Sleep is absolutely essential to good physical and mental health, and most adults need 7-9 hours of sleep EVERY night. Sleep deprivation — caused by insufficient sleep or poor quality of sleep — impairs the body’s immune system, physical reflexes, emotional stability, and cognitive functions, such as memory, decision-making, the capacity to focus one’s attention, and the ability to complete complex creative activities or mathematical calculations. Severe sleep deprivation may lead to weight gain, an increase in muscle, joint, and nerve pain, depression, and even hallucinations. Sleep disorders can also be symptomatic of more serious illness, such as clinical depression and/or heart disease, meaning that it’s essential to talk with your doctor if you are having problems falling, or staying, asleep.
If you or your doctor think that you might have a sleep disorder, the first step in further evaluation is to answer the 8 questions on the Epworth Sleepiness Scale. If your score is equal to or higher than 10, the results should be discussed with your doctor. Depending upon your symptoms, your physician may determine that you are a candidate for a sleep study.
Another step is to begin keeping a sleep diary that documents your daily activities, including your sleep activities (i.e. tossing and turning, waking in the middle of the night, sleepwalking, grinding teeth, etc.). Take careful note of the times you actually get good sleep versus the times you don’t. If you’re attempting to heal from an acute injury or a chronic illness, your treatment program will be greatly enhanced by your commitment to proper sleep hygiene.
Commonly-Diagnosed Sleep Problems
There are a large variety of sleep disorders. Some are caused by physical problems, such as an airway obstruction that leads to sleep apnea, or chronic pain or indigestion/reflux sufficient enough to cause insomnia. Sleep problems can also occur as a side effect of taking certain medications or supplements, or because of emotional difficulties including depression, post-traumatic stress disorders and/or anxiety about life situations. In many cases, there can be several factors contributing to the sleep disturbance, including anxiety about the sleep deprivation itself. Some commonly-diagnosed sleep disorders include:
Insomnia: Inability to fall asleep within 15 to 20 minutes.
Dyssomnia: Frequent awakenings throughout the night and/or early-morning awakenings.
Restless leg syndrome: When lying in bed, unpleasant “crawling” sensations in the legs that create an irresistible and sleep-disruptive urge to move one’s legs.
Sleepwalking: Walking during sleep or engaging in other activities, like eating, that are normally associated with wakefulness.
Sleep apnea: Obstruction of airway during sleep, causing breathing irregularities that interrupt and interfere with sleep. Sufferers are at higher risk of developing high blood pressure, heart disease, and stroke. Snoring may be a sign or symptom of sleep apnea, so it’s something you should mention to your doctor. (Click here for more info from the National Institutes of Health about sleep apnea.)
There is a wide range of over-the-counter and prescription medications advertised as sleep aids. All of them – including nutritional supplements, Chinese herbs, non-prescription-medications and prescribed-medications – may have side effects or cause drug interactions; for example, long-term use of Benadryl or Tylenol PM may increase your risk for developing Alzheimer’s. Please talk with your doctor before taking any sleep aids.
Alternative Treatments
Calcium (1,500 to 2,000 mg daily, taken after meals – 500 mg per meal – and 500 mg at bedtime). Calcium is a nutritional supplement that helps relax the body’s muscles.
Magnesium (1,000 mg daily). A nutritional supplement that helps to calm the body’s nervous system and relax the muscles.
Cortisol Manager (One tablet daily). Cortisol Manager reduces cortisol levels for all-day stress reduction and restful sleep. It’s safe to use every night.
Valerian (1,000 mg daily). Valerian is an American herb that has been found effective in helping to induce the onset of sleep.
Phosphatidylserine (PS 100; take one to two at bedtime). Phosphatidylserine is a phospholipid nutritional supplement that stops hyperactive production of cortisol in the body, allowing unhealthy, elevated cortisol levels to decrease, and consequently, more restful sleep to occur.
Melatonin (1 to 3 mg daily, but consult with your doctor before using, especially if you’re taking an antidepressant). Melatonin is a hormone that helps induce and maintain sleep. It can be useful in helping people recover from jet lag by reorganizing the sleep cycle (assisting the body in adjusting to time-zone changes).
L-Tryptophan (1,000 to 3,000 mg, 30 to 40 minutes before going to bed). L-Tryptophan is a serotonin-precursor, amino-acid nutritional supplement that can help initiate sleep and can be used to reduce chronic pain and depression.
