With all the anxiety from the pandemic, getting a good night’s sleep can be hard enough. But throw chronic pain into the mix, and things can get really frustrating. Luckily, there are some strategies you can use to manage your pain to get better sleep at night. In this second episode of a series with Dr. Shane Creado, he and the Amen discuss practical tips to keep that pain from keeping you up all night.
For more on Dr. Creado’s new book, “Peak Sleep Performance for Athletes” visit: https://www.amazon.com/Peak-Sleep-Performance-Athletes-Cutting-edge-ebook/dp/B085YFP9YW
For more on Dr. Creado’s online course, “Overcoming Insomnia”, visit: https://brainmd.com/overcoming-insomnia-course
Daniel Amen, MD:
Welcome to the Brain Warrior’s Way podcast. I’m Dr. Daniel Amen …
Tana Amen, BSN RN:
… And I’m Tana Amen. In our podcast, we provide you with the tools you need to become a warrior for the health of your brain and body.
The Brain Warrior’s Way podcast is brought to you by Amen Clinics, where we have been transforming lives for 30 years using tools like Brain SPECT imaging to personalize treatment to your brain. For more information, visit amenclinics.com.
The Brain Warrior’s Way podcast is also brought to you by Brain MD, where we produce the highest quality nutraceuticals to support the health of your brain and body. To learn more, go to brainmd.com. Welcome back. We are still here with Dr. Shane Creado, one of our Amen Clinics doctors who we just love. So knowledgeable in sleep, and so if you are struggling, please listen to this. Also, one thing we didn’t really, I think, emphasize enough is the sleep course we have that Dr. Creado did, because it’s just filled with fascinating … Every time I hear you talk, there’s just more that I learn because I realize there’s so much to take in, I didn’t take it all in the last time. So it’s a great course, and your new book. Peak Sleep Performance is the name of the book, correct?
Shane Creado, MD:
Well, thank you so much for being here. One thing I wanted to just touch on really quickly, before we jump into the topic of pain. In the last episode, we were talking about Put Me To Sleep, the supplement that you guys created over a couple of years. It’s fascinating. But one thing I wanted to mention as you were talking about it, why it works well is because it settles the brain down. If you talk to people who, especially through through this time, alcohol has gone through the roof, smoking weed has gone through the roof, and it’s because people can’t shut their brains off. I hear them, I hear them all the time. They’re on my page. “I can’t shut my brain off. I’m nervous. I’m too anxious to go to sleep.” So what I’m hearing is that that combination sort of gives you that same effect, but without the toxicity.
Exactly. That’s what’s so beautiful about it. It’s because it allows your brain to calm down so you can actually fall asleep. The harder you try to sleep, the more likely you are to fail. Along with the strategies in the book or the Overcoming Insomnia video series to calm the busy brain down, whether it’s relaxation or breathing, paradoxical intent, irrational versus rational thoughts, all those things will help you get into the mode of getting relaxed, getting your brain to wind down nicely, rather than just hoping it’s going to shut on and off like a light bulb, which it’s not going to do.
So we’re going to have links to Put Me To Sleep, to Dr. Creado’s new book, to the course at Amen University. But what did you learn in the first podcast, please post it on any of your social media sites, take a picture, send it to us. Also, leave comments, questions, concerns. If you would, if you leave a review for the Brain Warrior’s Way podcast, then we’ll enter you into a drawing for Tana’s cookbook, The Brain Warrior’s Way Cookbook, or if you’d rather have The End of Mental Illness, my book. So we love reviews.
So let’s talk about pain and it is just such a huge problem. A lot of us, as we get older, we have issues with pain. I know for me, I take Omega-3 fatty acids, I take brain curcumins and SAM-e and my knees don’t hurt. I hurt my knees playing football in college, intramural football in college, and so I have chronic knee pain if I’m not taking my supplements. Or I also notice if I eat sugar that pain levels go up, but people who’ve been in accidents, people who’ve had surgeries, the issue of chronic pain is huge and clearly can have an impact on sleep.
Yeah, I have a back problem as well, and what I noticed through the quarantine, I made sure I exercised, took my supplements, but because finding the foods you normally eat was a little different, we didn’t have the exact food we normally eat at our disposal and fingertips initially, we were eating a little more rice and things like that, which we don’t normally eat to supplement. I noticed immediately my back hurt more.
Because rice almost immediately turns to sugar-
… In the body, as does bread, pasta, and potatoes.
More inflammation there.
That goes with inflammation, which if you already have vulnerability, like you were born with scoliosis and you were in a bad car accident, that chronic pain can really get triggered.
It affects my sleep. No question.
[crosstalk [00:05:18] So what do people do? Is there anything different they might do to manage their sleep with pain?
Yes. There are specific strategies that they can do avoid resting in bed. So when you are in pain, you will feel that lying in bed while you’re awake may be far more restful, but the truth is if you want to rest, you got to do it out of bed. Because if you lie in bed awake in pain, you’re going to associate the bed with wakefulness and with pain. The bed is a place of safety and sleep, so there’s a clear distinction between resting and napping. Most people may get confused with those. So if you want [inaudible [00:06:04] rest, avoid resting in bed, number one. Number two, some people like doing progressive muscle relaxation strategies to meditate, to calm down, to wind down and go to sleep. But you might want to use a modified technique if you’ve had an injury because tensing up the muscles and relaxing them in a painful region may worsen your pain and inflammation and consequently affect your sleep.
