Sleep Tips

If you’re a person who likes to cut to the chase, skip down to the bottom to see the summary.

Painful Burning Feet

Touch your burning feet. Chances are they don’t feel hot to the touch. Certainly, they are not burning like your feet are telling you. Warning, if they do feel hot to the touch and are swollen, talk to your doctor as soon as possible.

The painful burning that is worst at bedtime is the #1 complaint of having neuropathy. It is believed this happens due to your nerves firing messages because of the existing damage. During the day, those nerves are sending normal messages like the ones sent when you walk, or have shoes or socks on your feet. A way to ease the painful burning is to give those nerves something else to “message” about.

Our favorite Sleep Tip

Many of us with neuropathy notice a significant difference in symptoms depending on the food we eat. Carbohydrates, including breads, pastas, sugary drinks and much more, turn into sugar in the body. You don’t have be diabetic for sugar to affect your neuropathy. Sugar affects us all. Alcohol is a drink that can have huge impacts on the sugar in you body, plus it is neurotoxic.

Try cutting out carbohydrates after 3:00 or 5:00 pm to see if it relieves some of the burning. We believe it will! Some people go so far as to adopt a Ketogenic diet. If you want to try this diet, do so under the supervision of your doctor or a registered dietitian.

Why does it matter?

Dr. Richard P. Jacoby together with Raquel Baldelomar talk in their book Sugar Crush about ways sugar directly affects the nerves:

1. The small sensory nerves called C-fibers get glycated, essentially clogged, with oxidized glucose (sugar), like caramel in your teeth.
2. A chemical reaction, called the Maillard Reaction, happens between glucose and protein resulting in a toxic scar tissue that keeps the nerves from functioning properly and creating lesions. Dr. Jacoby describes it as slowly cooking your nerves like a turkey in an oven.
3. When the results of sugar reacting with other things in the body build up in blood cells it makes them swell reducing blood flow depriving the nerves of much needed oxygen and nutrients.
4. The above processes are well documented, however this next one he theories on. He describes it as the nitric oxide pathway getting blocked after sugar results in ADMA in the body. This ADMA cause blood vessels to constrict again depriving nerves of what they need.

Their book with worth the read.

Try a wrapped ice, or cold pack on your feet. This will feel good and give the nerves in your feet a sensation to send messages about. Again, be sure it wrap it… don’t put frozen objects directly on your skin. This can cause even more damage to the nerves just under the surface which over time will make the pain and burning worse.

There are many creams and ointments on the market. It is hard to know which ones will actually be effective. Click available links below to find out more on each option

Some of the ones we have to to help include:

1. Camphor & menthol medicated ointment like Rawleigh, Vicks Vaporub, or BioFreeze (Menthol only)
2. Peppermint or cinnamon oil (essential oils)
3. Capsaicin based creams like BenGay, A535, or LivRelief
4. Arnica based creams
5. Lidocaine based creams
6. Expose your feet to an oscillating fan
7. Combine the fan with one of the topicals above
8. A CBD or THC based ointment Note: You can make your own by combining it with a camphor & menthol ointment

Ointments and creams have different concentrations of the medicinal ingredient providing the sensations. Work with your pharmacist to determine the product that has right concentration for your need.

It may be possible to interrupt the flow of messages by giving those noisy nerves a little “shock”, not literally! Try one of these:

1. Burning feet immersed in a cold foot bath feels really good (even if its the middle of the night). Cool or a little cold is good enough – don’t add ice! We’ve even heard of one person who would stick their feet in snow to “cool them off”! While many of us may be tempted, we do not recommend this as it can cause additional damage to the nerves.
2. Some have also reported using use a medicated, athlete’s foot spray (ones that feel like icy foam) shocks the feet enough to stop the burn.
3. Sometimes it is as simple as walking on cold tile for a few minutes can sometimes work.
4. Give your feet a massage with your hands or a massage tool may also snap the pain signals into stopping.

One of these options may be enough, but combining it with a topical, cold pack or fan may be needed if the nerves are particularly active.

