Courtesy of the National Sleep Foundation November 23, 2009
Sleep deprivation can have an enormous impact on your health and happiness. Apparently, it can also affect your ability to make split-second decisions, according to a recent study in the journal SLEEP. Researchers at the University of Texas at Austin split 49 West Point cadets into two groups, 21 of whom were deprived of sleep and 28 of whom were well-rested, and tested them on tasks that require quick decisions. According to the study, participants in each group performed the tasks twice, separated by a 24-hour period. Cadets who were sleep-deprived between testing periods saw their accuracy decline by 2.4 percent, and cadets who were well-rested between testing periods improved by 4.3 percent. W. Todd Maddox, one of the researchers, told HealthDay that the type of thinking tested in this study is “critical in situations when soldiers need to make split-second decisions based about whether a potential target is an enemy soldier, a civilian or one of their own.” While people vary in their need for sleep, experts agree that for most adults the amount needed to feel one’s best is somewhere between seven and nine hours per night.
SLEEP STEALERS
More often than not, you have a pretty good idea of what is keeping you awake at night — from the cat scratching at your bedroom door to the snoring partner next to you. But not all “sleep stealers” are obvious. Here are some big sleep stealers that could be keeping you up at night and you may not know it.
Psychological Factors Stress is considered by most sleep experts to be the number one cause of short-term sleeping difficulties. You are not going to solve all your problems while sitting in bed at night, so give it a rest and get some rest.
Lifestyle Stressors Without realizing it, you may be doing things during the day or night that can work against getting a good night’s sleep. These include drinking alcohol or beverages containing caffeine in the afternoon or evening, exercising close to bedtime, following an irregular morning and night time schedule, and working or doing other mentally intense activities right before or after getting into bed.
Medications In addition, certain medications such as decongestants, steroids and some medicines for high blood pressure, asthma, or depression can cause sleeping difficulties as a side effect.
FATIGUE & EXCESSIVE SLEEPINESS
Do you find it difficult to get out of bed in the morning? Do you sometimes feel sleepy while watching television or driving? If so, you may be one of the millions of Americans who suffer from excessive sleepiness, a condition that can significantly reduce quality of life, decrease productivity and interfere with relationships. Most people feel tired occasionally, but excessive sleepiness that persists is neither normal nor healthy.
CAUSES:
One of the primary causes of excessive sleepiness is self-imposed sleep deprivation. In the U.S. and many other parts of the world, sleep loss may occur as a result of economic or societal pressures. People may skimp on sleep in hopes of getting more done, and widespread access to technology makes it possible to stay busy (at the computer, for example) around the clock. By some estimates, people now sleep about 20 percent less than they did a century ago.
Working at night and sleeping during the day can also cause excessive sleepiness. Some people are able to adjust to such a schedule. However, others may never overcome the body’s natural tendency to be awake during the day and asleep at night. A similar phenomenon occurs with jet lag, in which the body is “out of sync” with the natural environment. In general, symptoms of jet lag increase with the number of time zones crossed. That is, someone flying from Beijing to San Francisco is more likely to suffer worse jet lag than someone flying from San Francisco to New York.
Excessive sleepiness is also linked with a number of primary sleep disorders. For example, sleep disordered breathing (SDB), which includes snoring and obstructive sleep apnea (OSA), is often associated with excessive sleepiness. Because SDB may result in frequent interruptions during sleep, it can lead to abnormal sleepiness during waking hours no matter how many hours a person actually spent in bed.
Insomnia is another main cause of perceived daytime sleepiness or fatigue. Insomnia symptoms may include difficulty falling asleep, difficulty staying asleep, and/or waking up still tired as well as daytime impairments such as excessive sleepiness, cognitive deficits (e.g., concentration and memory problems), fatigue, and irritability.
Narcolepsy is a neurological disorder characterized by disabling sleepiness. Most patients begin to experience symptoms in their teens or 20s, but symptoms may appear in younger children or older adults. Narcolepsy is also recognized by insomnia at bedtime, sudden sleep attacks, cataplexy (sudden muscular weakness), hallucinations, and sleep paralysis.
Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and a strong urge to move them. People who suffer from RLS may mistake the problem for insomnia since RLS symptoms are usually worse at night, leading to insomnia at night and excessive sleepiness during the day.
The good news is that these sleep disorders can be easily diagnosed and effectively treated. If you have excessive daytime sleepiness and/or feel you may suffer from a sleep disorder, talk to a healthcare professional about the problem as soon as possible.
Excessive sleepiness may also be caused by a variety of physical and mental illnesses as well as some medications. If you suffer from a medical condition and you are experiencing excessive sleepiness, talk to your healthcare professional about the problem. In many cases, properly treating the medical condition may alleviate sleepiness. In other cases, sleepiness must be treated independently.
POLL DATA:
Excessive sleepiness is not just a matter of feeling lousy – it can also affect mood, relationships, work, and quality of life. According to the results of NSF’s 2008 Sleep in America poll:
36 percent of American drive drowsy or fall asleep while driving
29 percent of Americans fall asleep or become very sleepy at work
20 percent have lost interest in sex because they are too sleepy
14 percent report having to miss family events, work functions, and leisure activities in the past month due to sleepiness.
Each of these consequences can have an enormous impact on an individual’s health and happiness.
One of the most serious risks associated with excessive sleepiness is drowsy driving. NSF’s 2008 poll revealed that a whopping 36 percent of American adults have nodded off or fallen asleep while driving. Sleepiness and driving do not mix. If you feel sleepy, you should not drive. Visit drowsydriving.org. to learn how to prevent a drowsy driving-related crash.
There are several tools used to evaluate a person for excessive sleepiness. An individual’s personal report of how they feel is also important in characterizing a sleepiness problem. Interviewing a person’s bed partner or those sleeping nearby is also helpful in identifying things that occur during sleep (e.g., snoring and breathing pauses during sleep).
Special questionnaires developed specifically to provide insight regarding daytime sleepiness (these include the Epworth Sleepiness Scale and Stanford Sleepiness Scale). Sleep diaries may also be helpful in assessing and evaluating sleepiness as well as any underlying factors.
Additionally, there are several tests that may be employed when a sleep disorder such as SDB or narcolepsy is suspected. Such tests may include an overnight sleep study or “polysomnogram,” and the Multiple Sleep Latency Test (MSLT).
