Today's post from beating-diabetes.com (see link below) is aimed at diabetics with neuropathy but applies to all of us living with nerve problems. It talks about a problem that millions of people with neuropathic symptoms have and that is sleep deprivation. You don't need telling how important a good night's rest is for your general health and feeling of well-being and if the symptoms of neuropathy regularly disrupt your sleep it can affect your whole life, leading to all sorts of problems during the waking hours. This article gives some very helpful advice as to how to tackle the problem. The solution doesn't always lie with prescription sleeping pills; there may be other ways of improving what can seem an insurmountable problem. Lack of sleep is a vastly underrated aspect of living with neuropathy and all good advice is welcome. 
Written By: Paul - May• 11•14
Diabetic neuropathy can develop into a nagging intrusiveness that will undermine you ability to enjoy a good night’s sleep. And lack of sleep will exacerbate the painful symptoms of neuropathy. What can you do about it?
Peripheral neuropathy is damage to the nerves in the feet and legs. When it is caused by long-term diabetes it is called diabetic neuropathy.
This nerve damage can cause a loss of feeling in the feet or symptoms such as tingling, numbness, burning, and pain. These symptoms come and go and can be quite intensive and disturbing from time to time.
It is permanent, so once it’s happened you cannot improve it by controlling your diabetes better. However, you can allay the symptoms (and prevent the damage getting worse) through a change in diet and exercise.
Sleep disturbances
As it can be very intrusive, neuropathy can disturb your sleep in a number of ways.
The pain and weird sensations (especially in the legs) of neuropathy can make it hard to fall asleep.
Many people find themselves focusing on their pain during the evening when daytime distractions are at a minimum which makes it more difficult to get to asleep. The pain can also kick in during the night and wake you up.
Neuropathy has been linked with sleep apnoea syndrome, ie pauses in breathing during sleep.
A meta-analysis published online in late 2013 by three Japanese researchers indicates that patients with diabetic neuropathy are twice as likely to have apnoea compared to diabetic patients who do not have neuropathy. This, however, does not mean that neuropathy is a cause of sleep apnoea.
The relationship between neuropathy and sleep is a two-way street. While neuropathy can cause your sleep to be disturbed, sleep that is disturbed (for other reasons) can make the symptoms of neuropathy worse.
In addition, being deprived of sleep can lower your pain threshold and your ability to tolerate pain, which makes your neuropathic pain feel worse.
Overcoming the effects of neuropathy on sleep
There are several things you can do to overcome the intrusiveness of neuropathy:
[1] You can use medicines, both over-the-counter and prescription medications. However these can cause drowsiness during the day, as well as other side affects and can cause dependency.
[2] You can try non-pharmacological treatments such as cognitive behavioural therapy, relaxation techniques, stress management, and acupuncture.
[3] You can follow the tips below for getting a good night’s sleep. This is probably the best thing you can do.
Getting a good night’s sleep despite your neuropathy
There are several things you can do to get a good night’s sleep. You may find some or all of the following useful:
Keep your blood glucose under control using diet and, if necessary, medications.
Get some exercise every day.
Go to bed at about the same time each night so you adhere to a regular sleep/wake schedule.
Make sure your bed is large and comfortable with a good mattress and supportive pillows.
Elevate the bed sheets so that they are not in direct contact with your legs and feet. You can do this using wire frames to create a tunnel for your feet under the blankets.
Ensure your room is cool (18 degrees Centigrade) and well ventilated.
Sleep in the dark in a noise free room (or use a blindfold and/or ear plugs).
Develop a bedtime ritual (eg, 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 going to bed.
Turn off your TV, smartphone, iPad, and computer a few hours before your bedtime.
Adopt relaxation techniques to help induce sleep such as setting an hour aside before bedtime to relax and unwind. Try meditation or deep breathing exercise.
http://beating-diabetes.com/index.php/diabetic-neuropathy-and-sleep/
Today's post from webcache.googleusercontent.com (see link below) comes from the New York Buyers Club, which is a well-known and established supplement company. However, it is also known for its very useful non-biased medical information and can be very useful if you are wondering about the pros and cons of taking supplements. This article talks specifically about sleep deprivation and depression being a vicious circle and suggest which non-prescription supplements may help. You may wonder what this has to do with neuropathy but the fact is that very many neuropathy patients have trouble getting a good nights rest. Their sleep is often disturbed by neuropathic symptoms flaring up at night. This in turn can lead to depression (not a big stretch if you have neuropathy and can't sleep). You may find some of the information and suggestions provided here to be useful in your own situation. Worth a read.
