Category Archives: Stress & Sleep

One of the more frequent topics I get asked about pertains to the usage and safety of various over-the-counter (OTC ) drugs. The two that seem to generate the most interest and widespread use are non-steroidal anti-inflammatory drugs (NSAIDs) and sleep-aids. While these partners in crime share some similar ingredients and side effects, they’re also very different as far as certain active ingredients and mechanism of action. So much so that they each deserve the adequate attention and proper breakdown provided through separate posts. The star of this week’s show will be the magical chemical combination synthesized in a lab and packaged in a pretty pill or succulent syrup in order to whisk us away to dreamland.

If you got lost in my creative description, we’re talking about sleep aids. For the purpose of this post we’re going to limit the focus to the OTC sleep aids and refrain from delving into the Ambien and Lunesta dimension filled with fluttering, neon purple butterflies. From past personal experience and outside feedback it would be accurate to rank Nyquil as one of the “GO-TOs” for sleep assistance.

Because of that we’ll break down some of its ingredients which are also commonly found in many others on your Walgreens shelf. Use this as a reference when and if you decide to go that route. Flip that box over so at the very least you’re aware of what you’re putting in your body and can perform your own risk vs. benefit educated analysis.

The first ingredient that demands attention is acetaminophen. This is the active ingredient in Tylenol and can be found in a wide variety of OTC drugs (Excedrin, Theraflu, etc.) under this name or others (paracetamol, acetyl-para-aminophenol, etc.). The fact that people still choose to utilize acetaminophen is baffling. In addition to a laundry list of side effects, the growing literature linking its potency to liver damage is staggering.

Acetaminophen is used to relieve pain, fever and assist as a remedy for allergies, cough, cold and the flu. However, in addition to the FDA acknowledged hepatotoxicity of the drug, continued use of the product has also been linked to kidney damage, asthma and even an increased risk of blood cancer. Not necessarily what you need when you are simply trying to catch some shut-eye.

Another heavy hitter in Nyquil and many other cough suppressants (including Robitussin) is dextromethorphan or DXM. This chemical is making headlines recently due to the growing recreational use and its hallucinogenic affects in large doses; so much so that the FDA has been re-evaluating certain aspects of the drug’s safety and restrictions.

Coincidentally, the procedure of reassessing already on the shelf drugs is commonplace. Nyquil and other products also used to contain the powerful nasal decongestant pseudoephedrine. However, products containing pseudoephedrine were pulled from the shelves seeing how it is one of the main ingredients in crystal meth. In an effort to keep products on the shelves, chemists have cooked up new concoctions to take the place of banned or restricted substances, but back to DXM.

As stated, this ingredient is added to for its antitussive or cough suppressant properties. Straight from Nyquil’s own site: rashes, itching, nausea, drowsiness, dizziness, hallucination and sudden infant death syndrome in babies are possible side effects from a “NORMAL DOSE.” DXM is actually classified as a dissociative drug (along with ketamine, nitrous oxide and PCP) that produces unresponsiveness to stimuli (like the need to cough) by blocking NMDA receptors in your brain. Unfortunately DXM also works on specific regions of the brain (including the retrosplenial and posterior cingulate cortex) and can cause potential disturbances in memory, learning, comprehension, and behavior.

Yikes, but I was only trying to sleep.

The last of the big 3 ingredients is doxylamine or doxylamine succinate. This drug falls in the class of a hypnotic and is utilized here as an antihistamine which serves as a short term sedative and sleep aid. Side effects include dry mouth, urinary retention, ataxia, drowsiness, memory problems, inability to concentrate, hallucinations, psychosis and hypersensitivity to surrounding environment. This is the ingredient that Nyquil adds to encourage sleep.

This brings up a good point. Taking a product which delivers numerous effects in order to utilize one seems quite reckless. Especially because you now know some of the other ingredients and what they can do.
Nyquil has attempted to address this with the release of ZZZquil which is labeled strictly as a sleep aid. In comparison this is a good thing because you’re cutting out all of the other unnecessary and potentially hazardous ingredients. The chemical used in ZZquil (and pretty much any OTC with “PM” after the name) is a more powerful antihistamine called diphenhydramine HCl.

