Sleep and Migraine – Webinar

0:00 Hi, welcome to my day in
0:09 Kanada. Ähm we are Here tonight
0:13 on this beautiful snowy night
0:18 Um with Malayga in Canada and
0:21 Rachel Luther, our guest for
0:22 tonight. Uh if you have just
0:26 joined us, welcome this is one
0:28 of our webinars that is part of
0:32 a series called Osteopharmacist
0:36 and I’m very very lucky and
0:38 honored to have Luther, our
0:40 guest pharmacist for tonight.
0:42 Um I met, I think I met you
0:45 more than a year ago, Rachel.
0:47 Was it a year ago or more? A
0:48 year ago or more for sure. Mm
0:51 hmm. So, Rachel is one of our
0:53 migraine pharmacy network
0:55 pharmacists and I think we
0:57 became best friends because of
0:59 the passion that you have. Uh
1:00 for people living with migraine
1:02 and your continuous search for
1:09 to help people living with
1:11 migraine and your patient in
1:12 general. Um sleep is one of
1:14 these things that we started
1:15 talking about and then you
1:17 explained to me about this
1:18 amazing program that you have.
1:20 Uh you are a registered
1:21 pharmacist. You do have a
1:24 pharmacy or that you that that
1:27 is in Fergus. Uh we’re going to
1:29 be giving the information on
1:31 the pharmacy. It’s sent to
1:33 Wellington Remedies RX that is
1:35 in Fergus. Um did I say
1:37 Ferguson or did I say Fergus?
1:39 No use of Fergus. Okay.
1:46 Rachel lives there with her
1:47 husband And two children. Uh
1:49 when she’s not in pharmacy,
1:50 I’ve just found this very
1:53 interesting information over a
1:55 very interesting fact. She’s
1:57 out looking for mushrooms with
2:00 her daughter on walks. And that
2:02 was, this is the first time
2:03 I’ve heard of someone going and
2:05 looking for mushrooms. Um,
2:06 alongside other things, you do,
2:09 you’re very active in your
2:10 community, you do help with
2:21 fundraising. You told me about
2:21 some of the fundraising
2:22 activities that you do for your
2:22 community. Welcome Rachel. It’s
2:23 a pleasure to have you. I’m
2:24 hoping that our guests tonight
2:25 and our viewers tonight will
2:26 enjoy this warm talk on a on a
2:32 very cold night. Thank you very
2:34 much. Thank you Heba for that
2:36 introduction. So
2:40 I’ll just get our presentation
2:40 up. And I might need some help
2:42 with that. Okay. There it is.
2:45 It’s Justin’s best. There you
2:47 go. Alright. So, tonight we’re
2:49 going to be talking about how
2:50 to get a good night’s sleep.
2:52 And cognitive behavioral
2:53 awareness program that I offer
2:55 at Center Wellington Remedies
2:57 RX. So, you’re probably here
3:00 because at some point in time,
3:01 you found yourself lying awake,
3:04 trying to get to sleep, and
3:05 unable to get to sleep. So,
3:08 tonight, the purpose of our
3:10 presentation is to kind of look
3:12 at some sleep myths, define
3:41 insomnia. We’re going to
3:41 discuss some predisposing,
3:42 precipitating, and perpetuating
3:43 factors for insomnia and then,
3:44 we’re going to look at how it
3:45 relates to migraine s because
3:46 that’s why we’re here at
3:46 Migraine Canada livestream
3:47 tonight and then, I’m going to
3:48 outline what a sleep therapy
3:49 program kind of looks like. So,
3:50 one myth is that everybody
3:50 needs eight hours of sleep at
3:51 least per night and this is not
3:52 really true. Uh some people may
3:53 need more, some people may need
3:54 less but people’s sleep needs
3:55 are individualized based on
3:55 them and maybe what’s going on
3:56 in their life as well. Another
3:57 myth is awakening a few times
3:59 per night is a real problem but
4:01 in fact, it’s quite normal to
4:02 wake up two or three times a
4:04 night just from normal ebbs and
4:05 flows in your sleep patterns
4:06 over the evening. Another myth
4:11 is when sleep worsen when sleep
4:13 worsens worsens with age, it
4:16 signals a major problem and
4:17 this isn’t the case. In fact,
4:20 as cruel as it may seem, as you
4:24 get older, you’re you don’t
4:25 really need as much sleep as
4:26 you did as when you were
4:27 younger. So, it’s a funny joke
4:31 that nature does on us but when
4:32 you get older, you don’t need
4:33 as much sleep and it doesn’t
4:35 signal a major problem if
4:37 you’re not sleeping. Sometimes,
4:38 it could be just your body
4:39 readjusting to how much sleep
4:41 it needs.
5:08 And the last myth is most
5:09 people just want a hill to fix
5:10 their insomnia. Study show that
5:11 most people just want to have
5:12 their insomnia fixed and if it
5:13 doesn’t they can do it without
5:14 a pill. They would prefer that.
5:18 So how is insomnia defined?
5:19 It’s a complaint or difficulty
5:20 initiating or maintaining
5:21 sleep. That can cause a
5:21 significant impairment or
5:22 distress in your functioning.
5:23 And it’s often associated with
5:24 fatigue. It’s defined as having
5:25 three or more nights per week
5:26 for three or three or more
5:26 months. That would mean that
5:27 it’s a chronic sleep problem.
5:28 Some predisposing things are
5:29 things that you can’t really
5:30 change. There were cards that
5:30 were dealt with you that
5:31 predispose you to maybe having
5:32 some poor sleep habits like
5:33 could be age, it could be that
5:34 it brings in your family.
