Neuroplasticity and Pain
Reading Time: 2 minutes“In chronic pain, the neurons get stuck in a rut of abnormal patterns of activity, becoming underactive or overactive.’” – John J. Ratey, MD Why the focus on how lifestyle choices impact the brain? The brain senses “ongoing danger and the pain pathways are reinforced instead of inhibited…the pain signaling has relentlessly wired the brain to enhance pain pathways”—keeping the pain turned on. It’s now an accepted fact that “we only experience pain when the electrical signals reach the thinking part of our brains.” This is why neuroscientists subscribe to the idea that pain takes place in a person’s mind. Before it was given any credibility, Dr. Brand believed that if we can learn to control the thinking stage of pain, “we will most likely succeed in keeping pain in its proper place, as servant and not master.” So, what is the mind’s secret to pain control? At least 16 places in the brain have been identified as pain-signaling sites, 9 of which are in the “thinking” part of the brain. Only about 5% of nerve cells normally process pain sensations, but in chronic pain, 15-25% of the cells are dedicated to pain. The chronic-pain brain has “learned” pain and devoted more pathways for pain perception. This is “neuroplasticity”—a change in the brain’s anatomy. Logically, the same principles of neuroplasticity that make the brain more “sensitive” to pain can be used to change brain pathways back to normal function and anatomy—essentially un-devoting pathways to pain perception. By using thoughts, images, sensations, memories, soothing emotions, movement, and beliefs to harness the power of our brains, we can “use the conscious part of our brain to modify the experience of our lives.” As Dr. Ratey says, “practice makes new brain.” What fires together wires together The more we do something in a particular way—speak a foreign language, practice a piano piece, remember to floss, focus on gratitudes—the more neurons are devoted to strengthening those connections. And the more the neurons fire together, the more likely it is they will fire together in the future. It’s why young children seem to effortlessly learn two languages simultaneously and why we never forget how to ride a bike. It’s also how we get into habits—good or bad—and why we choose to make lifestyle choices that help us manage our pain.
The Mind/Body Connection
Reading Time: 4 minutes“A sad soul can kill you quicker, far quicker, than a germ.” – John Steinbeck What if you could understand a connection between your brain and your body that is the key to managing your chronic illness? For example, pain has long been considered a physical reaction to an injury. But while the injury may cause pain, it is never the only reason we hurt. Science teaches that pain is felt when the nervous system responds to tissue damage: an injury occurs, a message goes to the spinal cord, and on to the brain, which registers the pain. This understanding of pain as only a response to tissue damage is incomplete. We now understand that our bodies and our minds work in tandem, and there is more to pain than the physical feeling. Deb Shapiro writes in her book, Your Body Speaks Your Mind, of having an upset stomach when she was a child and being asked by her grandmother if she was having a problem at school. “What she knew instinctively, we are at last beginning to prove scientifically: there is an intimate and dynamic relationship between what is going on in your life, and your feelings and thoughts, and what happens in your body.” We come from the “factory” with an array of responsive mechanisms in our body and brain. One prepares us for coping with sudden, frightening, or dangerous events: the sympathetic nervous system. Its role is to mobilize body resources for danger—the fight or flight response. When the SNS is dominant, certain body functions are restricted (salivation, digestion, and gut motility), while others are given extra resources (adrenaline production is stimulated, the heart rate is increased, blood vessels are constricted, air passages are dilated, and sweat glands are stimulated). The other responsive mechanism is the parasympathetic nervous system—the rest system. When it’s dominant, the heart rate slows, blood pressure falls, digestive organs work smoothly, and the immune system is optimized. The sympathetic nervous system mobilizes our body & mind for emergencies, offers those same resources for ongoing stress, and maintains the “household.” The parasympathetic nervous system calms our body and complements the sympathetic nervous system. It’s easy to see that when the sympathetic nervous system is on high alert (hyper-tension) for an extended period of time—as it can be when we are in chronically stressful situations—there is less time and energy for the body to be at rest. Here’s our reality check: chronic illness automatically puts the body in chronic stress. But some situations we describe as stressful turn out not to stress the mind or body unless we think of them as negative or fearful. Have you ever anticipated a future event with dread and become anxious just thinking about it? It hasn’t even occurred, and your sympathetic nervous system is responding—producing adrenaline, increasing heart rate, constricting blood vessels, dilating air passages. Wow! You might be saying, the relationship between the mind and body is a powerful one. Dr. Christiane Northrup compares our control over physical issues with being on a turbulent flight. “You have no control over the winds, or the skills, or the mental state of the pilot flying the plane. But you do have the power to minimize your discomfort. You can decide to read a book, strike up a conversation with the person next to you, wrap up in a warm blanket, sleep, listen to music, or watch a movie. Alternatively, you can listen to every engine noise and allow yourself to be debilitated by worry the entire flight. It’s your choice.” As you can see, the mind-body connection