Chinese herbs. These can be very helpful in treating and resolving sleep problems but need to be prescribed by a physician or licensed acupuncturist trained in Chinese herbal medicine.
Acupuncture. Talk with your doctor about the frequency of treatments that might be helpful for you.
Aerobic exercise. Three to four times a week, completed at least three hours prior to bedtime.
Immediate Steps You Can Take to Help Ensure You Get the Rest You Need
Plan your daily schedule to allow seven to nine hours for sleeping every night.
Keep a consistent sleep pattern, even on weekends.
Eliminate caffeine from your diet or reduce your consumption to one cup of coffee or tea, or one soda per day. Caffeine is a stimulant, and it takes six hours or more for your body to metabolize.
After 3 p.m., drink only non-caffeinated beverages.
Take B-vitamins and ginseng in the morning, not before bedtime.
Get regular physical exercise (three to four times a week).
Avoid drinking alcohol near bedtime (although alcohol may cause drowsiness initially, alcohol inhibits sleep continuation).
Make sure sleeping conditions are comfortable (proper temperature and darkness).
Create a bedtime-relaxation routine, which might include:
• Getting ready for and going to bed at the same time each night.
• Taking a hot shower or bath before bed.
• Enjoying a cup of chamomile tea before sleep.
• Reading a book rather than watching TV once in bed. (Instead of having a relaxing effect, watching television before bed actually stimulates the mind.)
• Journaling – as a way of getting problems “off your mind” and onto paper – so they can be dealt with in an orderly way in the future.
Overall, try to remain consistent with your sleep routine – even on weekends and holidays.
Q: Someone near and dear to me suffers from such powerful, long-standing shame that he cannot, or won’t, admit engaging in behaviors that are destructive to his personal relationships (e.g., verbal abuse). Is there any way to confront him gently, in a way that helps him feel safe so that he and his loved ones can start healing their respective relationships?
Jodi Brayton, L.C.S.W., M.S.W.:
This is such a great question on many levels. It involves a universal emotion – to be human is to feel shame – and the very wording of the question shows that the writer already understands the antidote to shame: love, connection, and compassion. I like that the writer gets the fact that destructive behavior should be confronted (in a safe way) in order to begin healing any relationship. There are some very thoughtful experts exploring current research on the issues of shame and compassion and I want to share some information that may be useful to you.
One of my favorite writers from a psycho-therapeutic point of view is Janina Fisher, Ph.D., a therapist who looks at the shame and self-loathing associated with childhood trauma from a neurobiological perspective. Fisher does a beautiful job of explaining that many of our negative behaviors are, or were at one time, beneficial adaptations to traumatic circumstances. Anger, for instance, may be a self-protective maneuver designed to push people away before they can hurt us. She explains how shame and perfectionism are adaptive strategies that drive responses such as hypervigilance, automatic obedience, and total submission; strategies that help young victims survive abuse[i].
The dilemma with confronting people who struggle with shame is that even the kindest, most gentle approach can confirm their worst beliefs about themselves. The thought, “it’s my fault,” can activate areas of the brain that lead to emotional and autonomic reactivity, according to Fisher, which may explain reactions that are destructive to personal relationships, such as verbal abuse.
Curiosity and mindfulness, on the other hand, tend to activate the medial prefrontal cortex, the part of the brain that regulates such emotional and autonomic reactivity[ii]. The job of a therapist is to help clients remain in the medial prefrontal cortex part of their brain because when we are curious and mindful we find meaning and gain perspective. Your friend is more likely to accept a recommendation of therapy if you come from the approach that he is not where he wants to be. The website janinafisher.com has several informative articles that can be downloaded for free.
Understanding the hard science behind behavior can help many people recognize and accept the need for change and there is fascinating research on the physiology behind the healing power of self-compassion. It seems that our body responds to an emotional attack of self-criticism just as it would to the physical threat of having a gun pointed in our direction. The fight or flight response is triggered and the stress hormone cortisol is released in order to mobilize our body to avoid or confront the threatening situation. We all know that too much cortisol over a long period of time can be destructive to our bodies; however, recent research shows that generating feelings of self-compassion can actually decrease those cortisol levels and increase the release of the hormone oxytocin in our system. When we increase the level of the oxytocin we increase feelings of calm, trust, safety, generosity, and closeness to others – all of which are needed to counter the painful emotion of shame[iii].