TREATMENT:
Once a cause for excessive sleepiness is determined, there are generally a range of treatment options available to patients, including behavioral and pharmacological (drug) therapies. For example, if the primary cause of sleepiness is OSA, continuous positive airway pressure (CPAP) or an oral appliance may be prescribed. If excessive sleepiness persists in OSA patients using CPAP or is the result of narcolepsy, approved medications may be appropriate. For sleepiness caused by voluntary sleep deprivation or poor sleep habits, treatment will center on adopting behavioral measures to make getting adequate sleep a top priority.
COPING:
Although everyone should employ all the elements of good sleep hygiene, this is particularly important for anyone with excessive sleepiness. These are behaviors and habits that can promote healthy sleep, which helps improve alertness during the day. They include:
Maintaining a consistent sleep schedule, even on the weekends
Developing a regular, relaxing bedtime routine
Using your bedroom only for sleep and sex; if you do this, you will strengthen the association between bed and sleep
Create a sleep environment that is dark, quiet, comfortable and slightly cool
Removing all work materials, televisions, phones, and other distractions from the bedroom
Avoiding caffeine in the second half of the day
Limiting alcohol – it can disturb sleep
For some people with excessive sleepiness, adopting healthy sleep habits is enough to resolve the problem.
People vary in their need for sleep, but experts agree that for most adults the amount needed to feel one’s best is somewhere between seven and nine hours per night. Teens and young adults usually need nine hours of sleep or more per night. If you suffer from excessive sleepiness that persists for more than three weeks despite allowing adequate time for sleep, discuss the problem with your healthcare professional.
GERD AND SLEEP
GERD, also known as acid reflux, is an acronym that stands for gastroesophageal reflux disease. It is a chronic illness that affects 5-7% of the world population and is associated with serious medical complications if untreated. GERD is the 3rd most common gastrointestinal disorder in the U.S. Most patients with GERD also experience nighttime heartburn, which is more bothersome. And according to the 2001 NSF Sleep in America poll, adults in America who experience nighttime heartburn are more likely to report having symptoms of sleep problems/disorders such as insomnia, sleep apnea, daytime sleepiness and restless legs syndrome than those who don’t have night time heartburn.
GERD describes a backflow of acid from the stomach into the esophagus. Most patients with GERD experience an increase in the severity of symptoms (usually heartburn or coughing and choking) while sleeping or attempting to sleep. If the acid backs up as far as the throat and larynx, the sleeper will wake up coughing and choking. If the acid only backs up as far as the esophagus the symptom is usually experienced as heartburn.
Most people refer to GERD as heartburn, although you can have it without heartburn. Sometimes GERD can cause serious complications including inflammation of the esophagus from stomach acid that causes bleeding or ulcers. In a relatively small number of patients, GERD has been reported to result in a condition called Barrett’s esophagus, which over time can lead to cancer. Also, studies have shown that asthma, chronic cough, and pulmonary fibrosis may be aggravated or even caused by GERD.
GERD is common and may be frequently overlooked in children. It can cause repeated vomiting, coughing, and other respiratory problems. Talk to your child’s doctor if the problem occurs regularly and causes discomfort.
No one knows why people get GERD but factors that may contribute to it include:
Also, certain foods can be associated with reflux events, including:
citrus fruits, chocolate, drinks with caffeine, fatty and fried foods, garlic and onions,
mint flavorings, spicy foods, tomato-based foods, like spaghetti sauce, chili, and pizza.
GERD affects people of all ages, ethnicities and cultures and tends to run in families.
SYMPTOMS:
The most frequently reported symptoms of GERD are:
Heartburn
Acid regurgitation
Inflammation of the gums
Erosion of the enamel of the teeth
Bad breath
Belching
Chronic sore throat
Some patients with GERD experience no symptoms at all. Because of the wide range of symptoms associated with GERD and the need to distinguish it from heart-related problems, the number of medical visits and tests needed to diagnose or rule out the disease tends to be quite high.
TREATMENT:
GERD is a recurrent and chronic disease that does not resolve itself. If you are diagnosed with GERD, there are several methods of treatment which your doctor will discuss with you including behavioral modifications, medications, surgery, or a combination of methods. Over-the-counter medications may provide temporary relief but will not prevent symptoms from recurring.
The lifestyle changes you can make to minimize GERD include avoiding fats, onions, chocolate and alcohol. Losing weight may also help alleviate GERD symptoms.
Because of the association between GERD and sleep apnea, people with nighttime GERD symptoms should be screening for sleep apnea.
COPING:
These lifestyle modifications should help minimize reflux:
Avoid lying down after a large meal
Eat smaller meals and maintain an upright, relaxed posture
Avoid fats, onions, chocolate and alcohol
Avoid potassium supplements
Always swallow medication in the upright position and wash it down with lots of water.
POLL DATA:
GERD is the 3rd most common gastrointestinal disorder in the US and one of the leading causes of disturbed sleep among people between the ages of 45 and 64, according to the 2002 NSF Sleep in America poll. Reviewed by William C. Orr, Ph.D.
CAFFEINE AND SLEEP
Caffeine has been called the most popular drug in the world. It is found naturally in over 60 plants including the coffee bean, tea leaf, kola nut and cacao pod. All over the world people consume caffeine on a daily basis in coffee, tea, cocoa, chocolate, some soft drinks, and some drugs.
Because caffeine is a stimulant, most people use it after waking up in the morning or to remain alert during the day. While it is important to note that caffeine cannot replace sleep, it can temporarily make us feel more alert by blocking sleep-inducing chemicals in the brain and increasing adrenaline production.
There is no nutritional need for caffeine in the diet. Moderate caffeine intake, however, is not associated with any recognized health risk. Three 8 oz. cups of coffee (250 milligrams of caffeine) per day is considered a moderate amount of caffeine. Six or more 8 oz. cups of coffee per day is considered excessive intake of caffeine.
Caffeine enters the bloodstream through the stomach and small intestine and can have a stimulating effect as soon as 15 minutes after it is consumed. Once in the body, caffeine will persist for several hours: it takes about 6 hours for one half of the caffeine to be eliminated. There are numerous studies to support the idea that caffeine causes physical dependence. If you suspect that you or someone you know is dependent on to caffeine, the best test is to eliminate it and look for signs of withdrawal, such as headache, fatigue and muscle pain.
