Sleep and pain 2011

Pain and Sleep Disruption Stasha Gominak, M.D. ETMC Neurologic Institute, 700 Olympic Plaza, 912 Tyler, TX (903) 596-3808 www.drgominak.com 11/4/2011

How do sleep disorders cause pain? Can we fix our patients’ pain by fixing their sleep?

Why don’t we doctors know much about Sleep? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Sleep and Headache ,[object Object],[object Object],[object Object],[object Object],[object Object]

CPAP cures other kinds of pain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Sleep and Pain ,[object Object],[object Object],[object Object],[object Object]

What follows is my explanation of why sleep disorders are epidemic, why chronic pain grows out of that epidemic. And how we can fix our patients!

Many Sleep Disorders ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Abnormal Sleep = Pain and Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

You have a sleep disorder if you answer “yes” to any of these ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

“Yes ….but” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What is Light Sleep? ,[object Object],[object Object],[object Object]

1st phase of deep sleep: Slow Wave Sleep ,[object Object],[object Object],[object Object],[object Object]

Growth Hormone in slow wave sleep makes kids grow ,[object Object],[object Object],[object Object],[object Object]

Growth Hormone in Slow Wave Sleep may help us heal ,[object Object],[object Object],[object Object],[object Object]

Deep Sleep: REM Sleep ,[object Object],[object Object],[object Object],[object Object],[object Object]

Normal Sleep - Basic Concepts ,[object Object],[object Object],[object Object],[object Object],[object Object]

What’s gone wrong and why? ,[object Object],[object Object],[object Object],[object Object],[object Object]

When and Why did this occur? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

9/10 chronic pain sufferers in my practice have abnormal sleep ,[object Object],[object Object],[object Object],Nucleus Reticularis Pontis Oralis

My patients’ sleep disorders ,[object Object],[object Object],[object Object],[object Object],[object Object]

The Wobbly Paralysis Switch ,[object Object],[object Object],[object Object],[object Object],Too Paralyzed Not Paralyzed Enough

Periaquiductal Gray runs the timing and paralysis of sleep ,[object Object],[object Object],[object Object],[object Object],[object Object],Nucleus Reticularis Pontis Oralis

Simplifying abnormal sleep studies : The timer or the paralysis switch ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Why does everyone and his brother seem to have Sleep Apnea? Did we make it up? Has it always been there or is it new? What’s causing it? Why is it more in “developed countries”?

I thought Sleep Apnea only happened to fat people Does obesity cause sleep apnea or does sleep apnea cause obesity?

Obesity and Sleep Apnea ,[object Object],[object Object],[object Object],[object Object]

What’s happening here that’s goofing up my patients’ sleep and making them fat? Nucleus reticularis pontis oralis

Why don’t we fix the sleep instead of blowing air up the nose? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Vitamins and Sleep ,[object Object],[object Object],[object Object],[object Object],[object Object]

Vitamin D and Sleep ,[object Object],[object Object],[object Object],[object Object]

Vitamin D Receptors concentrated 2 areas of the brain ,[object Object],[object Object]

What is Vitamin D anyway? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

In the 1970’s- 80’s Dr. Walter Stumpf “explained” what D hormone does

Dr. Walter Stumpf and D hormone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Why would we have a hormone made by UVB that bosses the pituitary and hypothalamus? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Summer: High D message (70-80) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Winter: Lower D message (40-60) ,[object Object],[object Object],[object Object],[object Object]

D Hormone and Sleep ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

D Hormone not Vitamin D ,[object Object],[object Object],[object Object],[object Object]

Epidemiologically related to D deficiency- (same list as sleep apnea) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Vitamin D inflammatory connection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Autoimmune Diseases Epidemiologically linked to D deficiency ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Disorders of GI tract epidemiologically related to D deficiency ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The odd history of Vitamin D and why you don’t know about it

Why did they call it a vitamin if it’s not one? Why the “D2” and “D3” numbers ? ,[object Object],[object Object],[object Object],[object Object]

D2 is NOT the same as D3 ,[object Object],[object Object],[object Object]

What does this D have to do with my practice? Can vitamin D cure my patients pain? No, but normal sleep can.

Restorative sleep is the cure for chronic pain ,[object Object],[object Object],[object Object],[object Object]

D too high makes the sleep abnormal too! ,[object Object],[object Object],[object Object],[object Object]

Vitamin D Toxicity and why the FDA’s not crazy ,[object Object],[object Object],[object Object],[object Object],[object Object]

How to replace the D to fix the sleep and why all the controversy about dosing? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What is the right level ? ,[object Object],[object Object],[object Object],[object Object]

What’s the right dose? ,[object Object],[object Object],[object Object],[object Object]

Daily dose different for each of us healthy level same for everyone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Other supporting factors ,[object Object],[object Object],[object Object],[object Object],[object Object]

Now what do I do? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Are there other medicines that interrupt my patient’s sleep? ,[object Object],[object Object],[object Object],[object Object],[object Object]

What should I do for my patients? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Listen to your patient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Long acting narcotics prolong the pain ,[object Object],[object Object],[object Object],[object Object],[object Object]

Try to take away long acting narcotics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case Report ,[object Object],[object Object],[object Object],[object Object],[object Object]

Be Patient, Keep D 60-80 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Vitamin D Toxicity and why the FDA’s not crazy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

D Hormone and D receptors: multilayered complexity ,[object Object],[object Object],[object Object],[object Object]

Sleep and pain 2011

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Sleep and pain 2011