It works at the level of neurotransmitters, which are the chemical messengers within the brain. It allows the neurotransmitter called histamine to build up in the spaces called synapses that are present between nerve cells. This leads to sedative effects and is accomplished by blocking its uptake into nearby cells. Diphenhydramine works both centrally within the brain as well as in peripheral nerve cells in other parts of the body.

Unfortunately, due to the above explained properties older people taking products with diphenhydramine such as Benadryl may be increasing their risk for cognitive impairment (delirium, slowed thinking, Alzheimer’s, etc.). Findings published in a 2009 issue of the ”Journal of Clinical Interventions in Aging” indicate that Benadryl, as a molecule that blocks the neurotransmitter acetylcholine, interrupts the normal functioning of the central and peripheral nervous systems. It was also noted that the effects of Benadryl are cumulative, so the more you consume, the more of an effect this will have on the nervous system and cognition.

This is another chemical that is under the FDA’s microscope and efforts have already been made to remove some products containing the substance from the market. Side effects of this chemical include dry mouth, nose and throat, drowsiness, dizziness, nausea, vomiting, loss of appetite, constipation, increased chest congestion, headache, muscle weakness, nervousness, and excitement (especially in children).

Bottom line with this is that you are taking a drug. You are introducing a foreign chemical into your body to un-naturally alter internal chemistry. Not only are you not curing or shortening the length of your problem, but you are also exposing yourself to a plethora of side effects from the active and “non-active” ingredients. You are attempting to silence your body’s way of telling you something is wrong.

Having said all that, although I preach and try to live like an idealist, I am a realist and realize that sleep is one of our most valuable commodities. Taking an OTC when you’re in a bind is not the end of the world. In light of the information given, I look at sleep aids like I do NSAIDs (Non-Steroidal Anti Inflammatory Drugs, i.e. Aspirin). Consideration to use either should be exercised only in emergency situations and with the full knowledge of what you are voluntarily ingesting. Utilizing any more than that as the usual solution to your pain or insomnia can be habit forming and dangerously disruptive to all aspects of your internal chemistry.

So what are your alternatives? Well, we addressed many aspects of proper sleep in previous posts ( https://clarkechiropracticwellness.com/2013/03/12/de-stress-your-life-part-1/ & https://clarkechiropracticwellness.com/2013/03/19/de-stress-your-life-part-2/ ), but simple things can be implemented first. Eat earlier in the evening. Eat smaller meals and less carbs as the day goes on. (Breakfast like a king, lunch like a prince, dinner like a pauper) Get up earlier. Exercise and make sure you expend some physical energy during the day. Allow yourself time to wind down before getting into bed. And when you do get into bed, make an effort to end the late night love affair with your television. Make it as dark as humanly possible in your room.

If these suggestions (implemented on a consistent basis) still don’t work, then consult your health care professional. Sleep, like all of our functions is controlled by the brain. Seeing someone who checks you for brain imbalances and the aforementioned HPA axis is a solid start. In my time in the clinic at Palmer College of Chiropractic a positive change in someone’s sleep pattern was one of the earliest and most welcomed changes seen at the beginning of treatment. It also served as a solid indicator that we were making positive changes within the brain and on the right track.

Sleep is absolutely necessary so that our bodies can utilize the energy not being used to sustain consciousness, to repair and revitalize for the next day. If you are someone who battles insomnia, I feel for you. Just know that there is help and it is imperative that you seek it. Also know that if you resort to a pill or syrup, especially habitually, your body will potentially pay the price.

Sweet Dreams

REFERENCES

http://www.fda.gov/drugs/drugsafety/informationbydrugclass/ucm165107.htm

http://www.ncbi.nlm.nih.gov/pubmed/7579069

http://nyquilingredients.org/

http://www.webmd.com/drugs/drug-14124

As a continuation of last week’s theme, we will now talk about tackling this issue of stress and the havoc it can wreak on your body and life. Last week we got pretty technical with the explanations, so this week I will attempt to provide you with implementable, practical changes you can make.

