Reflex Sympathetic Dystrophy Syndrome
Complex Regional Pain Syndrome

RSD(S)-CRPS Advisory
RSD and Sleep Disorders
RSD And Sleep Disorders

Are Sleep Disorders Common In People Who Have RSD?
--By R. Norman Harden, MD, Director, Center for Pain Studies, Addison Chair
Rehabilitation Institute of Chicago, Chicago, Illinois

Yes, I would say that at least 75% of people with RSD/CRPS, possibly as many as 90%,
have some sort of sleep disorder. Pain is, of course, the main culprit for those who have
difficulty falling asleep and for those who have difficulty staying asleep. At bedtime, the
mind starts to relax, and since there are no distractions the mind naturally focuses on pain.
Early morning awakening may occur if a person rolls onto the affected limb and is
awakened by pain.

Treating the sleep disorder is critical, not only because people who sleep well feel better,
have more energy, and are in a better mood, but sleep is critical to the body's
recuperation, repair and healing, especially with chronic disease. Repair and some parts of
the recuperation process occur only during sleep; for instance, 90% of Somatamedin C, a
hormone that is critical in maintaining nerve and muscle health, is produced in deepest
stages of sleep. If you don't make Somatamedin C, you are not going to repair tissues
from normal wear and tear, which in turn causes more pain. It is a vicious circle. People
in chronic pain don't get into these deep stages of sleep so essential to healing, and
Somatomedin C is only one example of critical neuroendocrine products produced during

We treat sleep disorders very aggressively. and try to use agents that hit "2 or 3 birds with
one stone." For example, some of the antidepressant drugs (such as nortriptaline or
doxepine) are actually great analgesics. The brain stem (where you produce several
critical neurochemicals such as serotonin and norepinephrine. coordinates pain, sleep, and
mood. These "antidepresseant agents" modulate serotonin and norepinephrine, critically
important for quality and quantity of sleep, normal mood and pain modulation. Since you
only have to take these agents once a day you can use them as anti-insomnia agents as
well as analgesics to help initiate sleep, prolong it, improve the quality of sleep, and relieve
the pain.

--The Stages Of Sleep--

There are five stages of sleep that cycle over and over again during a single night: stages
1, 2, 3, 4 and REM (rapid eye movement).Stages 1 through 4 are also known as non-rapid
eye movement sleep (NREM). Approximately 50% of our sleeping time is spent in stage 2
and 20% in REM. A complete sleep cycle, from the beginning of stage 1 to the end of
REM, usually takes about 90 minutes. An adult normally sleeps more than 2 hours a night
in REM.

Stage 1: a light sleep during which the muscles begin to relax and a person can be easily

Stage 2: brain activity slows down and eye movement stops.

Stages 3 and 4: deep sleep, during which all eye and muscle movement ceases. It can be
difficult to wake a person during deep sleep. Stage 3 is characterized by very slow brain
waves (delta waves), interspersed with small, quick waves. In stage 4, the brain waves
are all delta waves.

REM: It is during REM sleep that people dream. The muscles of the body stiffen, the eyes
move, the heart rate increases, breathing becomes more rapid and irregular, and the blood
pressure rises.

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