Regular Practices & Sleep Hygiene

1. Exposing your eyes to daylight early at sunrise, through out the day and as sunset approaches can help with keeping our biological sleep clock (circadian rhythm) in alignment. Note: not through windows and not wearing sunglasses, we need the real thing.
2. Exposing our eyes to (any) light from 10 pm to 4 am is very disruptive to our dopamine production which plays havoc with our sleep and should be avoided. The afternoon sunlight mentioned above can help lower these effects, but not completely.
3. Our body temperatures peak in late afternoon then start to drop. That drop helps us fall asleep. Speeding up that drop in temperature will accelerate the drop to sleep.  Hot baths, saunas, or hot showers can help with this. It seems backwards but when you get out of the hot environment it triggers the mechanism in your body to start cooling you down allowing you to fall asleep more easily. Maybe that’s why kids fall asleep easy after having a bath.
4. Set your room up to be cool when you are ready for bed. A cool room is important to keep our body temperature lower at night; and, since we move our hands and feet out from under the covers (or to cool spots on the sheets) to help keep us cool it helps us stay asleep.

There’s more to a good bedtime routine than brushing your teeth and turning out the light. Sleep hygiene is all about creating a consistent sleep routine and by making some changes to your behavior and your sleep environment. Below are 16 quick tips to ready your body and mind for sleep. Ok, 16 is not very quick.

1. Avoid sleeping in or napping 8 hours before bed
2. Avoid caffeine and other stimulants 4-6 hrs before bed
3. Engage in regular physical activity (but do it at least 3 hours before bed)
4. Avoid heavy snacking before bed
5. Avoid blue light (i.e. tech – including TV) 1.5 hours before bed (consider blue light blocking glasses)
6. Develop a pre-sleep routine (only do quiet relaxing activities before bed)
7. Remove distractions from your room – phones, work, pets (oh, they won’t be happy)
8. Keep your room cool and have fresh air if possible
9. Use a proper pillow and a good mattress
10. Use bedroom for sleep and intimacy only
11. Keep a consistent bedtime and rise time
12. Sleep only when sleepy – don’t go to bed just because its time
13. Create a quiet and comfortable sleep environment
14. Make your room as dark as possible, if you can’t use a sleep mask
15. Leave the bedroom if unable to sleep within 30 minutes – come back when tired
16. Avoid nighttime clock watching (hide or cover it if needed)

Supplements

Supplements can help, but they should be used sparingly as they can alter the body’s natural ability to get to sleep and you may become dependent. However, if sleep is a serious and chronic problem talk to your doctor about supplement and prescription options.

1. Melatonin This is a hormone well known to be associated with the body’s sleep cycle. Nearly every supplement brand on the market sells melatonin as a sleep aid. However, you can become dependent on it with regular use as your body produces less of its own.  It is best used only as needed for people who have the occasional trouble getting to sleep. Also, according to Dr. Andrew Huberman, of Huberman Labs: the dosages in supplements are too high; it has effects on other hormones like testosterone and estrogen; and, it won’t help keep you asleep. He instead recommends other supplements (see below), but only if other approaches don’t work.
   
2. Valerian is a root or herb also sold as a sleep aid. According to WebMD it acts as a sedative for the brain and nervous system; but scientific evidence backing up its effectiveness is mixed. 
   
3. Referring back to Dr. Huberman and his podcasts, if needed the supplements he suggests to help with sleep are the following:
   • Magnesium threonine has ability to cross the brain barrier to release the neurotransmitter GABA, which partially shuts off the forebrain. The parts of the brain responsible for thinking, planning, ruminating and executive function. (300-400g, 30-60 mins before bed).  Warning: Watch for gastro upset. Also note, there are many types of magnesium, so make sure you are getting the one meant for the purpose you want.
   • Theanine also activates GABA, but in addition it increases activation of chloride channels that lowers levels of brain activity (100-200 mg before bed). Theanine is also a neuroprotectant.
   • Apigenin is the active ingredient in Chamomile tea (50 mg, 30 mins before bed). Caution for women, similar to melatonin, it is also an estrogen inhibitor.

There are many other supplements suggested for sleep. Be wary. Do your homework and be sure you get your information from credible sources.