5:36 There’s some precipitating
5:38 factors or things that can kind
5:39 of bring it on like if you’re
5:41 the type of person who’s
5:41 anxious anyways, you’re more
5:43 likely to have some problem
5:45 sleep. If you have a tendency
5:47 to worry and have circular
5:49 thinking, again, that can cause
5:50 problems with having your mind
5:52 running so that you’re unable
5:53 to turn it off to sleep and
5:55 just if you’re generally a
5:56 hyper person, you’re going to
5:57 have problems with sleep There
6:00 are some things that can
6:01 perpetuate having sleep
6:02 problems like if you’re going
6:04 through a stressful time in
6:05 your life, if you have not a
6:08 very good routine when you’re
6:09 going to bed, if you work shift
6:11 work, it’s likely that you’re
6:12 going to have problems with
6:13 sleep and then there’s some
6:14 things that you could have
6:15 going on medically like chronic
6:17 pain and anxiety and depression
6:18 that can really help not help,
6:21 can really affect the quality
6:25 and quantity of the sleep that
6:26 you’re getting. So, how does
6:29 this all relate back to
6:30 migraine s which is why we’re
6:31 here. It’s kind of like a
6:33 chicken or egg type thing.
6:35 Sometimes, when you treat
6:36 migraine s, you may find that
6:39 your insomnia changes because
6:41 you probably can’t sleep
6:42 because you have a migraine and
6:44 that’s going to contribute to
6:46 your insomnia. So, if you treat
6:47 the migraine, that in turn may
6:49 check may help with your
6:51 insomnia and then, the flip
6:53 side of that, if you suffer
6:55 from insomnia, you have an
6:57 increased risk of developing
6:58 migraine and increase and
7:01 migraine frequency, an increase
7:03 in pain intensity, and an
7:04 increase on the impact that
7:06 your migraine s have. So, if
7:07 you treat the insomnia, then,
7:08 that can help with how many
7:11 migraine s you’re getting. Yes,
7:12 Heba. So, I and I mean, I saw
7:15 this presentation ahead of time
7:17 and when I saw this slide, I
7:20 the first thing I think of is
7:23 is it possible that insomnia
7:26 itself is one of the symptoms,
7:27 is one of the things that are
7:29 caused by migraine? Do we?
7:31 Yeah. Yeah, like a chicken
7:36 eggs. So, like if you treat
7:37 then, the migraine, then that
7:38 in turn will affect and maybe
7:40 take care of the insomnia. Does
7:43 that mean that it is still
7:46 within our control? If if it’s
7:48 part of the of the syndrome
7:49 itself or of the condition
7:50 itself, that we are able to
7:53 still interfere with with
7:55 insomnia or with sleep
7:56 interruptions or with sleep
7:59 disruptions that happen with
8:01 migraine, you think? Uh it
8:01 depends on to sleep is
8:03 secondary. If your sleep
8:05 problems are secondary to a
8:06 migraine. So then if you treat
8:08 the migraine, you in turn will
8:09 help with insomnia. But if you
8:12 have insomnia and that’s your
8:15 primary thing that’s going on.
8:16 And then when you really have
8:18 poor problem sleeping you get a
8:21 migraine as a result of that.
8:22 Then treating the insomnia will
8:24 in turn take care of a
8:26 migraine. It’s kind of like if
8:28 you think about somebody having
8:30 a lot of tension in through
8:32 their neck. If you treat the
8:35 tension in their neck, then,
8:36 you’re going to improve the
8:37 migraine. Yes. And then, if you
8:40 have a migraine and you treat
8:42 that migraine, then, the
8:44 sensations of the pain that you
8:46 feel in your neck are going to
8:47 get better because you’re not
8:48 having your body so, you know,
8:51 kind of wound up because your
8:53 perception of pain changes when
8:56 you’re in pain and then also
8:58 when you don’t have enough
8:59 sleep. Um is it possible also
9:03 that the the whole idea of fix
9:08 your sleep and your migraine is
9:10 going to be better is easier
9:12 said than done for people
9:14 living with migraine because
9:15 most of my patients come in and
9:17 say yeah I do have issues with
9:20 migraine with with sleep but
9:21 this has been ongoing for years
9:24 and the worst my migraine is
9:26 the more difficult it is for me
9:28 to control my sleep. So is is
9:31 there a correlation between
9:32 also how bad the migraine is or
9:34 how frequent your migraine
9:38 attacks are and how bad your
9:39 sleep is? Mm hmm. Yeah,
9:41 definitely. It feeds into each
9:42 other, right? It’s almost like
9:44 a passive feedback loop. So, if
9:46 you’re having like migraine s,
9:47 then, it’s going to F, well, I
9:50 guess negative but it’s
9:50 going to decrease your sleep,
9:52 right? So, you they kind of go
9:55 hand in hand and depending like
9:58 if you find that treating your
10:01 migraine s for years have not
10:02 really helped your insomnia,
10:03 then, you may very well benefit
10:04 from treat trying to go after
10:07 the insomnia. Um again, if you
10:10 find that your migraine s is
10:13 what’s keeping you up at night,
10:15 then, you may very well find
10:17 that instead of worrying about
10:18 your insomnia, treating your
10:20 migraine s is going to help in
10:21 turn your insomnia. Perfect.
10:24 Thank you very much. Thank you.
