually found the opposite to be true. Those busy counting sheep when trying to sleep actually took up to 20 minutes longer to fall asleep than those imagining other situations such as a relaxing beach. It was concluded that, as counting sheep is actually so boring & repetitive, our mind compensates by thinking of other distracting thought patterns, thus making it more difficult to relax & sleep!

Should I take Sleeping Tablets?

Another form of medication that is an obvious consideration when searching for ways to induce sleep are sleeping tablets. There are a wide variety of these which can be purchased over the counter or on prescription. However, it is important to look into whether such sleeping tablets can actually be a positive help for night-time pain or whether they can prevent awakening from sleep.

Before commenting on this, it is worth noting that, whilst sleep drugs are generally safe if the correct dosage & most suitable medication is used, there are numerous possible side-effects. These may include appetite changes, stomach complaints & headaches, dizziness & light-headedness. In addition, one may experience weakness & prolonged drowsiness during the day which can lead to an inability to maintain optimal performance during daytime activity. This can have an effect on many aspects from driving to operating machinery to workrelated tasks. Further effects of loss of muscle coordination, difficulties with balance or a dry or bitter-tasting mouth could also be felt.

Taking sleep medication long-term could also lead to over-dependence or addiction, masking the actual underlying cause of the sleep problem. Another practical factor to take into account is the high financial cost of taking sleep drugs long-term; it is unlikely that free healthcare services or health insurance companies will pick up the cost.

As to the question of whether sleep drugs can prevent wakefulness experienced through pain, it seems that they may not be a helpful solution. In order for a sleeping pill to bring about a sleep that is deep enough to combat pain & discomfort, it would need to be a powerful painkiller. Sleep aids are not painkillers, & the two work on the body in totally different ways. Therefore, the likelihood is that any pain being experienced will march right over the sedative properties of a sleep drug, thus awakening you and rendering the sleep medication ineffective. So, whilst peaceful sleep can indeed be encouraged through correct sleep medication if no pain is involved, it is not an ideal solution for the issue of night-time pain.

NAT - Compression inhibition technique for for Upper trapezius muscle - sitting. For patients suffering with chronic (tension) headaches, neck pain, upper shoulder pain and stress.


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“Healthy sleep is a vital factor in
the body's process of recovery”

Shoulder Pain & Sleep

by Emma Portnoi

“I could finally sleep... and this was the real gift, because when you cannot sleep, you cannot get yourself out of the ditch- there's not a chance” Elizabeth Gilbert, 'Eat, Pray, Love'.

Sleep..... as tiny babies we spend a large proportion of our day doing it; as kids we try to fight against it even when adults tell us we need it; as teenagers we love it, though frequently in the daylight hours rather than at night; as adults we crave it but never seem to find time to have enough of it &, as we reach old-age, & finally perhaps have more opportunity for it, we tend not to need so much!

Peaceful, undisturbed, sufficient sleep is vital for our well-being, so when it is interrupted by pain & discomfort, the effects can be upsetting & debilitating. Pain can be detrimental to our sleep cycle in various ways - one may either experience inability to actually fall asleep initially or to remain asleep for the recommended time period of 7-8 hours per night, or may repeatedly wake too early each morning. A vicious cycle can evolve as sleep deprivation can itself worsen pain, & this pain increase then causes further sleep deprivation.

Shoulder pain can lead to nagging discomfort at night & there are various shoulder complaints that can hinder ability to sleep well.

Shoulder impingement arises through inflammation of the bursa or the rotator cuff tendons of the shoulder. The shoulder joint is a complex network of muscles, tendons, bones & tissue which work together to enable flexible movement. The bursa sacs – small, fluid filled sacs within the joint space - help protect this network; inflammation of these sacs is known as shoulder bursitis. When the tendons & bursa of the rotator cuff, between the shoulder bones, are pinched, this is known as impingement syndrome. This can result in painful symptoms, as well as loss of strength & movement. As the condition worsens, it may be accompanied by shoulder pain whilst lying in bed, becoming severe enough to actually be awoken from sleep when turning in bed onto the affected shoulder.