Although caffeine is safe to consume in moderation, it is not recommended for children. It may negatively affect a child’s nutrition by replacing nutrient-dense foods such as milk. A child may also eat less because caffeine acts as an appetite suppressant. Caffeine can be safely eliminated from a child’s diet since there is no nutritional requirement for it.
Although the FDA does not advise against women who are pregnant or nursing to eliminate caffeine from the diet, many experts recommend limiting the amount consumed during that time to one or two 8 oz. servings per day.
SYMPTOMS:
Caffeine is a stimulant. In moderate doses, it can:
Increase alertness
Reduce fine motor coordination
Cause insomnia
Cause headaches, nervousness and dizziness
It has also been known to result in:
Anxiety
Irritability
Rapid heartbeat
Excessive urination
Sleep disturbance
A “caffeine crash” once the effects wear off.
TREATMENT:
If the conditions listed under “symptoms” occur, discontinue the use of caffeine. These effects are more likely to occur if caffeine is consumed in large doses. Children and women who are nursing or pregnant should avoid caffeine. People who are taking any prescription medication should talk to their doctors before consuming caffeine.
Knowing the caffeine content of your food and drinks can help you keep caffeine intake at a healthy level so you can still reap the benefits of a good night’s sleep.
COPING:
In order to sleep better at night and reduce daytime sleepiness, try practicing the following sleep tips:
Maintain a regular bed and wake time schedule including weekends
Establish a regular, relaxing bedtime routine such as taking a bath or listening to music
Create a sleep-conducive environment that is dark, quiet, comfortable and cool
Sleep on a comfortable mattress and pillows
Use your bedroom only for sleep and sex
Finish eating at least 2-3 hours before your regular bedtime
Exercise regularly but avoid it a few hours before bedtime
Avoid caffeine (e.g. coffee, tea, soft drinks, chocolate) close to bedtime
Don’t smoke — not only is it a major health risk it can lead to poor sleep
Avoid alcohol close to bedtime; it can lead to disrupted sleep later in the night.
POLL DATA:
According to the 2001 Sleep in America poll, 43% of Americans are “very likely” to use caffeinated beverages to combat daytime sleepiness.
Reviewed by: Greg Belenky, M.D.
DIET, EXERCISE AND SLEEP
For years your doctor, your mom and your friend who goes to the gym multiple times a week have probably been telling you to eat better and exercise more. It is all you hear on television, in the newspapers and on talk radio. New doctors and dieticians usher in new diets, new fads, and so you’ve made some lifestyle changes – cutting back on your fat and sweets intake, and doing some cardiovascular exercise a few days a week. Despite all this, you still feel burned out, can’t drop those extra pounds, and don’t have the energy to greet each day with enthusiasm. What are you missing?
THE THIRD PIECE OF THE PUZZLE: SLEEP
Though the exact mechanisms of how sleep works, how sleep rejuvenates the body and mind is still mysterious, one thing sleep specialists and scientists do know is that adequate sleep is necessary for healthy functioning. Research shows that all mammals need sleep, and that sleep regulates mood and is related to learning and memory functions. Not only will getting your zzzs help you perform on a test, learn a new skill or help you stay on task, but it may also be a critical factor in your health, weight and energy level.
SLEEP PROBLEMS AND OBESITY: INTERACTING EPIDEMICS
An estimated 18 million Americans have sleep apnea, a sleep-related breathing disorder that leads individuals to repeatedly stop breathing during sleep. Not only does sleep apnea seriously affect one’s quality of sleep, but it can also lead to health risks such as stroke, heart attack, congestive heart failure and excessive daytime sleepiness. Sleep apnea is often associated with people who are overweight – weight gain leads to compromised respiratory function when an individual’s trunk and neck area increase from weight gain.
These interacting problems of weight gain and sleep apnea make it difficult to help oneself off the slippery slope of health problems. From a behavioral perspective, those suffering from sleep apnea may be less motivated to diet or exercise – daytime sleepiness lowers their energy levels and makes it difficult to commit to an exercise and/or diet program which would improve both their weight and sleep apnea.
Unfortunately, losing a significant amount of weight in a healthy manner can be very difficult, so Richard Simon, MD recommends treating sleep apnea first: “Unfortunately, we do not have great treatments for obesity that have long-term success rates of much greater than 5–10%,” Simon says. “Thus I prefer to start therapy with [continue positive airway pressure] (70% success rate) and then add exercise (probably less than a 50% success rate). People feel restored when they are effectively treated for sleep apnea and are more willing to start exercising then.”
Sleep deprivation may also inhibit one’s ability to lose weight – even while exercising and eating well! A 1999 study at the University of Chicago showed that restricting sleep to just 4 hours per night for a week brought healthy young adults to the point that some had the glucose and insulin characteristics of diabetics. Such sleep restriction may have been a bit extreme, but it is also not altogether uncommon in our society and is a pattern deemed the “royal route to obesity” by Eve Van Cauter, PhD, who conducted the Chicago study.
GETTING IN SHAPE: HOW SLEEP AND EXERCISE DO A BODY GOOD
Though research shows that exercise is certainly good for one’s body and health, properly timing exercise is necessary to maximize the beneficial effects. For example, a good workout can make you more alert, speed up your metabolism and energize you for the day ahead, but exercise right before bedtime can lead to a poor night’s sleep.
All the jumping jacks in the world would not make up for a night of tossing and turning! Sleep experts recommend exercising at least three hours before bedtime, and the best time is usually late afternoon. Exercising at this time is beneficial because body temperature is related to sleep. Body temperatures rise during exercise and take as long as 6 hours to begin to drop. Because cooler body temperatures are associated with sleep onset, it’s important to allow the body time to cool off before sleep.
DIET AND SLEEP: A HEALTHY HELPING OF THE RIGHT STUFF
Are you someone who needs a fresh cup of java to coax you out of bed in the morning? Or perhaps you prefer an afternoon jolt from the cola vending machine? Or maybe you are more the candy bar type – in any case, you are not alone. In a 24/7 culture, cups of coffee, cans of soda and candy bars are staples of everyday consumers. For some, the day cannot begin without a cup of Starbucks and for many students today no study break is complete without a can of Coke. How did caffeine become the drug (and food) of choice?
In fact, lack of sleep creates a vicious cycle – the more tired you are, the more caffeine you will consume to stay awake during the day; but the more caffeine you consume, the harder it will be to fall asleep at night. Not only are foods and drinks high in caffeine likely to keep you up at night, but they are also usually replete with sugar or artificial sugar and not much else. When a healthy snack such as a carrot or granola bar is replaced with a can of Mountain Dew, you are at higher risk for putting on weight and it becomes harder to sustain energy for a longer period of time.