Posted by jarebe This article from the Spring 2014 edition of SUPPLEMENT: Newsletter of the New York Buyers Club
At the end of 2013, there was much buzz about new studies showing that curing insomnia in people with depression might double the chance of a complete recovery from depression. The studies, financed by the National Institute of Mental Health, were welcomed as the most significant advance in treating depression since the introduction of the “selective serotonin re-uptake inhibitor” (SSRI), Prozac, twenty-five years ago. In effect, the new research findings turn conventional wisdom on its head, since they suggest that insomnia can be a main cause of depression, rather than just a symptom or a side effect, as previously assumed. If you can successfully treat a depressed person’s insomnia, according to the new view, you eliminate one of the main factors causing the depressed state.
New research findings turn conventional wisdom on its head
suggesting that insomnia can be a main cause of depression
rather than just a symptom or a side effect as previously assumed
As we followed reports on this breakthrough research on insomnia and depression, we were especially encouraged to read comments like the one from Washington DC psychiatrist James Gordon, who has advocated an integrative approach to treating depression. Here’s his letter to The New York Times:
I welcome a new report’s finding that cognitive behavioral therapy is improving the outcome for depressed people with significant insomnia (“Sleep Therapy Seen as an Aid for Depression,” front page, Nov. 19).
It reminds us that changes in attitude and perspective, and a therapeutic relationship, can right biological imbalances — like disordered sleep — and significantly enhance the lives of troubled people. The study also puts the therapeutic role of antidepressant medication in perspective: the depressed participants who received behavioral therapy did equally well whether or not they were taking the drugs.
I hope that these results will encourage the National Institute of Mental Health, researchers, clinicians and all of us to expand our horizons.
There are a number of other nonpharmacological therapies, including meditation, physical exercise, dietary change and nutritional supplementation, acupuncture and group support, that show promise for improving clinical depression and enhancing brain function.
At NYBC we have long believed that non-prescription therapies, such as supplements, are valuable alternatives for treating mood disorders and sleep disorders When the Centers for Disease Control surveyed use of antidepressant drugs in 2008, it found that one in 10 Americans was taking an antidepressant, and many had taken these drugs for years. Over a period of ten years, antidepressant use in the U.S. had shot up by 400%! So the question arises: how much of this spectacular increase represented real gains in treatment, and how much was over-prescribing? As Dr. Gordon mentions in his letter above, in some cases behavioral therapy for depression has worked just as well whether people were taking antidepressants or not—hardly a strong argument for the value of the prescription drugs.
A well-publicized 2008 report in the New England Journal of Medicine
found that pharmaceutical companies had consistently reported
only the most favorable trial outcomes for their popular antidepressants
A well-publicized 2008 report in the New England Journal of Medicine found that pharmaceutical companies had consistently reported only the most favorable trial outcomes for their popular antidepressants, passing over evidence that suggested a more limited effectiveness. Furthermore, as with many drugs, especially those used over a long period, antidepressants have side effects. Higher bone fracture risk and multiple cardiovascular risks have been identified; sexual side effects are common with antidepressants in both men and women; and withdrawal symptoms for those tapering off antidepressants include a long list of problems, such as panic attacks, insomnia, poor concentration and impaired memory.
Turning to the alternatives, we describe below supplements that NYBC has highlighted over the years for sleep and mood disorders. Note cautions about their use, but also note that some of these products may actually carry added benefits, rather than unwanted side effects.
1. Melatonin is a hormone occurring naturally in the body, but some people who have trouble sleeping have low melatonin levels. Melatonin has been used for jet lag, for adjusting sleep-wake cycles for people doing shift work on varying schedules, and for insomnia, including insomnia due to high blood pressure medications called beta-blockers. It is also used as a sleep aid when discontinuing benzodiazepines (Klonopin, Xanax, etc.) and to reduce side effects when quitting smoking.
2. Fish Oil. Epidemiologists have noted that populations that eat fish regularly have low rates of depression. And research has found that omega-3 fatty acids in fish oil supplements can be of benefit in treating depression and bipolar disorder. Fish oil can also be taken with other anti-depressants as an adjunct therapy. Doses found effective in treating depression are quite high, 3 to 9 grams per day, so be aware of potential problems related to the supplement’s blood-thinning properties. Added benefit: fish oil can help manage cholesterol, and supports cardiovascular health.
