GIVING ‘NATURE’S NURSE’ A HELPING HAND: WHEN POOR SLEEP AND NEUROPATHIC PAIN BECOME A VICIOUS CYCLE, HERE ARE STEPS YOU CAN TAKE

Throughout the day, our bodies generate lots of waste. When we sleep, our lymphatic system helps drain those waste products away so our bodies can function properly.

This process, known as restorative sleep, is sometimes referred to as “Nature’s Nurse.” For those suffering from peripheral neuropathy or other types of neuropathic pain, “Nature’s Nurse” can be difficult to achieve.

Peripheral neuropathy is a symptom of many common diseases. It occurs when your nervous system is damaged or compromised; the nerves can’t properly send messages from the brain and spinal cord to the muscles, skin, and other parts of the body.

When neuropathic pain interferes with sleep, one’s capacity for restorative, healing sleep is severely limited. Without this nightly detox, it becomes harder to focus and concentrate, and it also affects the ability to tolerate pain.

Michael April, MD, a physical medicine and rehabilitation specialist with Sarasota Chiropractic and Physical Therapy in Sarasota, Florida, says that for his peripheral neuropathy patients, their struggle with getting a good night’s sleep is often more challenging than the pain itself.

“68% of people with neuropathic pain have sleep problems. The average amount of sleep my patients [get] is three to four hours [per night],” explains April. Since the recommendation for most adults is six to eight hours of sleep per night, the lack of sleep becomes debilitating: “How do you even function on three to four hours of sleep?”

Sleep itself can be grouped into five stages, with each progressive stage indicating deeper sleep:

­—Wake
­—N1: non-rapid eye movement (NREM)
­—N2: non-rapid eye movement (NREM)
­—N3: Slow wave or deep sleep (NREM)
­—N4: Rapid eye movement (REM)

Gary Kaplan, DO, the founder and medical director of the Kaplan Center for Integrative Medicine and a clinical associate professor at Georgetown University, says stage “N3”—slow wave sleep—is when the brain gets most of its detoxification accomplished. “If you are put in a sleep study and are woken up during stage three and four sleep, you’d have generalized pain by the end of the week,” he says.

Peripheral neuropathy becomes a vicious cycle where pain begets poor sleep, begetting more pain.

“Effectively, bad sleep leaks into every bit of your physiology,” explains Deepti Agarwal, MD, director of Interventional and Integrative Pain Management at Case Integrative Health in Chicago. “Studies have shown [bad sleep] decreases immunity, increases weight gain [a major contributor to neurocognitive decline], and creates hormonal imbalances. All of these things holistically make your body function nonoptimally and increase inflammation, thereby not helping any pain state.”

How to improve sleep to lessen neuropathic pain

A proper sleep routine can help you get that much-needed rest. It’s less about adding new things and more about subtracting bad habits from current routines.

—Turn off your smartphone (the bright blue light is wake-promoting). Try no TV or technology for one to two hours before bed.

—Eliminate and/or decrease alcohol consumption. Alcohol turns into a chemical while it breaks down and affects stages 3 and 4 of deep sleep and REM.

—Avoid intense exercise 90 minutes before bed.

—Avoid sugar. Eating right before bed can spike your blood sugar levels. When it crashes, it can wake you up.

—Keep it cool. Warm temperatures force the body to work harder to keep you cool, in effect interrupting your sleep.

—Establish a nighttime relaxation routine; relaxing the body can help it produce melatonin, which promotes sleep. Pick a time to go to bed and try to stay on the same schedule every night. Find a way to wind down before bed, through breathing exercises, reading, skin care, a bath, or other methods.

Seeking a diagnosis and effective treatment

Once a sleep routine is in place, the next step toward restorative sleep is a proper diagnosis and history. If an individual’s condition and pain are not being treated, sleep is going to be hard to come by.

If someone is experiencing numbness and tingling, it’s important to establish how and when the symptoms developed.

A variety of diseases or occurrences can cause peripheral neuropathy, and tests should be conducted to identify or eliminate them. These include diabetes, pre-diabetes, Parkinson’s disease, multiple sclerosis, HIV, Celiac disease (an autoimmune disease to gluten), Lyme disease (a bacterial infection from the bite of black-legged or deer ticks), vitamin deficiency (a B12 deficiency can cause neuropathy, which can be reversed), fibromyalgia (a disorder characterized by widespread pain in the bones and muscles accompanied by fatigue, sleep, memory and mood issues), Heavy Metal Poisoning and Toxicity (often caused by exposure to certain metals like mercury and lead, leading to sickness and pain), and pesticide poisoning (caused by contact with pesticides or chemicals intended to control a pest).

Once there is a diagnosis, treatments and medications can be implemented. As Kaplan puts it, “If you [can] reduce pain, people sleep better.”

The human body is designed to restore itself, every day, with restorative sleep. When pain becomes an obstacle to this primary function, the next step is to seek out a proper diagnosis so pain can be managed. Putting a plan in place for pain management can help pave the way for Nature’s Nurse to provide the antidote we all crave: a good night’s sleep

“Effectively, bad sleep leaks into every bit of your physiology. Studies have shown [bad sleep] decreases immunity, increases weight gain [a major contributor to neurocognitive decline], and creates hormonal imbalances. All of these things holistically make your body function nonoptimally and increase inflammation, thereby not helping any pain state.”