Shoulder dislocation occurs when the bone of the arm actually pops out of the shoulder socket. Usually, this is caused by an intense blow or impact or an extreme shoulder rotation. The resulting severe pain, swelling, movement loss & possible visible deformity need to be attended to immediately & careful recovery is vital. The shoulder will usually be immobilized in a sling for at least 2-3 weeks. Sleeping with this condition can be problematic due to both the pain experienced, as well as the need to protect the injured shoulder. Efficient protection can be helped by surrounding the shoulder area with pillows to prevent your body rolling onto the affected shoulder. Sleeping in a partially propped up position may also be necessary until removal of the arm sling.

Frozen shoulder can result from injury or operations; it may be associated with other medical conditions or indeed arise from an unknown cause. Also referred to as ' adhesive capsulitis”, onset can be spontaneous and causes severe pain & restriction of movement. The four stages of this are inflammation of the joint lining (synovium), causing moderate pain for 0-3 months. The second 'freezing' stage, at 3-9 months, includes scar formation causing severe pain. The third 'frozen' stage, at 9-15 months, is characterized by heightened stiffness with a little less pain & at the fourth 'thawing' stage, at 15-24 months, movement increases whilst pain decreases. The third 'frozen' stage can be especially uncomfortable at night, accompanied by searing pain when rolling over causing considerable disturbance. As described earlier, this can be alleviated by sleeping with an extra pillow placed under the affected area, preventing rolling onto the affected shoulder.

Experiencing problems as described above, together with other shoulder complaints such as shoulder separation, labral tears, arthritis, tendonitis, & rotator cuff tears, may well necessitate further help in managing pain whilst sleeping.

“It is estimated that two-thirds of
chronic pain sufferers experience
some kind of sleep disorder”

The estimation that almost two-thirds of chronic pain sufferers experience some kind of sleep disorder means that sleep aids are a vital part of treatment plans. Such aids can take various forms; constructing an efficient sleep environment, adopting sleepinducing habits, using psychological techniques to mentally induce sleep, prescription medication as well as herbal & nutritional aids. The various methods can be considered in addition to self-management of different ways to aid sleep.

We change body position several times each night whilst sleeping. The primary reason for this is to prevent undue stress & pressure on our skin from remaining too long in one position. Positioning pillows correctly when sleeping can help joints, muscles & breathing whilst, as mentioned earlier, helping decrease shoulder pain. Lying on a painful shoulder can exaggerate the problem, & lifting the painful shoulder higher than 90 degrees or over one's head could increase sensitivity. However, using a body pillow can be of some help. Body pillows, available in most bedding stores, are longer than regular pillows &, unlike smaller ones, tend to remain in place without shifting. Thus, once you are positioned comfortably in a safe posture, you should be able to maintain this stance throughout the night.

If sleeping on the side of the affected shoulder, the use of body pillows both in front & behind can alleviate pain. By raising up your knees around the pillow in front of you &, keeping elbows close to your side, rolling back gently on to the pillow behind, you will be lying at a slight angle & not directly on your shoulder blade.

If sleeping on the problematic shoulder side is not comfortable, you may need to train yourself to change habits and fall asleep on the opposite side or on your back – it does not take long to adjust to a new position. Falling asleep on your stomach with an arm tucked under a pillow is not recommended for shoulder pain sufferers – it is better to try sleeping on your back.

Breathing patterns can also serve to relieve pain. Whilst trying to get to sleep, deep breathing slows down heart rate which helps to focus attention on another source, away from your pain. Furthermore, inhaling deeply through the nose & then exhaling slowly through the mouth can loosen up tight muscles, which can lessen pain.

“Healthy sleep is a vital factor in
the body's process of recovery”

Hot & cold temperatures can also be a source of pain relief. The heat of a hot water bottle relaxes muscles & can give some temporary relief. A hot bath before bed, possibly with Epsom salts added, serves a similar purpose. Applying an ice pack is another quick remedy to aid relaxation & decrease pain.