3. Deficiencies in the B Vitamins, especially B12 and folate, can result in neurologic symptoms — for example, numbness, tingling and loss of dexterity — and the deterioration of mental function, which causes symptoms such as memory loss, confusion, disorientation, depression, irrational anger and paranoia. A number of studies have shown that vitamin B12 is deficient in a large percentage of people with HIV, and the deficiency can begin early in the disease. Supplementing with a B complex protects against deficiency and supports cognitive health and mental function.
4. Vitamin D deficiency has also been linked to depressed states. Lack of the “sunshine vitamin” may be especially associated with Seasonal Affective Disorder (SAD), the “winter blues.” Vitamin D also supports bone health, and may protect against colds and flus.
5. Theanine, an amino acid found in green tea, acts as a relaxing agent by increasing levels of certain neurotransmitters (=brain chemicals that shape your mood), including serotonin, dopamine, and GABA (gamma amino butyric acid). Human studies have been limited to date, but one small study showed that theanine decreases stress responses such as elevated heart rate. Another investigation compared theanine’s calming effect to that of a standard anti-anxiety prescription drug, and found that theanine performed somewhat better. Note that NYBC stocks Theanine Serene (Source Naturals), a combination supplement that includes theanine and GABA.
6. Probiotics. Very recent research has looked into the communication between the digestive system and the brain, with a goal of understanding how gut health may influence chronic conditions, including mood disorders like depression and anxiety. For example, it has been shown that certain probiotics promote production of the calming, anti-stress neurotransmitter GABA in the body, pointing to a direct influence of probiotics on mood. Other potential links between the gastrointestinal system’s microorganisms and brain function are currently being explored.
7. L-Tryptophan and 5-HTP (5-hydroxy L-tryptophan). These closely related supplements are converted in the body to serotonin and to melatonin. (Take L-tryptophan with carbohydrates to make it effective.) Their use as antidepressants has been studied, and they have also been found to aid sleep and suppress appetite. (To minimize appetite suppression, take the supplement an hour before bedtime.) Although L-Tryptophan and 5-HTP are close relatives, people may respond somewhat differently to them, so it may be worthwhile to try the other if the first doesn’t produce an effect An added benefit: 5-HTP may also decrease symptoms of fibromyalgia and migraine headaches.
8. In research funded by the National Institute of Mental Health, DHEA (dehydroepiandrosterone) was found to be an effective therapy for mild-to-moderate or severe midlife depression, on par with some prescription drugs. Moreover, the research showed that taking DHEA promoted both a significant lifting of depressive symptoms and an improvement in sexual functioning. Note that dosing recommendations vary for men versus women, and DHEA is not recommended for those diagnosed with prostate conditions or cancer.
9. SAMe (S-adenosyl-l-methionine) is produced naturally in the body from the amino acid methionine. Supplementing with SAMe increases concentrations of the neurotransmitters serotonin and dopamine. Several studies show SAMe having an antidepressant effect comparable to that of some prescription drugs. SAMe should be avoided in people with bipolar disorder, and should be used cautiously with other antidepressants, because the combination may push serotonin levels too high. Taking a B-complex vitamin while using SAMe can counter build-up of homocysteine, which has been linked to heart disease SAMe may also support joint health and liver function. Caution: the National Center for Complementary and Alternative Medicine has posted a warning that SAMe may increase likelihood of pneumocystis infection in immune-compromised people. Note: see also Trimethylglycine (TMG), which includes the raw materials that the body uses to manufacture SAMe. TMG is much less expensive than SAMe.
10. St. John’s Wort is a widely used herb with clinically demonstrated (multiple, well-controlled studies, mostly in Europe) anti-depressant effects for mild to moderate depression – generally without the side effects of prescription antidepressants. High doses of the herb may cause a sensitivity to light (phototoxicity), so avoid direct sunlight or sunbathing while using. Do not take St. John’s Wort with 5-HTP, serotonin re-uptake inhibitors (like Prozac), or with protease inhibitors, as it may affect beneficial liver enzymes. St. John’s Wort may also have activity against Epstein-Barr and herpes infections. (St John's Wort should not be used in conjunction with HIV medications Ed:)
11. Finally, we’ll mention another combination supplement that NYBC has stocked: GABA Soothe (Jarrow). The GABA in this supplement is the neurotransmitter that promotes calmness coupled with mental focus. Also included is theanine (see above for a description of its anti-anxiety effects) and an extract of ashwagandha, an herb which has long been used in the Ayurvedic tradition of India to reduce fatigue and tension associated with stress.