has huge implications for those of us with chronic illness. We have a choice of how we react to stimuli. Our actions—thoughts, activity, daily habit patterns —can either increase our perception problems or lessen their impact. It doesn’t mean we pay no attention to it, and the pain subsides. It’s about making choices that influence brain chemistry, which in turn controls our experience. What surprises many of us is how our mental status either increases our pain or helps to lower our perception of it. After becoming aware of the body’s reaction to emotion, many people see a connection between their depression and chronic pain, anxiety, and a pain flare. Taking personal responsibility for managing our pain can prevent us from falling into the hopelessness and depression often associated with chronic pain. Thoughts are processed in the cerebrum, and feelings are “layered” with thoughts in the cerebrum’s limbic system. The hypothalamus gland acts as a bridge between these areas. So, when we have a negative thought or when pain or stress is experienced, the hypothalamus stimulates the pituitary gland to release the hormone adrenaline. Look at the list of body responses to adrenaline release: increased heart rate elevated blood sugar suppressed immune system increased breathing rate a rise in blood pressure stomach acid secretion constricted blood vessels increased muscle tension. All of this from just a stressful thought! This is the fight or flight system turned inward. When the body is continuously flooded with adrenaline, organs are under chronic stress. Instead of the body addressing daily requirements, it is reacting to an ongoing emergency (likely what happens in post-traumatic stress disorder (PTSD). The mind-body connection in action: think negatively about our pain, and a negative emotion is produced. Do you identify with some of the following examples? Thought Emotional Experience I just can’t live with this pain one more day! fear, anger, hopelessness Why doesn’t my doctor figure out what’s making me hurt and get it solved once and for all?! anxiety, helplessness I wish I could go back to before this illness started—when I was healthy. sadness, remorse, grief Beverly Thorn observes: “Since the brain processes our thoughts and emotions, it makes sense that thoughts and feelings could also have an influence on the experience of pain. And there is mounting research evidence that thoughts and feelings have a direct physical impact on the way the brain processes pain.”
Rest and Renewal
Reading Time: 5 minutes“Sleep is that golden chain that ties health and our bodies together.” – Thomas Dekker After several months of experimenting with sleep practices and routines, you have undoubtedly increased the amount of shut-eye you get on a regular basis. But it’s easy to fall back into old habits, let others interrupt good intentions, or simply forget the tools we use to manage our chronic illness. Let’s visit some principles and review practices that can improve our sleep. Principles Know what makes you tick—the physical, emotional, mental, and spiritual. Each of us is unique in each of these areas, so knowing how things affect us and finding ways to create balance is a skill that complements every strategy in chronic illness management. Focus on what gives you pleasure and peace, not on what creates fear or dissatisfaction. Sleep is our soft spot, so a gentle approach is more effective than disciplined inflexibility. A plan to fit the season, temperature, and environmental factors heightens the likelihood of a good night’s sleep. Practices Day in, day out. Adopt a consistent schedule for bedtime and waking. Your body and mind can’t create regularity out of chaos. Exercise your right to sleep. OK, it’s a pun, but exercising early in the day will produce better sleep at night. That said, anything that requires the body or mind to work hard—eating, drinking cold beverages, environmental chaos, fear, or anxiety—prevents the body from going into sleep mode; so it’s a good idea to protect the two-hour zone prior to bedtime. Slowly but surely. Adopt routines and rituals that support restfulness. For one person, it might be a cup of herbal tea and a good book. For someone else in a warm climate, it could be a leisurely walk through the park. It’s easier to stop a vehicle that’s moving slowly than one that’s speeding. There’s a lesson in that for us. Go out like a light. Darkness is essential for the natural production of melatonin, the sleep hormone. Dim the lights and turn off TVs and computers 30-60 minutes before hitting the hay. Chickens tuck their heads under a wing at dusk and are clucking with first light the next morning. While it might not work for us to function with that schedule in the winter, when darkness takes up to 14 hours of the 24 hours in a day, it’s important to recognize how sleep is impacted by environmental elements. Rest assured. Thinking about things in the past or future can produce anxiety or guilt in the middle of the night. Have you noticed that what we fret about are often things we fear we’ll forget? Consider a nightly ritual of writing down concerns and problems before bedtime. If you wake in the middle of the night, add insomnia-producing thoughts to the list so you can let go of them. Focusing on gratitudes and breathing can calm the mental roar and allow you to fall asleep again. Do electronic readers interfere with sleep? New research supports older studies, which have found that screen time before bedtime can affect sleep. In the latest study, iPad readers took longer to fall asleep, felt less sleepy at bedtime, and had shorter REM sleep compared to those who read a print book. Those reading an electronic device also secreted less melatonin and felt more tired the following day, even if they got a full eight hours of sleep. Sleep deficiency—not getting enough sleep or obtaining poor quality sleep—has been linked to a plethora of serious health problems. If you MUST use an electronic