But if instead of harvesting the riches of rest, you wake up feeling withered on the vine, you’re not alone. According to a National Sleep Foundation (NSF) poll, seven in ten American adults say they experience frequent sleep problems and one in five say daytime sleepiness interferes with their daily activities.

It’s hardly a surprise that we aren’t reaping the benefits of shuteye, given the prevalence of sleep deprivation in our society. Sixty-three percent of adults do not get eight hours of sleep, reports the NSF, and 31% report sleeping less than seven hours each weeknight. This results is what experts term a “sleep debt,” an accumulation of missed hours of rest.

Our sleep debt has increased over the last five years, in part because we’re working longer hours than ever before. “There is a direct relationship between hours worked and its negative impact on sleep,” says NSF Vice President James C. Walsh, Ph.D. “This is particularly noticeable for people working more than 40 hours per week.”

As any mom knows, children can also sow the seeds of parental sleep deprivation. A baby crying to be fed, a child’s nightmare or an adolescent’s rebellion provides fertile ground for parental insomnia or interrupted sleep.

Busy lifestyles and the 24/7 availability of everything from electricity to Facebook also contribute to sleep deprivation, asserts Holly Vance, clinical pharmacist and patient education specialist for drugstore.com. “As people’s lifestyles get busier and busier, they sleep less and less,” she observes.

Vance is quick to recite a litany of repercussions of sleep deprivation. “Not getting enough sleep causes drowsiness, irritability, decreased productivity at work and problems with judgement,” she says. Lack of sleep also contributes to larger societal problems, such as an increase in traffic accidents and workplace injuries. “Not sleeping well does have a far-reaching impact on society,” Vance concludes.

“Sleep deprivation has severe consequences,” agrees William “Joel” Culpepper, a sleep disorders researcher and a biostatistician in the Office of Research at the University of Maryland-Baltimore’s School of Nursing. “Research-wise, we have not be able to definitively pinpoint the restoration that occurs during sleep, but we all know from our experience when we don’t get enough. We’re tired, we’re sleepy, we’re not nearly as productive, and we’re susceptible to colds and bugs.” In studies where rats were deprived of sleep for long periods, he says, “You saw marked deterioration in these animals. They stopped grooming, they stopped eating and they became ill. If you deprived rats (of sleep) long enough, they died. That was the bottom line.”

Sue Langford, a publishing executive and single mom in Northern California, feels like one of those lab rats. Langford has a demanding job and a five-year-old son that consume most of her waking hours. “I adore my son and I love my job, but I walk around like a zombie most of the time. I operate on about six hours of sleep a night, and I know that’s taking its toll.” Unlike many people who sleep in on weekends, thereby “catching up” and reducing their sleep debt, Langford rarely has that luxury. “Miles is raring to go at 6:30 in the morning, every morning, including weekends.”

Because she has so little time to herself, Langford finds that she stays up until midnight most nights. “When he takes a nap at preschool, Miles doesn’t go to bed until about 10:00, and I just need a couple of hours alone to decompress,” she says. When Langford tries to get into a routine of going to bed at the same time as her son, “I feel like I’m trading my sanity for the sake of sleep.”

Still, Langford snatches up opportunities to catch up on sleep when she can. “If my son takes a nap on weekend days, I’ll head off to bed, as well. And even though I feel guilty, on some mornings I’ll let Miles get up and watch cartoons, and I’ll doze for another half hour.” A recent experience makes Langford determined to make sleep a higher priority. “My son spent the night at a friend’s house, and for the first time in over a year, I actually slept – uninterrupted – until my body was ready to wake up. I felt like a new person, as though the fog had lifted, and it was a great feeling!” she exclaims.

Problem Sleepiness

The foggy or zombie-like feeling that Langford experiences is a typical symptom of problem sleepiness. Memory lapses, problems with concentration, and struggling to stay awake while watching TV or reading are weeds that flourish when the garden of sleep is neglected. According to the National Center on Sleep Disorders Research (NCSDR), the first step in remedying problem sleepiness is to evaluate how much sleep you’re actually getting. If it’s consistently less than eight hours, the NCSDR recommends gradually moving to an earlier bedtime, going to bed 15 minutes earlier each night for four nights. If your schedule doesn’t allow for a full eight hours of nighttime sleep, they suggest, try a daily nap.

While Langford’s sleep debt accumulated due to inadequate sleep, there are can be other causes of problem sleepiness. According to the NCSDR, certain medical conditions – such as asthma or those accompanied by chronic pain – can disrupt sleep, as can some prescription medications. Any of these can result in daytime drowsiness and compromised mental acuity. While alcohol can make a person go to sleep more easily, it causes sleep disruption during the night. Caffeine and nicotine are both stimulants, which can make it hard to both fall asleep and sleep through the night.

Problem sleepiness can also be a symptom of one of five more serious sleep disorders: insomnia, sleep apnea, narcolepsy, periodic limb movements in sleep and restless legs syndrome.

Insomnia

Virtually everyone will have an episode of insomnia during their lives – lying awake in bed watching the second hand rotate endlessly around the face of the clock, waking up at an ungodly hour and not being able to get back to sleep or waking up every hour on the hour. According to the NCSDR, there are three classifications of insomnia: transient, which lasts from a single night to a few weeks; intermittent, in which transient episodes recur from time to time; and chronic, which occurs on most nights and lasts a month or more.

