Effective lifestyle solutions for managing back pain, improving sleep, and handling medication side effects

Today’s post (#24) covers a collection of issues that I used to believe were age-related but my data demonstrated they were both caused by my lifestyle and were also solvable through my lifestyle. I am picking a few topics that I think may resonate with you: the inability to go back to sleep in the middle of the night, dealing with lower back pain and the curious case of feeling sleepy in the late mornings. Let me explain each of the three:

1. Inability to go back to sleep in the middle of the night: Those who have known me a long time can attest to the fact that my daily total sleep duration is less than most people. However, as research has now shown, it is the consistency of the sleep start and end times, along with the quality of the sleep stages (deep, REM, light, awake) that matter more than simply judging sleep by the total duration. While about 60% of my nights were good on these metrics, there were 40% where I would wake up in the middle of the night (restroom visit, something on my mind that was bothering me, indigestion, etc.) and I just couldn’t go back to sleep easily. I would toss and turn and finally get frustrated and get out of bed. I made some changes to reduce that 40% by drinking my last glass of water about two hours before going to bed, not being on my phone for 30 mins before bedtime, eating three hours before bedtime, etc. and those things helped bring down the 40% bad sleep nights down to about 20%, but that was still 20% more than it needed to be. Further experiments didn’t help reduce that and I had resigned myself to the fact that I had to live with it. That is, until I read this fascinating blog on breathing techniques and their impact on sleep. Unfortunately I can’t find that blog anymore but I do follow the simple breathing technique it suggested: close your eyes, take a few deep breaths that are about 6 seconds in and the same amount out. Focus on maintaining a consistent breathing pattern. Try to blank out your mind either by picking a single word that you can keep repeating in your mind or by focusing on your breath alone. Don’t stress about your thoughts wandering or getting the counts exactly right because that will work against you going back to sleep. Regular yoga practitioners have this down pat but I needed a bit of practice. And the results were amazing! I would start the process and within ten minutes or less, I would go back to sleep. Now there are very few nights where I am unable to go back to sleep, which are almost always due to the fact that I couldn’t say no to that last slice of cake or ice-cream! I should note that there are other techniques that may work well, such as the popular 4-7-8 technique (inhale for 4 seconds, hold for 7 seconds and exhale for 8 seconds) but I find that trying to keep a count of all that has been counterproductive for me, especially in the middle of the night when I don’t want a cognitive overload.
2. Lower back pain: In my case, there have been three very clear reasons for lower back pain: falls during soccer, poor form during a deadlift or a squat and poor posture. The soccer related back pain is usually short lived and I view it as the collateral damage of playing a contact sport, that I am willing to accept. The poor form during strength training was something I have overcome by getting the right guidance from a trainer as well as by not getting carried away with the weights I use. It is now rarely an issue. The last one – poor posture – is something I have to constantly remind myself of. It is not like I don’t know what good posture is all about but when I am not thinking, I find my core collapsing, that leads to rounded shoulders, an arched lower back, protruding abdomen and a tilted pelvis. I visited a posture expert, Dr. Esther Gokhale, at Stanford a few years ago. Based on her personal experiences, she came up with the Gokhale Method that has been published in a book as well as through her workshops and her TEDx talk. There are many fundamental concepts in her approach that are simple but powerful; I am going to simplify it to what I use on a daily basis. Roll your shoulders back which will make your hands feel like those of a dinosaur, stick out your butt, engage your core and your glutes and take deep breaths that feel like you are elongating your spine. This will feel strange at first and you will forget to keep it that way all day but every time you think about your posture, make these changes. Over time this becomes more natural but unfortunately a bad posture requires such little effort and energy that it is easy to fall back into it. The lower back pain is my reminder that it is my posture that I need to work on, and it never fails. The second image above serves as my modeling gig for the year; the bad vs. good image. As you can see, the changes aren’t that obvious between a bad and a good posture but they are critical.  For those interested in learning more about the Gokhale Method, I highly recommend signing up for Esther’s workshops or reading her book.

3. The curious case of feeling sleepy in the late mornings: I experienced this over the last couple of months where I would feel really sleepy in the late mornings and early afternoons. Initially I thought I was tired because my workouts were more intense or I required longer recovery times from my weekend soccer games or my sleep wasn’t as good but there wasn’t really anything that I had changed dramatically on any of those fronts. Looking at all my data that I had been tracking, I couldn’t find any clear correlation and so my only conclusion kept coming back to “this is what happens in your fifties…”. And then one day in the middle of all this, I didn’t feel sleepy in the late morning, which begged the question what was so special about that day. All of a sudden the reason became clear: I had been taking an anti-allergic (Zyrtec) every morning for years and it had worked well. About 2 months back, I had switched to a generic version which looked like it was essentially the same drug but significantly cheaper. I tracked the starting date of that medication to exactly the time my various markers (resting heart rate, sleep schedules, etc.) changed. The day I didn’t feel sleepy was the one day I had forgotten to take the medication. I immediately stopped taking the generic version of the medication and the results were instantaneous. I was back to feeling like my old self all over again. Post this incident, I have now started tracking my medications through my app so I can pinpoint which medication is having what side-effects. For each of you, there may be other such side-effects of medications you may not have attributed to it and continue to live with it. Hopefully this gives you some food for thought. One of the topics I will dedicate a whole blog post to is the area of pharmacogenomics: the study of how our genes affect our response to drugs, and therefore knowing our genetic makeup can lead to determining which drugs and what dosage, are right for each individual.

I hope these interventions are useful to those that have dealt with any of these issues. I would love to hear from those that this actually helped or if there is more clarity I should be providing to make the interventions more practically actionable.

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