http://webcache.googleusercontent.com/search?q=cache:g1tVAtpNWmIJ:nybc.wordpress.com/+&cd=17&hl=en&ct=clnk&gl=nl&client=firefox-a
Today's post from brainlessblogger.blogspot.nl (see link below) looks at the effects of impaired sleep patterns on fibromyalgia patients. Fibromyalgia is also a neurological condition closely linked to other forms of neuropathy and many neuropathy patients are well aware that their problems getting quality sleep have an on-going effect on the rest of their lives. The article looks at studies that suggest that short-term sleep deprivation can lead to an increase in adrenalin production and the patient actually feeling better ('running on adrenalin'). However, long-term sleep impairment does lead to an increase in pain due to fatigue and a build up of over-worked neural activity. Neuropathy patients are often kept awake, or wakened, by the pain or tingling itself, leading to a vicious circle of symptoms that reduce the quality of life considerably. The conclusion is that good sleep is essential - no surprise there but if lack of quality sleep is a problem for you, it's worthwhile getting expert advice to achieve as much undisturbed sleep as is possible in your case.
Insomnia, sleep disorders and impaired sleep have always been considered significant factors in regards to fibromyalgia syndrome and even explored as a cause to the syndrome. It is during deep sleep that people produce significant amounts of growth hormone which repair and maintain muscles. Therefore lack of deep sleep and interrupted sleep, which are predominate features with FM, have long been considered factors in pain intensity along with lack of overall time sleeping. Lack of sleep, therefore, must relate to pain levels. A recent study in the Journal of Pain, 2012, suggests this is not necessarily the case.
The Study
74 people with FM were asked to be a part of the University of Florida study and were observed over a 14 day time period. Given the small test group and time frame of the study we have to take these results with a grain of salt. In the study set up FM patients had a sleep diary where they would record how their sleep went and they also were to rate their pain levels every evening.
"For this study, a research team from the University of Florida hypothesized that decreased total sleep time would predict higher clinical pain in a sample of patients with fibromyalgia…Results of the analysis showed that four sleep measures evaluated in the study failed to significantly predict clinical pain. The authors noted that the effects of impaired sleep, such as fatigue and inactivity, may play more significant roles in clinical pain than measures of sleep duration or insomnia. Sciencedaily.com"
Why the results are surprising
These results are surprising because we would expect the opposite. Historically other studies have shown disruptive sleep patterns in people with chronic pain conditions will produce increased pain. Lack of sleep is in fact a factor that can produce pain in healthy people as well. Given the majority of FM patients have disrupted sleep one would expect the results to show decreased duration of sleep would increase pain the next day.
Why we cannot draw firm conclusions
The study is only of 74 people so this is not a large study and we cannot draw any conclusions from one small study. Secondly, the duration of the study itself was short, only over a span of two weeks, which given the nature of chronic pain and sleep disorders is hardly significant. A few days of less sleep can get someone, who regularly gets disrupted sleep, into a sleep deprivation state running on adrenaline. For the short term this will actually make them function fairly well on a pain basis. They will be in 'fight or flight' mode and not feel as much pain, or at least, not right away. However, accumulated sleep deprivation will cause the pain to build up such that we often see with FM the morning muscle pain being severe in the morning and becoming less severe as the day goes on. Ironically, also with short, disrupted sleep someone with FM may feel very alert in the morning because they have not actually gotten much sleep. They do not feel the pain from being in one position for a long period of time so there is no muscle aches from that. The lack of sleep, initially, makes them feel alert, energized and with no morning stiffness and pain. Whereas, longer durations of sleep are often still of poor quality leaving someone with FM still feeling groggy. They will often wake up with morning stiffness and pain from laying in one position for too long if they have managed to be asleep for any length of time. It is not necessarily duration that is a factor but quality. Therefore, it is not necessarily the case that decreasing the total sleep time would increase the pain the next day with someone with FM. Ten hours of poor quality sleep where the person woke up frequently and spent very little time in deep sleep cannot be compared to five solid good hours of sleep. Ten hours of poor quality sleep may leave the person feeling groggy, stiff and sore, while the five hours of restorative sleep may leave them feeling alert and well rested.
Nevertheless, FM patients suffer from poor quality sleep and, at times, other sleep disorders such as restless leg syndrome (RLS) or sleep apnea. Whether the duration of their sleep affects intensity or not certainly lack of sleep affects fatigue, mood and likely even overall health. It is vital with FM to try and maintain healthy sleep habits and a regular sleep cycle. Quality of sleep is just as important as quantity of sleep.
http://brainlessblogger.blogspot.com/2016/01/sleep-duration-and-fibromyalgia-pain.html
The Study