Food is also related to sleep by appetite and metabolism. Research by Dr. Van Cauter shows that people who do not get enough sleep are more likely to have bigger appetites due to the fact that their leptin levels (leptin is an appetite regulating hormone) fall, promoting appetite increase. This link between appetite and sleep provides further evidence that sleep and obesity are linked. To top it off, the psychological manifestations of fatigue, sleep and hunger are similar. Thus, when you are feeling sleepy you might feel like you need to head for the fridge instead of bed.
WHAT IT ALL MEANS: HOW DIET, SLEEP AND EXERCISE AFFECT YOU
By now you probably realize that health is complex – if one part of the body system suffers, you are likely to see consequences in other areas of your life. Though diet and exercise are critical components of healthy lifestyles, it is also important to remember that sleep is inherently linked with how we eat (and how much), how we exercise (and whether or not we lose weight), and how we function on a daily basis. Getting the proper amount of sleep each night is necessary to face the world with your best foot forward. Sleep will help you on the road to good fitness, good eating and good health.
NAPPING
More than 85% of mammalian species are polyphasic sleepers, meaning that they sleep for short periods throughout the day. Humans are part of the minority of monophasic sleepers, meaning that our days are divided into two distinct periods, one for sleep and one for wakefulness. It is not clear that this is the natural sleep pattern of humans. Young children and elderly persons nap, for example, and napping is a very important aspect of many cultures.
As a nation, the United States appears to be becoming more and more sleep deprived. And it may be our busy lifestyle that keeps us from napping. While naps do not necessarily make up for inadequate or poor quality nighttime sleep, a short nap of 20-30 minutes can help to improve mood, alertness and performance. Nappers are in good company: Winston Churchill, John F. Kennedy, Ronald Reagan, Napoleon, Albert Einstein, Thomas Edison and George W. Bush are known to have valued an afternoon nap.
TYPES:
Naps can be typed in three different ways:
Planned napping (also called preparatory napping) involves taking a nap before you actually get sleepy. You may use this technique when you know that you will be up later than your normal bed time or as a mechanism to ward off getting tired earlier.
Emergency napping occurs when you are suddenly very tired and cannot continue with the activity you were originally engaged in. This type of nap can be used to combat drowsy driving or fatigue while using heavy and dangerous machinery.
Habitual napping is practiced when a person takes a nap at the same time each day. Young children may fall asleep at about the same time each afternoon or an adult might take a short nap after lunch each day.
TIPS:
A short nap is usually recommended (20-30 minutes) for short-term alertness. This type of nap provides significant benefit for improved alertness and performance without leaving you feeling groggy or interfering with nighttime sleep.
Your surroundings can greatly impact your ability to fall asleep. Make sure that you have a restful place to lie down and that the temperature in the room is comfortable. Try to limit the amount of noise heard and the extent of the light filtering in. While some studies have shown that just spending time in bed can be beneficial, it is better to try to catch some zzz’s.
If you take a nap too late in the day, it might affect your nighttime sleep patterns and make it difficult to fall asleep at your regular bedtime. If you try to take it too early in the day, your body may not be ready for more sleep.
BENEFITS:
Naps can restore alertness, enhance performance, and reduce mistakes and accidents. A study at NASA on sleepy military pilots and astronauts found that a 40-minute nap improved performance by 34% and alertness 100%.
Naps can increase alertness in the period directly following the nap and may extend alertness a few hours later in the day. Scheduled napping has also been prescribed for those who are affected by narcolepsy. Napping has psychological benefits. A nap can be a pleasant luxury, a mini-vacation. It can provide an easy way to get some relaxation and rejuvenation.
Most people are aware that driving while sleepy is extremely dangerous. Still, many drivers press on when they feel drowsy in spite of the risks, putting themselves and others in harm’s way. While getting a full night’s sleep before driving is the ideal, taking a short nap before driving can reduce a person’s risk of having a drowsy driving crash. Sleep experts also recommend that if you feel drowsy when driving, you should immediately pull over to a rest area, drink a caffeinated beverage and take a 20-minute nap.
Shift work, which means working a schedule that deviates from the typical “9 to 5″ hours, may cause fatigue and performance impairments, especially for night shift workers. In a 2006 study, researchers at the Sleep Medicine and Research Center affiliated with St. John’s Mercy Medical Center and St. Luke’s Hospital in suburban St. Louis, MO, looked at the effectiveness of taking naps and consuming caffeine to cope with sleepiness during the night shift. They found that both naps and caffeine improved alertness and performance among night shift workers and that the combination of naps and caffeine had the most beneficial effect.
James K. Walsh, PhD, one of the researchers who conducted the study, explains, “Because of the body’s propensity for sleep at night, being alert and productive on the night shift can be challenging, even if you’ve had enough daytime sleep.” “Napping before work combined with consuming caffeine while on the job is an effective strategy for remaining alert on the night shift.”
NEGATIVE EFFECTS:
In spite of these benefits, napping is not always the best option for everyone. For example, some people have trouble sleeping any place other than their own bed, making a nap at the office or anywhere else unlikely. Other people simply have trouble sleeping in the daytime; it could be that certain individuals are more sensitive to the midday dip than others – those who are may feel sleepier and have an easier time napping. Here are some other negative effects:
Naps can leave people with sleep inertia, especially when they last more than 10-20 minutes. Sleep inertia is defined as the feeling of grogginess and disorientation that can come with awakening from a deep sleep. While this state usually only lasts for a few minutes to a half-hour, it can be detrimental to those who must perform immediately after waking from a napping period. Post-nap impairment and disorientation is more severe, and can last longer, in people who are sleep deprived or nap for longer periods.
Napping can also have a negative effect on other sleeping periods. A long nap or a nap taken too late in the day may adversely affect the length and quality of night time sleep. If you have trouble sleeping at night, a nap will only amplify problems.
One study has indicated that napping is associated with increased risk of heart failure in people already at risk.
STIGMAS:
While research has shown that napping is a beneficial way to relieve tiredness, it still has stigmas associated with it. Napping indicates laziness, a lack of ambition, and low standards. Napping is only for children, the sick and the elderly. Though the above statements are false, many segments of the public may still need to be educated on the benefits of napping.
