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Is Neuropathy Affecting Your Sleep?
By Leslie MacGregor Levine

Editor’s note: This is the second in a series of articles aimed at helping you better understand the link between anxiety, depression, sleep disturbances, and neuropathy.

Insomnia (or sleep disturbances) affects up to 50 percent of the general population.¹ It may take several forms: difficulty falling asleep at night, waking up too early in the morning, waking up frequently throughout the night; and generally poor sleep. In addition, people with insomnia can also develop ‘daytime’ symptoms—such as daytime sleepiness, fatigue, depressed mood, lack of energy, impaired cognition, memory problems, irritability, and decreased alertness and concentration—that, over time, takes a toll on relationships, productivity at work, and overall health and wellbeing.

      Is Neuropathy Affecting Your Sleep

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The Link Between Neuropathy and Sleep
Neuropathy can impact sleep in a number of ways. For some, the neuropathy symptoms may cause the sleep disturbances (e.g., neuropathic pain makes it difficult to fall asleep or stay asleep; abnormal sensations or hypersensitivity to touch, particularly in the feet and legs makes it difficult to fall asleep). With daytime distractions (e.g., work, friends, family, hobbies, etc.) at a minimum during the evening hours leading to bedtime, many patients will find themselves focusing more on the pain; and, so many report that their perception of the pain actually increases when attempting to fall asleep and this delays falling asleep. For others, the neuropathy symptoms may be made worse by sleep disturbances (e.g., sleep deprivation can lower your pain threshold and pain tolerance and make the existing neuropathic pain feel worse).

Managing Sleep Disturbances and Neuropathy
People who sleep poorly are also susceptible to depression and other mood disorders, changes in eating, decrease in physical activity, and an overall decline in health. Compounded with neuropathy, this becomes a vicious cycle.

  • Improving Daytime Habits and Bedtime Routines to Improve Sleep
    When dealing with neuropathy, you may find yourself thinking your insomnia is the least of your problems. But, the compounding effects of neuropathy and sleep disturbances require that you address both head on. Start by tracking your symptoms and sleep patterns, and then making healthy changes to your daytime habits and bedtime routine:

    - Keep a regular sleep/wake schedule;

    - Develop a bedtime ritual (e.g., taking a warm bath, reading light material);

    - Limit or eliminate caffeine four to six hours before bed and minimize daytime use;

    - Avoid smoking, especially near bedtime or if you awake in the middle of the night;

    - Avoid alcohol and heavy meals before you go to bed;

    - Turn off your TV, smartphone, iPad, and computer a few hours before your bedtime;

    - Adopt relaxation techniques to help induce sleep (e.g., give yourself an extra hour before bed to relax and unwind and time to write down worries and plans for the following day; meditation ; deep breathing exercises); and

    - Create a comfortable sleeping environment (e.g., make sure your bedroom is dark, quiet, and well-ventilated; use bed and pillows that are comfortable; elevate the bed sheets so that it is not in direct contact with your legs and feet).
  • Seeking Your Doctor’s Help to Address Sleep Disturbances
    If sleep problems persist and interfere with your ability to function, it may be time to consult your doctor. You will want to describe your sleep symptoms; effects of sleep symptoms on your daily activities and neuropathy; medication history (because many prescription medications can also affect the quality of your sleep, including some herbal remedies).

Upon evaluation of your neuropathy and sleep problems (as well as ruling out other causes of sleep disturbances), your doctor will review:

  • Self-help techniques—These are techniques you can adopt (as described above) if you are not already incorporating them to address your insomnia;
  • Non-pharmacological treatments—These include cognitive behavioral therapy, relaxation techniques, stress management, and acupuncture that can help improve sleep disturbances. They are preferred to prescription sleep medications which can lead to sleepiness during the day, can cause dependency, and come with side effects;
  • Pharmacological treatments—These are used as a last resort and should only be used for short periods of time especially when the insomnia is chronic. Sometimes, medicines used to reduce pain or aid sleep can affect your sleep.

    - Over-the-counter pain medications—For mild pain, over-the-counter pain medications (e.g., Tylenol, Advil) may suffice. Some over-the-counter pain medications also have an antihistamine to help with sleep (e.g., Advil PM or Tylenol PM).²

    - Prescription medications—For more severe or chronic pain, your doctor may recommend prescription pain medications (e.g., ultram, opioids such as oxycodone, hydrocodone bitartrate and acetaminophen, codeine, and morphine). Other drugs can also help with pain, such as some antidepressants and anticonvulsants. To help with sleep, your doctor might recommend drugs typically prescribed for anxiety, called benzodiazepines (e.g., lorazepam, clonazepam, triazolam). Your doctor may also consider nonbenzodiazepine hypnotics that are particularly helpful for sleep and appear to be better for longer-term use than benzodiazepines (e.g., zolpidem, eszopiclone, zaleplon).³

Poor sleep, depressed mood, and anxiety can complicate your (and your doctor’s) efforts to manage neuropathic pain. The key is to recognize this triad and partner with your doctor to find the right treatments and approaches that work best for you.

References:
1. Mai E. and Buysse D.J.  Insomnia: Prevalence, Impact, Pathogenesis, Differential Diagnosis, and Evaluation.  Sleep Med Clin. 2008;3(2):167-174

2. - 3. http://www.webmd.com/pain-management/features/arthritis-aches-keeping-you-up?page=3 (Accessed November 17, 2011).

L.Levine



Leslie MacGregor Levine is a former medical researcher who studied diabetic neuropathy at Harvard Medical School. A neuropathy patient herself, Leslie is leader of The Neuropathy Association’s Metrowest Boston (MA) Neuropathy Support Group.

 

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