DIET

I know it seems like a lot of the recommendations always seem to come back to the diet, but its importance cannot be overlooked. This is truly nature’s medicine and in an ideal world should be all we need to nourish our bodies. However, due to processing resulting in depletion, numerous sources of contamination and an overwhelming list of bad choices readily available, it is imperative that we educate and chose properly. When it comes to stress in particular, any type of food that causes inflammation can trigger or further perpetuate the previously discussed HPA pathway. We know the common culprits of gluten, dairy, soy, corn; but anyone can have an inflammatory reaction to any food. That is why it is a good idea to identify these potentially problematic foods by way of an elimination diet. There is a growing body of literature documenting people whose conditions vastly improved or were essentially eliminated due to something as simple as cutting a particular food out.

A couple of generic remedies to get you started if you think you have an issue would be to supplement with a B-complex and avoid caffeine. If you are over stressed, you have likely burned up your supply of essential B vitamins. And unfortunately for all you coffee addicts, I mean lovers out there; caffeine further activates the sympathetic nervous system and release of cortisol.

One of the products of the HPA pathway that we mentioned was cortisol. This is a necessary chemical in the proper amount, but too much or too little can be devastating to our insides. The number one cause of abnormal cortisol levels is dysglycemia or blood sugar issues. This means cut the junk food and carb heavy foods out of the routine diet. Attempt to, “eat breakfast like a king, lunch like a prince and dinner like a pauper.” This is almost the exact opposite than most of us do all ready, as we usually go to town on dinner and even top it off with some late night sweets. Again, not what we need to be doing on a regular basis. This sends our blood sugar out of whack and thus our cortisol levels, resulting in HPA dysfunction and leading us to our next issue.

SLEEP

This may be one of the most underrated aspects of our health. Sleep is so essential that a lack of it is considered by many to be a potential carcinogen. Sleep has a relationship with stress similar to that of inflammation and stress. Each can disrupt the other, and once set in motion, their dysfunction feed off each other. It is not only cortisol that is involved in sleep regulation, but melatonin. These two chemicals work opposite each other and maintain what we call our circadian rhythm. This is our day and night, sleep and wake cycle. It is essential to keep this in check in order to minimize our stress. This rhythm can be primed by attaining some natural light exposure during the day. When the retinal cells are exposed to light by way of our eyes, our bodies produce the precursor to melatonin, serotonin. When the light to dark transition is registered by our eyes, an enzyme is activated that is part of the serotonin to melatonin conversion.

Too much cortisol (constant stress) actually inhibits the release of melatonin and thus our attainment of sleep. Other things that deplete our supply of melatonin include a junk food diet, birth control pills, hormone replacement therapies, and bacterial infections (H.Pylori). Ladies (and some of you self-conscious fellas) make sure to check your anti-aging crèmes. Many of these and other anti-inflammatory crèmes contain progesterone or prednisone which actually leads to lower melatonin levels and thus less satisfying sleep.

If possible, try to exercise earlier in the day. Depending on how hard you go at it, exercise will result in a release of cortisol. Our natural circadian rhythm has this high in the morning to get us going and tapering off as we get closer to bed time. This allows melatonin to rise and us to go nighty night. However, if you exercise too late and ramp those cortisol levels up, now you may be tired and wired. Physically tired, but your mind will just not shut up until the cortisol levels come back down. Add a big, carb heavy recovery meal after your p.m. workout and now you have to deal with elevated blood sugar that will keep you up as well.

Quality of sleep is just as important. In order to truly reap the benefits of sleep and provide your body with rest and release of nocturnal growth factor needed to provide repair and prep for the next day, at least 8-9 hours should be obtained. I know this seems quite unrealistic to most of us, but shooting for an extra 30-60 minutes a night may do wonders for you. You also want to make sure you are sleeping in a completely dark room. Turn the TV off, get some dark curtains, and even put your alarm clocks face down. Any type of light can disrupt your quality of sleep. There are actually proteins in your red blood cells that register light, carrying this information to your brain and blocking your night time companion, melatonin.