So you can avoid tightening the muscles too much or choose a different relaxation techniques, like breathing or just guided imagery or other strategies. A lot of people with pain might be afraid of sleeping too soundly because may wake up really stiff and painful. Morning stretching maybe helpful for the soreness and the stiffness. But remember that if you don’t get enough sleep, then you will feel less alert, more lethargic, and your sensitivity to pain will be increased. So if someone is well rested and they perceive their pain to be five out of 10, if 10 is the worst, if they’re not well rested, they might perceive that same pain to actually be eight or nine or 10 out of 10. That’s dangerous because they might require higher doses of pain medications or muscle relaxants. But we also know muscle relaxants can worsen your incidents of sleep apnea.
Opioid pain medications are devastating to the brain. They can worsen the risk of central sleep apnea. So the more sleep you get, the more pain tolerance you have, the less doses of this harmful medications you need to take the time. [crosstalk [00:07:47] Physical activity is also important. So stretching before bedtime, but not vigorous exercise before bedtime, and the amount of physical activity. So if you’re in the PT program because of an injury, do it several hours before a desired bedtime. You’ll be able to sleep better. You’ll be recovering faster. There’ll be less inflammation because you’re getting better sleep and your rehab will be quicker to progress.
Let me tell you a story about chronic pain. So I first got interested in it when I first started doing SPAC. A police officer, his name was Steve, was admitted to the hospital after a suicide attempt. I was really fond of him. He had had six back surgeries after two car accidents, where he was involved in chases where he was chasing the bad guys. He said, “I just could never get away from the pain.” The opiates helped him in the short run, but made it worse in the long run. When I scanned him, his cingulate gyrus was the hottest I’ve ever seen to that point. When your anterior cingulate, it’s in the frontal lobes deep in the middle, is overactive, people tend to get stuck on negative thoughts and negative behaviors. What I did is I put him on an SSRI to calm it down.
I think Prozac at the time, and he felt so much better. What he said that was really interesting, he said, “I still have pain, but I don’t think about it all the time.” So the obsessional quality with the pain went down. So now I might put them on serotonin mood support or on happy saffron, but the 5HTP in Put Me To Sleep really helps that obsessional quality. We often say, it’s like you have a little mouse in your head on an exercise wheel and the mouse can’t get off. It’s just going over and over, and it’s really angry and it’s screaming at you. Often people get the mouse drunk or they get the mouse stoned as a way to shut it up, but there are other strategies that can help.
I’ve often thought about in relationship to what you’re talking about. If you think about something, because I’ve experienced a lot of pain for various reasons. It’s almost impossible not to focus on it when that’s when that’s all you sort of have right then. You’re focused on the thing that is requiring the most attention. So if you notice, I’ve heard a lot of people say this when talking about pain, all of a sudden they get distracted by something, their kid comes in the room, gives them a big hug or has a problem. They forget the pain temporarily. So it’s not gone, but you’re not focused on it. So it would seem to me like doing things that would switch your focus would be very helpful.
Yes, yes. That’s observer bias. So the more you focus on something, the more amplified it becomes. So distraction techniques, coping strategies, understanding that there are ways in which you can help with pain and with injuries. So we always go with the PRICE routine for any injury, protection, rest, ice, compression, elevation. I want to talk about crisis, where you have the sleep component as a crucial part in the overall recovery from injuries and maintaining a good pain tolerance too, because you’ll have less inflammation, less stress hormone levels like cortisol, higher levels of testosterone and muscle building hormones, better pain tolerance there. The areas of the brain that help you manage emotional things and pain and rational thinking can be improved.
Prefrontal cortex, the temporal lobes, the deep limbic system, then anterior cingulate gyrus, and the basal ganglia on our SPECT images, they can improve through better sleep and better pain tolerance.
One thing I want to talk about before we have to stop is hypnosis. You have experience with it. on Brain, Fit, Life, there’s actually a hypnotic exercise I do for people in pain. So ultimately pain is experienced in your brain and calming the anterior cingulate along with the insular cortex, which is between the frontal lobes and the temporal lobes, that’s often where pain is experienced, when that’s high people have this high sense of angst and unhappiness. So angst is actually the best word to think of for the anterior insular, that putting someone in a hypnotic trance and giving them helpful suggestions to turn off the pain can actually be helpful. Do you have any experience with that?
Absolutely. So I trained in hypnosis and also neural linguistic programming. Through certain suggestions, you can actually reduce the subjective sensation of someone’s pain. I once did a fun exercise with a patient who had over eating and she felt like she had eaten a burger after the session ended. The person is still awake and they’re completely in control and it can reduce the pain in actual time. You fill out of pain form before the session and after the session. Most of the time, it’s reduced by over 50% within 20 minutes.
I didn’t know you did NLP. I’m fascinated. I love NLP. I love it. I think it’s a powerful, powerful technique.
Yeah, he’s one of us. All right.
When we come back, we’re going to talk about a sleep and work performance. Your new book is on peak performance, Peak Sleep Performance: The Cutting Edge Sleep Science That Will Guarantee A Competitive Advantage. That you can get on Amazon. Or Overcoming Insomnia at Amen university. It’s just spectacular. If you’re having trouble with sleep, this can help optimize your sleep for the rest of your life. It’s a great investment. Also, you can get, Put Me To Sleep on brainmd.com. Stay with us.
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