A recent study in the research journal Sleep examined the benefits of naps of various lengths and no naps. The results showed that a 10-minute nap produced the most benefit in terms of reduced sleepiness and improved cognitive performance. A nap lasting 30 minutes or longer is more likely to be accompanied by sleep inertia, which is the period of grogginess that sometimes follows sleep.
By now you are probably thinking about ways to incorporate naps into your daily routine. Keep in mind that getting enough sleep on regular basis is the best way to stay alert and feel your best. But when fatigue sets in, a quick nap can do wonders for your mental and physical stamina.
Fibromyalgia is a devastating condition to live with. I lived with it myself, and I know. When you have fibromyalgia, you are in pain every minute of every day. Your general practitioner or rheumatologist will provide you with pain medication, from which you can get some relief, but the pain never really goes away. Living like that wears you down both physically and emotionally.
From my own personal experience, I know that doctors don’t leave you with much hope, in terms of possible improvement of your condition. My own doctor told me, “We’ve talked about this before. It’s always going to be this way, so accept it.”
His words did nothing to push me in the direction of acceptance. Quite the opposite, in fact. My doctor made me absolutely determined to do anything and everything that I could to move out of that world of constant pain.
I had discovered the wonders of EFT not long before my diagnosis. I was tapping for work related stress, and getting some very good results. When I look back now, I know that EFT was the only thing that allowed me to stay in a job that I hated and still be functional.
What I realized at some point was that the more stress I was able to tap away with EFT, the less pain I had. On the days that my stress level was at its’ highest, my pain was nearly intolerable.
That was, for me, a wonderful incentive to keep on tapping. The tapping not only allowed me to feel better emotionally, it also reduced my pain and made me more comfortable physically.
As it became more and more obvious that my pain level was going down, I dared to start dreaming of getting off the medications that I was taking, two of which were for pain, and one which helped me to sleep. I continued to tap on the work stress on a daily basis, but now also tapped on the pain directly, and how it made me feel. I found that I had anger, frustration, sadness and a sense that my body had let me down. I tapped on all of it.
I began keeping a tapping journal. I kept track of what I tapped on each day, what feelings that bought up, what kind of relief I got, and what outstanding issues (tail enders) came up during my tapping. The journal really helped to keep me focused on my goal.
After several months of tapping and journaling, it became obvious to me that my pain level was low enough to start working on getting the drugs out of my system. I started with my strongest pain killer, weaning myself off it, until I no longer was taking it at all. Next came my second pain killer, which I also weaned myself off, being careful to keep journaling about what went on each day. Next I reduced the medication that I was taking to help me sleep, and finally stopped it completely. The last step for me was being weaned off of the Cymbalta that my rheumatologist had recommended. This is a drug with most unpleasant side effects at times, and you should never stop it suddenly, or on your own. I was taken off Cymbalta gradually, with reduced doses, under the supervision of my doctor.
After years of being heavily medicated, I was now drug free except for my medication for hypertension. What a personal victory that was, and what a lesson it was for me as far as the closed minds of many doctors. It never even occurred to my rheumatologist that my condition could improve, and since he had no hope, he took away mine, a terrible thing to do.
If you suffer from fibromyalgia, and would like to start tapping on your pain and what might be at the bottom of it, your best bet is to start a tapping journal of your own. Start tracking:
Your daily pain levels.
How that pain makes you feel. (Sad, angry, helpless, etc.)
What can you NOT do now, that you could do before?
Is there a secondary gain for you in not being able to do those things?
Would peoples’ expectations of you change if you were to stop having so much pain?
Do you get more attention/care/nurturing because you’re in pain?
How much relief do you get when you tap directly on the pain?
How much relief do you get when you tap on the emotions around the pain?
What kind of tapping seems to work best for you?
By keeping a journal about these kinds of issues, you track your progress and are able to easily see what is most effective for you. Using EFT to address your condition is good. Doing this while keeping a tapping journal is even better.
Perhaps most important of all on a journey like this is to be persistent, and try to not get discouraged. Relief doesn’t happen overnight, and you need to be encouraged by each small victory that you have. Hang in there, keep tapping, and you too can move past fibromyalgia.
Visit my website at http://seeking-serenity.com.
Download the FREE ebook “The Forgiveness Workbook” here.
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orthopedic muscle testing for inhibition or over-facilitation. Related
functional anatomy, neurological innervation, aberrant movement patterns and clinical overviews are discussed.
Attendees will learn how to combine the 3 components of
Trigenics®, resisted exercise movement, distortional stimulation of
mechanoreceptors.and biofeeback breathing. Specific protocols for
treatment of individual muscles are demonstrated, practiced and integrated.
What Are The Experts Saying About Trigenics®?
“Trigenics is the quickest acting and most astoundingly effective technique for the treatment of musculoskeletal conditions I’ve ever used!! The neurological model is
absolutely revolutionary!!”
Dr. Rudolf Garza, DC, ND, American Academy of Pain Management, Los Angeles, CA
The Trigenics seminar teaches a system based on neurology and biomechanics that is effective in improving patient outcomes. It is easy to implement into a practice and is highly recommended.”
Anthony J. Criscuolo, DC, DACBSP
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This post is a day late, as yesterday I had to render myself useless. Most people do so after a long night of drinking; I, on the other hand, have to do so after a long day and night of ass kicking, because my Fibromyalgia, among other things, like to kick my ass in return. Good thing I don’t take no for an answer.
Lions by Sarah Gray-Perez
I woke up at 6:30 on Tuesday morning, got a bunch of things done, then hopped in my car, drove across the GW, and picked up my buddy Sarah and her two-year-old son Julian so that we could go to the Bronx Zoo. I spent a good percentage of my childhood years there, marveling at the elephants. Unfortunately the elephants were not out, but we got to see all the big cats, which excites me almost as much. On one hand, the zoo makes me sad, but on the other, relieved that the animals are safe. I often wish that lions were not carnivorous or at all interested in sometimes hurting humans who get too close, because all I want to do is cuddle with one. They are magnificently gorgeous creatures, who I often compare Rusty, my orange/blonde striped Domestic Long Hair cat to – not only because of his color, but also because of his attitude, saunter, and very large paws. I also say he yawns like a lion, and received confirmation as I walked over to the Bronx Zoo lions and witnessed one yawn twice. An exact replica of what I witness on a daily basis.
