Calming and Stabilizing Your Nervous System

Objectives

• When your nervous system is inflamed and hyper-reactive, lesser levels of stress cause your body to go into flight or fight.
• In contrast, you are able to more easily deal with challenges if you feel safe and calm.
• Four categories of factors influence your baseline physiological state of safety versus threat: 1) sleep 2) diet 3) exercise/activity level 4) childhood programming/ patterns.
• All of these factors are addressed throughout the course, but the initial focus is on getting adequate sleep.

Your nervous system gathers about 20-40 million bits of information per second, and interprets the sum total as safe or threatening. Signals are continuously sent out to adjust the body’s physiology (output) and actions to optimize your function. The reactivity of your nervous system ranges from calm to hypervigilant. These four categories of factors influence the sensitivity of the nervous system.

• Consistently restful sleep is necessary for your brain to refuel and empty waste products.
• Lack of exercise affects your physiology and also your capacity to cope with both mental and physical stress.
• A poor diet is inflammatory.
• Your baseline physiology is also affected by your past. Survival depends on learning what is dangerous and then avoiding it in the future. If you were raised in a chaotic abusive environment, many situations were dangerous or perceived as such. That doesn’t change as you age even when you intellectually know you are safe. So, more scenarios in the present seem threatening with less stress than you might expect.

Although all these variables affecting your nervous system are presented throughout the course, successfully addressing sleep is a high priority. The DOC Journey approaches will be marginally effective if you aren’t getting 7 or 8 hours of restful sleep. Not sleeping is NOT an option. No major decisions regarding your medical care should be made until you feel rested during the day. This is particularly true regarding surgical procedures.

 

 

Systematic Approach to Sleep

Insomnia is consistently solvable with a stepwise approach regardless of the level of your pain. The key is focus and persistence. It is a myth that you need less sleep as an adult and at least seven hours of sleep is desirable. Few patients suffering from chronic pain are getting adequate sleep.

Incorporating sleep into the treatment was my first step in conceiving the DOC protocol. I had a new resource that was effective and measurable. My patients’ sense of well-being improved and often other symptoms diminished.

Sleep and pain

I originally thought that people suffering from chronic pain couldn’t sleep because of their pain. But a large study out of Israel demonstrated that lack of sleep induces chronic low back pain, and that the reverse was not true – that pain caused insomnia.¹

Another study documented that consistently poor sleep was a greater predictor of disability than the severity of back pain. Even more interesting was that this was also true for leg pain (sciatica), which surgeons generally feel is an incredibly disabling symptom.²

I treated one businessman who had experienced chronic neck pain for almost two years. There was no specific injury. He continued working as an owner of a small accounting firm, but he was miserable. He had been through multiple courses of physical therapy. I started him on a strong sleep medication, which immediately allowed him to experience restful sleep. I saw him back at two weeks and noted the medication was working well. I was planning on starting aggressive physical therapy on the next visit. When he returned six weeks later, I was surprised that he was pain-free without any other interventions.

                           

 

Start sleeping – NOW

Most people find a way to sleep using a combination of the suggestions listed below. If you are still struggling after a few weeks, Discuss sleep with your primary care physician. The details of each of these suggestions are outlined in chapter 14 of my book, Back in Control. Please use this as a resource.

Approaches to Insomnia

Self-directed

1. Sleep hygiene – well-known set of principles to optimize sleep.
2. Stress management at bedtime – i.e., don’t read business emails for at least an hour before going to bed.
3. Exercise – Physical conditioning improves sleep, but don’t exercise late in the evening.
4. Expressive writing –  shortens the time it takes to fall asleep.
5. CBT-I –  Cognitive Behavioral Therapy Insomnia is documented to improve sleep. Online resources are readily available.
6. Over-the-counter sleep aids – I do not have specific recommendations. They may be helpful, but should not be used long-term. Alert your physicians if you are using them.

Under the guidance of a physician

1. Prescription Medications – Many stronger medications are effective for treating insomnia. I have observed that if you are suffering from chronic mental and/or physcial pain that you often need a kick-start with strong sleep meds. Once your nervous system quiets down you can and should come from them relatively soon. Using narcotics for sleep is not recommended and creates many additional problems.
2. Diagnosing a sleep disorder – there are over 100 sleep disorders with the most common one being sleep apnea. Sleep apnea is caused from your airway intermittently becoming partially occluded. Oxygen levels drop as you gasp for air. Sleep quality is poor, and daytime sleepness is one of the hallmarks of this disorder. More importantly, your heart is stressed and its function is progressively compromised. It is important to diagnose and treat it if there is any suspicion. Restless Leg Syndrome is another common sleep disorder that is treatable with the correct medications.

Recap

The other factors affect the reactivity of your nervous system, buy a consistently restful night’s sleep is necessary for healing. It must be not only be addressed, but at least partially solved as an early step. Most people improve their sleep with simple self-directed interventions, but you should not hesitate to seek help from your physician.

Questions and considerations

1. Assess your sleep.
   1. How many hours do you sleep per night?
   2. How often do you wake up?
   3. How long does it take for you to fall asleep?
   4. Do you feel rested in the morning?
   5. Do you fall asleep easily during waking hours?
2. Do you notice a difference in your physical and mental symptoms after several nights of restful sleep? What symptoms are worse with poor sleep?
3. From a practical perspective, how can you really enjoy your life if you are tired? Why pursue so many other treatments without covering this base?
4. Temporarily push away the other aspects of your situation and focus on sleep. It is a clear and measurable variable.
5. “I can’t sleep because of my pain.” You have to flip that idea around. Remember, it is lack of sleep that is causing so many problems.

References

1. Agmon M and Galit Armon. “Increased insomnia symptoms predict the onset of back pain among employed adults.” PLOS One (2014); 9: 1-7.
2. Zarrabian MM, et al. “Relationship between sleep, pain, and disability in patients with spinal pathology.” Archives of Physical Medicine and Rehabilitation (2014); 95:1504-1509.