How Small, Consistent Efforts Create Real Change

If you talk to most succesful investors the mantra they constantly espouse is small sums invested regularly make moer difference than occasional larger deposits. Investing £100/ month for 20 years is very likely to beat investing a £24,000 lump sum – assuming you can get your hands on that sort of money in teh first place. It’s time in the market that matters. The patter goes that time in the market beats timing the market.

Well I think the same principles can be applied to health and well-being. By now most people know that meditation, mindfulness and breathing practices are beneficial to mental health. It’s no longer the domain of the new age, spirituial or religious. But it’s not easy. It can be uncomfortable and it’s easy to get disheartened when your mind wanders – as it will – after a frustratingly short period of time. Twenty minutes can seem like an eternity.

Don’t be disheartened though.. New research suggests that whilst profound changes in brain structure can occur with prolonged meditation sessions, sessions as short as 30 seconds can have a useful positive effect on the day ahead. Literally just taking time out to truly focus on your breath, to truly enage with yourself, to truly recognise your internal state…. microdosing mindfulness. It can be massively beneficial to get you through stressful times where downtime is in short supply.

I’ve been thinking more and more that this can be applied to musculoskeletal pain as well. Sometimes I’ll get patients in who have been presecribed a long list of exercises that may take 45 minutes or more, to do daily to help with rehab. While this amount of rehab will most likely help in the long run, its quite intimidating, encroaching into a busy day, and so can end up cast aside. So why not bring micro-dosing into the physical rehab space as well? One to two minute done daily, consistently is achievable and will surely beat 30 minutes sporadically, maybe once a week…

My particular achilles heel is neck pain  (if you’ll excuse the mixed anatomical metaphor). At its worst it travels up my neck and into full blown tension headaches. Acupuncture does help, but poor posture reactivates it over time. I have a little 10 minute movement and stretching routine that gets done in theory every night, but in reality 5 times a week. On top of that I’ve started microdosing additional movements on the daily dog walk. One – clutching my arms behind my back to open up my chest. Two – holding the dog lead in both hands then circling the lead over my head to behind my back. These two simple movements that I incorporate into my daily life have so far held these headaches at bay for the longest time in many years… just by incorporating two movements into something I’m already doing.

So if you have pain that keeps re-occuring its worth thinking what you might be doing that exacerbates it and what could you “micro-dose” to stop it?

Fascia & Pain

Until recently fascia was the thing that surgeons cut through to get to the interesting bits. It’s cast aside to access and assess the state of internal organs, muscles, nerves, blood vessels and tendons. Fascia itself is a thin layer of connective tissue, like a sausage skin, that sits under the skin and holds everything together. The most well known fascia is probably the plantar fascia, responsible for intense pain of plantar fasciitis. Its not just on the foot. It’s everywhere, all through the body.

Superficial fascia sits just under the skin and contains nerve fibres that detect pressure, temperature and movement. There’s also a deeper layer – usefully called deep fascia – which binds muscle, organs, blood vessels and more. This fascia is rich in fibres that sense position and movement (proprioception) and pain.

Fascia And Nerves…

Fascia is an important part of our structure. Whilst its very thin its not something to be ignored to get to the big prizes of muscle and internal organs. Most human fascia contains approximately 250 million nerve endings. Roughly the same as you’ll find in skin. If you suffer from chronic pain the number of these nerve fibres that sense pain can grows. Studies in rats have suggested the amount of nerve fibres may almost triple, which may explain why its so hard to treat chronic pain. Its thought that chronic inflammation causes the proliferation of these nerve fibres.

Keeping Yourself Healthy

What if I gave the teenage version of you a brand new car? The only condition of this gift being that you had to keep this car for life? Most people who chose to accept this car would cherish it. Beyond the annual MOT any issue would be addressed before they became terminal or you’d lose your transport. *

Well if you think about it, the car is a pretty good analogy for the human body. Neglect it and there’s a good chance it’ll malfunction. Some people are born a Mercedes, others Fiats. Whatever body you’ve inherited, hewn from steel or a bit wonky, its your responsibility to maintain it as best you can. Yet most owners give less attention to their own bodies than their cars. Think about it – a service and MOT per year. What part of the body compares…

Teeth are probably the most well attended to part of our bodies. Bi-annual check-ups. Poking around in your mouth dentists discover if you’ve got a problem looming on the horizon. You know it too – the sinking feeling of an impending filling as the dentist struggles to extract their probe from a gooey tooth. Eyes are probably next on the list although its generally only every 2 years for these, which seems a long interval to me for such an important sensory organ, essentially just an extension of the brain. I’m ambivalent about a wonky smile but pretty keen on being able to see well.