While women with a history of depression and those over the age of 60 are predisposed to chronic insomnia, transient and intermittent sleeplessness can be caused by environmental or emotional factors. Stress, noise, extreme temperatures, jet lag and side effects from prescription medications can all affect our ability to get to sleep and to stay asleep.

For those who suffer from insomnia, the problem of daytime sleepiness pales in comparison to the emotional roller coaster of anxiety about sleep. Each night becomes a battle, and anxiety mounts about whether or not sleep will come. Yet, even when insomnia feels entrenched, there are some relatively simple strategies you can use to get off the merry-go-round of sleeplessness.

Drugstore.com’s Holly Vance enumerates myriad tips to combat insomnia, but says that taking stock of your sleep habits should be first on your list. “You might not even realize you have bad sleep habits until you evaluate them.” Vance says, and advises, “The most important step in breaking the pattern of sleeplessness is getting in the habit of a regular sleep schedule. Go to bed at the same time each night, and wake up at the same time each morning – even on weekends.” In addition, Vance recommends that the insomniac eliminate naps. “This may be tough to do, but a lot of people fall into the habit of taking a nap in the afternoon, and it just perpetuates the cycle (of sleeplessness).”

Making your boudoir sleep-friendly is another key to a restful night. “If you live in a noisy home or apartment,” says Vance, “introduce white noise that drowns out cars or trains.” And keep your bedroom off limits to anything other than sleep or sex. “A lot of people bring work or laptops to bed – that’s a no-no. Don’t sit in bed and watch movies. All of these things can contribute to poor sleep habits.”

Vance also suggests trying relaxation techniques, such as yoga, meditation, or visualization, before going to bed. She also encourages regular exercise, though not right before bedtime.

If these techniques don’t work, Vance indicates that an over-the-counter sleep remedy might be appropriate once or twice a month. Diphenhydraamine and doxylamine are actually antihistamines, which have drowsiness as a side effect. “You’re actually taking advantage of the side effects to help you sleep,” Vance says, but cautions, “You don’t want to use them regularly; after a few days, they’re going to become less effective.”

For sporadic insomnia, you could also go herbal and try valerian, a root which, according to Vance, “increases deep sleep and dreaming, but doesn’t cause a morning hangover and drowsiness.”

While once touted as a miracle drug, melatonin ultimately received mixed reviews. “Melatonin is a hormone involved in the sleep cycle,” says Vance, “but it’s a little controversial. (Researchers) are not sure how it works and who it’s going to work for, plus there are conflicting studies about its effectiveness.”

If your sleep habits are impeccable and over-the-counter and herbal remedies still leave you grasping for slumber, a trip to the doctor might be in order. A health professional can not only rule out more serious sleep disorders and underlying medical problems, but can also, if necessary, prescribe a sleep aid. “Prescription drugs,” says Vance “can break the cycle of sleeplessness.” She does caution, however, that they are generally only recommended for short-term use, since prolonged use can trigger dependence problems.

Drugs like Restoril (known as benzodiazepines) cause drowsiness when taken 30 minutes before bedtime, though they can result in a morning hangover. According to Vance, Ambien is a slightly different drug and can have fewer side effects.

Antidepressants, such as trazadone and amitriptyline, are also used to promote sleep. “No one is sure how they work,” says Vance. “Some think they affect the sleep cycle and others think they have a drowsiness side effect, and you’re just using that side effect.”

Sleep Apnea

For Leslie Davidson, sleep apnea was like a creeper vine that was slowly choking the life out of her. In the beginning, “I would wake up in the middle of the night with a feeling of fear and an adrenaline rush,” she recalls. “Then, for over a year, I had chronic bronchitis, which I couldn’t figure out.” One day, she started having the need to “go unconscious – I can’t even call it sleeping. I couldn’t drive more than half an hour without having to pull over somewhere and go unconscious.” She experienced a subtle emotional shift toward depression, which led her to start taking the antidepressant Zoloft. Eventually, she began waking up every hour with dry mouth and the need to go to the bathroom.

Davidson, a business owner in Sacramento, Calif., took the first step toward regaining her breath and her life when she picked up a pamphlet on sleep apnea. “I read the symptoms, and I basically had all of them,” she says with a laugh. She went to a sleep specialist shortly thereafter and, Davidson recalls, “When she examined me, she could tell by looking in my mouth that I was a candidate for sleep apnea because of the shape of my throat and my palette.”

In obstructive sleep apnea, the airway becomes blocked, causing breathing pauses during sleep. According to the National Center on Sleep Disorders Research, the sleeper struggles to breathe, but air cannot easily flow into or out of the nose or mouth. Heavy snoring, lapses in breathing and frequent waking characterize this sleep disorder, which affects as many as 18 million Americans. Symptoms can also include choking sensations, early morning headaches and problem sleepiness. Sleep apnea is considered a life-threatening disorder, as it is associated with irregular heartbeat, high blood pressure, heart attack and stroke.

The doctor scheduled Davidson for a sleep study at a local hospital. Typically, sleep apnea is diagnosed using polysomnography, which records brain activity, eye movement, muscle activity, heart rate, respiratory effort, air flow and blood oxygen levels during sleep. Davidson reported that the experience, “wasn’t painful, but it wasn’t pleasant, because they glue little sensors all over your head and face and chest.” After seeing her test results, Davidson’s doctor told her she had stopped breathing 188 times during the night. “That was only moderately bad,” Davidson somberly recalls. “For a lot of people, it’s much worse.”