reader before bedtime, several devices offer a blue-light blocker app, and filter screen protectors can be found for other products by typing “blue light screen filter for [device]” into your internet browser. Medication There are times when life produces new challenges or extra anxiety, and your physician may suggest the use of medications. Here’s a short wrap-up on how the most common prescriptions and over-the-counter meds work: Most sleeping pills are “sedative hypnotics” and include benzodiazepines, barbiturates, and various hypnotics. Xanax, Valium, Ativan, and Librium are anti-anxiety medications. While these drugs may be useful in the short term, all benzodiazepines are potentially addictive. Halcion is an older sedative-hypnotic that has largely been replaced by newer medications. Barbiturates depress the central nervous system and are usually limited to anesthesia. Newer medications (Lunesta, Sonata, and Ambien) help reduce the time it takes to fall asleep and are less likely than benzodiazepines to be habit-forming. Sleeping pills have side effects like most medications, but individual response varies. Some medical conditions, such as asthma and COPD, require careful oversight because sleeping pills slow breathing. When taking medications, any changes in digestion, headaches or heartburn, shaking or weakness should be reported to your physician immediately. Most over-the-counter sleep aids are antihistamines. They can induce sleepiness, but can also cause next-day drowsiness. Care should be taken not to take them with other drugs containing antihistamines (like cold or allergy meds). Any sleep aid should be taken only when 7-8 hours of sleep time is ensured because they can cause significant drowsiness. Over time, some medications cause dependence, where sleeping becomes difficult or impossible without the drug. As with any medication, discuss dosage and use with the doctor or pharmacist, and utilize your knowledge of sleep practices to minimize your need for drugs. Read more. Natural Remedies The use of natural sleep aids is helpful to some. Be aware that these are not regulated by the FDA and our bodies all respond to supplements in different ways. The following guidelines are published by WebMD. Melatonin is a hormone produced in the pineal gland in the center of your brain. Some people may not produce enough, and most of us get in the way of production. If used, 0.1-0.3 milligrams may be sufficient to promote sleep. Some users report going to sleep faster, but waking in the middle of the night; others feel groggy or depressed. Supplements can be used to jump-start a
Could Low-Dose Naltrexone Help With Chronic Pain?
Reading Time: 2 minutesBy: Christina Le-Short, MD If you live with chronic pain, you may have heard about low-dose naltrexone, or LDN. It has been getting more attention because it is a non-opioid medication that may help some people with chronic pain, especially when the nervous system has become overly sensitive. LDN is usually prescribed in very small doses, often around 1 to 5 mg daily, and is used off-label for pain.¹ What makes LDN interesting is that it may work differently from many traditional pain medications. Rather than simply dulling pain signals, it may help calm some of the inflammatory and sensitization processes involved in chronic pain. That is why it is often discussed for conditions like fibromyalgia and other pain states where the body’s alarm system seems stuck in the “on” position. The evidence for LDN is most encouraging in fibromyalgia. Reviews and meta-analyses suggest that some patients experience improvement in pain and related symptoms, and that LDN is generally well tolerated. At the same time, the studies have been small, so more research is still needed. For patients, one of the biggest appeals of LDN is that it is not an opioid and is usually not sedating. Some people who respond to it report improvement not just in pain, but also in fatigue, sleep, brain fog, and flares. It is not a cure, and it does not work for everyone, but it can be a reasonable option to discuss as part of a broader pain treatment plan.² LDN is generally considered well tolerated, but side effects can happen. The most commonly reported ones include vivid dreams, trouble sleeping, headache, nausea, and stomach upset. One important caution: because naltrexone blocks opioid receptors, LDN is usually not a good fit for people who are taking regular opioid pain medication unless there is a very specific clinician-guided plan. It can also complicate pain control around surgery or acute injuries if opioid medication is needed.³ The bottom line is that LDN is a promising non-opioid option for some people with chronic pain, especially those with fibromyalgia, widespread pain, or pain sensitization, but it works best when it is part of a larger plan that may also include movement, pacing, sleep support, rehabilitation, and behavioral strategies. Interested in whether LDN could be right for you? At Override, we take a whole-person approach to chronic pain. We look at the full picture, including your symptoms, goals, medical history, nervous system sensitivity, sleep, stress, movement, and what you have already tried. If you are interested in whether LDN may be a fit for you, our team can help you think through the potential benefits, risks, and how it fits into a broader plan to help you feel and function better. ¹ Aitcheson, N., Lin, Z., & Tynan, K. (2023). Low-dose naltrexone in the treatment of fibromyalgia: A systematic review and narrative synthesis. Australian Journal of General Practice. ² Vatvani, A. D., Patel, P., Hariyanto, T. I., & Yanto, T. A. (2024). Efficacy and safety of low-dose naltrexone for the management of fibromyalgia: A systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Korean Journal of Pain, 37(4), 367–378. https://doi.org/10.3344/kjp.24202 ³ U.S. Food and Drug Administration. REVIA (naltrexone hydrochloride tablets USP) 50 mg, Opioid Antagonist. FDA label, 2013.