10:26 Yeah. Alright. So, what is a
10:30 sleep therapy program? So, a
10:32 sleep therapy program basically
10:34 has four pillars. Sleep
10:35 restriction, stimulus control,
10:38 cognitive restructuring, and
10:39 relaxation training. Here are
10:44 some steps that can help with a
10:46 solid night sleep. It’s
10:47 important to go to bed only
10:49 when you’re sleepy and not
10:50 before your threshold bedtime.
10:52 And it’s important to maintain
10:54 a regular threshold rise time
10:57 in the morning. Another
10:59 important thing that you
11:00 probably have heard at some
11:01 point in time if anybody who
11:02 has problems with sleep have
11:04 heard that you should only use
11:05 your bed for sleeping. Or
11:07 sexual activity. It’s important
11:09 to make sure that you associate
11:11 your bed with sleeps and you
11:14 not watch any television or use
11:15 electronic devices or eat or
11:16 read bed because we want our
11:19 mind and body and our brain to
11:21 think bed, sleep, or sexual
11:25 activity If you find that
11:28 you’re that you’re unable to
11:30 get to sleep or fall asleep
11:32 within 10 to 15 minutes, don’t
11:33 lay there and toss and turn for
11:35 hours on end. Just get up and
11:37 return to bed when you’re
11:39 sleepy and do this as many
11:40 times as you want and the whole
11:42 point of that is to make sure
11:44 that your bed isn’t associated
11:48 any type of anxiety or any type
11:51 of negative feelings want our
11:53 bed to be a place where our
11:54 body knows it’s time to shut
11:55 down. If you ever find that
11:58 sleep is overwhelming, you may
11:59 take a short nap but make sure
12:02 it’s no longer than 45 minutes
12:03 because then you get into
12:04 issues with like feeling too
12:06 sleepy afterwards. Um and you
12:07 make sure it’s between only one
12:09 and four because you really
12:10 want to make sure that you’re
12:11 not messing up your sleeps for
12:13 later in the evening. One of
12:15 the ways like when I find I
12:16 need to take a nap, if I want
12:19 and I don’t want to sleep 1145
12:21 minutes. I’ll just have a big
12:22 tall glass of water. Because
12:24 then I know that I’m not
12:25 going to be sleeping for a long
12:26 time because I’ll be like woken
12:28 up on my bladder. So that is
12:30 one tip. And then the other
12:32 part of a sleep awareness or
12:36 sleep therapy type program is
12:37 maintaining a sleep diary. And
12:39 the idea of maintaining a sleep
12:41 diary is it allows you to
12:44 personalize how much sleep in
12:44 your bedtime that you should
12:46 have. And gives a lot of
12:48 insight into what maybe an
12:49 issue for your sleep.
12:55 So, there’s some resources and
12:56 good books to read. I, this
12:59 program is based on a program I
13:01 did with Queen’s University.
13:03 Sink Into Sleep was written by
13:05 Judith Davidson and it’s a
13:08 really good book that offers
13:09 the six-step approach to
13:12 helping you get a good night’s
13:13 sleep. There’s another book
13:14 called Quiet Your Mind and Go
13:17 to Sleep and another one called
13:19 In The Insomnia Struggle.
13:21 There’s also some online
13:23 resources and apps that you can
13:25 get but Sync in the Sleep. com
13:26 or My Sleep Well. CA are great
13:28 resources online. If you’re
13:30 looking for more information on
13:33 Sleep Therapy programs or ways
13:36 to calculate your own sleep
13:37 efficiency and stuff. So, if
13:41 you’d like to connect with me,
13:42 you could use the booking link,
13:45 Book My Pharmacy. com slash two
13:47 two six three eight three nine
13:49 four six one and you book under
13:52 Enhanced Pharmacy Care
13:53 Services. Um it’s under
13:55 insomnia intake and there’s a
13:57 free 15-minute consultation to
13:59 see if it’s a good fit for you
14:00 and the cost of one-hour
14:02 session is $120. Typically,
14:05 it’s a six-step program. So,
14:06 there’s six sessions in total
14:07 but you can tailor this based
14:09 on your own needs. And lastly,
14:14 I wanted to in this
14:16 presentation with a breathing
14:17 exercise. So, give you a tool
14:18 to use in your toolbox to help
14:20 you at home. So, breathing is a
14:24 good way to tap into our
14:24 nervous systems and this
14:26 particular type of breathing is
14:28 called 478 breathing. So, it
14:31 starts off by sitting in the
14:33 world’s best posture with your
14:35 back straight. You want to make
14:36 sure that your tip of your
14:38 tongue is on the tissue just
14:39 behind your upper front teeth
14:41 and you’re going to keep your
14:42 tongue there throughout the
14:43 whole exercise. We’re going to
14:44 breathe out our mouse. We’re
14:48 going to close our mouth and
14:49 we’re going to breathe in
14:50 through our nose while counting
14:52 to four. Then you’re going to
14:56 hold your breath and count to
14:58 seven.
15:02 And then you’re going to
15:03 breathe out through your mouth
15:05 and count to eight.
15:12 We’re going to repeat these
15:13 steps three more times and we
15:15 want you to practice this
15:16 exercise at least twice a day.
15:18 The ratio of four, 7, and eight
15:21 is important and we want you to
15:23 keep that ratio throughout the
15:24 exercise and if you find it’s
15:25 hard to hold your breath for
15:27 seven seconds, you can count
15:29 faster because we’re not really
15:31 looking for a full seconds
15:33 here. We’re looking for four
15:35 beats basically. So, whatever
15:37 you want to breathe in and then
15:39 hold it for 7 seconds and or
15:41 seven beats and then breathe it
15:43 out for eight beats and like I
15:44 said it helps to calm our
15:47 nervous system and help kind of
15:49 ground you. So, twice a day is
15:52 what we recommend. So I’m now
15:56 available for questions.
