A Rubik's cube of minor health problems--are they related?

September 12, 2011 1:33 PM

I am having trouble sleeping, which is leading to minor migraines. In addition I have a host a minor ailments and am not sure which problem to try and solve first, and which flavor of medicine would be the most helpful. In other words, I feel stuck.

I have gotten stuck in a series of minor ailments that seem connected. I’m asking for opinions on which one to address first--it feels like a puzze of sorts, and if I can address the most important issue perhaps some of the minor ones will resolve themselves. I have insurance and will see a doctor, I’m just trying to decide which doctor to see first.

Currently, I sleep about six hours and 20 minutes a night. I teach school, and during the summer I was able to sleep in a bit longer, about 7.5 hours per night, or at least fall back to sleep if I awoke in the middle of the night. Since the start of the school year I tend to wake up after about six hours. My sleep study from several years ago didn’t indicate apnea or other breathing problems. One sleep doctor recommended amilytripilin, but that just left me feeling groggy. Taking half a pill four hours prior to bedtime would help a little.

I'm a little anxious about school and feeling underprepared.

Often after not getting enough sleep, I start getting these small migraines that feel like sinus headaches, usually on the left side of my face/head. I sleep on my left side. Two months I had sinus surgery, septoplasty, and I am breathing better through my nose than in the past. The facial pain manifest itself prior to the surgery as well. The headaches leave me feeling less-than-functional. Ibuprofen helps, as does a very occasional percocet. I’m not sure if these are sinus headaches or migraines. I usually end up napping, then staying up late the same night, which affects my sleep the next day.

I’ve also been experiencing some mild heartburn, but also difficult swallowing which I believe is related to the acid reflux. My ENT says there are no visible growths in my throat and suggested I see a swallowing specialist.

I’ve got tendonitis in my right achilles tendon. It is better than it was, but has been stiff and bothersome for a little over a year.

I have been diagnosed by a psychiatrist with ADHD.

I am 45 and 223 lbs. 6’6.

Should I focus on exercise, diet and weight loss? Meditation for what seems like work stress impacting my sleep? Get ADHD medication in the hopes that it increases my productivity and decreases my stress? Yoga?

I need to do something, as I am tired of being tired and unproductive. I’m just not sure where to start. Thanks!

[after reading what I've written I actually think I'll go see a cognitive behavioral therapist]

posted by mecran01 to health & fitness (25 answers total)

Dont know if its legal where you are located (plus being a teacher could worry you), but two birds with one stone. Cannabis.
posted by handbanana at 1:36 PM on September 12, 2011

Try about 6-10mg of Melatonin before bed.
posted by griphus at 1:42 PM on September 12, 2011

Also: how close to bedtime do you eat, and what is it?
posted by griphus at 1:43 PM on September 12, 2011

I've tried kava and various OTC stuff from health food stores. It helps a little. Honestly, I'm pretty sure that if I started using cannabis that it'd be a lot like that scene from the old tv show Taxi where Jim takes his first bite of a "special" brownie. Plus, I can't, I'm Mormon.
posted by mecran01 at 1:43 PM on September 12, 2011

Eating before bedtime: I'll snack right before I sleep sometimes, like a peanut butter sandwich or cheese sandwich and milk. Starting to not do that so much.

I've tried melatonin, and it's ok. Sometimes I feel groggy the next day. In terms of sleep hygiene I've been keeping the lights low prior to sleep but still use the laptop in bed.
posted by mecran01 at 1:45 PM on September 12, 2011

Try exercising during the day. DO NOT START HARD. Try walking for 20 mins at night, and then you can slowly build up to jogging if you like. Especially as a student sometimes all the work you are doing leaves your body restless, and while your mind is exhausted you arnt really tired. Doing a little bit of exercise might be just what you are looking for.
As for everything else, you might want to take a look at your diet and see if there are other foods you could eat that would not cause heartburn, and may also help.

Also, it is important that you have a regular sleep cycle. If you are going to bed at different times every night, it may behoove you to try going to bed at the same time every night. This tends to help you fall asleep faster and ensure you sleep more regularly.
posted by kevinhartmn at 1:49 PM on September 12, 2011

IANAD at all. This is simply what I would do if I had your symptoms. In re: to the headaches, tendonitis and heartburn, I would wager that these are all separate from each other, and therefore, resolving/improving any of them is unlikely to fix the others. So you might as well pursue treatment of all three separately, soon and simultaneously.

For these three things also, I would agree with your inclination to improve lifestyle to improve them longterm, but there are short-term treatments of the headaches (if they are migraines) and the heartburn, at least. The tendonitis is a little harder, but I bet a doctor might have some quick things you could improve with.

I'd disagree with your inclination to see a therapist first, however (although I don't mean to say you shouldn't plan on it soon). I would see a GP for guidance on what to do about each issue. And the most pressing thing I would want treated would be the headaches, and perhaps the sleep issue. If you are having frequent headaches and difficulty sleeping, it's no wonder you are having trouble deciding what to do next. I think you should insist on immediate help with the headaches and sleeping, even if your doctor says that things like frequent triptans for headaches and/or sleeping pills are not long term solutions.

