Leg Cramps and Possible Prevention

In order to keep the title readable, I left out muscle spasms, charley horse, and calf cramps. All may be related and are often caused by similar problems. All can be painful, wake us up during sleep, and prevent us from getting a good night's sleep. Some of us even have them during the day.

Many of us with diabetes can suffer from the pain, and not knowing the cause can be as painful when we don't know how to prevent this.

First, I want to discuss some of the probable causes.

#1. Dehydration Some people are not aware that they are dehydrated, while others when asked can admit that they could have been. If there is a chance that this is the cause, I suggest increasing fluid intake (water) during the day, unless you have a medical restriction.

#2. Potassium deficiency Are you taking a diuretic for hypertension, many people with diabetes are taking at least one. Doctors hesitate to do the necessary tests to determine deficiencies of potassium. Magnesium, calcium, and vitamin B12 and a few other minerals need to be tested.

#3. Neuropathy If the person has neuropathy, there may be hyperactivity of the nerve/muscle causing the cramps. Malfunctioning nerves, which could be caused by a problem such as a spinal cord injury or pinched nerve in the neck or back? For neuropathy, vitamin B12 is often the culprit.

#4. Overuse Have you been exercising more than usual? Muscles that are overused can cramp. This is often the least cause and generally will disappear after a few days. Be careful of exercising in the heat and not stretching correctly before exercising.

#5. Exposure to cold temperatures or cold water Take a warm shower or bath before bed to relax the muscles and make sure your body is warm before going to bed.

#6. Other medical conditions Blood flow problems in the legs (peripheral arterial disease), kidney disease, thyroid disease, and multiple sclerosis can cause cramps..

#7. Sitting for a long time This is something many people miss, as well as standing on a hard surface for a long time, or putting your legs in awkward positions while you sleep.

#8. Taking certain medicines Medicines, such as antipsychotics, birth control pills, diuretics, statins, and steroids are common causes of leg and muscle cramps and can be side effects of the medications. For a more comprehensive list, read this article in WebMD.

#9. Poor blood circulation in the legs This should be checked by your doctor as this can become serious and lead to other problems.

What if muscle cramps keep coming back?

Have a serious talk with your doctor if the muscle cramps keep coming back are severe enough to consistently interrupt you sleep. These may be symptoms of another problem, such as restless legs syndrome. If cramps keep coming back, bother you a lot, or interfere with your sleep, your doctor may prescribe medicine that relaxes your muscles. If any of the above conditions exist and the doctor will not test for the deficiencies in number 2 above, it may be necessary to consider a new doctor.

Other help for muscle cramps include calf muscle stretches done routinely before going to bed. This is a pretty low-risk intervention and should be worth a try. You may read about this in this blog.

How can you prevent muscle cramps?

These tips may help prevent muscle cramps:

1. Drink plenty of water and other fluids, enough so that your urine is light yellow or clear like water.
2. Limit or avoid drinks with alcohol or caffeine. These can make you dehydrated, which means your body has lost too much fluid.
3. Make sure you are eating healthy foods that are rich in calcium, potassium, magnesium, and vitamin B12.
4. Ride a bike or stationary bike to condition and stretch your muscles.
5. Stretch your muscles every day, especially before and after exercise and at bedtime.
6. Don't suddenly increase the amount of exercise you get. Increase your exercise a little each week.
7. Take a daily multivitamin supplement.
8. Use a heating pad on the affected muscle.

If you are taking medicines that are known to cause leg cramps, your doctor may prescribe different medicines or change to dose to provide relief.

Children and Sleep Apnea

This study found overweight kids who had surgery were more likely to become obese within seven months. Tonsillectomies are commonly done to relieve sleep apnea in children, but a new study confirms that the treatment can speed kids' weight gain -- especially if they're already overweight. This is often the problem and many surgeons will not tell the family that this happens and urge them to exercise with their children to prevent this from happening.

The researchers did say that it is a concern, because obesity is a risk factor for a range of health problems, including sleep apnea. They are not advising against tonsillectomy for the children who need it. They are saying that doctors (plus surgeons) and parents should be taught that a healthy diet and exercise become even more important after the children have surgery. The researchers state that the surgery does create a 'certainty' that weight gain is an effect of the surgery.