While behavioral changes, such as discontinuing the use of alcohol, tobacco, and sleeping pills, may shorten apneic periods during sleep, treatment most often involves the use of a continuous positive airway pressure (CPAP) device. The mask of a CPAP fits over the nose and mouth, and pressure from a blower forces air through the nasal passages, preventing the throat from collapsing during sleep.

Once Davidson began using a CPAP, “waking up with feelings of fear stopped right away. I haven’t had bronchitis since, and no problems with driving. Plus, as my doctor predicted, I got off the Zoloft within three months.” Although some people have difficulty adjusting to a CPAP, Davidson adapted easily. “You just learn little tricks, like putting the hose under the covers with you if the air’s too cold, or using a humidifier if the air’s too dry.” She says, “My CPAP is my lifeline. I go nowhere without my CPAP. That’s my baby.”

Treatment for sleep apnea can sometimes include dental appliances, to reposition the lower jaw and tongue, and oxygen administration. And while some surgical procedures have been developed to remove excess tissue at the back of the throat, the NCSDR estimates only a 30-50% success rate for surgery. They caution that long-term side effects and benefits of the procedures are not known, and that there is no way to anticipate who will benefit from this procedure.

Superfat people sometimes have extra tissue in the throat and mouth, which can contribute to sleep apnea when combined with an abnormality in the upper airway. Yet, given the 95-98% failure rate of weight loss attempts, dieting is hardly the first-line treatment for the sleep disorder. Davidson, who is superfat, reports that her doctor told her that “Fat can aggravate sleep apnea, but it’s not the cause of it.”

Davidson encourages anyone who suspects they might have sleep apnea to get tested. “It slips upon you gradually, so that you don’t remember what it was like (before). It’s definitely, absolutely life threatening, but it doesn’t seem like it. It’s a condition that you can’t see, so it’s easier to let it slide.”

Narcolepsy

According to the National Center on Sleep Disorders Research, narcolepsy is as common as Parkinson’s disease or multiple sclerosis – as many as 200,000 Americans have this sleep disorder. Narcolepsy is characterized primarily by overwhelming sleepiness during the day – even after a good night’s sleep. People who have narcolepsy may also experience episodes of sudden loss of muscle function, called cataplexy, which are triggered by emotional reactions such as laughter, anger or fear. Sleep paralysis, a temporary inability to talk or move when falling asleep or waking up, and hypnagogic hallucinations, vivid dream-like experiences that occur while dozing or falling asleep, are two other symptoms of this sleep disorder.

The University of Maryland’s Joel Culpepper says that, although there’s not a definitive scientific explanation for narcolepsy, “It’s believed that somehow those areas of the brain that control motor function during sleep manifest themselves when (the person is) awake. The border is considerably blurred.” He adds that there’s a strong genetic component to narcolepsy, and recent research has isolated a gene in dogs. “There’s still considerable work to be done,” Culpepper says, “but they’re honing in on (the gene).

“For those with narcolepsy,” Culpepper continues, “it’s such a dramatic event in their lives. It can have a rather sudden onset, usually in the late teens or early twenties. Sleep attacks, where there is literally the inability to fight against sleep onset, are scary and startling.”

Narcolepsy, like sleep apnea, is typically diagnosed with a polysomnogram. A multiple sleep latency test, which is administered during the day and measures how fast a person falls asleep and the time it takes to reach the various stages of sleep, is also used in diagnosing the disorder, since people with narcolepsy usually fall asleep and enter the REM (rapid eye movement) stage of sleep rapidly.

While there is no cure for narcolepsy, treatment includes central nervous system stimulants, drugs – such as antidepressants – that suppress REM sleep, and scheduling two or three short naps during the day.

Restless Legs Syndrome
Periodic Leg Movements during Sleep

While restless legs syndrome (RLS) and periodic leg movements during sleep (PLMS) are thought by some to be at two points on the same sleep disorder continuum, Culpepper maintains that the latest scientific literature treats them as two separate disorders. “There’s a basic distinction between the two. With RLS, there is uncomfortable tingling and cramping (in the legs) as you’re trying to fall asleep. PLMS symptoms are very characteristic – the toes come up toward the knee, there’s a rhythmical pattern, and it occurs in spurts throughout the night. (PLMS) is associated with arousals and, in severe cases, full awakening.”

Since childhood, Julie Young has lived the nightmare of both disorders. Young, 25, who works as a construction company office manager in Nantucket, Mass., and who has a web design business on the side, remembers times in her girlhood when she would cry herself to sleep at night because her legs hurt so badly. “When I was young, I used to thrash around in my sleep, and my mom didn’t want me to sleep with her because I would kick her all night,” she recalls. When she got older, Young would wake up with bruises on her legs, mystified as to how they got there. Looking back, “I assume they were from kicking myself during bouts of PLMS,” she says. When she was in college, Young’s boyfriend (Matt, now her husband) would complain – echoing the lament of other PLMS sufferers’ significant others – that she was “running” in her sleep.

According to the National Center on Sleep Disorders, the involuntary jerking or bending leg movements that characterize PLMS typically occur every ten to 60 seconds during sleep, and some people can experience hundreds of movements per night, which severely impacts the quality of their lives. Young and her husband took turns sleeping in the spare bedroom because her PLMS was keeping Matt awake. “It put a strain on our relationship,” Young recalls, “because we were losing that closeness.” In addition, she says, “I was always tired and cranky from lack of sleep. I started to get very depressed. I was sullen and irritable all the time. My productivity at work began to slip, and I was getting called on it. I tried everything I could, but I was still always tired.”

Restless legs syndrome manifests when the person lies down or sits for long periods of time. The RLS sufferer describes creeping, crawling, tingling, or painful sensations in the legs, along with an irresistible urge to move them. Young recalls that, “Driving for long distances or sitting for long periods of time became difficult. I would have to move my legs or the ‘creepy crawly’ feelings would start.” When she and Matt moved from Maryland to Kansas a few years ago, “We had to stop many times on our cross country trip so that I could stretch my legs. The sensations weren’t painful, just annoying, and nothing seemed to stop them.”

While some cases of RLS are transitory – it’s not uncommon for pregnant women to experience symptoms in the third trimester, but they usually disappear after delivery – most are permanent, although the severity of the disorder may ebb and flow over a lifetime. Because there is no diagnostic test for RLS or PLMS, health professionals rely on the patient’s (or her partner’s) report of her symptoms.

Unfortunately, there is no definitive treatment for either PLMS or RLS. In the medication arena, central nervous system depressants do not fully suppress symptoms, but may allow sufferers to get more rest. Drugs used to treat Parkinson’s disease can also reduce symptoms of both disorders, but they do not work for everyone. Pain-killing opiates sometimes work for people with very severe cases of PLMS or RLS, but have their own drawbacks.

Young’s experience in treating her sleep disorders has been nothing short of nightmarish. Her online research led to her self-diagnosis and a trip to a sleep specialist. Since then, Young has variously taken a central nervous system depressant, three different drugs used to treat Parkinson’s disease, and an anti-depressant. Some helped her get more sleep but did nothing for her PLMS; others worked for awhile, but stopped when she developed a tolerance to the drugs; and another made her deathly ill. Currently, Young is taking the dopamine agonist Mirapex, which is more commonly used for Parkinson’s patients. It’s working fairly well, and Young says, “It allows me to get a good night’s sleep and my husband doesn’t seem to notice the kicking so much anymore. My work and relationships have improved, since I’m getting more sleep and have my RLS under better control.”

Young doesn’t consider it a wonder drug, however. “I’m still exceptionally tired most of the time, I sometimes have a hard time concentrating on things, and I occasionally have a short-term memory problem. I will stay with Mirapex until it stops working, and then I will look into other medicines.”

Although much research has been devoted to the science of sleep, answers to why slumber is so beneficial have been elusive. The reigning theory is that sleep allows our brains to consolidate our memories and enables the recovery of our organs and metabolism. But regardless of the science, sowing the seeds of good sleep habits and reaping the benefits of eight hours – or whatever your body needs – of shuteye is crucial to our health and well-being.

Good nutrition, exercise and sleep are the triumvirate of good health, but sleep often takes a back seat to the other two. As Joel Culpepper says, “The trend continues to be for people to pay close attention to their (nutrition and exercise), and we need to put the same emphasis on sleep. It has an impact on every aspect of our lives. If we find ourselves nodding off at our desks, that should be an indication that we need to make some changes.”

Delve Deeper

The Great Escape
Your bedroom should be haven where you can retreat from the world. When furnishing your oasis, don’t neglect what Better Sleep Council Director Andrea Herman calls “the heart of the comfort zone” – your mattress. The Better Sleep Council, a non-profit organization funded by the mattress industry, suggests that, when shopping for a new mattress, you follow these guidelines:

1. Support: The mattress and foundation should gently support your body at all points and keep your spine in the same body position as a good standing posture
2. Comfort: Trust your body to tell you which mattress feels best. Mattresses don’t have to be hard as a board to be good for you
3. Space: Choose a mattress size that gives you enough room for free, easy movement, especially if you’re sleeping with a partner
4. Matching Sleep Sets: Matching mattresses and foundations are designed to work together. The foundation acts as a giant shock absorber, and lends added support and durability
5. Durability and Warranty: The performance of a poor quality sleep set can deteriorate very quickly, while top quality sets can provide comfort and support for a number of years. The warranty protects again product and workmanship defects
6. Value: Shop for the best value, not the lowest price. Buying the best you can afford is a healthy investment in yourself.

Wells finally consulted a chiropractor, but not long after, she drove six and a half hours to a convention, where she dashed up and down the hotel stairs several times each day and danced all night, every night. On drive back to her San Francisco home, the executive administrator says, the back of her knee tightened up, then became numb. “I came home and alternated with heat and ice and took the herbal muscle relaxants that the chiropractor prescribed, but my biggest mistake was not going to the hospital right then.” Within 24 hours, Wells says, she was back up and getting ready for work when “I bent over, heard a snap, and just went down. I had to crawl to my bed.” When another day went by and she couldn’t stand up or control her bladder, she went to the hospital via ambulance, where she was diagnosed with a herniated disk and faced a four-day hospital stay.

Wells, a veteran of the back pain wars, is not alone. For most of us, it’s not a question of if we will suffer from back pain, but when. Almost 90 percent of adults will endure a back pain “episode” in their lifetime, and for many it will be the beginning of a recurring condition that will plague them for the rest of their lives. Lower back pain is the number two reason for absence from work, following the common cold.

The spine is pretty amazing. It can move side to side, backward and forward and it can rotate. However, it is this amazing mobility that is at the root of all our back problems.

“If we fix one joint in the low back slightly, no joint will move normally,” says Dr. Jerome McAndrews of the American Chiropractic Association. “If the problem is corrected right away – great! If not, eventually the [whole spine] will compensate.”