Kristen Neff, Ph.D., one of the leading researchers on the physiology of self-compassion, has a website – self-compassion.org – that many of my clients find useful. It offers several guided meditations and various exercises designed to help people increase their self-compassion skills. There’s also a self-administered test that measures the elements of self-compassion, as well as the things that hinder our self-compassion, such as self-judgment, isolation, and over-identification. You can recommend this site not only to counter the effects of shame but to anyone who wants to live a more contented and fulfilling life.
The last writer I want to mention is a researcher who has an exceptional ability to inspire people to go to those deep, dark places of shame and fear. Brené Brown, Ph.D., believes that we begin healing by sharing our difficult stories with appropriate others in order to feel worthy, connected, and lovable. She gave a 2010 TEDx Houston talk on the power of vulnerability that was one of the most popular talks on TED.com. She followed up with a second talk in 2012 called Listening to Shame, and together these talks have received over 25 million views. They are chock-full of humor, humanity, and interesting information and you can recommend these talks based on the entertainment value alone.
Another thing I hope you consider reading, and/or offering to your friend, is Brené Brown’s book, The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are. Brown has devoted most of her professional career to the study of human vulnerability, courage, worthiness, and shame, and she really leads by example in this book. In order to help others find the courage to explore their own feelings of inadequacy, Brown fearlessly, and wholeheartedly shares hers. This leaves the reader with a sense of connection to our common humanity, as opposed to the feeling of isolation and alienation that results from keeping things hidden. Many people find this book a valuable tool for self-exploration.
The concept that permeates all the works cited above – and that can help your friend find the non-judgmental state of mind he’ll need in order to observe his own thoughts and behavior in a safe way – is mindfulness. Suggesting mindful practices, such as meditation, prayer, and journaling (especially a gratitude journal) could prove most valuable in helping your friend gain perspective and find a sense of peace even in the most complicated and difficult situations.
Thank you so much for this opportunity to share this information. Your question is important and the task is a challenging one, but Brené Brown sums up what is at risk with the following quote[iv]:
“Owning our story can be hard but not nearly as difficult as spending our lives running from it. Embracing our vulnerabilities is risky but not nearly as dangerous as giving up on love and belonging and joy – the experiences that make us the most vulnerable. Only when we are brave enough to explore the darkness will we discover the infinite power of our light.”
– Jodi Brayton, L.C.S.W., M.S.W.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
[i] Fisher, J. Working with the Neurobiological Legacy of Early Trauma: Paper presented at the Annual Conference, American Mental Health Counselors July, 2003. [ii] Fisher, J. Brain to Brain: The Therapist as Neurobiological Regulator. Psychotherapy Networker. 34:1, January 2010. [iii] Neff, K. D. (2012). The science of self compassion. In C. Germer & R. Siegel (Eds.) Compassion and Wisdom in Psychotherapy. New York: Guilford Press. [iv] Brown, B. (2010). The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are (p. 6). Center City, Minnesota: Hazelden Publishing.
We break down the hidden side effects of three common pain meds.
It’s time to reevaluate how we deal with pain. Pain meds, even the ones that are easily available or ones we think of as safe, can have unintended consequences that take a toll on your body.”We think they’re safe because they’re available over-the-counter, and we consume them like they’re candy,” says Gary Kaplan, DO, author of Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression. “But we need to be much more thoughtful in how we handle our aches and pains.”
Before you reach into the medicine cabinet, consider these lesser-known side effects of pain pills.
Acetaminophen
Acetaminophen (the ingredient found in Tylenol) seems to have the fewest drawbacks, but that doesn’t mean it’s perfectly safe. “It’s OK as long as you do not exceed the recommended dose,” says Dr. Kaplan. “When you exceed the recommended dose, the real risk becomes liver toxicity and damage to the liver.” He stresses that this is why you cannot drink alcohol when taking acetaminophen.
In addition to risks of liver toxicity, new research suggests that acetaminophen blunts not only your pain but also your emotions. In a study from Ohio State University, those who took acetaminophen did not experience the same emotional highs or lows as people taking a placebo.
Pregnant women should also be wary of acetaminophen. “What we thought were OK medications for pregnant women to be taking probably were not,” says Dr. Kaplan.