Diaphragmatic Breathing
Reading Time: 3 minutes“Diaphragmatic breathing is my secret weapon against pain.” -Becky Curtis Breathing is a natural process we don’t think about much. Because it is so automatic, we just assume we’re doing it right. But there are two different ways to breathe. One is shallow chest breathing, high in the chest. The other is diaphragmatic breathing‒deep breathing that expands the rib cage. As we learn to pay attention to our breathing, we will discover a wonderful stress management tool that can be used any time or place. Chest breathing is considered shallow breathing and is the automatic way we breathe when stressed. The next time you are tense, notice your breathing pattern. You may feel tightness in the chest and realize you occasionally “catch up” with an extra-deep breath (one that sounds like a heavy sigh to those around you). If you pay attention, you may feel like you’re not getting enough air, and will notice how shallow and short your breaths are–all because the neck and chest muscles are less efficient than the diaphragm at bringing fresh air into the lungs. Chest breathing can create both chemical and structural imbalance (tension) in the body. We live in a stressed-out society where tension seems to be the norm. And stress takes its toll on the body, causing: Headaches Shoulder and neck pain Low back pain What is Diaphragmatic Breathing? The diaphragm is a dome- shaped sheet of muscle that extends across the bottom of the rib cage. It is the strongest and most efficient breathing muscle. Utilizing the diaphragm to breathe will: Bring increased oxygen into the lungs Decrease muscle tension Regulate body metabolism Ease and reverse the biochemical effects of shallow breathing (that engage the sympathetic nervous system) Strengthen the diaphragm for increased efficiency What Diaphragmatic Breathing Does For Stress Reduction and Pain Management: Those of us with Chronic illness are often chest breathers. Because we fear more pain or are stressed, we take small, shallow breaths. This only makes things worse, however, as chest breathing increases muscle tension—thus increasing the pain. What can diaphragmatic breathing do for you? Help to relax tense muscles. Be a great distraction tool. Because our brain can only concentrate on one thing at a time, a focus on breathing takes the mind away from the stress and pain. Reduce physical symptoms of anxiety and stress—especially through slow, deep breathing. Improve circulation, which improves clear thinking and relaxes body tissues. All these reactions ease tension and, thus, reduce stress and pain. How to Do Diaphragmatic Breathing: To begin, sit with your feet flat on the floor or lie on your back. Place one hand on your high chest and the other over your rib area (above the abdomen). As you breathe deeply, your upper chest should be still. You will feel your entire torso (rib cage and abdomen) expand as you fully inflate the lungs. Now exhale completely, pushing the air out with the abdominal muscles. As you exhale, relax your face, shoulders, neck, chest, back, and anything else that is tense. This will become easier with practice, until you automatically engage the diaphragm—not just while sitting or lying down. Try deep breathing several times per hour until it becomes a natural part of your life. You should begin to feel less stress and tension. This is a secret weapon to use against pain flares, too—anywhere, anytime you need it! When you have mastered diaphragmatic breathing, you may want to practice and use Dr. Andrew Weil’s instructions for a little extra calming. Place the tip of your tongue against the ridge behind and above your front teeth and keep it there through the whole exercise. Inhale deeply and quietly through the nose to a count of 4 (with your mouth closed). Hold your breath for a count of 7. Exhale completely through your mouth (making a “whoosh” sound) to a count of 8. Repeat steps 2, 3, and 4 for a total of four breaths. Practice this exercise at least twice a day and whenever you feel stressed, anxious, or off center. Adjust the approach so it works best for you. Why This Works: The autonomic nervous system (responsible for involuntary functions like heart rate and digestion) can be divided into two subsystems—sympathetic and parasympathetic. The first keeps us safe; the second relaxes us and keeps the body in balance. Think of the sympathetic nervous system as the rapid-response system that engages our fight-or-flight response. Things that increase sympathetic tone include:
When “You’re Fine” Doesn’t Feel Fine
Reading Time: 3 minutesBy: Kili Preitauer, CEO of Override Have you ever had a doctor tell you your scans are clear? That everything looks normal? That they can’t find the cause of your pain? And yet… you’re still in pain. For many people, hearing “you’re fine” doesn’t feel reassuring. It feels dismissive. It can make you question yourself, your body, and whether anyone is really listening. Let’s start here: Your pain is real. You’re not imagining it. You’re not exaggerating it. And you’re certainly not alone. So, Why Does This Happen? Our healthcare system is very good at finding structural problems, things like tears, fractures, or inflammation, you can see on a scan. But pain is more complex than that. Sometimes, even after the body has healed, the pain doesn’t go away. A Different Way to Understand Pain Think of your nervous system like a security guard whose job is to keep you safe. When everything is working well, the guard only reacts to real danger. But after an injury or a long period of pain, that system can become overprotective. It may start reacting to normal movement or everyday activity as if something is wrong. It may sound the alarm even when there’s no longer a real threat. The system isn’t broken. It’s trying a little too hard to protect you. Pain Can Be Learned Here’s something most people are never told: Pain isn’t just a signal from the body. It’s also something the brain can learn. Your brain is constantly adapting. This ability is called neuroplasticity, it allows you to learn new skills, build habits, and form patterns. But it also means your brain can learn pain. The more those pain signals fire, the more the brain reinforces them. Neurons that fire together, wire together. Over time, your nervous system can become more sensitive, making pain show up faster, stronger, and more often, even when the original injury has healed. What the Science Shows