Herbal remedy pillows, which can either be heated or cooled, provide a hot/cold medical treatment through skin absorption of the herb essence. The deeper penetration than that of regular heating pads can help relieve discomfort.

Shoulder pain may necessitate the use of medication to assist peaceful sleeping. Some of the most commonly used serve to reduce inflammation. There are 2 major categories of these- steroids & non-steroidal anti-inflammatory medications (NSAIDs).

Steroid drugs are derived from a natural hormone which is produced by the body. They can be given either orally in tablet form, through inhalers (mouth/nasal sprays), as lotions, gels or creams or through cortisone injections. Cortisone injections are not pain relievers in themselves; they treat the source of the inflammation & thus pain relief is felt due to a decrease in the inflammation. High concentrations of the cortisone can be injected into specific inflamed areas, with potential side-effects kept to a minimum. Pain relief is usually felt within a few days, lasting up to several weeks. However the risks of side-effects of steroids need to be considered, particularly if taken long-term or in high doses. Such effects may include weight gain, thinning of the skin, brittle bones, increased risk of infection, mood swings, high blood fats & cataracts.

NSAIDs also serve to relieve pain & inflammation, & include well-known medication such as ibuprofen (nurofen), aspirin, & diclofenac. They block the production of prostaglandins – hormone-like substances which are involved in pain & inflammation of the shoulder, as well as other body parts. For most people, no side-effects are experienced but if they do occur, they are often associated with stomach problems such as indigestion, ulcers or allergic reactions. They may be unsuitable for some high-risk groups such as those with history of heart attacks, strokes, high blood pressure, diabetes, kidney or liver disease or pregnant or breastfeeding women. Paracetamol, which is not a NSAID, is widely taken to relieve pain & is free of side-effects & can be used long-term.

Herbal remedies are an often welcome alternative to prescription drugs in tackling sleep problems caused by pain. It is worth noting that around 50% of prescription drugs are plant-derived – therefore the basis for modern day medicine is actually natural. The major difference is that regular drugs have been laboratory processed, losing some of their natural goodness along the way, whereas herbal remedies are 100% natural. Alongside treating pain, they may also contain valuable vitamins & minerals which our bodies need. Many herbal remedies fight inflammation as well as easing pain. Plant extracts including cayenne pepper oil, rosemary infused oil, arnica tincture, white willow, ginger extract, chickweed & lavender can be administered in various forms such as tablets, liquid, lotions, oils & skin patches. In the USA & Europe, the use of herbal remedies is less common in clinical settings than in African & Asian countries; however, in recent years, there has been increasing scientific evidence of their effectiveness in treating night-time pain.

Healthy sleep is a vital factor in the body's process of recovery from injuries of the shoulder, along with all other injuries. Nutritional sleep aids, made from natural ingredients, can help promote the restful, deep sleep needed for the body to restore itself. Various key ingredients each have specific properties to ease the sleep process – the camomile flower, passion flower, hops & valerian root all decrease stress & anxiety levels (pain itself can be a cause of such stress); melatonin can raise levels of 'sleepiness', thus enabling faster onset of sleep for longer stretches of time; griffonia seed & tryptophan increase serotonin production. Serotonin is a hormone which plays an important part in regulating mood & sleep & higher levels promote feelings of happiness & relaxation. Our ability to encourage our body to get a good night's sleep, through gentle & natural sleep remedies, enables more efficient healing from damage to muscles, joints & tendons & other shoulder complaints.

Whilst the sleep disturbances brought about through shoulder pain & injury cannot always be avoided & can be an irritating nuisance, it is important to remember that sleep itself is a great healer. The wide range of methods & interventions available to manage & encourage more restful sleep need to be considered carefully. Not all methods are suitable for all types of shoulder pain or injury & therefore it is important to take some advice before engaging in ways to promote sleep – be it through adapting our sleep environment, medication, herbal remedies or sleep-inducing techniques.

Whatever the pain experienced, & whichever methods are selected to try to alleviate it, may the precious commodity of healthy & peaceful sleep be granted to all!


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