Is a Good Night’s Sleep the Best Prescription for Depression and Pain?

sleep14Depression and chronic pain are two common conditions that are also associated with poor sleep quality. While it is often thought that the sleep issues are secondary to these conditions, a new study conducted by researchers from the University of Alabama indicates that depression and pain due to osteoarthritis could be the result of poor sleep quality instead of the other way around.

Background Data:

Prior research has shown that people with hip and knee osteoarthritis (OA) are more likely to have insomnia, daytime sleepiness, and depression, than those without OA. The obvious relationship is that the arthritis pain affects sleep and makes people depressed. However, a 2012 study published in the journal SLEEP looked at sleep quality in people who were in chronic pain, including those with osteoarthritis and researchers found:

  • The amount of pain that people were in before they went to bed had little to do with how well they slept.
  • A person’s sleep quality predicted how much pain they were in the next day. People who slept poorly had more pain the following day.

Other studies have shown that poor sleep quality can trigger inflammatory pathways that make arthritis pain worse, and poor sleep also make people more sensitive to the feeling of pain from any cause.

New Data:

To better examine the relationship between OA, pain, and depression, 367 patients with OA of the knee from a variety of sources were recruited to participate in a trial. The participants completed a detailed questionnaire that identified overall health, depression, pain, joint function, and sleep quality. One-year follow-up was available for 288 patients.

Analysis of the data collected from the questionnaires indicated that comparing the initial baseline with 1-year follow-up data, sleep disturbance at baseline was linked with increased depression and further loss of joint function, but interestingly not more pain.

Since the questionnaire used in the study was not specifically designed to identify the exact sleep issues in OA patients, further research is needed to more fully pinpoint what is abnormal about OA patients’ sleep. Nonetheless, the conclusion from the study is the disturbance in sleep definitely precedes the depression, loss of joint function, and likely increased pain associated with OA. Hence, the takeaway message is that improving sleep quality is a key goal in preventing the progression of OA as well as the associated depression.


Early on in my clinical practice, I realized that improving my patient’s ability to get a good night’s sleep was usually the quickest way to help them feel better in every way. Over the years I have used a number of natural products that can help to improve sleep quality. The specific product that I now recommend as a first step is the one that I developed: Tranquil Sleep from Natural Factors. This formula provides the combination of melatonin (3 mg), 5-HTP (30 mg), and L-theanine (200 mg) in a great tasting chewable tablet or soft-gelatin capsule. These three ingredients work together to decrease the time required to get to sleep and to decrease the number of nighttime awakenings. Here is a brief description of each ingredient as it relates to improving sleep quality. If you don’t use Tranquil Sleep, you can get the same effect by combining them on your own

Melatonin is the most popular natural aid for improving sleep quality. Supplementation with melatonin has been shown in several studies to be very effective in helping induce and maintain sleep in both children and adults and in both people with normal sleep patterns and those with insomnia. Typical dosage is 3 mg at bedtime.

5-HTP (5-Hydroxytryptophan) is converted in the brain to serotonin – an important initiator of sleep. It is one step closer to serotonin than l-tryptophan and has shown more consistent results in promoting and maintaining sleep, even though used at lower dosages. One of the key benefits of 5-HTP is its ability to increase REM sleep (typically by about 25%) while increasing deep sleep stages 3 and 4 without lengthening total sleep time. Recommended dosage for improving sleep quality in combination with melatonin is 25 to 50 mg at bedtime.

L-Theanine is a unique amino acid found in green tea. Clinical studies have demonstrated that L-theanine reduces stress, improves the quality of sleep, diminishes the symptoms of the premenstrual syndrome, heightens mental acuity and reduces negative side effects of caffeine. It is an excellent support agent to melatonin and 5-HTP. Recommended dosage is 200 mg at bedtime.


Parmelee PA, Tighe CA, Dautovich ND. Sleep disturbance in Osteoarthritis: Linkages with pain, disability and depressive symptoms. Arthritis Care Res. 2014 Oct 6. doi: 10.1002/acr.22459. [Epub ahead of print]

Dr. Michael Murray

Painkillers "double risk of deafness" for men

Men who regularly take over-the-counter painkillers are twice as likely to suffer hearing problems than those who don’t, a study has shown.

Researchers found that younger men are particularly at risk.

Taking acetaminophen (paracetamol) at least twice a week doubles the risk of mild to severe deafness before the age of 50.

Other painkillers, including aspirin and ibuprofen, are also linked to hearing loss, the American researchers found.

The findings have not shown that painkillers directly cause deafness, but the scientists say they add to the evidence of a connection between the two.

Doctors have long known that high doses of aspirin can cause temporary tinnitus – or ringing in the ears.

However, low doses of the painkiller have been shown to protect against deafness caused by noise and antibiotics.

And previous anecdotal evidence has suggested non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen can harm hearing in people.

For the latest findings, researchers from Harvard University, Boston, tracked the health and lifestyles of more than 26,000 men every two years for 18 years.

The subjects were asked about their use of painkillers and whether they had hearing problems.

By the end of the study, nearly 3,500 reported some type of hearing loss.

Taking into account the age, weight, background and medical history of the men, the researchers established a link between hearing problems and common painkillers.

Although the study did not look at women, the researchers believe painkiller use could have an effect on their hearing.

Men under 60 who took at least two aspirins every week were 33 per cent more likely to suffer hearing loss than men who took fewer than two aspirins, the study showed. It found no link for men aged 60 and over.

Men under 50 who regularly took ibuprofen and other NSAIDS were 61 per cent more likely to have hearing problems, while those aged 50 to 59 were 32 per cent more likely to suffer.

Those aged 60 and above had a 16 per cent higher chance of deafness.

But the biggest link was found in men under the age of 50 who regularly took paracetamol. They are 99 per cent more likely to suffer hearing problems.

Men aged 50 to 59 who regularly took acetaminophen (paracetamol) were 38 per cent more likely to have hearing loss, while those aged 60 and over had a 16 per cent greater chance, the researchers report in The American Journal of Medicine.

For all groups, regular use meant taking at least two painkillers a week over a long period. The longer the period, the greater risk of hearing loss, it was found.

Dr Sharon Curhan, an author of the study based at Brigham and Women’s Hospital, Boston, said: “Given the high prevalence of regular analgesic use and health and social implications of hearing impairment, this represents an important public health issue.”

The researchers admitted that although they found a connection, they have not shown that painkillers cause hearing problems.

The researchers did not have any information on how much noise the men were exposed to did not ask why they took painkillers.

However, the scientists say that the drugs may cause damage to part of the inner ear.

There is however a natural protease enzyme that unlike aspirin and many other anti-inflammatories rarely causes unwanted side effects.