Anyway, if your car and even your teeth get treated so well, why not the rest of your body? The gooey tooth is the equivalent of the tight muscle. It can sit there completely undetected, just waiting for a trigger which can then cause immeasurable pain at some point in the future. The trigger could be a poor night sleep, tying a shoelace, a stressful week at work. By putting pressure on these muscles therapists can detect where problems my occur in the future. This is particularly important for recurring problems, such as back pain or headaches, as quite often when the pain goes the problem hasn’t necessarily disappeared, the pain has just entered a latent phase, waiting for a future trigger.

* This is an idea I appropriated from billionaire octogenarian investor, Warren Buffet, who compared the human body to a car, which should be cared for for life. Despite his staggering wealth he tends to buy quite ordinary cars and drive them for a decade or more before changing them, embodying his own advice.

Is Insomnia Normal?

In terms of modern-day living to be awake through the night is not helpful. We mostly lead very hectic, switched on life-styles, meaning the only chance we get to be quiet and still is at night when we are sleeping. As we shall see though, waking through the night is a natural phenomena, perhaps hard-wired in to our genetic make-up.

In terms of the history of humans, waking up in the night is absolutely normal. In the pre-industrial world (over 200 years ago) we typically went to bed for a few hours then woke around 1am. We would then do chores or talk quietly and muse on our dreams and ideas for a couple of hours. We would then go back to sleep to then wake at dawn. This known as Bimodal Sleep and is typical of many animals in the wild.

In 1990 sleep researcher Thoma Wehr conducted an experiment in which the volunteers were deprived of artificial light and any of the stress of having to get to work/ earn money etc. Within 3 weeks they had fallen into the bi-modal pattern of sleep – waking in the night for a couple of hours of quiet contemplation. In addition to the couple of hours in the middle of the night they also got a couple of hours of quiet contemplation in the dark before falling into a deep sleep. Most of the participants reported feeling much more relaxed, less fatigued and more at ease.

Wehr postulates that insomnia may be more prevalent as we age, because our body struggles to “over-ride” its innate need for bimodal sleep. The bi-modal sleep pattern takes over and then we are labelled suffering insomnia. I would say it is the anxiety about not sleeping that is more harmful to our health than actually being awake for a couple of hour a night – which is a normal phenomena.

Its amazing that this information has only been around since 1990. It was only unearthed when Dr Ekirch of Virginia Tech, a Professor of History, started to research the history of sleep. As he probed back further in time to pre-industrial times he found references to “first sleep”. On investigation he found that these people were indeed sleeping in two distinct, bi-modal, patterns. This was natural sleep, unaffected by electricity and all the distractions it brings of lights, computers, TV’s etc.

REM & Non REM Sleep

During sleep we cycle between REM and Non REM states.

REM: The REM State typically starts 90 minutes after you’ve gone to sleep. Heart rate and breathing speed up and your eyes start to move rapidly – hence the name Rapid Eye Movement. The brain is highly active during this phase. Busy dreaming. Humans are born dreaming. The typical newborn dreams for about 10 hours a day. Whilst your brain is busy dreaming and processing information and storing memories from the day, your muscles are very relaxed or in some cases paralysed.

Non REM: During the deep state of Non REM sleep the body repairs and regenerates tissues, builds bone and muscle, and strengthens the immune system.

Whats the problem with not sleeping enough

Its not necessarily the quantity of sleep but also the quality that matters. Research has shown that any deep sleep, be that 8 hours of block sleep or a 30 minute nap enables our brains to function better. The increased function can manifest as improved creativity, intelligence and memory.