RELAX

This is easier said than done. However, it is essential to living well. You need to take time out of your day to zone out and put things in perspective. Deep breathing. Try to peel away the layers of thought like an onion. When I was investigating some basic premises of Buddhism in 2005, a couple of tenants stuck with me that directly pertain to the issue at hand. One was to smooth your mind pond out; get rid of all the waves or ripples so that you can see things for how they truly are, including your own reflection. When our minds are clouded by scattered thoughts and worry it creates distortion in our mind or turbulence in our mind pond and a true understanding of reality can never be attained.

Another thought is that worries arise from the mind and that nothing and nobody can make you worry without your permission. This is not to say that you will not have concern or compassion for others, but when it comes to money, job, material things, etc.; these are at the root of our mental stress response. Being constantly worried by these afflictions can trigger, strengthen and sustain the HPA pathway, as well all those lovely side effects we covered last post. Do your best to keep things in perspective, realize how fortunate you are. Be prepared, but don’t worry about hypothetical future events that may or may not take place. Don’t let your thoughts contribute to any physiological destruction. Find something that works for you and make it a point to mediate, zone out, reflect, pray, whatever you want to call it each day. You may find this small amount of time set aside will keep you calm, cool and collected.

MAINTANENCE

Due to all of the complicated factors that can contribute to dysfunction within this system, your best bet is to be checked out by a functional doctor trained and armed with the knowledge and tools to diagnosis and treat any potential dysfunction. What preceded this last recommendation were basic suggestions that will assist in controlling stress and the stress response, but as we all know, each one of us is different. Being different we each have different reasons for dysfunction, and respond differently to various modes of treatment.
Not sure if you may have an issue involving your HPA?

Do you notice yourself having “senior moments” forgetting or losing things or requiring lists and notes to remember things? This could be a direct indication of hippocampal dysfunction, which is broken down due to too much cortisol. Coincidentally this is also the first site of your brain to be affected in Alzheimer’s.

Do you have an inability to fall asleep or stay asleep?

Do you have difficulty waking up in the morning or not feel rested after sleep?

Do you find that you don’t recover well from physical activity?

Do you notice a drop of energy between 4 p.m. and 7 p.m. each day?

Having any of these issues can indicate over activation of your stress induced HPA axis manifesting itself as a dysfunctional circadian rhythm. Sounds complicated. Scary even, but don’t fret. There is help out there and it doesn’t have to come in the form of a prescription. It takes recognizing the potentially serious consequences of this dysfunction and making your health a priority. With all of the potential pitfalls that await us each and every day, it only makes sense to do all you can to stack the deck in your favor. Seeing a functional doctor like myself for these types of issues would entail a thorough history and exam, questionnaires, basic blood work and a salivary cortisol profile. These tools could then point us in the right direction as we attempt to identify and rectify the origin of the dysfunction through therapy, supplementation and lifestyle changes. Issues like this and others can be identified early or outright prevented if we would pay our bodies the respect they deserve. It’s funny. We have no problems making sure we get the latest update on our iphones or taking our cars in for routine service, but not our own bodies. And then we wonder why they break down.

As always feel free to leave a comment, question or suggestion at the bottom of the page. Or contact me directly via the contact information also provided at the bottom of the page. You can also click the follow link to the right to receive a notification email each week with a direct link to each new post. For those of you in the Brevard County area, I invite you to stay tuned in to the weekly posts and for upcoming information regarding the opening of Clarke Chiropractic and Wellness. I look forward to working with you in the future.

When attempting to achieve a life of thriving, rather than merely surviving, appropriate attention must be paid to the potential detrimental effects of stress. In our society the term stress generally refers to a negatively heightened emotional state due to a specific event or overload of activities. This is known as mental stress. Physical stress on the body caused by injury, bad posture or sustained over exertion (endurance athletes) can wreak the same havoc. In order to truly understand why we should attempt to de-stress our lives, a brief overview of the physiological mechanism behind stress and its effects should be understood.