After I dropped them home, I parked my car and took the A train downtown to 14th with my friend Sara(without an h). It was time to head over to Highline Ballroom to interview Jesse Blaze Snider – who yes, is the son of Twisted Sister’s Dee Snider, one of the best frontmen in the history of music, but more than anything a huge talent in his own right. I think we’ve talked about doing an interview for at least two years now. So at long last, we had 15 minutes to sit down backstage and talk amongst the members of seven bands beginning to change and prepare for the show. Once we finished, the doors weren’t opening for another half hour, and the show wasn’t starting for an hour after that, so Sara and I decided to go get dinner and regroup before heading back to Highline once again.
Snider headlined a showcase of local bands titled “All Things Rock” put together by Break’n Through, to benefit VH1’s Save The Music Foundation, which is one of my absolute favorite charities in existence. I spotted Paulie Z. (according to Paulie’s Twitter, his brother David Z. was there as well) from rock band ZO2, who have their own show Z Rock on IFC (Sundays @11/10c), as well as Kevin Christiana from season 4 of Bravo’s Project Runway, although I didn’t know it at the time. Sara and I knew we knew him – but not from where. He appeared to be a chick magnet, and later an excited drunk in front of the stage, with his friend constantly yelling in my ear about who he was – “He’s Kevin Christiana! Uh, Jesse just thanked him onstage! Didn’t you hear?! Do you want to take his photo?!” – while I was photographing Snider’s set. Interesting, to say the least. As we walked down west 16th after leaving the venue Sara shouted “Project Runway!” and an episode with Christiana flashed by in my memory. DUH.
After grabbing a Dunkaccino to heal my exhausted mind and my ailing back and shoulder region due to a half broken camera bag that weighs more than I do, we collapsed on the A train and then drove back home to “Dirty Jerz.”
FYI, only a selection of exits along the Turnpike are ACTUALLY dirty, but thanks for such a swell nickname.
VH1’s Save The Music Foundation: http://www.vh1savethemusic.com/ Break’n Through: http://www.breaknthrough.com Jesse Blaze Snider: http://www.facebook.com/JesseSniderMusic Fibromyalgia Research: http://www.nfra.net/
Judi Vance has dedicated her life to educating the public about the harmful ingredients in cosmetics. She is presently campaigning to have these harmful ingredients totally banned. She publishes a newsletter called The Cosmetic Health Report and is the author of Beauty to Die For: the Cosmetic Consequence.
My journey into cosmetic research began about ten years ago when I was told I would not recover my health. I was suffering from chronic fatigue syndrome, fibromyalgia, lupus, rheumatoid arthritis, allergies and immunological defect; I was having 10 to 12 seizures a day, and walking with two canes. I had always been a heavy user of cosmetics, and began to suspect in particular the acrylic nails I had used for years, so I began to research the ingredients they use.
INGREDIENTS IN COSMETICS Cosmetics are anything that we apply to our bodies including soap, toothpaste, shampoo, mouthwash, deodorant and shaving cream. There isn’t one person I have ever met who knew anything about cosmetics, and that is because the chemistry of cosmetics has always been cloaked in secrecy. The United States has had labelling laws for the last 20 years, but here in Canada there are no labels on containers. We need to let Health Canada know how seriously we need labels to disclose what is actually in these products.
MOLECULES WHICH PENETRATE THE BODY When you put a coating of creme or shaving gel on your face, these chemicals penetrate the skin and get inside the body, but not everything you put on your skin is actually going to be absorbed. Some molecules are too large to get in, but some are very tiny and can stay in the body for many days. Everyone used to think the skin is the perfect barrier, but one of the transport systems that takes these harmful ingredients into the body is the hair follicle.
SODIUM LAURYL SULFATE Sodium lauryl sulfate is a very strong surfactant that was developed for washing garage floors. The problem is that it denatures protein, and the body is made up of protein. Sodium lauryl sulfate is used in shampoos, toothpaste, lotions and creams. Research shows that it causes damage to the eyes, the cells and the entire body. It can combine with other ingredients in the container and create nitrosamines which cause skin damage and irritation. A dental association in Japan tested sodium lauryl sulfate on bacteria, and found that it is a mutagen which means that it can change the genetics within the cell. In children under six, just the absorption of this ingredient through the scalp every day is enough to prevent their eye proteins from linking up properly. These harmful ingredients are banned in Europe and Central America. Sodium laureth sulfate is also a toxic surfactant (milder but has ether added which is worse) used in shampoos and toothpastes.
PROPYLENE GLYCOL This is anti-freeze. If it spills in the garage, we wipe it up right away because we know that dogs and cats lick it and could die from it. The manufacturer of propylene glycol actually sends out a safety data sheet which states that when applied to the skin it causes liver abnormalities and kidney damage. Propylene glycol has the ability to get into the skin, into the blood stream and into the body where it is stored for days and weeks at a time. It can actually alter brain waves to a state of anxiety. Propylene glycol is used in most cosmetic products, as well as food products like ice cream and muffins. It is a humectant and holds in the moisture. It is used in practically every single lipstick on the market, so has clear access to the limbic system of the brain.
COLOURANTS I wore red lipstick for years and years, and I don’t wear it anymore. I don’t trust anybody’s reds. If you took FD & C Red No.3, which is found in a great deal of cosmetics and put it into a petrie dish with breast tissue, you will find breast cancer. This ingredient is still on the market, and we know it causes cancer.
NAIL POLISH The nails do absorb chemicals from nail polish, remover and the glue used with acrylic nails.
CONTAMINANTS These contaminants do not appear on the label. It is not the cosmetic manufacturers who cause the contamination, but the suppliers of the raw materials. What we want in the industry is to have the actual raw materials cleaned up. Contamination can occur from the cleaning of the plants or from the solvents they use, and most of the products on the market are contaminated. DEA (diethanol amine) is widely used in shampoos, and scientists have been reporting that DEA, whether or not it’s a DEA cocamide, mixes with the nitrogen-containing molecule in the same container and creates nitrosamines which get into your body and are carcinogens. Sometimes ingredients which aren’t harmful alone may go on to create a formaldehyde or a contaminant. In a recent study, they tested 54 ethoxylated moisturizing ingredients, and found all 54 of them contained exceedingly high levels of 1,4 dioxane which is a powerful xeno-estrogen.