He explains that boys exposed to acetaminophen in the womb are at higher risk for undescended testes, leading to a higher risk for low sperm count and, potentially, in the long term, testicular cancer. The highest risk for this is during the second trimester of pregnancy, and it can occur with even low, intermittent use.
NSAIDs
Non-steroidal anti-inflammatory drugs, or NSAIDs are easily available over-the-counter, but they come with a long list of health concerns. “These medications that we’ve been told are completely safe, and we take them without a second thought, are, in fact, not completely safe and need to be used with great discretion,” says Dr. Kaplan. “They need to be taken only when needed.”
“The thing that everyone thinks about is the risk for gastric ulcers and bleeding from the gastrointestinal tract,” says Dr. Kaplan. “But the bigger risk is that, with regular use of these medications, we see small intestine ulcers that occur in upwards of 80 percent of people taking these medications regularly. This is going to cause a massive disruption of the gut flora.”
Dr. Kaplan points out that more and more research is coming out showing the impact of the gut on the brain. “So a healthy gut is absolutely essential to having a healthy brain,” he says. “If we’re taking medications that are causing ulcerations in the small intestine, completely screwing up our gut flora and completely screwing up our ability to absorb proper nutrients, when all is said and done, these are not good medications to be taking on a regular basis.”
Heart disease is another health concern associated with NSAIDs. The U.S. Food and Drug Administration issued a warning that NSAIDs can increase the risk for heart attack or stroke, even in otherwise healthy individuals.
Dr. Kaplan says that using these medications less than three times per week is probably safe, but more than that and you are taking a real risk.
And if you have a heart condition and are taking meds for that condition, definitely consult with your doctor about the potential for drug-drug interactions. For instance, Dr. Kaplan explains that if you’re taking aspirin to prevent a heart attack and then take ibuprofen for pain, the ibuprofen will negate the aspirin.
NSAIDs may also interact with antidepressants, increasing the risk of bleeding in the brain, or hemorrhaging, Korean researchers found.
Other risks of taking NSAIDs include increased sun sensitivity and potential kidney damage.
NSAIDs also have risks for pregnant women and babies during all three trimesters, says Dr. Kaplan. Taken during the first trimester, NSAIDs increase the risk for miscarriage. During the second trimester, NSAIDs can have similar effects on baby boys as acetaminophen. And during the third trimester, taking NSAIDs can lead to congenital heart issues in the newborn.
Opioids
The health impacts of prescription opioids are more well known, yet there are people who do take them regularly. “There is a time and a place for opioid medications, but it needs to be very limited and very thoughtful,” says Dr. Kaplan. “There are those with chronic pain on opioid medications, but this is really an admission of failure on our part in our ability to solve the problem because the opioids don’t fix the underlying problem, they just cover up the pain.”
Problems with opioids include constipation, low testosterone, and, since opioids are addictive, withdrawal. During pregnancy, they increase the risk for neurotube defects by about 2.2 times and can lead to withdrawal symptoms in the baby as well as preterm birth.
Looking for Alternatives
“Before we pop a pill, we need to stop and think about what may be causing the pain and what we can do to relieve the pain,” says Dr. Kaplan. Rather than covering up the pain, therapies that include icing, stretching, heat, acupuncture, massage, and physical therapy, eating curcumin-rich turmeric, and taking glucosamine sulfate can help resolve the issue.
“We want to look at how we can fix the problems that have health effects not only at the joint but throughout the entire body,” he adds.
How Sleep Disorders Affect Us and How To Lay Them to Rest
/in Conditions/by Gary Kaplan, DOSleep is absolutely essential to good physical and mental health, and most adults need 7-9 hours of sleep EVERY night. Sleep deprivation — caused by insufficient sleep or poor quality of sleep — impairs the body’s immune system, physical reflexes, emotional stability, and cognitive functions, such as memory, decision-making, the capacity to focus one’s attention, and the ability to complete complex creative activities or mathematical calculations. Severe sleep deprivation may lead to weight gain, an increase in muscle, joint, and nerve pain, depression, and even hallucinations. Sleep disorders can also be symptomatic of more serious illness, such as clinical depression and/or heart disease, meaning that it’s essential to talk with your doctor if you are having problems falling, or staying, asleep.