“That's because children in the study were randomly assigned to have surgery or to "watchful waiting" -- putting off surgery and staying with other options, such as medications to better control any nasal allergies or asthma symptoms. Altogether, 204 children aged 5 to 9 were assigned to have surgery right away, while 192 stuck with watchful waiting. It was found that over seven months, children who underwent surgery showed a quicker average weight gain, versus kids in the comparison group.

It was a small difference overall. And for children who were normal weight, there was no major effect. It was not making normal-weight children obese. It was alarming that of those children that were overweight before surgery, 52 percent had become officially obese seven months after surgery. 21 percent of overweight children in the watchful-waiting group were obese.

Sleep apnea also causes metabolic changes. The growth hormone is released at night, and sleep apnea can interfere with that. The body may adapt metabolism in an effort to maintain a child's growth. Then when sleep apnea is managed, the children are set up for rapid weight gain. Now, with childhood obesity on the rise, many kids with sleep apnea are already overweight or obese. If they rapidly put on pounds, their sleep apnea might return in six months to a year.

Diet and exercise are key for children with sleep apnea. Many can do well without surgery using CPAP, proper nutrition, and exercise. This reminds me of blogs from February and March 2012 when I was sending articles to a set of parents in another state that were trying to avoid surgery on their son. Their insurance and I agreed that surgery should be the last resort and they are very happy this was possible. Their sleep doctor emphasized proper nutrition and exercise with the CPAP use and the entire family has responded very positively.

Family Support May Be Beneficial For CPAP Users

Family support for CPAP use may help in using the equipment. I know that does not matter for me because without my CPAP equipment use, I would be overtired and difficult to be around. Other people depend on family support for doing anything that their doctor may prescribe or recommend. I have seen this first hand and when I ask friends why they won't take a medication or use their CPAP machine, I normally receive this answer – 'my spouse makes fun of using it' or 'my family thinks it is funny and make a comedy out my using it.”

I now have a widow of a friend that is regretting the fun she made of her husband using a CPAP machine and full-face mask. Last week he did not wake up after suffering an apnea and even CPR could not revive him. She is a nurse and should have known better than making fun of his CPAP and its use. The autopsy revealed that he had died from a heart attack. On several occasions, I had warned him that this could happen and that he needed to use the equipment every night. I had even introduced him to the mask liners which had stopped the air leaks and noises from the mask when the seal was broken.

Yes, he was about 40 pounds overweight and had been in a sleep lab for his diagnosis, but his wife was not sympathetic and constantly made fun of the equipment and his use of it. I attended his funeral, but avoided his wife, but afterward she wanted to talk to me. I told her there was nothing to talk about and I was there for him. I left without saying anything.

This study by the American Academy of Sleep Medicine, is very clear in stating that people with obstructive sleep apnea (OSA) who are single or have unsupportive family relationships may be less likely to adhere to continuous positive airway pressure therapy.

Results show that individuals who were married or living with a partner had better CPAP adherence after the first three months of treatment than individuals who were single. Higher ratings of family relationship quality also were associated with better adherence. Results of the study were adjusted for potential confounding factors including age, gender, and body mass index.

If you are a CPAP user, a spouse of a CPAP user, or a family member of a CPAP user, do them a favor and give them your support, please. Read the article in the link above and help them use the CPAP equipment; they just might live longer and be around when you need them.

“The American Academy of Sleep Medicine reports that obstructive sleep apnea is a common sleep illness affecting up to seven percent of men and five percent of women. It involves repetitive episodes of complete or partial upper airway obstruction occurring during sleep despite an ongoing effort to breathe. The most effective treatment option for OSA is CPAP therapy, which helps to keep the airway open by providing a stream of air through a mask that is worn during sleep.”

Sleep Apnea May Be Tied to Diabetes

Prior to this study, most studies included few patients and were too short in length. Now we have a larger study and a suggested link between sleep apnea and diabetes.  Unfortunately, the study had some critical limitations. The limitations included lack of family history of diabetes, the race of the participants, and the possible misclassification of some subjects due to the limitations of the administrative health data used.

