Thursday 22 February 2018

Put knee pain and sleep problems to rest

Dr Nina Byrnes
Dr Nina Byrnes

Dr Nina Byrnes

Until the 1950s, we thought sleep was a time when the brain rested. We now know that this isn't true and the brain performs many important functions as we rest.

A good night's sleep is essential to our physical and mental wellbeing. If you have difficulty falling asleep and then you have to get up early, you are essentially sleep deprived on an ongoing basis. Sleep deprivation can be dangerous. You have reduced concentration and productivity, increased risk of stress and mood change, and an increased risk of accidents and harm.!

Insomnia is difficulty initiating or maintaining sleep. This is not what you have. It is more likely that you have problems with the setting of your body clock. These problems are called circadian sleep disorders.

Anyone who has experienced jet lag has some experience of a circadian sleep disorder. When we cross time zones, our bodies need a few days to adjust to a new day-night routine. Circadian rhythm is a complex process that isn't fully understood, but we do know that exposure to light and the hormone melatonin play a role.

It sounds like you may have a condition called Delayed Sleep Phase Syndrome ( DSPS). This condition is more common in adolescents and young adults, affecting approximately 7pc to 16pc of this population. Those with DSPS are often described as night owls. They stay up late, sleep in the next day, but have no other sleep difficulties. There is an increased risk of mood disorders. This condition can run in families.

There are number of suggested treatments for DSPS. A good routine is best. Children and adolescents should be taught to follow a regular sleep routine. Going to bed and getting up the same time, no matter what the day, will help maintain a good sleep pattern. Stimulants such as caffeine should be avoided. The bedroom atmosphere is important. Think of it as a cave. Keep it cool, dark and quiet.

Shifting the sleep schedule is the core treatments for DSPS. Chronotherapy involves moving the sleep time forward by three hours a day until you are going to bed and getting up at the right time. This would have to be done on a week off as you will spend one or two days sleeping by day and up by night. Another option is to move the sleep and wake time back by 15 minutes a day until a correct sleep time is reached. Once you have achieved this, sticking to a regular routine is essential. No more late mornings allowed. !

Other research also suggests that taking melatonin a few hours before bedtime can help restore a healthy circadian rhythm. It is only available on prescription in Ireland, so discuss this with your doctor.

Avoidance of bright light in the evenings is essential. All screens, including phones, computers and TV, should be off two hours before bedtime. Bedroom clocks can also be a light and should be avoided. Some sleep specialists prescribe exposure to bright light for a half-hour early in the morning in order to establish a normal wake time.

I can't fall asleep until late and then I can't get up early next day. It started when I was a teenager, but I was able to cope in college because I didn't have many early lectures. Now I have a job, I'm finding it really hard. Is there anything I can do?

My 13-year-old son has been complaining of pain just below his knee. He does play a lot of sports but hasn't injured himself lately. There is a slight swelling just below his knee that can be sore to touch. Should I be worried?

It sounds like your son may have a condition called Osgood Schlatter's disease. It is what we call an overuse syndrome. Until recent times, it was more common in boys but now that girls are remaining more active, it's incidence is increasing here too.

Osgood Shlatter's usually strikes during times of rapid growth. Growth plates are found at the end of growing bones. The tissue here is a bit softer and more prone to injury. When active children take a growth spurt, their strong tendons and muscles may put stress on the ends of these bones. In some cases, a tiny flake of bone may be pulled away or a tender lump may appear. Osgood Schlatters normally goes away on its own and is not usually seen in those over the age of 16.

Rest is the best treatment. Taking a break from vigorous sports will allow the inflammation and soreness to settle down.

Over the counter painkillers such as paracetamol and ibuprofen may give some relief. Applying heat or ice may also help. Wearing gel pads over the bump may protect it from painful bangs

A physiotherapist may be able to help by easing the transition back to activity and teaching some appropriate stretching exercise for before and after activity.

There are few long-term consequences of Osgood Shlatters. Rarely the painful bony growth needs to be removed. Osgood Shlatters does not cause pain at rest, pain that awakens one at night or pain in the thigh.

These pains may be due to other conditions and a chat with your doctor about them is required.

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