There are many causes of back pain but almost 90 percent of all back problems are simply due to a strain on the muscles.

The pain that is caused by a muscle strain is often called “non-specific” pain. Like that which Elizabeth Wells experienced before her disk herniated, It is often described as a general discomfort or achiness over the entire lower back, pain that shoots into the buttocks or leg, stiffness when you first get out of bed or pain that feels better when you move around.

There are a variety of tests, such as MRIs or CAT scans, that can help diagnose your pain. But the experts at BackPainAnswers.com say such tests are not necessary: “What is necessary…is a good clinical exam made by an interested and experienced physician who isn’t giving you the bum’s rush.” Often, your range of movement will tell a doctor what is wrong and what is necessary for treatment.

Initial treatment will often include some kind of painkiller and a non-steroidal anti-inflammatory medication to reduce swelling and irritation. During her hospital stay, Wells took – with gratitude – the muscle relaxant Flexural and the painkillers Demerol and Vicodin. From this point on, doctor recommendations and treatment options will greatly vary. Obviously, the kind of health care professional you are consulting may determine the kind of recommendation that is made.

“I can only say what worked for me,” remarks Caroline Brigham, 29, who recently suffered six months with her first serious back problem. “My doctor wanted to send me to a neurosurgeon. With visions of scalpels and anesthesia and hospitals in my head – not to mention disability pay – I decided to exhaust all other options first.”

When Brigham’s primary care physician refused to refer her to a chiropractor, she went on her own. Working in partnership with a spine specialist who was able to prescribe narcotic-level painkillers until the treatments began to take effect, the chiropractor had her almost back to normal in six weeks. “I think the best thing a patient can do is think for herself. If you aren’t feeling better or if you are uncomfortable with your doctor’s course of treatment, get another opinion. I’m glad I did,” she said.

The Agency for Healthcare Policy and Research has concluded that only two percent of people with back pain in the acute stage require surgery, but about 250,000 people a year have back surgery, at the cost of about $15,000 each.

“Once you have had surgery,” report Dr. Andrews, “the odds that you will have several follow-up surgeries are great.

Elizabeth Wells’ earlier experience with a chiropractor was less than ideal, so she was comfortable following her physician’s recommended course of treatment. “In the hospital, a physical therapist taught me the proper way to get out of bed and take a shower so I wouldn’t re-injure my back.” Once out of the hospital, Wells continued to take muscle relaxants and painkillers, and began what she considers to be her key to recovery – walking in the swimming pool. “I started water walking twice a day, for 20 minutes each session. The first time it was extremely painful, but by the fourth or fifth time it wasn’t bad at all.”

After ten days, Wells met with her physical therapist, who helped her modify standard back exercises to accommodate her large body. “Instead of doing exercises on the floor, the therapist showed me how to do them on my bed, and she modified others so I didn’t have to slide down the wall.”

A woman’s size does not effect the treatment options open to her. Some doctors, however, such as Dr. Russell Windsor, an orthopedic surgeon at the Hospital for Special Surgery in New York, feel that size can affect the time it takes to heal. According to Dr. Windsor, “Once injured, weight may significantly slow the recovery and healing process due to the [additional stress on the spine] that occurs in larger individuals,” he asserts.

Wells theorizes that many doctors assume plus-size patients will have a slow recovery. “My doctor was shocked that I got better so quickly, but I think it was because I did modified exercises and activities like water walking that are gentler on a large body. The water takes all the pressure off your body, so that you don’t have anything weighing you down, so to speak,” Wells says with a smile. Wells, who at the time of her injury worked as a buyer in a plus-size clothing store, was back at work on light duty within four weeks.

By ignoring the first signs of back pain and engaging in risky activities, Wells exacerbated the problem by not following the basic tenets of back health. Keep from making the same mistakes by following these guidelines:

Diagnosis. If you injure your back or develop back pain, see your doctor. Remember that you can always get another opinion, additional tests or see a different kind of specialist. It is especially important to see your doctor if you think the pain could be caused by any kind of infection or if you have risks for other serious illnesses.

Ice and Heat. For the first couple of days after the injury occurs, apply ice to the area. This will bring down swelling and inflammation. After that time, according to Dr. Russell Windsor, many sufferers find that moist heat brings them the most relief, because it brings a greater blood supply to the muscles in the area and helps to loosen them for easier movement.

The Team Approach. Many back pain experts are advising patients to find a pain clinic that provides a team approach to treating back pain – where physicians, chiropractors, physical therapists and mental health professionals all work together to solve back problems. According to a briefing published in January of this year by the Center for the Advancement of Health, chronic pain patients who receive this kind of treatment experience a greater reduction of pain and improvement in mood than patients treated by one kind of practitioner.

“As the pain persists, [chronic sufferers] become more anxious and depressed, engage in fewer activities, spend less time on a job or quit working, become withdrawn and more focused on their pain. The likelihood that any one specialist…could take care of all their problems is pretty slim,” says Dennis C. Turk, Ph.D., a psychologist and professor at the University of Washington in Seattle.

Movement. If your doctor determines that the pain is a muscle strain, the best thing you can do after a day or two of rest and icing the area is to keep moving.

“Bed rest is the worst thing for me,” says Debby Loraine, who has suffered from back pain for 15 years after initially lifting a heavy picnic cooler. “I stiffen up if I stay immobile too long. As much as it might hurt at first, I always feel better if I get up, get a hot shower and get moving.”

According to Dr. McAndrews, even just four days of bed rest can cause permanent muscle damage. A day in bed can cause your muscle strength to decline by up to three percent per day. At some points, the benefits your back will gain by resting will be outweighed by the future problems such deconditioning can cause. In addition, the longer you stay in bed, the greater your chances of becoming depressed.

Sleeping Positions. While bed rest may not always be appropriate, you are going to have to sleep at some point. Investing in a good mattress may solve part of the problem. Many practitioners recommend sleeping on your back, with a thin pillow under your head, with more pillows under your knees. This position takes the stress off the lower back, and allows the muscles to rest and relax. If you are uncomfortable sleeping on your back, try lying on your side with a pillow between your legs.

As a supersize woman, Elizabeth Wells finds no relief by sleeping in a bed; she swears by the wonders of a La-Z-Boy recliner. “When I sleep in a bed, the weight of my stomach presses against my back and causes pressure. But when I sleep in my recliner, there’s lumbar support and it takes the pressure off of my back.”

The Right Moves. While keeping mobile is important, be sure to move the right way. When you bend to pick something up, or, for example, to move laundry from the washer to the dryer, bend at your hips, not at the waist. When you lift something from the floor, don’t bend at the waist; squat, hold the object close to your body and return to a standing position by pushing upward with your legs. To get out of bed, roll onto your side, and let your feet drop over the side of the bed. Use your bottom arm to push your body into a sitting position and then use your legs to push yourself upward into a standing position.

Sitting Pretty. Your chair at work should offer lumbar support and is best if hard-backed. Your feet should sit flat on the floor and your computer should be at eye level. And remember, sitting at a desk all day can be one of the worst things you can do for your back, says Dr. McAndrews, because it contracts the leg muscles, which over time can cause severe back problems. Try to get up and walk around your office at least once an hour.

Elizabeth Wells seconds that notion, saying, “At work, I try to get up and walk around. It’s so much better for my back to stand or lay than to sit.”

Most people don’t think about their car seats being bad for their backs, but they can be. The driving position (legs and arms suspended and immobile, possibly for long periods of time) puts a great deal of stress on our backs. People who drive for a living are twice as likely to have back problems. So when car shopping, test-drive the seat as well as the engine and look for lumbar support, arm rests, support on both sides of the torso, a headrest and a good deal of adjustability. And when you are taking a long car trip, make frequent stops to stretch and walk around.

Wells solved the car dilemma by buying a truck earlier this year. “It’s perfect,” she exclaims. “When I get out of the truck, my back doesn’t hurt like it does when I get out of a car. Plus, I think it helps my back that my feet aren’t cramped because my legs are so long,” says the 5’10” Wells.

Smoking. If the millions of other reasons haven’t convinced you to stop smoking, do it for your back. One effect of smoking is that it limits the blood supply to all the tissues in your body. When your back receives an inadequate supply of blood, it is more prone to injury and less able to repair damage. One study showed smokers were twice as likely to suffer from back pain than non-smokers were.

Relaxation. For many people, relaxation – not just of the back muscles, but of the mind as well – may be the key to alleviating pain. When you mentally stress, your body often tenses. It would follow, then, that stress makes lower back pain feel even worse.

Often, listening to relaxation tapes, meditating, or completing muscle relaxation exercises will help lessen back pain. For it to be truly effective, however, you should find a relaxation technique you like and practice it on a regular basis. According to the Midwest Center for Stress and Anxiety, the repetition of a meditation makes it easier for your subconscious to “retrieve” that feeling when it’s needed.

Exercise. Just as movement is important during a back episode, regular exercise is just as important in preventing future occurrences. According to Dr. McAndrews, walking is the best overall exercise for keeping leg, back and abdominal muscles strong and flexible. Swimming is another excellent choice because, although it strengthens and tones muscles, it relieves the stress and pressure on your back.

For extra insurance, ask your doctor or physical therapist for some back strengthening exercises, like those shown here, to do on a daily basis. They only take a few minutes, but you will feel a difference almost immediately. It is important that the back muscles are kept loose and conditioned so they will be better able to deflect muscle strain and unusual movements.

Recurrences

Alleviating acute pain is only the first step in the process of regaining back health. To avoid future recurrences, says psychologist Turk, “We teach people to think about ‘rehabilitation’ rather than ‘cure.'” While a cure means a permanent fix, rehabilitation involves learning to “pace your activities and to keep active to increase your strength and endurance and prevent pain flare-ups.” Concludes Turk, “The goal is to find ways to help people become much better self-managers of their own condition.”

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“Alternative” Therapies

In the past, therapies outside the medical model were rarely covered by health insurance plans, and a patient who chose to try an alternative therapy was on her own financially. But as studies have shown that the cost of missed work, disability insurance and hospital stays for back surgery greatly outweigh the costs of these non-invasive therapies, some insurers are beginning to cover these treatments.

Physical Therapy: A physical therapist develops a routine that includes exercises that stretch the muscles, build strength and lessen pain, to improve your immediate condition and help prevent recurring problems in the future.

Acupuncture: An acupuncturist uses needles to stimulate the brain to release pain-reducing chemicals into the body. This method will alleviate the pain, but it won’t heal the problem in the long run.

Massage Therapy: Massage relaxes muscles to relieve spasms. It will also relieve mental tension and anxiety, and can help with healing by exploring metaphysical causes of back problems.

Yoga and Tai Chi: Yoga and Tai Chi exercises can help prevent further problems from occurring because they increase muscle flexibility and relax the mind.

Chiropractic: Most chiropractors will treat back pain with manipulation, in which they use their hands to move a joint out of its normal range of motion. This repetitive movement may cause the joint be become more mobile over time, which usually decreases pain.

TENS: In transcutaneous electrical nerve stimulation, small pads connected to cables are laid on the skin in the region of pain. Barely perceptible electrical impulses are applied to the area for a short period of time. The electrodes “interfere” with the sending of impulses of pain to the brain, causing your injured area to be less painful. This treatment is painless, and patients can rent or buy these machines to keep at home.

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The prevailing belief of the mainstream scientific community can be summed up as “fat-is-bad/thin-is-good.” While being larger than average was once seen as a positive attribute, Twiggy-esque ideals began to haunt the public’s and medical community’s consciousness’. Indeed, scientists now view someone with a high body weight as having a chronic disease requiring lifelong treatment. Dietary and behavioral changes, along with pharmaceuticals, have been promoted as the way to achieve and maintain thinness, which is now equated with health and longevity. As a result, a weight loss industry with annual revenues of $33 billion now exists in the U.S.

However, the anomalies to the mainstream belief that extra weight is harmful are accumulating, with a growing body of research demonstrating that permanent weight loss is achievable by only a small percentage of those who attempt it (approximately 3-5%); that some methods of weight loss can be harmful (remember Redux and fen-phen?); that for some people, conditions associated with a higher weight (high blood pressure, gallstones) may actually result from weight loss attempts; and that large people can improve their health without ever losing a pound.

Thus, the scientists who conduct the research that results in this new information are challenging the current paradigm about weight. In addition, this renegade research rings true for a growing number of nutritionists, health educators, therapists, physicians and other health care professionals, who find that these theories validate their clinical experience.

The question then becomes, why haven’t we, the public, heard about the theories and research that may point to an alternative view of weight? Is there a coven of diet industry bigwigs out there, cackling around a cauldron of Slim-Fast and conspiring to keep this research suppressed? Has media bias resulted in the underreporting of important scientific findings? Or is it something far less sinister – simply a number of factors that make changing public perception a Sisyphian task? In fact, there appears to be evidence to support all of the above.

But before we start, let us first review the machinations of the world of research publishing. In order for a study to be considered legitimate by both the scientific community and the media, it must be published in a peer-reviewed journal. The Journal of the American Medical Association and the New England Journal of Medicine are examples of these. After a researcher’s study is completed, s/he must write a paper on the subject and submit it to a journal. That journal editor then sends the paper out to experts in the field to be critiqued. No one receives payment of any kind: not the writer or the reviewers. If the paper doesn’t receive the amount of favorable commentary the journal requires, it is returned to the sender unpublished.

Being published is the lifeblood of researchers. Publication or lack thereof impacts whether or not they receive funding for future research, their standing at the academic institutions at which they’re based, and their level of credibility within their field. “Publish or perish” is the axiom of those who inhabit this world.

The experience of psychologist David M. Garner, Ph.D. may support the conspiracy theory. Dr. Garner, who is widely published in the field of eating disorders and is an adjunct professor at both Bowling Green State University and the University of Toledo, as well as the director of the Toledo Center for Eating Disorders, says, “For many years, there has been a problem with research that led to conclusions that are critical of the traditional weight loss industry.”

About a decade ago, Garner and his colleague, Susan C. Wooley, Ph.D., Professor Emeritus at the University of Cincinnati College of Medicine, submitted an article to a major scientific journal for review. The article, which was used as a background document for the House of Representatives’ 1990 committee investigation of the diet industry, was critical of the traditional dietary and behavioral treatments of obesity.

“The scientific review process for our paper was disturbing, to say the least,” Garner says now. Their paper was sent out to three experts for review, and came back with mixed conclusions. Garner and Wooley addressed most of the concerns in what they considered a thorough fashion and resubmitted the article. According to Garner, “Apparently, the journal editor could not make up his mind and sent the paper out to other experts in the second round of reviews.”

Eventually, the article was rejected, in part on the basis of another expert’s review. “We were sent this review as support for the editor’s decision,” says Garner. It was only later that they found out that a highly favorable review of their paper, written by Paul Ernsberger, Ph.D., a biomedical researcher at Case Western Reserve University, had been suppressed by the journal editor, in that Garner and Wooley never received a copy. “Dr. Ernsberger later sent me a copy of his review, which was one of the most scholarly and complimentary reviews I have ever received – or in this case, not received,” recalls Garner. “Clearly, the failure to forward a copy of this review reflected editorial policies rather than fair and impartial science.”

Ultimately, their article, “Confronting the Failure of Behavioral and Dietary Treatments for Obesity” was reviewed by the editor of Clinical Psychology Review and was accepted with editorial accolades. It was published in that journal in 1991.

Esther Rothblum, Ph.D., a professor of psychology at the University of Vermont who is the preeminent researcher on weight and social stigma in this country – if not the world – had similar experiences. “One expert reviewer wrote that the findings in one of my obesity studies were not valid ‘because they differed from those currently held by psychologists,’ and went on to cite Glamour magazine – in a prestigious medical journal! – to back up this point,” she says, incredulously.

As for how the mainstream media reports studies that go against the mainstream, Dr. Susan Wooley’s experience suggests that they often simply dismiss it. When she was interviewed on 20/20, for example, the ever-combative John Stossel’s response to her findings was “Why should we believe you? You’re fat yourself. Couldn’t you be biased?” Wooley (who, when asked for a photo to accompany this article responded, “Oh, I don’t have a new one. Just tell them I look like a queen-size Sandra Dee with brown hair”) recalls, “I was introduced on the program as an expert, and it took them three minutes to discredit me.”