16:03 Hey. I will be adding the link
16:08 and the the email for those who
16:12 want to connect with you. So
16:15 maybe I can start some of these
16:16 questions because of the number
16:19 of questions I get on sleep
16:21 that I I think you possibly can
16:24 give us a good answer to. So
16:27 the first one is what
16:29 supplements can someone get
16:32 help with sleep. And this one
16:35 is the one that I always get.
16:37 Eh in the pharmacy and in the
16:40 virtual visits that we have
16:42 with people living with
16:43 migraine coming for virtual
16:45 consults. The first thing they
16:45 ask me is what supplement can I
16:48 actually have to help me with
16:50 my oh it’s very fitting that
16:54 these series is called Ask the
16:55 Pharmacist. So what I would
16:57 recommend is talking to your
16:59 pharmacist to make sure that
17:00 the medications or anything
17:01 over counter is good for you
17:04 with the medications that
17:05 you’re on because I’ve had
17:07 patients who have used
17:08 medications over the counter
17:09 and had ended up in hospital
17:11 because it did not mesh mesh
17:13 with their medications and they
17:15 just figured it was safe
17:16 because it was over the counter
17:17 and they didn’t need a
17:18 prescription for it and they
17:19 were taking way too much and it
17:22 landed them in the hospital
17:22 with serotonin syndrome. So,
17:24 I’ll just preface this with
17:26 that. Um magnesium works great
17:29 to help prevent migraines but
17:30 it can also to relax our body
17:32 before going to bed. It’s
17:35 important with magnesium that
17:38 you increase the dose slowly
17:39 because it can relax our
17:42 digestive systems before it
17:44 relax our bodies and cause
17:46 diarrhea. So, we wouldn’t want
17:47 you to go too high on that. Um
17:50 but magnesium is a good
17:51 supplement for both kind of two
17:54 birds, one stone type thing. Um
17:55 both migraine s and insomnia.
17:58 And then over the counter some
18:00 people will take melatonin but
18:02 again it can affect some
18:04 medications. So I’d really want
18:05 you to check with your
18:06 pharmacist to make sure it’s
18:07 right for you. Because I
18:08 wouldn’t want you to take
18:11 something that’s not safe. Um
18:13 the best thing really and truly
18:15 for sleep is having a a regular
18:18 routine waking up time and a
18:21 routine going to bedtime. In
18:24 the science behind it is so
18:25 that you can sync up your
18:27 circadian rhythm which is a
18:29 twenty-four hour cycle with our
18:31 Sleep Drive. Which builds
18:33 slowly throughout the day. So
18:35 if you can sync up those two by
18:36 having a regular time that you
18:38 wake up in the morning and a
18:40 regular time that you go to bed
18:42 in the evening. Then that can
18:43 help to increase your chances
18:45 of going to sleep without being
18:47 frustrated. So I have a
18:48 question here. Um is from I
18:54 think Tushi is the name and it
18:56 says, I take melatonin along
18:58 with magnesium. At what time in
19:01 the evening should I take it?
19:02 So, now this is to again, it’s
19:06 melatonin and magnesium. Myself
19:08 I’m I don’t start with
19:11 melatonin but if you’re in
19:12 melatonin and that does help
19:14 with your sleep and it’s not
19:15 interacting with any of your
19:16 medications, I do not usually
19:18 stop it. Continue to take but
19:20 the question here is what time
19:23 in the evening should I be
19:24 taking it so that it’s
19:27 effective in helping me with
19:29 sleep? Personally, I recommend
19:30 a few hours before sleep taking
19:32 the melatonin and then the
19:34 magnesium at least an hour
19:35 before bed, you might have
19:37 something different or how
19:38 about how do you recommend your
19:39 magnesium for your migraine
19:41 supplement? Um it depends. So,
19:44 magnesium can be taken all in
19:45 one dose and that’s the next
19:47 question. What form of
19:48 magnesium is good for my I know
19:50 that with migraine Canada with
19:53 the Canadian Headache Society
19:55 two forms of magnesium have
19:56 been seen or have been studied
19:59 enough to be in the guidelines
20:01 and these are magnesium citrate
20:03 and we do recommend magnesium
20:05 citrate if you have
20:07 constipation because it does
20:10 work on your powers. It does
20:12 relax the bowels and it does it
20:14 can help with constipation
20:16 might give you diarrhea if you
20:17 do have constipation. So we do
20:21 we do recommend citrate. If you
20:22 do have bowel issues that are
20:25 in the form of constipation. If
20:26 you have a sensitive stomach,
20:27 no issue with bowel movement,
20:29 then, it’s glycinate. The dose
20:32 that we usually recommend is
20:33 600. I do agree with you Rachel
20:36 that it’s always a good idea to
20:38 start with a lower dose and I
20:40 do say duet at least make sure
20:44 that you take it twice a day
20:45 just because of that effect. It
20:47 has on balance. If you find
20:49 that it doesn’t change your
20:50 bowel movement or does not have
20:52 any complications, you can take
20:53 it all in one go. Magnesium by
20:57 itself has been showed in
20:59 studies to help in abortive it
21:02 does have an abortive action on
21:04 migraine. So, dividing it to
21:06 two or three times daily might
21:09 actually help if you are in the
21:12 middle of a migraine attack. It
21:14 also helps if you have cramps
21:15 around your period you have
21:19 menstrual cramps that is a good
21:22 way to actually divide it. I
21:25 say take it with supper usually
21:28 only because with food is a
21:29 good idea almost always if if
21:33 there’s nothing to prevent us
21:34 from taking it with food, then
21:37 I always say take good food.