Researchers have studied this by following people with back pain over time. At the beginning, patients looked very similar, same level of pain, similar injuries, similar experiences. But over time, about half of them recovered, while the other half developed long-term pain. The difference wasn’t just in their bodies. It was in their brains. Two areas became more strongly connected in people who developed chronic pain: The medial prefrontal cortex, which helps with meaning, emotions, and how we interpret experiences The nucleus accumbens, which is involved in motivation, reward, and how we respond to threat This increased communication between these regions could actually predict who would still be in pain later. In other words, for some people, the brain had started to reinforce the pain experience, even after the body had healed. So What Does This Mean for You? If you’ve been told “everything looks fine,” but you’re still in pain, it doesn’t mean it’s all in your head. It may mean that your nervous system is still on high alert. Your body may have healed, but your brain is still working overtime to protect you. And that’s something that can be addressed. Why Traditional Approaches Don’t Always Work Treatments like medications, injections, or adjustments can be helpful, especially early on. But if the nervous system has become sensitized, those approaches alone may not fully resolve the problem. Because at that point, the pain isn’t just about the body anymore. It’s about how the brain and nervous system are processing signals. A More Complete Approach to Pain At Override, we believe in treating both the body and the nervous system. We work with patients to: Calm an overactive nervous system Retrain how the brain interprets signals Gradually rebuild trust in movement and activity Address the physical and functional aspects of pain Because lasting relief doesn’t come from addressing just one piece of the puzzle. You’re Not Alone If you’ve felt dismissed, frustrated, or stuck, you’re not alone. We’ve worked with thousands of patients who have heard the same thing: “You’re fine,” while still living with daily pain. We hear you. We believe you. And there is a path forward.
From Burnout to Purpose: Why Lifestyle Medicine Is Changing How Clinicians Practice
Reading Time: 2 minutesBy: Kili Preitauer, CEO of Override I run a multidisciplinary telehealth group practice with more than 40 clinicians across pain medicine, psychology, physical therapy, and coaching. One pattern we consistently see is clinicians coming to us after feeling burned out in more traditional models of care. They often describe feeling rushed, reactive, and disconnected from meaningful patient progress. Many are looking for a different way to practice, one that allows them to address root causes, spend time on education and behavior change, and work within a team. When clinicians shift into that model, we often see not only improved patient outcomes but also a noticeable improvement in their sense of purpose and professional satisfaction. That’s why these findings on lifestyle medicine and burnout resonate with me. 1. Initial Thoughts on the Findings I’m not surprised by the findings. Burnout is frequently tied to moral distress and a sense of ineffectiveness. When clinicians are able to practice in a way that addresses the drivers of chronic disease, sleep, stress, movement, nutrition, and social connection, they often feel more aligned with why they entered medicine in the first place. In our practice, we see clinicians regain a sense of impact when they can work upstream instead of simply managing downstream complications. 2. Why Lifestyle Medicine May Improve Clinician Wellbeing There are several likely mechanisms. First, lifestyle medicine shifts the clinical encounter from reactive to proactive. That shift increases a clinician’s sense of agency. Second, it often allows for longitudinal relationships. Seeing a patient’s pain improve because they are sleeping better, moving more, and regulating stress differently creates visible progress. That reinforces professional efficacy. Third, lifestyle-based approaches tend to be collaborative and team-oriented. In a multidisciplinary setting, clinicians are not carrying the entire burden of change alone. That shared responsibility reduces isolation, which is a significant contributor to burnout. We regularly see clinicians report greater satisfaction when they can work within a biopsychosocial framework rather than feeling confined to brief, procedure-focused visits. 3. What Lifestyle Medicine Is Lifestyle medicine is an evidence-based approach to preventing and managing chronic disease by addressing modifiable behaviors and social determinants of health. Core pillars include: Nutrition Physical activity Sleep Stress management Social connection Reduction of harmful substances It complements traditional medical therapies. It is not an alternative to evidence-based medicine, but an expansion of it to address the underlying contributors to disease and dysfunction. 4. Broader Benefits of Reduced Burnout Reducing burnout has system-wide implications. Lower clinician burnout is associated with improved communication, better safety outcomes, lower turnover, and stronger patient trust. From a leadership perspective, clinician well-being is not separate from patient outcomes. When clinicians feel effective and supported, care quality improves. The two are tightly linked. 5. Limitations Lifestyle medicine is not a cure for systemic burnout. Administrative burden, productivity pressure, and EHR inefficiencies remain significant drivers. It should be viewed as one piece of a broader solution that includes organizational change, workflow redesign, and access to mental health support when needed. No single clinical philosophy can compensate for structural dysfunction. 6. How Clinicians Can Use These Findings Clinicians experiencing burnout can reflect on whether their current practice model allows them to work in a way that feels aligned with their professional values. In some cases, small shifts toward more education, prevention, and longitudinal engagement can increase meaning. In other cases, it may require larger structural changes in the practice setting. Importantly, the principles of lifestyle medicine apply to clinicians themselves. Sleep, movement, stress regulation, and social connection are not just patient interventions; they are protective factors for clinician health as well.
Sleep
Reading Time: 4 minutes“A well-spent day brings happy sleep.” -Leonardo da Vinci Time warp…mid-1800s: You live in the country—no electricity, and lamp oil is a valuable commodity. So, when the sun starts to go down, you begin to relax and prepare for bedtime. Your brain starts producing sleep hormones. You then fall asleep and stay that way until the sun comes up in the morning. This is how it was done before the invention of the light bulb. The 21st century: You get home from work and rush to get things done. You barely notice the sun going down because your home is full of artificial light. You keep going until you just want to sit down‒a natural reaction to being up for 16+ hours. So, you plop down in front of the TV. Finally, you force yourself to bed, and hopefully sleep. Unfortunately, a high percentage of us—especially when we live with chronic illness—struggle with getting to sleep and staying asleep. Here’s why: sleep is regulated by the production of sleep hormones, such as melatonin, and enhanced by other internal logic that relaxes our conscious mind and body for a good night of sleep. The brain doesn’t start the production of melatonin until it is dark and the body is relaxed—up to a two-hour process. Consider how a typical routine—of rushing and working hard before “relaxing” in front of the TV’s blue light, high-throttle programming, and news full of the latest world and local woes—impacts your ability to sleep. Sleep deprivation affects behavior, mood, ability to cope, thinking, the immune system, and our experience of pain. While adequate sleep is essential just for us to feel good, it also allows the body to produce substances that fight infection and inflammation. It is during our sleeping hours that many body functions are renewed and supported—even the production of chemicals that enhance deep sleep and communications with organs such as the stomach (a connection that helps prevent mindless eating and food cravings during the day). Jim Horne, PhD (Director of the Loughborough University sleep research laboratory), notes that complex brain work, such as updating working memory, planning, attention, sense of time, and verbal fluency, are functions most likely to suffer with sleep loss. “…what seems to be happening is that the functional part of the brain appears to be working even harder …to no avail.” In order for the nervous system to work properly, it needs to be restored each night. When we get too little sleep, we are less equipped to deal with stress. We can be irritable, get drowsy during work hours or while driving, have difficulty concentrating, become forgetful, and lose physical coordination. If sleep deprivation goes on long enough, it can cause wild mood swings and even hallucinations. Adequate sleep is essential to the management of chronic pain. If your night is during the day, your challenges to good sleep are more complex. Routine, a cool darkened room, and undisturbed sleep are must-haves. You may find that white noise (a fan or a recording of water, wind, or rain) overrides the sounds of traffic and others in the house, available in the form of machines and smartphone apps. How much sleep do we need? Consider how much sleep it takes for you to: □ feel rested □ concentrate and stay focused □ get out of bed easily □ maintain a happy mood □ avoid drowsiness the next day Schedule Consistent Sleep Schedule: Our bodies are regulated by a circadian clock‒a timepiece that requires regularity to maintain its rhythm. The more regular your schedule, the stronger your clock will be. Going to bed at the same time each night and waking at the same time every morning provides regular production and utilization of melatonin. Naps: While there are benefits to napping, those who have trouble sleeping at night may find that napping only makes regular sleep more difficult. If you need a nap, limit it to 10-20 minutes (as your sleep schedule improves, you can cut back on napping until you no longer count on it as a supplement). If you experience ongoing problems getting to sleep, avoid naps altogether. Environment and Activities A Relaxing Ritual: We get so busy that it’s easy to keep going until we hit the bed. To prepare for sleep, try winding down with some reading (from a book instead of an electronic device), listening to soothing music, or light stretching 30+ minutes before bedtime. Reduced light and a calm atmosphere prepare our bodies to produce melatonin, which in turn, helps us sleep. Make a list of things that relax you, and avoid the TV and computer (the light and the stimulation keep the brain from relaxing) an hour or two before bedtime. A Relaxing Place: It’s important to keep stress out of the bedroom. It should be a welcoming, restful space—ideally cool and dark. The best rule: nothing but sleep and sex in the bedroom. Planned Worry: If worry is something that keeps you awake, make a plan for taking care of those thoughts before bedtime. Try keeping a pad of paper and a pen handy, then write your worry list just before turning out the light. Or, if a worry pops into your head when you’re trying to sleep, write it down and promise to deal with it the next day. Exercise: If you don’t feel like you are able to exercise due to your illness, don’t sweat it. Your coach has probably already offered to share his or her courage with you until you’ve built your own. In the meantime, learn everything you can about what your body can handle and keep an open mind on how to lessen its impact on your life. If exercise is something you’d like to try, start slow and easy. Talk to your doctor or physical therapist, and work with your coach to set goals and track successes. Read more. Eating and Drinking Caffeine: Caffeine can cause a disruption in your sleep, since it can stay in your
Intuitive Eating
Reading Time: 6 minutes“When you’re focused on food (or not eating food), you can’t focus on living your life.When you focus on living your life, food becomes much less important.” -Michelle May, MD Although we think of ourselves as super-intelligent, we do quite a lot of what we do instinctively. We walk upright, we are alert to danger, we communicate with words and gestures, and we get sleepy when it gets dark. But when it comes to eating, our instincts are sometimes frustrated by someone else’s advice or our own failure to do what comes naturally. If we observe healthy animals in nature, they do everything they do by instinct—what we might call intuitive living: eating, resting, drinking, birthing, fleeing from danger, fighting to preserve their species. But notice that when they live near a touristy spot, their eating habits change, and their fear of humans disappears—they are conditioned to alter their instincts for some benefit. Every car door that opens signals a chipmunk to dart into view for a cracker or peanut; in captivity, animals move closer to the fence when they smell visitors’ food; the household pet races to its dish when anyone walks near the feeding area. Along with Mother’s advice to eat this, not that, we’ve all listened to enough news and advertising to know that eating is important to our health. Trouble is, information and environment complicate what was once an intuitive activity to save us from starving to death. Today, our options for food are almost unlimited—no longer driven by location, seasonal availability, cooking techniques, and preserving methods. When we live with chronic illness, the things we do intuitively may change—perhaps more sitting or lying down, discontinuing a sport or favorite activities, fearing certain movements. Instinctual functions are impacted by our emotions, other people’s activity, complex schedules, and the myriad of options we live with. Media constantly barrages us with suggestions that we should try this food, drink this beverage, take this medication, fear this condition, go on this diet, compare ourselves to this model—until living moves completely away from a natural (intuitive) function, and enters the realms of competition, imitation, avoidance, and self-medicating. It’s almost like changing the question, “What do I want to eat?” to: What do I want to avoid? What should I eat to feel better? Who do I want to imitate? How can I eat less (or more) than she does? In the ‘60s, Twiggy changed our view of “sexy” to mean “skinny.” And changes in family structures, community sizes, working hours, and food manufacturing turned eating three meals a day at home as a family into fast-food drive-thru meals, TV snacking, supplement shakes, and dieting. Yes, environment and emotions have a lot to do with how we eat. The Diet Trap It’s so easy to buy into instant results in our on-demand culture. Diets are one of those temptations. A movie star lost 20 pounds in one week so she could fit into her Oscars dress…therefore, so can I. He says his secret to building muscle is eating protein, not carbs, so I’m going to stop eating carbs altogether. Registered dieticians and numerous scientific studies warn us that dieting doesn’t provide long-term health or weight loss. Instead dieting: makes the body think it’s being starved, so it starts hoarding fat reserves by slowing the metabolism; causes us to experience increased cravings; may play a role in binge eating and eating disorders; increases weight loss resistance with every dieting episode; shifts the body into a survival mode that matches weight loss with weight gain; contributes to low self-esteem—either from “failing” or from the belief that I am defective. So what is the alternative when we want to be a healthy weight? Being in Control vs. Being in Charge Dieting may provide the worst gambling payout, ever. Yet we let the ads, books, and magazines convince us we can control our appetite and impulses. Let’s think about how controlling ourselves feels (whether we succeed or not): tense, guilty, fearful of failing. Not exactly the best way to relax or care for ourselves, is it? If we are going to live successfully with chronic pain or illness, it’s essential to switch tactics. Trying to be in control of something that isn’t fully understandable (body, mind, universe, spouse, or kids) can make us feel a little crazy. Being in charge of elements within our capacity to direct and choose helps us to: acknowledge personal responsibility and values, and work with universal laws and widely-accepted principles. Respecting what we can’t change—the law of gravity, for instance—demonstrates intelligence. Acknowledging our limitations—to multitask or lift 50-pound boxes—is what we do once we choose not to argue with reality. Working with our body and mind (a team) is a lot more productive than engaging in warfare, the driving principle of dieting. Our bodies are incredible machines, built to seek and maintain homeostasis (metabolic equilibrium and biological balance). This doesn’t mean that everybody is built to look like some lithe supermodel or to pole vault 20 feet. It means that—aside from physical limitations—my body will seek homeostasis if I give it the tools it needs. Physical Hunger vs. Emotional Hunger Hunger is a natural, instinctive body signal to satisfy hunger and feed the body’s nutritional needs. Instead, we tend to plan our social lives around food and drink. Then, when emotions and stress get in the mix, eating takes on a lot of behaviors: overeating, non-nutritional eating, calorie-heavy snacking, bingeing, or starvation dieting. Can you identify your feelings around any of these actions? Is food filling an emotional deficit, healing a wound, taking the place of friends, dulling pain, or has it become the enemy? What is Intuitive Eating? Intuitive eating “relies on your internal cues and signals,” explains Michelle May, MD.* Because it can be hard to tell the difference between wanting to eat and needing to eat, a system for checking in with body, mind, and heart will bring eating into an intuitive realm, she explains. Focusing
Self-Compassion