If you or your doctor think that you might have a sleep disorder, the first step in further evaluation is to answer the 8 questions on the Epworth Sleepiness Scale. If your score is equal to or higher than 10, the results should be discussed with your doctor. Depending upon your symptoms, your physician may determine that you are a candidate for a sleep study.
Another step is to begin keeping a sleep diary that documents your daily activities, including your sleep activities (i.e. tossing and turning, waking in the middle of the night, sleepwalking, grinding teeth, etc.). Take careful note of the times you actually get good sleep versus the times you don’t. If you’re attempting to heal from an acute injury or a chronic illness, your treatment program will be greatly enhanced by your commitment to proper sleep hygiene.
Commonly-Diagnosed Sleep Problems
There are a large variety of sleep disorders. Some are caused by physical problems, such as an airway obstruction that leads to sleep apnea, or chronic pain or indigestion/reflux sufficient enough to cause insomnia. Sleep problems can also occur as a side effect of taking certain medications or supplements, or because of emotional difficulties including depression, post-traumatic stress disorders and/or anxiety about life situations. In many cases, there can be several factors contributing to the sleep disturbance, including anxiety about the sleep deprivation itself. Some commonly-diagnosed sleep disorders include:
Questions? Give Us a Call!
703-532-4892 x2
Treatment of Sleep Disorders
There is a wide range of over-the-counter and prescription medications advertised as sleep aids. All of them – including nutritional supplements, Chinese herbs, non-prescription-medications and prescribed-medications – may have side effects or cause drug interactions; for example, long-term use of Benadryl or Tylenol PM may increase your risk for developing Alzheimer’s. Please talk with your doctor before taking any sleep aids.
Alternative Treatments
Immediate Steps You Can Take to Help Ensure You Get the Rest You Need
• Getting ready for and going to bed at the same time each night.
• Taking a hot shower or bath before bed.
• Enjoying a cup of chamomile tea before sleep.
• Reading a book rather than watching TV once in bed. (Instead of having a relaxing effect, watching television before bed actually stimulates the mind.)
• Journaling – as a way of getting problems “off your mind” and onto paper – so they can be dealt with in an orderly way in the future.
Overall, try to remain consistent with your sleep routine – even on weekends and holidays.
Good night!
This article was first seen on US News & World Report.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
How to Help Someone Who Exhibits Destructive Behavior
/in Mental Health/by Jodi Brayton, LCSWQ: Someone near and dear to me suffers from such powerful, long-standing shame that he cannot, or won’t, admit engaging in behaviors that are destructive to his personal relationships (e.g., verbal abuse). Is there any way to confront him gently, in a way that helps him feel safe so that he and his loved ones can start healing their respective relationships?
Jodi Brayton, L.C.S.W., M.S.W.:
This is such a great question on many levels. It involves a universal emotion – to be human is to feel shame – and the very wording of the question shows that the writer already understands the antidote to shame: love, connection, and compassion. I like that the writer gets the fact that destructive behavior should be confronted (in a safe way) in order to begin healing any relationship. There are some very thoughtful experts exploring current research on the issues of shame and compassion and I want to share some information that may be useful to you.
One of my favorite writers from a psycho-therapeutic point of view is Janina Fisher, Ph.D., a therapist who looks at the shame and self-loathing associated with childhood trauma from a neurobiological perspective. Fisher does a beautiful job of explaining that many of our negative behaviors are, or were at one time, beneficial adaptations to traumatic circumstances. Anger, for instance, may be a self-protective maneuver designed to push people away before they can hurt us. She explains how shame and perfectionism are adaptive strategies that drive responses such as hypervigilance, automatic obedience, and total submission; strategies that help young victims survive abuse[i].
The dilemma with confronting people who struggle with shame is that even the kindest, most gentle approach can confirm their worst beliefs about themselves. The thought, “it’s my fault,” can activate areas of the brain that lead to emotional and autonomic reactivity, according to Fisher, which may explain reactions that are destructive to personal relationships, such as verbal abuse.
Curiosity and mindfulness, on the other hand, tend to activate the medial prefrontal cortex, the part of the brain that regulates such emotional and autonomic reactivity[ii]. The job of a therapist is to help clients remain in the medial prefrontal cortex part of their brain because when we are curious and mindful we find meaning and gain perspective. Your friend is more likely to accept a recommendation of therapy if you come from the approach that he is not where he wants to be. The website janinafisher.com has several informative articles that can be downloaded for free.
Questions? Give Us a Call!
703-532-4892 x2
Understanding the hard science behind behavior can help many people recognize and accept the need for change and there is fascinating research on the physiology behind the healing power of self-compassion. It seems that our body responds to an emotional attack of self-criticism just as it would to the physical threat of having a gun pointed in our direction. The fight or flight response is triggered and the stress hormone cortisol is released in order to mobilize our body to avoid or confront the threatening situation. We all know that too much cortisol over a long period of time can be destructive to our bodies; however, recent research shows that generating feelings of self-compassion can actually decrease those cortisol levels and increase the release of the hormone oxytocin in our system. When we increase the level of the oxytocin we increase feelings of calm, trust, safety, generosity, and closeness to others – all of which are needed to counter the painful emotion of shame[iii].
Kristen Neff, Ph.D., one of the leading researchers on the physiology of self-compassion, has a website – self-compassion.org – that many of my clients find useful. It offers several guided meditations and various exercises designed to help people increase their self-compassion skills. There’s also a self-administered test that measures the elements of self-compassion, as well as the things that hinder our self-compassion, such as self-judgment, isolation, and over-identification. You can recommend this site not only to counter the effects of shame but to anyone who wants to live a more contented and fulfilling life.
The last writer I want to mention is a researcher who has an exceptional ability to inspire people to go to those deep, dark places of shame and fear. Brené Brown, Ph.D., believes that we begin healing by sharing our difficult stories with appropriate others in order to feel worthy, connected, and lovable. She gave a 2010 TEDx Houston talk on the power of vulnerability that was one of the most popular talks on TED.com. She followed up with a second talk in 2012 called Listening to Shame, and together these talks have received over 25 million views. They are chock-full of humor, humanity, and interesting information and you can recommend these talks based on the entertainment value alone.
Another thing I hope you consider reading, and/or offering to your friend, is Brené Brown’s book, The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are. Brown has devoted most of her professional career to the study of human vulnerability, courage, worthiness, and shame, and she really leads by example in this book. In order to help others find the courage to explore their own feelings of inadequacy, Brown fearlessly, and wholeheartedly shares hers. This leaves the reader with a sense of connection to our common humanity, as opposed to the feeling of isolation and alienation that results from keeping things hidden. Many people find this book a valuable tool for self-exploration.
The concept that permeates all the works cited above – and that can help your friend find the non-judgmental state of mind he’ll need in order to observe his own thoughts and behavior in a safe way – is mindfulness. Suggesting mindful practices, such as meditation, prayer, and journaling (especially a gratitude journal) could prove most valuable in helping your friend gain perspective and find a sense of peace even in the most complicated and difficult situations.
Thank you so much for this opportunity to share this information. Your question is important and the task is a challenging one, but Brené Brown sums up what is at risk with the following quote[iv]:
“Owning our story can be hard but not nearly as difficult as spending our lives running from it. Embracing our vulnerabilities is risky but not nearly as dangerous as giving up on love and belonging and joy – the experiences that make us the most vulnerable. Only when we are brave enough to explore the darkness will we discover the infinite power of our light.”
– Jodi Brayton, L.C.S.W., M.S.W.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
[i] Fisher, J. Working with the Neurobiological Legacy of Early Trauma: Paper presented at the Annual Conference, American Mental Health Counselors July, 2003.
[ii] Fisher, J. Brain to Brain: The Therapist as Neurobiological Regulator. Psychotherapy Networker. 34:1, January 2010.
[iii] Neff, K. D. (2012). The science of self compassion. In C. Germer & R. Siegel (Eds.) Compassion and Wisdom in Psychotherapy. New York: Guilford Press.
[iv] Brown, B. (2010). The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are (p. 6). Center City, Minnesota: Hazelden Publishing.
Is It Safe to Keep Taking Your Pain Reliever?
/in Treatments/by Kaplan CenterWhy No Pain Pill Is Totally Safe
By Julia Westbrook
We break down the hidden side effects of three common pain meds.
It’s time to reevaluate how we deal with pain. Pain meds, even the ones that are easily available or ones we think of as safe, can have unintended consequences that take a toll on your body.”We think they’re safe because they’re available over-the-counter, and we consume them like they’re candy,” says Gary Kaplan, DO, author of Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression. “But we need to be much more thoughtful in how we handle our aches and pains.”