21:39 Um, I do have one question here
21:42 that says, I’m still not clear
21:44 why migraine impacts sleep and
21:45 other than due to pain. Yeah,
21:49 it is pain. Okay. Right? If
21:51 you’re in pain, you’re not
21:52 going to sleep. Our little
21:53 caveman brains are not made to
21:55 sleep. If you were a caveman
21:57 living eons ago and you had
22:00 pain, that meant that you had
22:03 to stay awake so that you could
22:04 stay alive. So, in this day and
22:07 age, if you have pain, even
22:11 though you’re still safe, our
22:12 caveman brains still state
22:13 makes you stay awake if you’re
22:14 in pain. That’s why chronic
22:16 pain is a perpetuating factor
22:19 for insomnia. Okay. Because our
22:20 brains just shut down the same
22:22 way when you’re in chronic
22:23 pain. One of the things that I
22:25 did read as well in answer to
22:27 this is I remember that sleep
22:31 disruptions and and sleep
22:32 disturbances might be a trigger
22:35 for migraine. But also they
22:37 could be a pre-monetary
22:39 symptom. And that is they are
22:41 part of the evolution or of the
22:44 actual cycle of migraine. It it
22:48 there’s a lot of there are a
22:50 lot of changes in our brain
22:52 that are related to the
22:53 migraine attack. The migraine
22:55 attack is not only your head
22:56 pain it might start 48 hours
22:59 before where you do see these
23:03 interruptions in your sleep
23:04 that you see that you’re some
23:07 people get a little bit they
23:09 start yawning for instance.
23:10 That’s a plea monitoring
23:11 symptom And these are related
23:14 to the condition itself and the
23:16 way that there are changes in
23:19 the neurotransmitters and also
23:22 vascular changes that make our
23:25 body react in a way. We’re
23:28 still not fully there in
23:30 understanding why certain
23:33 things happen with migraine.
23:35 Yeah. It’s so such an
23:36 interesting thing. We’ve we’re
23:38 learning a lot more about
23:39 migraine. But yeah we’re and
23:41 certainly the other thing is
23:43 that once a migraine is being
23:45 treated say with Triptan or
23:46 something. I find a lot of
23:48 patients just go to sleep. So
23:49 if you slipped off your
23:50 migraine the whole day how are
23:52 you going to expect to go to
23:53 sleep that night? Right?
23:55 Because you know part your
23:58 rehabilitation was sleep.
23:59 That’s how you got over your
24:00 migraine but now, like, you’re
24:02 throwing off your rhythm of
24:03 sleep. You don’t, you’ve used
24:05 up your sleep drive by taking
24:07 an F to give over the migraine.
24:08 So, now, your body needs to
24:10 build up that sleep drive again
24:11 and it’s off kilter with the
24:12 circadian rhythm. So, you’re
24:14 going to have problems with
24:15 sleep as a result of your
24:16 migraine. It it’s exactly what
24:20 Jodie Macmillan is saying. She
24:22 says, I find I usually can’t
24:24 sleep when I have a migraine My
24:26 medication makes me sleepy.
24:28 Plus sleep helps get rid of the
24:30 migraine. Yeah. Plays havoc on
24:33 having a regular sleep
24:34 schedule. Do you have any
24:36 recommendations on how I can
24:37 restart or regain good sleep
24:40 hygiene after sleeping during
24:42 the day with a migraine and
24:43 that is a very common complaint
24:46 is that we’re telling everybody
24:48 we’re saying make sure you have
24:50 a good sleep hygiene. Do not
24:53 undersleep or do not sleep too
24:54 little or too much with
24:55 migraine, migraine does like a
24:59 routine, that’s like that
25:01 continuity and that you know,
25:03 predictability especially with
25:05 sleep and sleep schedule. How
25:07 how do you think what you
25:10 really need to do is give
25:11 yourself grace. Like, yeah,
25:14 you’re going to have problems
25:15 with sleep for a few days.
25:16 Don’t beat yourself up over it.
25:17 You just got over a major
25:19 migraine. Give yourself some
25:22 grace. You’re going to take a
25:23 couple days and then you can
25:24 get back onto your regular
25:25 sleep schedule but be kind
25:27 self. It’s normal when you have
25:29 problems with sleep after a
25:30 migraine. I love this. This is
25:33 absolutely what we need to
25:35 always remind ourselves that
25:37 you know you’ve just gone
25:39 through a really tough period
25:43 of time and if it takes you a
25:45 little bit longer to go into
25:47 sleep. Or into a schedule then
25:50 be kind to yourself and accept
25:52 that it might be challenging.
25:54 But do we have any tips?
25:56 Anything that might make it
25:57 easier you think? Uh to go to
26:00 bed like that night. You
26:02 probably are going to stay
26:03 awake. But you need to make
26:04 sure that you don’t go to bed
26:05 until you’re actually tired.