FWIW, I have gone to the MD with 'grocery lists' of issues like this. We have shot them down with separate plans for each 'ailment'. Something is bound to get better with a strategy like that, and thus make the rest seem more manageable. Plus, if you agree to a plan for your headaches like, 'Try triptans and a prophylactic treatment right away. IN the meantime, improve sleep patterns,' the doctor should be willing to try short term fixes. Whereas, if you go in with the attitude that you just want a shortterm fix, and don't see value in lifestyle changes, the doctor may actually be more hesitant to let you try the shortterm fixes.
posted by Tandem Affinity at 1:49 PM on September 12, 2011 [1 favorite]

I have sleep problems all my life. I feel for you. I also suffer from migraines and cluster headaches. I'm still trying to figure out my headaches. But, for my sleep, I take either diphenhydramine (benedryl) - one 25 mg tablet a night. OR, lately I've been taking one tablet of Unisom - but NOT the diphenydramine one. It's the doxylamine one (also found in Nyquil). I am able to fall asleep faster but more importantly, if I wake up in the middle of the night, I am able to get right back to sleep. I do not feel groggy in the morning. Of course YMMV.

Honestly (at least for me), once my sleep is under control I feel like I can handle the other things (like exercise, dieting, etc.). But without feeling rested I can do very little.
posted by Sassyfras at 1:51 PM on September 12, 2011

IANAD, but I had Year-Long Hell Insomnia last year. Based on a conversation with my doctor at that time, and on tips from in here:

1. Magnesium helps with sleep, and also helps with QUALITY of sleep. Even if you still get only 6-1/2 hours, magnesium can help make sure they're a GOOD 6-1/2 hours.

2. Try valerian, but in capsule form. I told my doctor I was trying a tea, and she said to try using the capsules instead; they're a bit stronger. Also, she said that they may take a couple weeks to really take noticeable effect, so hang in there with that. I can attest that they did help a lot.

3. STOP USING THE LAPTOP IN BED. I don't have as much trouble with sleep any more, but if I sneak the laptop into bed with me, I always do -- I get a little too wound-up mentally, even if I've only been using it to watch Youtube videos of kittens or something..

Getting better sleep will help with a lot of stuff overall, but those are all things you can do without a prescription. (Although I'd talk to your doctor about the valerian, just in case.)

Good luck.
posted by EmpressCallipygos at 1:57 PM on September 12, 2011 [1 favorite]

Also, make sure you get bright natural light early in the morning. And avoid screens/bright lights at night. Bright light suppresses our production of melatonin; darkness stimulates it.

Also, tart cherry juice contains natural melatonin. I've had a lot of luck with it.
posted by enzymatic at 2:21 PM on September 12, 2011

Should I focus on exercise, diet.. .

Yes. What is your diet like, anyway?
posted by TheTingTangTong at 2:59 PM on September 12, 2011

GERD is known to cause sinus symptoms/problems like congestion, sore throat, and headaches. Treat the heartburn/reflux with over the counter meds.

I'd also do over-the-counter treatment for reflux and elevate the head of your bed so that you're sleeping at an angle.

Eating right before bed will exacerbate GERD.

I rarely have painful heartburn, the primary symptoms of my refux are ear-nose-throat related.
posted by the young rope-rider at 3:09 PM on September 12, 2011 [1 favorite]

Sorry, I repeated over the counter treatment twice when I meant to tell you to cut out foods that tend to cause reflux. There are some good lists elsewhere online.
posted by the young rope-rider at 3:10 PM on September 12, 2011

Have you ever been tested for allergies?
posted by zoetrope at 3:57 PM on September 12, 2011

Seconding Tandom -- a good general practitioner should be able to help you assess the relative severity of these various issues and in what order/with whom to get them treated. Depending on where you live, having a referral from a GP can help you get your appointment with the required specialist more quickly.
posted by bettafish at 4:08 PM on September 12, 2011 [1 favorite]

Er, Tandem! Sorry about that.
posted by bettafish at 4:08 PM on September 12, 2011

My money's on anxiety for the insomnia and reflux.

For the heartburn, an easy thing to do is take a maximum strength pepcid twice a day for two weeks and see if that helps. Cut out the coffee, tea, acidy foods. (Google GERD diet). If it isn't better (not healed--better) in two weeks, see a doctor about it. GERD can totally cause sinus problems.

Exercise. Cardio's great, but I find weight training with heavy weights helps me feel sleepier at night. I'm sure there's a scientific explanation. Swimming is also great.

Try yoga. Buy into it. Resign yourself to looking silly for an hour. Give yourself six or seven classes to start feeling comfortable/competent (it's so easy to quit after the third or fourth class because you think you'll never figure out how to do it--but stick with it). You will really feel more relaxed afterward.