Before you reach into the medicine cabinet, consider these lesser-known side effects of pain pills.
Acetaminophen
Acetaminophen (the ingredient found in Tylenol) seems to have the fewest drawbacks, but that doesn’t mean it’s perfectly safe. “It’s OK as long as you do not exceed the recommended dose,” says Dr. Kaplan. “When you exceed the recommended dose, the real risk becomes liver toxicity and damage to the liver.” He stresses that this is why you cannot drink alcohol when taking acetaminophen.
In addition to risks of liver toxicity, new research suggests that acetaminophen blunts not only your pain but also your emotions. In a study from Ohio State University, those who took acetaminophen did not experience the same emotional highs or lows as people taking a placebo.
Pregnant women should also be wary of acetaminophen. “What we thought were OK medications for pregnant women to be taking probably were not,” says Dr. Kaplan.
He explains that boys exposed to acetaminophen in the womb are at higher risk for undescended testes, leading to a higher risk for low sperm count and, potentially, in the long term, testicular cancer. The highest risk for this is during the second trimester of pregnancy, and it can occur with even low, intermittent use.
NSAIDs
Non-steroidal anti-inflammatory drugs, or NSAIDs are easily available over-the-counter, but they come with a long list of health concerns. “These medications that we’ve been told are completely safe, and we take them without a second thought, are, in fact, not completely safe and need to be used with great discretion,” says Dr. Kaplan. “They need to be taken only when needed.”
“The thing that everyone thinks about is the risk for gastric ulcers and bleeding from the gastrointestinal tract,” says Dr. Kaplan. “But the bigger risk is that, with regular use of these medications, we see small intestine ulcers that occur in upwards of 80 percent of people taking these medications regularly. This is going to cause a massive disruption of the gut flora.”
Dr. Kaplan points out that more and more research is coming out showing the impact of the gut on the brain. “So a healthy gut is absolutely essential to having a healthy brain,” he says. “If we’re taking medications that are causing ulcerations in the small intestine, completely screwing up our gut flora and completely screwing up our ability to absorb proper nutrients, when all is said and done, these are not good medications to be taking on a regular basis.”
Heart disease is another health concern associated with NSAIDs. The U.S. Food and Drug Administration issued a warning that NSAIDs can increase the risk for heart attack or stroke, even in otherwise healthy individuals.
Dr. Kaplan says that using these medications less than three times per week is probably safe, but more than that and you are taking a real risk.
And if you have a heart condition and are taking meds for that condition, definitely consult with your doctor about the potential for drug-drug interactions. For instance, Dr. Kaplan explains that if you’re taking aspirin to prevent a heart attack and then take ibuprofen for pain, the ibuprofen will negate the aspirin.
NSAIDs may also interact with antidepressants, increasing the risk of bleeding in the brain, or hemorrhaging, Korean researchers found.
Other risks of taking NSAIDs include increased sun sensitivity and potential kidney damage.
NSAIDs also have risks for pregnant women and babies during all three trimesters, says Dr. Kaplan. Taken during the first trimester, NSAIDs increase the risk for miscarriage. During the second trimester, NSAIDs can have similar effects on baby boys as acetaminophen. And during the third trimester, taking NSAIDs can lead to congenital heart issues in the newborn.
Opioids
The health impacts of prescription opioids are more well known, yet there are people who do take them regularly. “There is a time and a place for opioid medications, but it needs to be very limited and very thoughtful,” says Dr. Kaplan. “There are those with chronic pain on opioid medications, but this is really an admission of failure on our part in our ability to solve the problem because the opioids don’t fix the underlying problem, they just cover up the pain.”
Problems with opioids include constipation, low testosterone, and, since opioids are addictive, withdrawal. During pregnancy, they increase the risk for neurotube defects by about 2.2 times and can lead to withdrawal symptoms in the baby as well as preterm birth.
Looking for Alternatives
“Before we pop a pill, we need to stop and think about what may be causing the pain and what we can do to relieve the pain,” says Dr. Kaplan. Rather than covering up the pain, therapies that include icing, stretching, heat, acupuncture, massage, and physical therapy, eating curcumin-rich turmeric, and taking glucosamine sulfate can help resolve the issue.
“We want to look at how we can fix the problems that have health effects not only at the joint but throughout the entire body,” he adds.
As first seen on RodaleNews.com.