On the other hand poor sleep can lead to:

• Weight Gain: The effects of insomnia on weight gain are two fold: 1. Your metabolism slows down. 2. Increased feelings of sleepiness may predispose you to poor diet choices – reaching for high glucose foods to give you an instant energy boost.
• Compromised Immunity: When you don’t get enough sleep your immune system is compromised. It doesn’t release enough protective proteins, meaning your less able to fight invading viruses and also recover once you’re ill.
• Depression: Depression can be directly caused from not enough sleep. Equally the pressure to “sleep well” can also induce a type of sleep anxiety also harmful to your health.

Some Tips To Help Banish Insomnia

Whilst waking through the night is normal. Skipping 2 hours of precious shut eye is not very useful when you’re staring down the barrel of a 10 hour shift at work. So how can you improve on your sleep?

1. Exercise

Regular moderate exercise can help you fall asleep faster and deeper. Be careful not to exercise too close to bedtime as the rush of feel-good endorphins flooding your body isn’t likely to pre-dispose you to sleepiness.

2. Nap

Limit daytime napping if possible to under 30 minutes. If you’ve had a terrible nights sleep and aren’t functioning well a nap may be just what you need to feel refreshed again.

3. Manage Stress

Being overloaded isn’t going to help you sleep. Try to set some time aside in your day to just be. Go for a walk, do some tai chi, sit on a bench. Write lists out and delegate tasks to remove some stress from your life. Stress is insidious and not only wreaks havoc on your sleep but also your health.

4. Relax

Try not to be on your computer or laptop up until the moment your head hits the pillow. Try to enforce a no laptop and no TV rule after 9pm. There is an argument that the artificial bright lights flooding into your eyes isn’t conducive to sleep.

5. Eat Early

You want your body to be in as relaxed state as possible before you go to bed. This means not only giving your eyes and brain a break but also giving your stomach and intestines a rest. Eating late will test your digestive system and is unlikely to lead to a restful sleep so try to eat before 6pm if possible.

6. Eliminate Alcohol

While alcohol can help you fall into a slumber it also can lead to frequent wakings through the night. Needless to say don’t drink caffeinated drinks before you go to bed and be aware that caffeine can stay in your system for up to 24 hours.

If you’re still having problems sleeping and have tried all the techniques above, it may be time to bring out the big guns…

7. Go Back To Pre-Industrial Times

This is extreme, but anecdotal experiments on keeping all lights off in the house permanently have vastly improved subjects sleeping patterns (and lowered their electricity bills…). Try keeping all lights off for a week. That also means the laptop, TV, iPad and phone all need to disappear after dark as well.

8. Make Yourself As Uncomfortable As Possible

A bit counter-intuitive this one. If you find yourself awake at night unable to sleep. Get out of bed immediately. Don’t reward yourself with TV and cookies. Instead you have to let your brain know that getting up in the middle of night is not a good thing.

Pick up the most tedious book you can lay your hands on. Find the draughtiest part of your house and start reading the book… standing up. The idea behind this is that you aren’t sub consciously rewarding yourself for waking up. You’re punishing yourself. What you’re doing is both uncomfortable and boring and you will likely find that you get pretty tired pretty quickly.

9. Get back to nature.

Why not try camping. The constant barrage of light from computer screens, tablets, TV’s and… lights can interfere with your circadian rhythm (simply put – the rhythm that tells you to sleep when its dark and wake when its light). Camping forces you to live by these rythms more. If you’re going to do this try and leave your phone, ipad etc at home or in your car.

10. Don’t Lie In.

Apart from messing with your sleep routine lying in has been linked to chronic fatigue, increased irritability and even increased risk of heart disease. If you lie in at the weekend in an attempt to win back hours lost during the week this can cause particular problems in the form of social jetlag. This is a term coined by Dr Till Roenneberg, professor at the Institute of Medical Psychology at the University of Munich.

…And Don’t Do This…

If all else fails it can be tempting to reach for sleeping pills (hypnotics) when you can’t sleep. In small doses, to get you through a purple patch, they can be very useful. Don’t get into the trap of taking them long term though.

It’s not only me who thinks this, the Joint Formulary Committee 2009 warns that hypnotics should only be used in acute cases and limited to a short course of therapy. Despite this about 10 million prescriptions for hypnotics are dispensed every year in England (PCA 2007). Remaining on these tablets for long periods of time presents hazards for patients, including risk of dependence, accidents and other adverse effects on health.

Key Points