Don't be afraid to ask for a prescription sleep aid to get over the hump.

Try wearing a night guard at sleep. Your headache could be due to grinding your teeth at night or clenching your jaw (also manifestations of stress).
posted by thinkingwoman at 4:53 PM on September 12, 2011 [1 favorite]

Oh, and get rigorous about sleep hygiene. Go to bed and wake up at the same time every day, even on the weekends (if you stay out late, still make yourself get up at your usual time. nap later if you have to). Dim your house lights in the evening. No screens an hour before bed. Falling asleep to music is OK, but no TV or laptop. (I suppose listening to TV is OK if you cover the screen with a heavy blanket, but you don't want the light). Make sure your room is cool. Get lots of light in the morning.
posted by thinkingwoman at 4:56 PM on September 12, 2011 [1 favorite]

2nding the suggestion to go and see your GP as a starting point. They'll point you to specialists as required but may well be able to provide treatments for all of this.

As far as my personal non doctor experience goes - I don't normally suffer with insomnia but if I am sleep deprived I get dull headaches that only go away with a decent dose of ibuprofen or if I go to sleep and get adequate rest...I also find that inadequate sleep makes any and all other ailments worse/prevents them from improving as quickly as they should. In particular it is a major stressor for me and thus makes acid reflux and heartburn symptoms a lot worse. So my instinct would be that some of this stuff is indeed linked but that's just my instinct.
posted by koahiatamadl at 9:07 PM on September 12, 2011

These comments are great and very needed. Thanks, and I will report back in two weeks.
posted by mecran01 at 11:39 PM on September 12, 2011

Sounds wierd but its true. Stop eating any Yellow chease and anythingwith annatto extract. I cant have it. It would cause me to not sleep, have horrible migraines and stomach problems. Its slowly being put into all processed food.

Try it .
posted by majortom1981 at 4:45 AM on September 13, 2011

It looks like I will treat the sleep first, then address the anxiety, which appears to be at the root of the sleep, and see a GP about the stomach acid and other minor problems. As part of the GERD treatment I will be eating a very restricted diet, so that may help with anything allergy-related.
posted by mecran01 at 10:33 AM on September 13, 2011

When you see a doctor, do bring up everything; that way each problem can be addressed.

IANAD or YD, but it could be that some of the problems are inter-related and feeding off one another. Reflux can keep you from sleeping at night. I've always found it a bad idea to eat within at least 2, and better yet 4, hours of going to bed (but I do have to eat a little something 4 hours before, or I have no blood sugar and wake up glued to the pillow, but I have a delicate balancing act). Use one of those wedges to elevate the head of your mattress. Take Pepcid or Zantac before bed if you need to.

Migraines can be exacerbated by lack of sleep. Talk to your doctor about sleep - it's okay to need sleep meds as a last resort. I'm on quite a few which I rotate, but I have absolute weapons-grade insomnia (100 MG of benadryl fails to fell me). I feel so much better if I get adequate sleep. One OTC thing that works great for me is something called "Natural Calm" which is a magnesium powder you mix with water.

Also - be sure you don't have sleep apnea; and no, apnea is NOT a condition of fat middle-aged men. Young, thin women can have it too. Do you:

- snore or snort, choke or gag in your sleep?
- mumble, smack your lips or make funny mouth noises in your sleep?
- wake up gasping or choking, with a dry mouth, or hot and sweaty even in a cool room?
- have dreams of drowning or choking?
- find that your sheets and blankets are a mess in the morning from kicking, tossing and turning (this also might be an indicator of restless leg syndrome)?

Get a sleep test if necessary. So many physical problems feed off of poor sleep, and fixing the sleep problem may not cure other existing health problems but will help keep them under control.
posted by Rosie M. Banks at 6:05 AM on September 14, 2011

No TV or computer for at least an hour before bed-time. Read a book, or listen to a radio talk - anything quiet and soothing, nothing active. No light whatsoever in the bedroom. Same time to bed every night. Get up early and do not sleep in the day unless totally exhausted, in which case a maximum 20 minute 'power nap'. If you wake up in the night, do not move, do not put on the light, lie still and reflect on how good it is to be alive, for example.
posted by nickji at 2:31 AM on September 15, 2011

update: I've done some minor updates, mostly keeping the laptop out of the bedroom, taking 25 mg of doxylamine succinate before bedtime, not eating after 7pm and keeping the lights low in the evening. I've noticed that with improved sleep my GERD is less bothersome and my daily energy levels have improved and I'm feeling less anxiety. Valerian didn't do much except give me some weird dreams. Took one of my wife's Zolpidem (generic Ambien) and it got me to sleep nice and early but I woke up about six hours later at 4:45 a.m. then fell back asleep 40 minutes later for two hours. Calcium/Magnesium tabs have also made little difference.
posted by mecran01 at 8:37 AM on September 26, 2011