Non-Sleep Deep Rest

Non-sleep deep rest (NSDR) practices are, as the name describes, ways to rest the body and mind without going to sleep. These practices include yoga, yoga nidra, meditation, deep breathing exercises, relaxation exercises, tai chi, qigong and prayer, to name a few. Two benefits of regular practice are: an easier time getting to sleep, and better quality sleep!

We could have an entire tip sheet on NSDR, and may do so, but for now know these practices are indeed a long game option with many health and wellbeing benefits besides sleep. These practices are gaining popularity because they work. If you are needing to slow your racing mind at night deep breathing and guided meditations work to settle and bring your mind into the present. Body scans for relaxing the muscles or mentally focusing on pain points helps bring the body into a state more ready for meditation as well as for sleep.

Yoga Nidra, a lesser known form of NSDR, is similar to meditation, but may be the better choice when trying to actually get to sleep. In Yoga Nidra the practitioner lays down (instead of sits) and completely relaxes the body while becoming aware of the ‘inner world’, where as meditation concentrates on a single focus like the breath. Yoga Nidra is said to be one of the deepest states of relaxation. As an example you can experience Yoga Nidra by listening to this 23 minute video.

So, does mediation (or other NSDR practices) help with sleep?

Yes. As evidence, according to the SleepFoundation.org researchers have found mindfulness meditation help with insomnia and potentially sleep quality:

Mindfulness meditation, in particular, appears to improve sleep quality and reduce daytime disturbance in people with chronic insomnia and older adults. In the long term, these improvements may be comparable to effects seen from sleep medication or other established methods for insomnia treatment. 

SleepFoundation.org

NSDR activities are called “practices” because we must practice them regularly to gain the benefits. Even a few minutes a day has an impact.

We hope these tips and the underlying resources help you and your loved one find some relief and get some sleep.

Summary

1. Help stop your burning feet at night by cutting carbohydrates
2. Use a wrapped cold pack to give the nerves in your feet something else to “message” about
3. Find a medicated topical and combine it with a fan blowing on your feet
4. Shock your feet with a cold plunge, medicated foot spray, or massage
5. Learn how the body regulates when to sleep and use techniques to work with the body’s natural systems
6. Learn sleep hygiene
7. Explore supplement possibilities with your doctor
8. For long term gain, engage in a non-sleep deep rest practice that works for you

if you are able, please give back to the Calgary Neuropathy Association helping us grow, seek out more useful neuropathy knowledge.

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References:

1. CNA Article: #1 Cut Down Sugar
2. Book: Sugar Crush by Dr. R. P. Jacoby and Raquel Baldelomar
3. CNA Article: #25 Valerian: A Herb to Help you Sleep
4. CNA Article: #26 Foods That help you Sleep
5. CNA Article: #45 Relaxation: Beyond a Good Night’s Sleep
6. CNA Article: #54 Lidocaine – Numbing the Pain
7. CNA Article: #57 Pain & Sleep-a double edge
8. CNA Article: #58 Analgesics for PN
9. CNA Article: #60 L-Theanine’s relaxing effects
10. CNA Video: Courtney Hutchinson: Sleep Hygiene and Chronic Pain
11. CNA Video: Dawn Ross: Part 3-Calming the Nervous System & Sleep
12. WebMD: https://www.webmd.com/vitamins/ai/ingredientmono-870/valerian
13. Cleveland Clinic: What is Yoga Nidra?
14. SleepFoundation.org: https://www.sleepfoundation.org/insomnia/treatment/meditation
15. PubMed: https://pubmed.ncbi.nlm.nih.gov/25142566/
16. PubMed: https://pubmed.ncbi.nlm.nih.gov/25686304/
17. PubMed: https://pubmed.ncbi.nlm.nih.gov/21397868/
18. Huberman Labs podcasts:

• Episode 4: Find Your “Temperature Minimum” to defeat Jetlag, Shift Work & Sleeplessness, January 25, 2021 (Link)
• Episode 3: Using Science to Optimize Sleep, Learning & Metabolism January 18, 2021 (Link)
• Episode 2: Master your Sleep & be more Alert When Awake January 11, 2021 (Link)
• Episode 1: How your Brain Works & Changes January 04, 2021 (Link)