This is a severe fault of the study and that is the reason I only used the words 'may be tied' in the title. I don't care that they used the word “tied” in their title with claims of a link between obstructive sleep apnea and diabetes. Yes, there are some similarities between the two and being overweight is very common. As to one causing the other, this is still unproven. I will continue so that you can make up your own mind.

Lead author, Tetyana Kendzerska, MD, PhD, of the University of Toronto says, "Our study, with a larger sample size and a median follow-up of 67 months was able to address some of the limitations of earlier studies on the connection between OSA and diabetes. We found that among patients with OSA, the initial severity of the disease predicted the subsequent risk for incident diabetes."

The study included 8,678 adults with suspected OSA without diabetes at baseline who underwent a diagnostic sleep study between 1994 and 2010 and were followed through May 2011 using provincial health administrative data to examine the occurrence of diabetes. The apnea-hypopnea index (AHI) was used to assess sleep apnea severity. The AHI indicates severity based on the number of apneas per hour of sleep. Patients were classified as not having OSA (AHI < 5), or having mild (AHI 5-14.9), moderate (AHI 15-30) or severe (AHI>30) OSA.

During the follow-up, 1017 (11.7%) patients developed diabetes. In analyses, adjusting for known risk factors for diabetes, including age, sex, body mass index, neck circumference, smoking, income status and comorbidities at baseline, patients with an AHI>30 had a 30% higher risk of developing diabetes than those with an AHI <5 .="" 23="" a="" developing="" diabetes.="" had="" increased="" mild="" moderate="" of="" or="" osa="" p="" patients="" risk="" with="">

"After adjusting for other potential causes, we were able to demonstrate a significant association between OSA severity and the risk of developing diabetes, said Dr. Kendzerska. Our findings that prolonged oxygen desaturation, shorter sleep time, and higher heart rate were associated with diabetes are consistent with the pathophysiological mechanisms thought to underlie the relationship between OSA and diabetes."

Can We Afford 40% of Our Citizens to Have Diabetes?

This two out of every five projection of diabetes for adults is gloomy and at the same time should alert us to other problems we are facing. Then add to this that the rates for black women and Hispanics will be at 50 percent. And these projections do not include children and adolescents. What are the other problems we are facing?

This is just a partial list, but a very serious situation.

#1. There will be longer waits for doctor appointments. This is because of a projected doctor shortage.

#2. A serious lack of diabetes education is about to take place. It is serious enough at present, but with the activities of one certified diabetes educator group and their activities in opposing anyone being able to assist in education, it will become worse. This group is declaring that only CDEs are capable (not) of giving this education and others are not capable is the height of being conceited. With both CDE organizations unwilling to use telemedicine or group education, education will become a short commodity.

I will give credit where credit is due and that is many doctors in rural areas are taking diabetes patients that are willing and giving them education about diabetes to work for them as peer mentors or peer-to-peer workers. I have even been pleasantly surprised by the response I have received from the two doctors in Kansas that I have volunteered for as a peer mentor. They are having many of their patients ask me questions via email because they are not getting many questions answered by the telemedicine operation in Kansas. Time seems to be a constraint.

#3. Endocrinologists are even more overwhelmed because doctors are pushing many diabetes patients to them. This long article in Medscape helps explain the problem.

#4. No figures are being given for the numbers of new diabetes patients that have developed diabetes because of statins. At least we know that it may be near ten percent based on this study in Italy. See my blog from yesterday.

#5. No help is being provided by our government to encourage diet change. The USDA keeps promoting whole grains and other high carbohydrate foods instead of low carbohydrate, high fat nutrition. We also have the corn and wheat organizations influencing the registered dietitians to promote this as well.

Doctors, in their jaded wisdom, have coined the term "diabesity" to reflect the combined effects of the diabetes and obesity epidemics. They claim they go hand-in-hand, but give no reason for those obese patients without diabetes. And why should those people that are thin and diagnosed with type 2 diabetes need to put up with these prejudiced doctors. Plus these same doctors are not doing anything to educate patients or applying pressure to our government to change the nutrition of the population.

Not all the news from the study was bad -- the researchers found that people with type 2 diabetes are living longer than in the past. The CDC researchers estimated that the number of years lost to a diabetes patient diagnosed at age 40 decreased from nearly 8 years in the 1990s to about 6 years in the 2000s for men, and from almost 9 years to just under 7 years for women.