The main mechanism responsible for our body’s response to stress is called the HPA axis. This stands for Hypothalamus (part of the brain), Pituitary gland (responsible for production/storage and/or secretion of various hormones), and Adrenal glands (sit on top of the kidneys and also secrete hormones). When we become “stressed” or “wound up,” the stressful sensory input is processed in the brain and the HPA axis is activated as our body’s attempt to adapt to this heightened more demanding state. Ultimately the pathway leads to sympathetic nervous system stimulation that then stimulates the medulla of the adrenal glands, secreting nor-epinephrine and epinephrine which are the chief neurotransmitters of the previously discussed sympathetic nervous system. Remember your sympathetic nervous system is your “fight or flight” system, so it is appropriate that it would be activated in what is perceived as a stressful situation. We’ve gone over some of the pitfalls of an overactive sympathetic nervous system in previous posts.

A critical thing happens here from the release of nor-epinephrine and epinephrine from the adrenal medulla. The sympathetic nervous system has been activated along with the release of inflammatory mediators called cytokines. This is a key part to understanding potential hazards. Not only does stress cause an inflammatory response, BUT inflammation (from injury or DIET, see where I’m going with this people? It’s all connected) can actually start the HPA axis and thus prompt and contribute to the stress response.

Now a normal inflammatory response to damage is a function of your immune system and is actually a good thing. The problem arises when there is too much inflammation. Your body knows this and in order to combat the stress induced inflammation releases a substance called cortisol in order to reduce the inflammation. It does this however, by dampening your immune system leaving us much more susceptible to infection and becoming sick. On the flip side to this, if your HPA axis is not functioning properly, this immune suppression that the cortisol is secreted to carry out may be lost. Now we have an individual with growing inflammation and an overzealous, under regulated immune response which can lead us toward numerous chronic and autoimmune diseases. The key here is to stay balanced and find that zone that works best for your particular physiology.

This has struck a particular cord with me as of late as I became frustrated that I was walking around with a runny nose and productive cough. I’ve been eating right and staying active, so what gives? Well, I was forced to look in the mirror and realize that going too hard can be just as damaging as living an overfed, sedentary life to begin with. I know most of you out there know what I’m talking about. Whether it’s a combination of work, school, exercise, kids, social life; something from the day in and day out grind has to give and unfortunately it is usually our health. This is our body trying to scream at us and tell us to ease up before even more serious damage is done.

Our bodies are designed to handle stress, but not at the sustained doses we are exposed to in modern day. Like all processes in the body, the HPA axis demonstrates what we call plasticity. This is basically a form of adaptation that can be utilized in our favor at times, but in this case works against us. Without a break or release, our stress pathway continues to fire, becoming stronger and stronger and easier and easier to be stimulated. You can now find yourself suffering from the effects of stress from normally unstressful stimuli or events, or even worse be in a constant state of HPA firing until fatigue and/or eventual death.

Without going into the actual detailed mechanisms involved in each issue, over activation of the HPA stress pathway and its partners in crime can lead to decreased immune system function, higher blood pressure, breakdown of connective tissue including the collagen in your skin (you ever notice how weathered those habitual marathoners look?), blood sugar and insulin dysfunction similar to that of a diabetic, increased body fat especially deposited around that mid-section, decreased libido and fertility, thyroid dysfunction (one of the most common diagnoses these days. Instead of prescribing synthroid maybe take a look at this pathway as the adrenal glands have been known to work opposite to the thyroid gland. Translation = overactive adrenals = underactive thyroid), osteoporosis (cortisol leaches calcium from your bones) and cardiovascular disease (the calcium leached from your bones has to go somewhere, and some gets deposited in your arteries = atherosclerosis), cortical degeneration leading to a decline in a multitude of higher functions especially memory, even insomnia. I know it seems counter-intuitive and that you should be able to pass right out if you’re constantly going hard, but this is just a perfect example of the complexity of chemical disruption that occurs when non-stop stress reigns.

Well, that was a mouthful. As always, I go into this stuff because I personally don’t sit well with being told what to do without explanation. As you can see, when we do that in today’s world we open ourselves up for all sorts of fun things. If you’re still actually reading at this point, I commend you. Next time, the focus will be on ways to de-stress and getting you closer towards thriving. But for now, take a break. I don’t want you to get all stressed out reading this.