According to Wooley, for many decades research has revealed that diets really don’t work and the reasons why, and that powerful genetic influences affect body size. However, she says, “We’re just beginning to hear about it from major media sources.”

Ed Silverman, a reporter for the New Jersey Star-Ledger, articulates the trap that many journalists fall into when he says, “There is a working assumption that all fat is bad, along with a cultural bias. This is just more justification for harping on the dangers of fat, and reporters tend to turn to sources who validate that belief.”

To Glenn Gaesser, Ph.D., an associate professor at the University of Virginia and a fellow of the American College of Sports Medicine, one of the more annoying falsehoods endlessly repeated by the media is the statistic that “300,000 people die each year from obesity.” That sound bite originated with former Surgeon General C. Everett Koop during the launch of his organization, Shape Up America. Gaesser resolved to find the source of that statistic, and discovered it in a study done by Foege and McGinnis. Much to his surprise, the study never mentioned weight. Instead, it said that 300,000 deaths each year were related to a combination of dietary factors and sedentary lifestyles.

Why has this bogus statistic become a media mantra? According to Silverman, “The average reporter…often (doesn’t) have time to really delve into the subject. As a result, you miss the more sophisticated nuances that lurk behind the machinations, and you get people in the media who take Koop’s pronouncements for granted, not knowing his non-profit organization is funded by grants from the weight loss industry.”

Silverman knows something about the way that economic interests may influence the manner in which research is promoted or suppressed. In 1997, he and a colleague at the Star-Ledger completed a year-long investigative report, “Fat Pills, Fat Profits,” which, among other findings, clearly demonstrated that “Some of the doctors, researchers and scientists who shape the public’s perception of obesity and what the government should do about it accept money from companies that profit from weight loss pills and programs.”

From a startling diagram accompanying their series of articles, one can clearly see how some might view the mainstream obesity research community as incestuous. Almost half of the members of the National Institutes of Health (NIH) Task Force on the Prevention and Treatment of Obesity (the federal government’s weight-related public health policymaking committee, which we – as taxpayers – support) are affiliated with the diet-industry-funded American Obesity Association. Two of these scientists are members of a council funded by Knoll Pharmaceuticals, makers of the diet drug Meridia. And both Koop and Shape Up America’s executive director are on the advisory council of the American Obesity Association.

In the early ’90s, a NIH panel reviewed all of the studies on weight loss, and found that, instead of improving health, weight loss actually increased mortality. Dr. Glenn Gaesser recalls being told by a reputable source that, “one of the panel members actually said, ‘I don’t believe it, and even if it’s true, we can’t let the American public know about it.'”

Given that the vast majority of research money is provided either by the National Institutes of Health or by pharmaceutical companies, one may wonder whether the policymakers’ potential conflicts of interest has an impact on the types of research that are funded.

When discussing the molasses-like speed of change in shifting the weight paradigm, some authorities also point a finger at the public. “The diet industry doesn’t want to hear this, but people don’t want to believe it either,” says Pat Lyons, RN, MA, director of Connections Women’s Health Consulting Network. “So instead of promoting a healthy lifestyle for people of all sizes, we have an unenlightened ‘fat-is-bad/thin-is-good’ consciousness.” Lynn McAfee, director of the Medical Advocacy Project of the Council on Size and Weight Discrimination, says, “People have to change, too. We have to be willing to change our perceptions instead of preferring to keep our illusions.”

Despite the seeming damning evidence, most experts don’t see a conspiracy at work. Instead, they feel that mainstream obesity researchers are simply the reigning royalty within the present structure. According to Dr. Cheri Erdman, “Research (from the new weight paradigm) isn’t so much suppressed as ignored.” Dr. Gaesser concurs, saying, “There is very selective use of literature with regard to size. Pharmaceutical companies quote directly from findings in their favor and dismiss any study that shows otherwise. If it’s anything about improving health independent of weight loss, those references are not publicized.”

Dr. Esther Rothblum attributes the difficulty of getting published less to conspiracy and more to cultural bias. “It’s always very hard to be at the vanguard of anything,” she says. Her theory is that it takes people time to ‘get it,’ regardless of the subject. “Years ago, I was asked questions like, ‘Why would you be studying women?’ and ‘Why bother to analyze gender?’ That’s funny now, but that’s how people think.”

Lynn McAfee also doesn’t believe there’s a conspiracy at work. She says with conviction, “As for an organized effort on the part of the diet industry to prevent the public from finding out the truth, that is not happening.” She believes that, “They make individual attempts to ignore the research, but they’re not ‘in it together.’ They hate each other too much to do anything together, even something this vital to their survival. The diet business is that competitive.”

Instead, they suggest that perhaps the fact that we haven’t heard as much about the alternative theories of weight is due less to collusion, and more to a collision of cultural bias, a lazy media, economic interests and a public clinging to the old “truths.” Time will tell whether the “anomalies” to the current dogma about weight will reach critical mass, and thus crash the belief system. If they do, it will be interesting to see what new truth rises from the ashes.

Whatever The Truth may be, we consumers should probably bear in mind that science is Big Business, and therefore, not always as objective as we might assume. Ultimately, we should keep in mind that our health is individual and that what works best in our lives is our own personal choice.

This article was originally published in a 1999 print issue.

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