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Tue, May 21

Chronic back pain disrupts sleep

Dear Dr. Rosenberg,

I have had chronic low back pain for several years. The pain can keep me from falling asleep and frequently awakens me from sleep. I am wondering if my poor sleep can be a contributing factor?

A: Yes, about 40% of people with low back pain suffer from insomnia. The lack of sleep lowers their pain threshold by several mechanisms.

The first is due to decreased production of growth hormone, which is predominantly produced during deep sleep. The second is due to the release of inflammatory mediators associated with poor sleep. Finally, insufficient sleep triggers the release of stress hormones that tighten muscles. I would recommend you discuss with your health care provider ways to treat your insomnia. Most studies have shown an improvement in pain when the sleep issue is treated.

Dear Dr. Rosenberg,

My husband is a loud snorer and he snores every night. Is snoring dangerous to his health?

A: Snoring alone has little adverse consequences on the person. However, one study showed an increase in carotid atherosclerosis in snorers believed to be due to vibratory damage. More importantly, it can be a sign of sleep apnea. If your husband stops breathing in his sleep, complains of fatigue and/or sleepiness, awakens with morning headaches or gets up to urinate frequently, he may have sleep apnea. If he has any of these symptoms, I would bring it to the attention of your health care provider.

Dear Dr. Rosenberg,

I recently had a home sleep test. According to the results, I have sleep apnea. Apparently, I only have it when I am on my back. Are there any treatments for this other than CPAP?

A: Yes, if the test indicates normal, less than five events per hour other than on your back, you may be a candidate for positional therapy. This can be accomplished by sewing a tennis ball into the back pocket of a shirt or by purchasing a device called the Zzoma Positional Therapy Belt. I would recommend you first discuss the test with your sleep physician to be sure that this is a viable option.

Dear Dr. Rosenberg,

My husband’s parents both died of heart attacks. He sleeps only five hours a night. I have been told that insufficient sleep can predispose one to cardiovascular disease. Is that true? I’m worried that he may end up like his mom and dad.

A: Yes. In a recent study in Sweden, 50-year-old men were followed for over 20 years concerning sleep duration. They found that middle-aged men who slept five hours or less per night had twice the risk of developing a major cardiovascular event during the following two decades than men who slept seven to eight hours.

This research was presented at the 2018 European Society of Cardiology Congress. The events included heart attacks, strokes, heart failure, and sudden cardiac death. I would try to impress upon your husband the importance of sleeping at least 6.5 hours.

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