Thursday, July 25, 2013

Sleep On It

5 Sleep postures affect your health

Most patients in my clinic receive advice on sleep posture. I want them to put the six to eight hours they sleep to use healing, not exacerbating the condition for which they came to me in the first place.
1. On back. Arms to sides.
This is anatomic position, though applied to supine (face up) sleeping for our purposes.
Stand naturally/relaxed. Your arms are at your sides. No  head tilt. Feet are approximately at shoulder width. Exactly the position most recommended for spinal health.
Yep. That guy's naked. Let's try to be adult about this.
In this position there is muscular balance: no tension here, relaxation there. The spine isn't contorted. Joints aren't tensioned. Pillows are available to maintain the cervical curve. If those are not used, pillows should be thin enough so as not to bring chin toward chest to maintain the above position.
For those with low back complaints and also to aid in maintaining this posture, a pillow or bolster placed beneath the knees to slightly elevate is also a common recommendation.
This is most often my recommendation for a sleep posture. But one posture doesn't fit all.
If you snore, or-- worse-- if you have sleep apnea, this posture should be avoided.
On his back? Check.
2. On back. Arm(s) up.
Look at Snory up there. Right arm up. Put your arm up like his. Do you feel the tension that creates? Now hold that position for an hour. No, don't do that. Aside from muscle imbalance-- tension here, relaxation there-- the humerus is forced forward. For some, this will place unwanted traction on  nerves and vessels. The position above is actually an orthopedic test position for thoracic outlet syndrome.
Still a good position for the spine.
3. Side-lying
Over half of us sleep on our sides. This isn't bad-- but it can be.
I tell my side sleepers to try to keep as close to anatomic position as possible. That means pillows sufficient to keep the head/neck in a neutral position and arms as near as possible to the body's sides. It can be tough.
This is a good position for snorers. Spinal curves are maintained. Sleeping on the left may help relieve heartburn (If you have heartburn we need to do more than change your posture at night.)
But then there's troubles. Most will do one of several things. Roll shoulder in with arm out or down, or elevate shoulder with arm up or out. For arms up, see above.
The rolled shoulder bit is something I encounter continuously. It is often apparent on visual exam. The sleeper has trained their shoulder to be dysfunctional. The sleeping position becomes the default waking position. The scapula rides high and loses motion. The humeral head is rolled forward and inward, making the biceps groove face inward. This can lead to or worsen any of the following which motivates our sleeper to see me: decreased shoulder motion, shoulder pain, painful arc syndrome, bursitis, tendonitis, tender points and/or trigger points, thoracic outlet syndrome.
And what to do about legs? For those with hip or pelvic problems this can be a poor choice position.  For them I recommend a pillow between the knees to approximate anatomic position. A body pillow can help as well, for both arm and leg placement.
4. Prone
No, no, no.
Stomach sleepers do all sorts of contortionist tricks. The most obvious and universal is their head has to turn to one side. If they want to breathe.
Today's tip for happiness: Do NOT image search "fetus".
On your side with knees slightly bent is good. Drawing your knees up to your chest is not. Unless you're still a fetus and then congratulations on your strides in literacy.
In the womb you had no need for spinal curves. Now life without them is pain. Also, ma was giving you your oxygen. Sleep like this now and you restrict deep breathing.
Over the years I have been asked repeatedly to recommend beds/pillows. Can't do it.
Those with low back problems often find the harder the better. Many will sleep on the floor when pain is acute. Some stiffen their bed by placing a board under the mattress. Some travel with their own pillow-- often found after much trial and error.
There is no simple answer. No golden rule.
Having said that, I will now shill for the mattress/pillow makers.
They say replace every five to ten years. Broad range. Not helpful.
If your mattress is no longer supporting you, no matter whether soft or firm, it is time to part ways.
Take your prospective new sleeping partner for a spin. Try them out right there in the store.
Buying a mattress is akin to buying shoes. You have to try them on and see how they fit.
For all the hokey my-life-was-changed-by-my-new-mattress commercials, there really and truly is something to it.
Doubt it? Sleep on this for a month and get back to me.

Thursday, July 11, 2013

9 Meds To Kill Your Memory

They come in on a string of medications. The older ones carry a list of their medications in purse or wallet. And they are forgetful. They have "senior moments". 

Memory loss isn't an inevitable consequence of aging. If ma or pa are getting forgetful, consider their medicine burden.  After all, 7 of 10 Americans are on a medication of some sort. Meds such as...

Zocor, Crestor, Lipitor, et al.
Statins lower cholesterol. They are among the most prescribed drugs in the world.
Cholesterol is absolutely necessary for your existence. Monkeying with your cholesterol has undesirable consequences including memory loss.
A study here found that 75% of statin users "experienced cognitive ADRs (Adverse Drug Reactions)determined to be probably or definitely related to statin therapy". And, notably, the FDA has required labeling to include memory loss warnings since 2012.

Wonder why folks choose the sunny summer and tropical locales for vacay?

Amitriptyline/Elavil, Nortriptyline/Pamelor, Desipramine/Norpramin, and other tricyclic antidepressants.
These are currently among the most prescribed meds in the US.
These drugs block serotonin and norepinephrine which are necessary to modulate memory formation.
This migraine brought to you by your painkiller.

Hypertension drugs
Metoprolol/ Lopressor/Toprol, Propranolol/Inderal, and other beta blockers.
Used to treat high blood pressure and arrythmias, but also to treat  migraines, chest pain, and glaucoma.

Gambling. The perfect partner to inappropriate sexual behaviour.

Parkinson's disease drugs-- dopamine agonists
Ropinirole/Requip, Apomorphine, Apokyn/Pramipexole, Pramipexole/Mirapex
Used for Parkinson's disease, but also restless leg syndrome. The wide range of side effects includes, curiously enough, inappropriate sexual behavior. I doubt being unable to remember the behaviour will be a benefit.

Antianxiety drugs-- benzodiazepines
Alprazolam/Xanax, Diazepam/Valium, Triazolam/Halcion, Lorazepam/Ativan,  Midazolam/Versed, Chlordiazepoxide/Librium and others
Used to treat anxiety, but also muscle spasm and insomnia.

Old line antihistamines
Diphenhydramine/Benadryl and others.
While used to treat allergies,  they may also be used for nausea, vomiting, or insomnia.


Sleep disorder drugs-- nonbenzodiazepine
Eszopiclone/Lunesta, Zolpidem/Ambien, Zaleplon/Sonata
Another class linked to curious and undesirable side effects beyond memory loss. You may recall these as an additional Kennedy curse.

Antiseizure/Nerve pain drugs
Gabapentin/Neurontin, Carbamazepine/Tegretol, Levetiracetam/Keppra, Topiramate/Topamax, Pregabalin/Lyrica, Valproic acid/Depakote and others
They were a hit as antiseizure meds, and now they've gained new life as nerve pain meds and to treat bipolar disorder.

Poppy seed bagel anyone?

Opioid painkillers
Fentanyl/Duragesic, Hydrocodone/Vicodin, Hydromorphone/Dilaudid, and Oxycodone/OxyContin/Percocet.
If you missed it, the feds have been cracking down on opioids for some time. Opioid overdose deaths have increased nearly 500% in one decade among US women.
Like others on this list they interfere with messaging within the brain.

Bonus edit: