Introduction:
Depression and chronic pain are two common conditions that are also associated with poor sleep quality. While it is often thought that the sleep issues are secondary to these conditions, a new study conducted by researchers from the University of Alabama indicates that depression and pain due to osteoarthritis could be the result of poor sleep quality instead of the other way around.
Background Data:
Prior research has shown that people with hip and knee osteoarthritis (OA) are more likely to have insomnia, daytime sleepiness, and depression, than those without OA. The obvious relationship is that the arthritis pain affects sleep and makes people depressed. However, a 2012 study published in the journal SLEEP looked at sleep quality in people who were in chronic pain, including those with osteoarthritis and researchers found:
- The amount of pain that people were in before they went to bed had little to do with how well they slept.
- A person’s sleep quality predicted how much pain they were in the next day. People who slept poorly had more pain the following day.
Other studies have shown that poor sleep quality can trigger inflammatory pathways that make arthritis pain worse, and poor sleep also make people more sensitive to the feeling of pain from any cause.
New Data:
To better examine the relationship between OA, pain, and depression, 367 patients with OA of the knee from a variety of sources were recruited to participate in a trial. The participants completed a detailed questionnaire that identified overall health, depression, pain, joint function, and sleep quality. One-year follow-up was available for 288 patients.
Analysis of the data collected from the questionnaires indicated that comparing the initial baseline with 1-year follow-up data, sleep disturbance at baseline was linked with increased depression and further loss of joint function, but interestingly not more pain.
Since the questionnaire used in the study was not specifically designed to identify the exact sleep issues in OA patients, further research is needed to more fully pinpoint what is abnormal about OA patients’ sleep. Nonetheless, the conclusion from the study is the disturbance in sleep definitely precedes the depression, loss of joint function, and likely increased pain associated with OA. Hence, the takeaway message is that improving sleep quality is a key goal in preventing the progression of OA as well as the associated depression.
Commentary:
Early on in my clinical practice, I realized that improving my patient’s ability to get a good night’s sleep was usually the quickest way to help them feel better in every way. Over the years I have used a number of natural products that can help to improve sleep quality. The specific product that I now recommend as a first step is the one that I developed: Tranquil Sleep from Natural Factors. This formula provides the combination of melatonin (3 mg), 5-HTP (30 mg), and L-theanine (200 mg) in a great tasting chewable tablet or soft-gelatin capsule. These three ingredients work together to decrease the time required to get to sleep and to decrease the number of nighttime awakenings. Here is a brief description of each ingredient as it relates to improving sleep quality. If you don’t use Tranquil Sleep, you can get the same effect by combining them on your own
Melatonin is the most popular natural aid for improving sleep quality. Supplementation with melatonin has been shown in several studies to be very effective in helping induce and maintain sleep in both children and adults and in both people with normal sleep patterns and those with insomnia. Typical dosage is 3 mg at bedtime.
5-HTP (5-Hydroxytryptophan) is converted in the brain to serotonin – an important initiator of sleep. It is one step closer to serotonin than l-tryptophan and has shown more consistent results in promoting and maintaining sleep, even though used at lower dosages. One of the key benefits of 5-HTP is its ability to increase REM sleep (typically by about 25%) while increasing deep sleep stages 3 and 4 without lengthening total sleep time. Recommended dosage for improving sleep quality in combination with melatonin is 25 to 50 mg at bedtime.
L-Theanine is a unique amino acid found in green tea. Clinical studies have demonstrated that L-theanine reduces stress, improves the quality of sleep, diminishes the symptoms of the premenstrual syndrome, heightens mental acuity and reduces negative side effects of caffeine. It is an excellent support agent to melatonin and 5-HTP. Recommended dosage is 200 mg at bedtime.
Reference:
Parmelee PA, Tighe CA, Dautovich ND. Sleep disturbance in Osteoarthritis: Linkages with pain, disability and depressive symptoms. Arthritis Care Res. 2014 Oct 6. doi: 10.1002/acr.22459. [Epub ahead of print]
Dr. Michael Murray
11/11/2014