XENO-ESTROGENS Women today have so many problems with their hormones being out of balance with PMS and menopausal symptoms, and this shouldn’t be because it doesn’t occur in Third World countries, China or Japan. Menopause is a North American disease and it may just be that we have created it through cosmetic use. We have a major problem with hormone mimickers like xeno-estrogens affecting our endocrine systems. A xeno-estrogen communicates with our cells as if it were an estrogen. Many ingredients in cosmetics have the ability to be a xeno-estrogen. If found in a shampoo, it can lower the sperm count in men! And any exposure between the ages of birth to about six years old can definitely alter a child’s hormones. So I always say “Mothers if you want your boys to grow up to be cowboys don’t put them in a bubble bath!”
EXTRACTION PROCESS We hear a lot today about ingredients coming from natural sources like coconuts. But to get the oil from a coconut and put it into a container of shampoo or face cream, it has to go through some type of chemical process, and in this process, many contaminants are formed. Many of us are not aware that essential oils and other products have been extracted from the plant with solvents like propylene glycol and benzene. There are better ways of doing this such as cold pressing, natural extractions and distilling.
FRAGRANCES Fragrance goes straight into the limbic system of the brain. A friend of mine who is a great researcher sent me some scans of people’s brains before and after being exposed to fragrance. Perfumes and fragrances are actually made of 5,000 hydrocarbons which are all synthetics. There are no roses pressed into that beautiful bottle. When a person’s body begins to break down, the first thing that happens is they become sensitive to perfumes, room sprays, laundry detergents, etc. We are actually absorbing and breathing these in, and the Environmental Protection Agency lists them as causing nervous disorders and brain disorders, and they are investigating a connection between fragrance and multiple sclerosis, chronic fatigue and fibromyalgia. Anything that a person is breathing in should be absolutely natural, and if you are using essential oils you must make sure that they have not been processed with some type of chemical solvent like propylene glycol or benzene.
ESSENTIAL OILS You cannot assume that the natural essential oils are all naturally processed. Most of them are contaminated, since 95% of companies extract the essential oil with solvents like propylene glycol, and they don’t tell you because it’s still considered pure oil. When it’s contaminated like this, the healing properties of the plant are diminished. Synthetic essential oils are also on the market, and these cannot do the same thing as the natural product. Most of the essential oils must be checked to make sure they are not synthetic and that the extraction process is natural (steam distilled). It is under investigation right now, and will be reported in my newsletters.
BABY PRODUCTS CONTAIN PETROLEUM BY-PRODUCTS AND CARCINOGENS Because shampoos irritate baby’s eyes, they put an ingredient called ethylene oxide in the shampoo. Look on the Internet; you won’t find one report which doesn’t call it a carcinogen. It loads their system up with 1,4 dioxane. Another problem with baby products is that they contain an enormous amount of petroleum by-products like mineral oil and petrolatum, and petroleum by-products can be contaminated with polycyclic hydrocarbons, dangerous carcinogens. Babies do not have immune systems which are able to tolerate these chemicals, so it’s very important to have all baby products reevaluated. There is enough fluoride in a tube of toothpaste to kill a child. Children sometimes take too much on their toothbrush and swallow quite a lot.
MELATONIN Not all synthetics are bad. Not one drop of melatonin on the market is natural; it is all synthetically derived, and yet we know that melatonin works and it is not harmful to the body. The synthetic molecule is identical to the natural molecule. It’s just that they had to kill thousands and thousands of horses originally to get enough of the natural substance to run studies in the first place. So in some instances, it is preferable to use the synthetic rather than the natural form of the ingredient.
RECIPES My book has a chapter with recipes for making your own cosmetics, but the problem with making your own cosmetics is that the oils in the cremes are so heavy that they do not allow your skin to breath and expel toxins, so you have to be very careful about that. These days moisturizers are formulated using silicone which forms a mesh-like covering on the skin which allows your skin to breathe.
LET’S CLEAN UP THE PRODUCTS Cosmetic ingredients are not regulated by the government. The industry is self-regulating. You must educate yourselves and demand that the manufacturers use safe ingredients and processes like vacuum stripping to remove the contaminants. This will increase the price of the raw material by about five times, but the cosmetic industry usually has maybe 5 to 15 cents worth of ingredients in it and the rest has all been going to profit, so there is plenty of room for change. Keep up to date with ongoing changes in cosmetic formulating by reading my free newsletter The Cosmetic Health Report which has critiques on cosmetic manufacturing companies, product spotlights, lobbying updates, cosmetic recipes and free seminars.
* * * You may contact Judi at The Cosmetic Health Report phone: 604-683-6312; fax: 604-681-4445; website: www.cosmetichealthreport.com
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Isn’t reading something that is completely true, free of any pretense bullshit…so much more…interesting?
YES!! YES IT IS!!!
So here goes my truth…glamour, rage, passion and all:
Ever since I was a litte kid, around 12 or so…I’ve wanted the same thing for Christmas. Each new year passes, new distractions in tow…but my wishes nor my compulsions have never really been met nor have they changed enough to really matter.
When I was a little kid, first diagnosed with Vitiligo…I made a promise to myself…a secret promise. I promised that if I was still alive with this ugly skin by the age of thirty, that I would kill myself.
Then very bittersweetly, my 30th Birthday came and left. By this new age, I had already come to realize they would never cure this “cosmetic disease” when it is so profitable. Also, there are much worse diseases out there to be worked on. Mine didn’t really matter so much. It didn’t kill people, it only made them wish they were dead ;c/
By the age of 30, my life was so backwards out of control…I don’t think I felt much in reality anyway. I didn’t have a loving family anymore. My own personal home-life was a fucking wreck!!! Mentally and emotionally I had been so abused and tormented…that the word function was not a word I could use as an *active* verb in a sentence with my name any longer, ever again.
As 31, 32, 33 and 34 all went by…a little more of Kimberly Ann’s sanity was left along the way somewhere…piece-by-piece, hope-by-hope and dream-by-dream.
At my shockingly now age of 35, I find myself in a peculiar place. I’ve been institutionalized once (overnight.) I have only one family member, and although I love her…I drive her crazy and the stress of me probably causes her issues with her own health (I’m so sorry Mom.) My boyfriend, never gets to see me anymore. My friends barely put up with me, because I never go out anymore. Oh, and now I have this chronic fucking pain syndrome (Fibromyalgia) that has taken a sad girl trapped in permanent ugly skin, and also now made that skin and tissue and muscle hurt like hell every single day for no reason at all. And now I have lumps on my neck. I don’t know what they are yet. I see another specialist next week. JOY, more friggin’ doctors.
