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Alpha non-REM sleep disorder

There are two major categories: insomnia, in which people have difficulty falling asleep, staying asleep or waking too early, or they have non-restorative sleep. alpha non-REM sleep disorder, sleep disorder. In non-restorative sleep, as you know - which is sort of classic in fibromyalgia - they say they, they fall asleep, they sleep fine and they wake up and they are exhausted. Many of these people have not a clue that they have a sleep disorder, in fact they get kind of upset if you tell them that. They have ascribed their fatigue to the systemic nature of the fibromyalgia without any understanding that a large part of their fatigue is coming from their non-restorative sleep disorder.

Then there is an extremely important one, that I would encourage all of you to ask about, to actually put in your evaluation of patients, and that is whether they are getting sufficient sleep. I’ve actually, just in correcting this one problem, have effected 40-60% improvement in alpha non-REM sleep disorder, sleep disorder. What you need to ask patients is how much sleep do they need to feel healthy? Of course, some people can’t remember because they’ve never had it. So if they can’t remember or don’t know we assume that they need eight hours because that’s the most common amount. But some people can actually tell you what exactly what they need, as you might know what you need to feel good. Because of their work and their lifestyle situation they are chronically not getting that amount and that is a major source of their fatigue if they go too long like that alpha non-REM sleep disorder.

To retrain your sleep requires doing a lot of special things. It requires giving up a lot of things. It requires being diligent and disciplined. Some of the things are kind of a pain in the neck, you know. Of course, going to bed at a regular time. But all of these behavioral modifications you only have to do until you get your sleep hardy. Once you get your sleep hardy you don’t have to do all these special things. It’s sort of like a broken leg. You have to make special accommodations. Once it’s healed, it’s healed and you can go running on it. So we try to get people to understand that all of this is temporary.

My definition of hardy sleep, or healthy sleep, is being able to go to sleep when you want as opposed to staying up until you drop; sleep as long as you need and awake feeling rested five out of seven mornings without medication, alcohol or supplements. That would include herbal supplements. The issue isn’t that herbal supplements might be bad for you.

Now, I divide behavioral sleep retraining into six areas. Encouraging natural homeostatic drive for sleep, circadian rhythm and training, eliminating sleep-disturbing substances, enhancing sleep behaviors, additional behaviors, nutritional and environmental factors. I am going to go through each of these. I’m not going to cover every one because of the time factor but a lot of these are listed in your handout. In fact, all the major ones here are listed in your handouts. You don’t have to write them down. Naps are routinely not allowed. Most sleep educators will tell you that naps are not good because they reduce your sleep debt. The only exception I’d make to this are people with CPHD’s and active inflammatory rheumatic diseases, RA, AS, etc. People with active inflammation sometimes need a little more sleep and people with CPHD’s if they go too long and get overtired, they do worse at night. It’s extremely important, the absolutely most important thing that they have to do is have a regular sleep schedule. Every sleep educator will tell you that. We do encourage them to get into an aerobic fitness program.

Then there is circadian in training, which is what it’s called in the sleep literature. It is essential to have a regular sleep schedule seven days a week. Not just five and destroy it on the weekends. And then there’s the issue of white light. White light will alter melatonin metabolism but red light won’t. So if they need a night light somewhere in the house we recommend a red light instead of white. That’s why your digital dials on your clock radios are now red. Then one of the most important circadian in training techniques is to have the person see early morning light before 9 o’clock in the morning. Going outside for approximately 30 minutes and it’s even more effective if they combine it with walking or some stretching. The early morning light has less luxor _ than mid afternoon light and therefore when the body and the brain is exposed to that light the brain is trained that morning is earlier and therefore the brain prepares for bed earlier at night. When I first started doing this with patients I was absolutely astounded at how many of my patients do not get out of the house until 2 o’clock in the afternoon, which could really disturb

The other thing is, if they have peak energy at night, they have to get rid of it. We have to extinguish it. They have to really focus on winding down after dinner. We try to start with calming activities an hour before bed but if that isn’t sufficient they have to start working on calming down after dinner and not engaging in a lot of activities that wake them up. I’m sure you are familiar

Now, sleep-disturbing substances have to be addressed and I would say - obviously you don’t have the time to do this whole thing, the sleep retraining of your patients. You may not have someone in your area who can do it. But these things on here, addressing these issues are certainly within the realm of a physician and I think it would help you get dramatic progress with your patients; assessing their caffeine, advising them to decaffeinate - we’ve talked about that - smoking is a problem. It’s the most difficult thing to get people not to do. We do recommend that if they can’t give it up, to not smoke after 7 o’clock in the evening. Then there is mahwong. Mahwong is the Chinese amphetamine, it is ephedra. In your handout on page five is a list I got off an Internet website on common mahwong-containing products. And right now around the country, one product that is particularly popular is Metabolite or its knock-off Metabolith and there are hundreds of these weight-loss and energy products on the market that are billed as natural and their ingredients are mahwong and caffeine. They are considered particularly dangerous for people with heart problems or if they take mahwong and drink caffeine during the day. So these are billed as natural and herbal. They

Other sleep-enhancing behaviors: everybody knows about using the bedroom only for sleep and sex so your brain can become conditioned to that and doesn’t think about doing paper work, etc. when it sees the bedroom. We talked about calming activities. The value of calming activities an hour before bed is to behaviorally increase serotonin in the brain. We do ask people to go for a trial. Usually several weeks of no TV the hour before bed. This is not well received, but we do advise they can tape their favorite shows and watch them earlier in the evening. After that, depending on some individuals and depending on what they watch and whether TV makes them sleepy or not, we may reinstate it. For some people it is just too stimulating. The more fragile their sleep the more stimulating it is. Bedtime rituals are very important. The more ritualistic they are, the more regular the routine, the more the brain gets conditioned the hour before bed to the process can happen. I recommend people get into their alpha non-REM sleep disorder, sleep disorder