26:07 And that might be later than
26:09 your regular bedtime. But try
26:11 to wake up that same time in
26:12 the morning. Okay. Because that
26:14 same time in the morning time
26:15 is really important. And I
26:17 really liked your idea that bed
26:19 is only for sleeping. So if
26:21 you’re in bed staying there for
26:23 hours just get out of bed. You
26:26 know go go get out of bed. Do a
26:29 cup that’s what I think. Maybe
26:32 a cup of chamomile. Yeah. Or
26:37 something that helps calm down
26:40 your nerves. Um do not drink
26:42 coffee during the day. Uh if
26:45 you have slept and you want to
26:49 be able to sleep again, do not
26:50 drink coffee because that might
26:52 make you more awake. Um what
26:55 else can we give as advice for
26:58 Jodi? Make sure that the next
27:00 day she probably will need to
27:02 have a 45 minute nap because
27:04 she’ll probably be later
27:04 staying up She’ll wake up at
27:07 the same time that she would
27:09 normally wake up and then take
27:10 a nap between, plan for a nap
27:12 between one and four and then,
27:14 the next night, try to go to
27:15 bed at your regular time. I
27:18 hope I’m not missing some of
27:19 your questions but I will try
27:20 to go back because I can see a
27:23 lot of a lot of questions
27:26 coming in. Um the next question
27:30 is I am the big issue for me
27:33 that’s Mary Rai. She says the
27:36 big issue for me is that I’m in
27:37 chronic pain and that doesn’t
27:39 let me fall asleep. So, even a
27:40 regular teen doesn’t help. Is
27:44 there something safe to take
27:46 nightly to reduce the pain
27:48 enough so that I can sleep? So
27:50 Mary, I don’t know where you
27:52 are in Canada. I’m not sure if
27:54 you are in Ontario. I suffer
27:58 from chronic pain. I also
27:59 suffer from insomnia. And so
28:03 there are chronic pain programs
28:06 in a lot of different provinces
28:09 that you may avail of to help
28:10 you with chronic pain and
28:12 thinking about the science of
28:13 pain. And I could do a whole
28:15 other thing on chronic pain.
28:16 But basically when you have
28:19 chronic pain a lot of treatment
28:23 for insomnia and pain is about
28:26 changing your mindset with
28:27 pain. Um and the programs
28:32 kind of talk about the same
28:33 thing that we talk about here
28:35 tonight with insomnia and kind
28:38 of knowing what you can control
28:39 and what you can’t control. And
28:40 making sure that have a regular
28:43 routine, bedtime, or nighttime.
28:45 Um the other thing for chronic
28:47 pain suffers is making sure
28:49 that you are able to be
28:50 comfortable. So, sometimes it’s
28:52 about like maybe you need extra
28:54 pillows to support your body or
28:55 support that painful part of
28:57 you. Um maybe a hot bath before
29:01 you go to bed with some epsom
29:02 salts to help relax your
29:04 muscles before you go to sleep
29:05 would be useful. Magnesium
29:08 would be very good if you have
29:09 a lot of muscle tightness
29:10 because it can help with that
29:11 as well. So, when you have
29:13 chronic pain, there’s a lot of
29:15 work that you can do kind of
29:17 like on your perception of your
29:19 chronic pain that can be useful
29:21 to help with acceptance and
29:24 insomnia. I’m sorry. I’m
29:26 getting also some questions on
29:29 on text as from some of our
29:32 patients. Um and listeners
29:36 today. Uh one of the questions
29:38 I also got was around my pain
29:42 medication and what I’m
29:45 prescribed. Like if I have more
29:46 than one condition. Yeah. Some
29:49 of these medications make you
29:51 sleepy. And I’m supposed to
29:53 take them more than once during
29:54 the day. What what do I do? Try
29:58 hard. Your hardest not to take
29:59 a nap. And that may mean you do
30:02 something like do a puzzle or
30:04 you do sudoco or you go out for
30:06 a walk after you take it so
30:08 that you’re using your body. Um
30:10 it doesn’t have to be a lot
30:12 like you did. You don’t have to
30:13 go for like a fifty-mile hike
30:15 or anything. I’m just saying if
30:16 you walk around your block, if
30:18 you can with your pain, that
30:20 can be useful but medicine that
30:23 makes you tired, that you take
30:24 multiple times throughout the
30:25 day. Again, give yourself
30:27 grace. You’re going to be tired
30:28 and accept that you’re going to
30:29 be tired and then come up with
30:30 ways that keep your mind busy
30:34 so that you don’t succumb to
30:35 the napping and the napping
30:38 throughout the day is
30:39 definitely going to give you
30:39 problems with sleeping at
30:40 night. And unfortunately a lot
30:43 of the medications that we’ve
30:45 had so far were not really
30:47 designed for migraine. We’ve
30:49 they they were designed for
30:50 other conditions. We have the
30:51 new ones but not everybody is
30:54 on them. Not everybody can get
30:56 them. Not everybody can afford
30:58 them if they’re not covered. So
30:59 the the it become a matter of
31:02 trade off? What are we trading
31:04 off? Ah with these medications
31:07 or is it controlling migraine
31:10 or is it there’s not there’s a
31:13 lot of trade-offs that people
31:14 living with migraine have to
31:16 actually what’s your is the
31:19 benefits of it outright
31:21 outweighing the risks of having
31:22 insomnia? Like are you getting
31:24 what you wanted that
31:24 medication? And that’s why
31:27 having a good relationship with
31:28 your community. Pharmacist is
31:29 so important. And if you don’t
31:29 have a relationship with your
31:32 Community Pharmacist, find one
31:34 that you can because community
31:36 pharmacists who know you and
31:38 know your name and know what
31:39 you’re on are so important to
31:42 the evolution of your care. And
31:43 I I always get this question
31:45 because I am specializing in
31:47 migraine. I know you are also
31:49 focused on these conditions
31:51 where you are able to intervene
31:54 and you’re able to actually do
31:56 more counselling than just the
31:58 regular you know some of these
32:01 dispensing different kind of
32:04 pharmacy let’s say practices.