Could this specialist be my long awaited Christmas present??? Because if I have cancer, I will refuse to treat it!! I’ve been done with this life full of psychical illness, mental illness, addiction, shit-fuck relatives and a shit-fuck system that probably wishes I would die anyway. I cost Illinois money, and that precious money that could be used to save/improve upon a random poor girls life…really belongs some rich, fat, bald, fucker (aka: a Chicago politician), so he can get his fuck on with a whore and some blow in a swanky yet discreet hotel. Money well spent eh?? At least he’d smile when he was getting “serviced.” Me?? I’m done smiling. I’m done with everything.
I wish I was worth the effort, I wish I wasn’t such an easy target for torment. But I’m nobody. I’m a social security number and a burden.
Just so there is not any confusion…I am not a drug addict. I am not going to kill myself. I am not going to do much of anything, because I’m too sad, too sick and in too much pain to even want to try to do anything.
So, Dearest Santa…here I go again…what I want for Christmas…IS TO FUCKING DIE!!!
I’m so tired. I’m so very tired. I don’t belong here anymore. I’m nobody. I’m less than nobody, cause I’m still in the fucking way.
Love, some sad and hopeless chick that’s been walked over a few hundred times too many!!!
Last week was one heck of a week! I had been waiting for that week for months… the day when the decision on whether or not I get into the pain program was determined. I go to Kaiser, but I believe this process is probably similar at any hospital/ medical center. The main point you have to remember… DON’T GIVE UP! Be vigilant about your health, it’s YOUR body, and at the end of the day you are the only one that will make it a priority.
It all started when the nurse practitioner I had been seeing for years… retired. I was suddenly at a loss. She was very caring and seemed to know what was going on and prescribing my meds, taking me off work when I needed, etc. She was a Subject Matter Expert. So I thought. I still have extremely great thoughts about her, but not in any of that time did she even MENTION this Level 2 Pain Program.
May 2009. My first appt with, and I’ll call him… “Dr. No Bedside Manners” was horrible. He barely acknowledged me as having Fibro, was really abrupt while examining me… didn’t acknowledge I was in real pain even though I was clearly crying while he was examining me… told me that I shouldn’t still be taking opiods after all this time, basically made me feel like a drug addict… just all in all… not a good visit. This after seeing a very sympathetic, understanding yet knowledgeable NP before. I seriously thought to myself… “Oh crap, here I am again, back in Kaiser hell…” BUT I do have to acknowledge that he told me about the Level 2 Pain program and enrolled me in the introduction class. That’s pretty big… so kudos to Dr. No Bedside Manners for that. At any rate, when I walked out of there, I looked at my husband and decided that would be the last time I saw that guy.
My Intro class was scheduled for July. Unfortunately I had to travel for work, unexpectedly the same week and had to cancel out of my class. Had I known the consequence of that decision, I would have never canceled. When I received my new date, it was not until October 6th! I called every few weeks and there was just no way I was getting a new date. In fact, I received a call and the class was pushed out a few days!
In between May and October, I was bounced from my PCP to the Dept of Physical Med & Rehab. This is the Dept that does the referrals to the Level 2 Pain Program. I took the time to fill out a complete profile of myself and gave it to a Physiologist who put the information into the computer… only to tell me that she can’t treat me, but will refer me to the program (again) and basically her only role is as the “gatekeeper” to the Level 2 Pain Program. What? She can’t prescribe meds, she can’t help with my handicap placard, she can’t help me determine if I should continue to work or not…. she can’t help me period! Very good use of my time… and after this visit, I looked at my husband and we just walked to the car in silence and once in the car I just burst into tears.
So… back to my PCP… between May and October is a long time to be in excruciating pain. I needed a solution for my pain. I was not sleeping, I could barely walk most days. I was almost 100% confined to my bed. My life sucked. I up’d my anti-depressant, I had hit bottom. My PCP is looking at me, she says “I’m not a pain specialist, I can try to help you, but I’m not sure what I can do…” I’m ready to just give up.
Through all this, the only consistently good things? The support from my family… AWESOME! The support from my boss… WONDERFUL! The support from my friends… BEAUTIFUL! They are all the best, I couldn’t ask for better. I have been truly blessed from this perspective.
If it hadn’t been for all the support, I don’t know what I would have done. Let’s just skip to the good now. It’s now Friday, October 9th (my son’s 17th bday) and I’m at the Intro to the Level 2 Pain Program class. Before coming, I had to fill out this 7-8 page form which provides a very comprehensive/ detailed overview of my pain problem. During the class, we are taught how pain is processed, active vs. passive chronic pain treatment, cycle of pain, about opiates… and about the chronic pain team. While in class, my information is reviewed by a psychologist.
There is only one absolute criteria that you have to pass… you cannot be on any opiates to join the program. You have to sign an agreement that you will discontinue use. This wasn’t an issue for me… I only take a few times a month. Once you finish the intro class, you get a call from the Nurse Care Manager to set up the pain team evaluation appt. And now we have gone full circle… back to where I started….
October 2009. Last week was my pain team evaluation appt. It was four hours and I met with a Doctor, Psychologist and a Physical Therapist. Each for 45 minutes. Earlier in the week I had a phone appt. with a Clinical Pharmacist to review all the meds I was taking and had taken previously. At the end of the three 45 minute sessions the three + Pharmacist + Nurse Care Manager all got together in a room and agreed on a treatment plan for me. They then brought me in the room and reviewed it with me. They recommended that I:
Participate in the 10-week Level 2 Pain Program starting in January
Light aerobic exercise 2-3 times a day for 10-15 minutes to work towards 30 minutes a day
Individual PT appts
Biofeedback appts
Individual Psych appts for cognitive strategies
Make some changes on my meds
There were two options for the Pain Program. There was a pilot program starting November 2 for Fibro and Migraine patients but the team felt it would be too heavy-duty on the exercise as well as the people they were including were, for lack of better words, in better shape than me, I was not ready for it.
I am really excited to get into this. I hear great things about this. Success rate is very high providing you always follow what you learn and make it a change in your life and don’t fall back to your old habits.
This was a long post, but I wanted to make sure you understood the process I went through. This way, when you start to go through it, maybe you will be better equipped and your expectation will be more realistically set. It’s not a quick one… so please be patient.
determined to do anything and everything that I could to move out of that world of constant pain.