There is still a mountain of work that needs to be accomplished to help our population learn about proper nutrition – from the government level to the individual level.

Statin Adherence Increases Diabetes Cases

I admit I don't understand doctors that feel the risk of type 2 diabetes is secondary to the benefits of statin use. Since they do not take statins they have no concern about developing diabetes and therefore they make these statements with no thought about the costs or problems of diabetes.

Yet these doctors still insist the benefits of statins in reducing cardiovascular events clearly overwhelm the diabetes risk. The critical error in the study is that they do not report on cardiovascular events so the study is weighed for the results they wanted to report.

The risk of new-onset diabetes increases with increasing adherence to statin therapy, according to a study published online June 26 in Diabetes Care.

Giovanni Corrao, Ph.D., from the University of Milano-Bicocca in Italy, and colleagues examined the correlation between adherence to statin therapy and the risk of developing diabetes in a study involving 115,709 residents of the Italian Lombardy region. Participants were newly treated with statins during 2003 to 2004 and were followed from the index prescription until 2010. Patients who began treatment with an antidiabetic agent or were hospitalized for a main diagnosis of type 2 diabetes (outcome) were identified during this period. The proportion of days covered with statins was measured to determine adherence (exposure).

“The researchers found that 11,154 cohort members experienced the outcome during follow-up. The hazard ratios for the exposure-outcome association varied with adherence, with hazard ratios of 1.12 for those with low statin adherence (26 to 50 percent); 1.22 for intermediate adherence (51 to 75 percent); and 1.32 for high adherence (≥75 percent), versus very-low adherence (<25 i="" percent="">

About a tenth of the participants developed type 2 diabetes and this does not seem insignificant to me. This leads me to understand why the rate of diabetes is increasing worldwide at such an alarming rate.

Using CPAP During a Cold

Okay, you are using a CPAP machine and waking up rested. You have overcome your resistance to using the machine on a daily basis and are happy using it. Now, you are coming down with a head cold and are wondering what to do and think you should possibly take a break from using it until you are over the cold.

It is okay to take a break from using CPAP, if you have a cold. You may find that you have a residual benefit from the treatment, even several days into the break. This is because the inflammation and swelling of the tissues in the upper airway will take time to become affected again. See my blog from yesterday for possible breathing help using a CPAP.

When you have an upper respiratory infection, such as the common cold may make it more difficult to use CPAP. Similar to what occurs with allergies, the nose may become congested and runny. A stuffy nose may make it hard to breathe with the machine. The discharge of mucus may dirty the CPAP mask, especially if you use nasal pillows. The flow of air may also cause irritation if you have a sore throat. Each time you cough, opening the mouth may make the pressure uncomfortable.

If you do decide to continue using your CPAP during your cold, you may find it helpful to use a medication to alleviate a stuffy nose. Over-the-counter saline spray is inexpensive and effective. It can be used as often as you need it and will moisten the lining of the nose. Afrin spray may also provide relief, but it should not be used long term due to the risk for rebound congestion of the nose.

Other prescription medications may relieve chronic congestion related to allergies, including topical nasal steroids sprays such as Flonase, Nasonex, Patanase, and Astelin. It may also be helpful to rinse the nasal sinuses with a neti pot. If you have diabetes, be careful and only use prescription medications under the direction of a doctor, as many can raise blood glucose more than you want.

Some people actually like to use CPAP during a cold, especially if there is not a lot of nasal discharge. The heated and humidified air may add comfort and relief. This pressurized air may also move mucus along the nasal passage and decrease congestion. My CPAP has a heated humidifier and does help during a cold.

During and after your cold, it is important to be diligent about cleaning the CPAP mask, tubing, and humidifier tank. Give everything a thorough rinse with a mild soap and water.

Even if you want to take a break from CPAP when you have a cold, you don’t have to. If you find that you can tolerate the treatment during illness, it will help you to sleep better and wake feeling more rested. Except for one particularly bad cold, I have been quite comfortable using my CPAP machine and it has actually helped lessen the symptoms of my colds. You may need to experiment to find if this works for you.

Sleep Tips to Help You Breathe Easier with a Cold

How often do you suffer from a cold? Whether you have a head cold, a chest cold, or a combination sinus and head cold, there are ways to make it more bearable and help with breathing. Most of the time using one or more of these suggestions allows me to continue using my CPAP machine during a cold.