32:08 And I always get this question
32:09 that my my pharmacist doesn’t
32:12 know this. But you’ll find
32:14 another pharmacist. Not only
32:16 this but kind of enlist them. I
32:19 would enlist my pharmacist. If
32:21 I needed to I would build that
32:24 relationship and get them
32:25 interested in learning more for
32:29 my for a around my condition
32:31 and also learning more other
32:33 people who are living with a
32:36 condition. I learned most of
32:37 what I know now by talking to
32:40 people living with I’ve learned
32:41 so much just because of the
32:45 questions that we’re getting
32:47 because of the different people
32:50 who are telling me I’ve I’ve
32:52 seen hundreds of patients not
32:53 to are the same when it comes
32:56 to migraine interestingly
32:58 enough. So in physio pharmacist
33:00 find a pharmacist that will
33:01 take interest. In taking care
33:05 of you and they will spend the
33:07 time and the effort. Um
33:09 Canadian. Pharmacist s should
33:11 know you by name. That’s my
33:13 that’s my thing. Your
33:14 pharmacist should know you by
33:15 name. They should know you when
33:16 to walk in the door. And if
33:17 they don’t then make sure they
33:19 know you. And you’re make sure
33:20 you’re unforgettable. And
33:21 they’ll learn ways like
33:23 pharmacists are like we always
33:25 have to do continuing
33:26 education. And so if you if
33:28 they get to know you and know
33:30 your disease then they should
33:32 be helping you. And they will.
33:33 That’s just how pharmacists
33:35 are. I don’t know Rachel. If
33:37 you if you saw that we’ve just
33:40 launched an at a a Canada wide
33:43 training for pharmacists on
33:47 migraine. It is available at no
33:48 cost. It we have just launched
33:51 it in around Christmas
33:53 actually. It was our Christmas
33:55 gift. Wow. And we are asking
33:58 each and every pharmacist in
33:59 Canada to go ahead, do this
34:02 free training, and you know get
34:05 to learn more about migraine
34:07 and how to support people
34:08 living with migraine. So, if
34:11 your pharmacist, if you have a
34:13 good relationship with your
34:14 pharmacist, enlist them for us.
34:15 Tell them, you know, go and do
34:18 some extra things. Well, it’s
34:18 not for us. It’s for you.
34:20 Because the more they know, the
34:22 more they’ll be able to help
34:23 you. Exactly. Exactly. You
34:25 enlist them and they actually
34:27 get to help you more. Um I have
34:31 someone saying I prefer
34:32 independent. Again, independent
34:35 pharmacies for this reason.
34:36 Been going the same one for
34:37 twenty-six. Yes. Exactly.
34:44 Pharmacist s want to help. All
34:44 of them. Um when you’re an
34:45 independent you possibly have
34:49 different drivers than if
34:51 you’re working for a big
34:53 organization that mandates what
34:55 you do. I I believe that all
34:59 pharmacists want to help.
35:00 Independent independent
35:02 pharmacists get to choose what
35:03 they do. I’m going to. So you
35:05 get to choose how many people
35:07 you have working with you. How
35:08 much support you have. And when
35:09 you work in corporate pharmacy,
35:11 you don’t have that flexibility
35:13 and you don’t have that support
35:15 that you need to be able to
35:16 support your patients sometimes
35:18 in the fullest way. So, I have
35:21 Kat asking, I’m taking another
35:24 question around supplements as
35:26 well. I’m taking 200 milligram
35:27 of bisclycinate, magnesium, one
35:29 hour before bed. Should I be
35:31 eating something light with it?
35:33 I find if I don’t, the next
35:34 morning, I have diarrhea. Am I
35:37 taking the right type of
35:38 magnesium for migraine
35:39 prevention. Okay, that’s an
35:42 interesting question. Mm hmm.
35:45 It is an interesting question.
35:46 It depends on what type of food
35:48 that you’re taking with it.
35:49 Like, because if you’re taking
35:50 like, say a glass of milk with
35:52 it, then, you’re likely not
35:54 absorbing as much magnesium
35:55 with that. It depends on what
35:57 you’re eating. And is this the
36:02 right type if she’s having
36:03 diarrhea? No. Okay. So what
36:07 should we be doing? Because
36:09 glycinate is the one that is
36:10 least causing diarrhea for
36:12 people living with migraine. I
36:14 would decrease the dose. Okay.
36:16 Would you do it? Would you ask
36:20 her to do it around lunch then?
36:22 And see if there’s a
36:23 difference. Would you ask the
36:27 benefit with sleep? Okay. Um.