Reading Time: 5 minutes“Taking good care of yourself means the people in your life receive the best of you rather than what is left of you.” -Lucille Zimmerman One of the most common emotional responses to life’s pressures is a lack of self-compassion. Despite connective technology, we often find ourselves isolated, obsessed with our own self-esteem or spending most of our energy on others: taking care of children, aging parents, spouses or friends. In this over-full lifestyle, it’s easy to turn our backs on ourselves. We become self-critical and judgmental, especially when our lives have unfolded in ways that we couldn’t have imagined. Americans devote Valentine’s Day to showing love and compassion to others, but how often do we give that same love and compassion to ourselves? Worse yet, we’re often our own worst critic. This tendency leads to negative self-talk and behavior patterns that increase the stress response. Self-criticism and inwardly-focused judgments can lead to anger, depression, and even physical illness. And this is not helpful in our journey to manage chronic illness. What is Self-Compassion? Dr. Kristin Neff, leading researcher on the topic, defines self-compassion in her book: “Having compassion for oneself is really no different than having compassion for others. Think about what the experience of compassion feels like. First, to have compassion for others you must notice that they are suffering….Second, compassion involves feeling moved by others’ suffering so that your heart responds to their pain (the word compassion literally means to “suffer with”)….you feel warmth, caring, and the desire to help the suffering person in some way. Having compassion also means that you offer understanding and kindness to others when they fail or make mistakes, rather than judging them harshly. Finally, when you feel compassion for another (rather than mere pity), it means that you realize that suffering, failure, and imperfection is part of the shared human experience.” So, proposes Neff, “instead of mercilessly judging and criticizing yourself for various inadequacies or shortcomings, self-compassion means you are kind and understanding when confronted with personal failings—after all, who ever said you were supposed to be perfect?” What Self-Compassion is NOT As important as Dr. Neff’s study of what self-compassion is would be her study of what it is not. She draws a distinct line between self-compassion and self-pity. When we feel self-pity, we are focused on our own problems and forget that others have similar challenges. We tend not connect with others, feeling that we’re the only ones in the world who are suffering. Elements of Self-Compassion According to Dr. Neff, there are three elements of self-compassion: Self-kindness — Rather than ignoring our discomfort or “beating ourselves up” with self-criticism, self-compassion involves warmth and understanding toward ourselves when we suffer, fail, or feel inadequate. Self-compassionate people accept that being imperfect, failing, and experiencing difficulties is unavoidable, so they tend to be gentle with themselves when confronting painful experiences. We cannot always be or get exactly what we want. When we argue with reality, suffering increases in the form of stress, frustration, and self-criticism. Common humanity — “Self-compassion involves recognizing that suffering and personal inadequacy are part of the shared human experience—something that we all go through, rather than being something that happens to ‘me’ alone.” Mindfulness — Being mindful of our feelings—neither suppressing nor exaggerating them—allows us to observe negative thoughts and emotions without judgment. Studies show that ignoring or denying our feelings and emotions actually creates confusion in the brain’s emotional/memory process. It’s best to consciously choose to learn from our feelings and focus our attention on something we desire or value. Principles of Self-Compassion The basic principles of self-compassion are likely not new to us. We’ve experienced compassion for another person or animal at some time in our lives, but directing the same tolerance or gentleness inward can be uncomfortable. Here are some practical ways to cultivate self-compassion in our daily lives: Be more mindful — Self-care and self-compassion aren’t necessarily the same thing. We implement self-care by exercising more or eating healthfully, and we can also be tuned into the way we talk to ourselves. Mindfulness practices vary widely: creating space to calm mental chatter and exploring ways to practice self-compassion help us stay tuned into the present moment, instead of rehashing the past or worrying about the future. Write it out — Writing can be an effective way to tap into our inner dialogue and catch negative self-talk. Write a loving letter to yourself in the same way you would to a friend who might need encouragement. Or have a written conversation with the part of you that’s struggling, using curiosity to explore vulnerable feelings freely and without judgment. If you are your own worst critic, log your negative self-talk and do a “truth” test on the things you tell yourself (Is this accurate? Is it a 100% truthful statement? Is this something I would say to anyone else?). Acknowledge your feelings — We tend to view our feelings as our reality and to place judgments of right or wrong on them. Feelings are fluid and should guide us like a compass rather than weigh us down like an anchor. Instead of judging your feelings, try recognizing them and the clues they might be giving you about what you need. Suppressing (denying) our feelings isn’t healthy, but we can choose our responses to situations that are not bringing us the joy or results we desire. Admitting our humanness, respecting our feelings, and taking appropriate action to meet our own needs are acts of true self-compassion. Learn to focus on what’s important to you — This takes practice, especially when the brain’s alarm is going off due to pain, illness, symptoms, or stress. But it’s important for a balanced brain that we acknowledge our stressors and then choose what’s most important to us at the moment—focusing on that rather than perseverating about the thing that’s set off the alarm. Think about ice skaters or gymnasts competing in the Olympics. Pay attention to their demeanor
