Sleep disturbance and chronic pain are formidable foes

Ask Dr. Keith Roach M.D Bffo DMffln Eadlii MJD)

Sleep disturbance and chronic pain are formidable foes

DEAR DR. ROACH: Several years ago, my doctor told me to start taking Tylenol PM to help me get to sleep at night and to avoid some neuropathy pain. I have been taking two before bedtime, as directed. Some nights I awaken after six or seven hours and have to take two plain Tylenol to continue my sleep. I was diagnosed with peripheral neuropathy about three years ago, when I went to the orthopedist with a lower-back problem. The back problem was diagnosed as a pinched nerve. At the time, I would wake up during the night with pain from my lower-right backside, down my right leg and into the right foot. The doctor put me on gabapentin, which I still take.

The Tylenol PM helps me get to sleep, and I sleep well for six or seven hours, but some nights, I wake up hurting and have trouble getting back to sleep. My concern is the longterm use of the Tylenol PM. -W.H.

ANSWER: Tylenol PM contains acetaminophen (the substance in plain Tylenol) and diphenhydramine (sold as Benadryl and as many sleep aids). Acetaminophen is a mildly to moderately effective pain reliever, and diphenhydramine is both an antihistamine and a mild sedative for many people.

Sleep disturbance is a big problem for many with chronic pain, including pain from neuropathy. Chronic sleep deprivation decreases quality of life and often worsens any perceived pain. Improving sleep is a good goal for people with chronic pain. In general, I try to avoid diphenhydramine, because it decreases wakefulness for many people in the morning (described as 'grogginess'); it also increases fall risk and motor vehicle collisions in those who drive.

There may be better ways of helping you sleep besides medication.

DEAR DR. ROACH: Could you explain just what electrolytes are and why they are so important to our bodies? -L.D.R.

ANSWER: The word 'electrolyte' means that a substance can make water able to conduct electricity, because it contains electrically charged particles. In the body, the most important electrolytes are sodium, potassium, magnesium and calcium, which are positively charged, and chloride, carbonate and phosphate, which are negative. They are absolutely critical to the function of the body, and are regulated to a high degree, mostly through the kidneys, but also through the GI tract. Levels that are too high or too low are life-threatening. They are necessary for muscle and nerve functioning. Our bodies are very good at retaining them, but we do need to obtain them from food. *** DR. ROACH WRITES: I received many letters about a recent column on a cyclist with leg cramps. About half said they were cured by the type of stretching I recommended, while others suggested different remedies, the most frequent of which was magnesium. However, I found several studies that showed magnesium was no better than placebo, except in the case of people who had actual magnesium deficiency. Magnesium deficiency is uncommon, except among people who are taking medications that can reduce the body's magnesium levels, especially diuretics.

Fortunately, I heard back from the original reader, who told me he hadn't had a single episode of cramping after starting his stretching regimen, which included stretches both before and after riding.