#1. Use a Nasal Strip. Applied externally to the middle of the nose, nasal strips have an adhesive on one side. Choose the appropriate size (small, medium, or large), wash, and dry your face before applying.

#2. Take a Hot Shower Before Bed. The steam and humidity of a shower cause sinuses to drain and the lining of the nasal passages to constrict, relieving some of the stuffiness of a cold. You can achieve the same effect by sipping a cup of hot tea or having a bowl of hot soup.

Chicken soup, the age-old cold remedy, may indeed have special benefits. When researchers at Mount Sinai Medical Center tested the venerable cold prescription in 15 cold sufferers, chicken soup proved more effective than plain hot water in clearing out sinuses.

Avoid drinking cold beverages near bedtime, however. I know from experience that even drinking cold water increases congestion. Other cold beverages have the same effect when done within a few hours of bedtime.

#3. Use a Saline Rinse. One of the safest ways to unblock congested sinuses and get a good night’s sleep is to use a saline rinse, in either a spray bottle or a neti pot. A neti pot is a small container with a narrow spout that’s used to pour small amounts of saline rinse into the nostrils. The saltwater washes mucus and irritants from your nose and helps the cells that move the mucus.

It's important, according to the CDC, that if you irrigate, flush, or rinse your sinuses, you use distilled, sterile, or previously boiled water to make up the irrigation solution. It’s also important to rinse the irrigation device after each use and leave it open to air-dry. Saline is a safer bet than over-the-counter or prescription spray nasal decongestants. Although topical decongestants effectively reduce congestion, versions that contain pseudoephedrine may cause sleeplessness and agitation. You may be able to breathe easier but not be able to fall asleep.

If you have to use a nasal decongestant, stop after 3 days and throw the bottle away.

Prescription sleeping pills may also be a bad idea when you have a cold. Sleeping pills can exacerbate upper respiratory obstruction in people with sleep apnea, which is a common problem for people who are overweight or obese. If a cold is the reason, you’re having trouble sleeping, it’s far better to treat the symptoms of the cold than take a sleeping pill.

#4. Elevate the Head of the Bed. One common recommendation is to prop your head up on pillows to help sinuses drain more easily. This is bad advice, as by bending your neck at an unnatural position, you can actually make it harder to breathe. Instead, use a large, wedge-shaped pillow that raises the upper body from the waist up. Or raise the head of the bed by placing bricks, books, or a telephone directory under the legs. Don’t raise it more than 6 inches, however, or the tilt will make you slide out of bed. The slight incline causes blood to flow away from the head and thus reduces inflammation of the air passages.

#5. Apply a Mentholated Gel. This is another venerable treatment that remains popular. And it may help, although not the way many people once thought. Studies have shown that menthol doesn’t actually open up the airways. Instead, the cooling sensation it causes makes people feel as if they’re breathing more freely. And let’s face it, that’s what’s important when you’re trying to treat the symptoms of a cold.

This does not often help those using a CPAP machine with nasal pillows or a nasal mask. If you do try this, do not be surprised if it does not help.

#6. Sleep on Schedule. When cold symptoms make it tough to sleep, paying attention to the basic rules of good sleep hygiene is more important than ever.

By now most of us know the basics:

• Go to bed and wake up on a regular schedule. (That way, when bedtime rolls around, you’re in the habit of going to sleep.)
• Avoid stimulating beverages like caffeinated coffee or alcohol in the hours before going to sleep.
• Reserve your bed for sleep, not a place to work, read, or watch TV.
• And if you do find yourself tossing and turning, get out of bed (and the bedroom, if possible) so you don’t associate bed with insomnia. Do something that you find relaxing until you feel tired enough to go to sleep.

Good sleep hygiene can be as effective as prescription drugs in helping some people sleep.

“Getting enough shut-eye may be especially critical during cold and flu season, according to a 2009 study by researchers at Carnegie Mellon University in Pittsburgh. The researchers enlisted 153 volunteers who agreed to be quarantined and then exposed to the viruses that cause most colds. Those who slept less than 7 hours were almost three times more likely to develop colds than those who got 8 hours of sleep or more.”