36:30 So she could probably do it at
36:32 supper time. And then that’s
36:34 with more food and it’s closer
36:36 to bedtime. But if she finds
36:37 she gets too tired too quickly
36:39 then she could just move it a
36:41 little bit later and then have
36:43 it with slice of toast or some
36:44 crackers or something. Nothing
36:45 with a lot of calcium. Okay. Um
36:49 but it it you already say I
36:52 find if I don’t eat it with
36:54 something light then I do have
36:57 the idea so I think you have
36:58 your answer kind of right there
36:59 in the because you know
37:02 yourself best. I would know how
37:06 your body is better than you
37:09 and I don’t think any of us can
37:11 claim to know how your body
37:13 reacts to certain things as you
37:14 do. And that’s cat. Uh I’m not
37:17 I’m not sure how to say your
37:19 last name Kat. I’m really
37:20 sorry. I’m going to guess it’s
37:22 tracks. But I’m not sure. Um
37:26 someone asked me what is the
37:27 name or the link to the
37:28 training program for Pharmacist
37:30 s. Uh it is through the Ontario
37:32 Pharmacist s Association. It’s
37:34 called Mastermind. And this
37:36 course I will try to find the
37:38 link and I will I can put it in
37:40 the comments, but it is at no
37:42 charge, and it was developed
37:44 with the Canadian Headache
37:45 Society, Migraine Canada
37:47 contributed to this, and we had
37:49 another one that was done
37:52 possibly a year or more ago,
37:54 that was for GPs, and this has
37:56 been extended to pharmacists
37:58 because of the interest that we
38:02 have from pharmacists to help
38:04 more people living with
38:04 migraine. Um, one more question
38:07 that was I think I saw
38:09 something around Rem Sleep. Ah
38:12 let me try and find that
38:13 question. Can you speak about
38:15 waking up and staying up? I
38:17 can’t fall asleep until late
38:19 and my probably kicks in a few
38:22 hours before I wake up and I
38:24 hit snooze many times. So many
38:27 questions in the same question.
38:28 I don’t know if you so the most
38:30 important thing when it comes
38:31 to sleep is having that time
38:34 that you wake up. Be the time.
38:38 So, you, even if you put your
38:41 alarm clock on in another room,
38:44 on the other side of the room,
38:46 something that makes you get
38:47 out of bed because if you have
38:49 a shifting sleep time, then,
38:52 your circadian rhythm is also
38:54 shifting. So, we want to make
38:56 sure that those rhythms match
38:58 up and are synchronized so that
39:00 you have your circadian rhythm
39:02 and your sleep drive working
39:04 together to help you go to
39:05 sleep at night time and so, the
39:06 best you could do is have a a
39:09 wrapped rice time that’s always
39:11 consistent at the same time. Um
39:15 having problems, what was the
39:15 other question? Like, following
39:17 waking up or something or
39:18 having problems going to sleep?
39:19 Because they can’t wake up as
39:24 well. They they are too tired
39:25 to even wake up because it’s
39:28 they’re not got even though
39:29 they’re trying to sleep, they
39:31 do not sleep early enough.
39:33 Yeah. So this this slide we’re
39:35 talked about six steps to solid
39:37 sleep. Make sure you’re
39:39 practicing those which is good
39:41 hygiene. Uh good sleep hygiene.
39:42 So making sure that if you find
39:45 you’re going to sleep and
39:45 you’re frustrated with sleep
39:48 and you’re taking longer than
39:48 10 to 15 minutes, get up, go
39:50 read a book don’t watch TV,
39:53 don’t look at your phone, don’t
39:54 go scrolling on the TikToks.
39:56 Make sure that you’re doing
39:57 something that’s not
39:59 stimulating in that way to your
40:01 brain Um put together a puzzle.
40:05 Um fold socks. Anything that is
40:09 going to help you only go to
40:12 sleep once you’re sleepy. And
40:14 then once you’re sleep once you
40:17 have that done like it takes
40:19 about two or three weeks for
40:20 your body to get used to this
40:21 new routine because our bodies
40:23 are really good and phenomenal
40:24 at things like that. Um but If
40:27 you practice those things and
40:29 wake up at the same time,
40:30 eventually, over two or three
40:32 weeks, you’ll find that your
40:34 body will allow and learn this
40:35 new routine to allow you to get
40:37 to sleep better. Um what do you
40:40 think about alcohol and sleep?
40:42 Because a lot of people do
40:45 drink or do have a glass of
40:48 wine with dinner and they feel
40:50 that it helps them sleep. Is
40:52 there anything that that we
40:54 know about alcohol and the
40:56 effect on sleep? Hope we that
40:58 if you have concommitted or you
41:01 also have sleep apnea along
41:03 with everything else that can
41:04 affect sleep apnea and can make
41:06 it worse. In terms of
41:09 specifically for sleep, it is
41:10 not a recommended thing to help
41:13 you sleep. It is not something
41:14 that like the the risks of
41:19 drinking alcohol and being
41:21 dependent upon alcohol to help
41:22 you sleep does not give you the
41:25 enough benefit. So, it’s not
41:27 something that would be
41:29 recommended. Okay. I have a
41:32 question, another one, is I
41:34 don’t wake up, that’s Larissa
41:36 Williams. She’s saying, I don’t
41:37 wake up to my alarm next to me
41:39 or on my rest. Wrist. Let alone
41:41 in another room. Is this
41:43 related to the fatigue
41:44 surrounding migraine? It can be
41:47 but it could signal that if you
41:49 haven’t had a sleep study done
41:51 that you need to get a sleep
41:52 study done And that’s something
41:55 that you’d have to talk to your
41:55 family doctor to arrange and it
41:57 can take you some time to get
41:58 in. But it’s worthwhile to see
42:01 what’s going on with your
42:02 sleep. And how can someone get
42:06 a sleep study dad? So there’s a
42:10 screener that you can do called
42:10 Stop Vang to see if you have a
42:14 if you are at a high risk for
42:15 having sleep apnea. So. What is
42:18 it called? Can we put it in the
42:20 comments? Yeah stop bang.
42:22 Actually if you see the comment
42:26 section Questionnaire. So it’s
42:30 a questionnaire that you
42:31 actually fill and based on it
42:33 you know if you need a sleep
42:34 study? Yeah. Yeah. Um it’s like
42:37 you get a point for say if
42:39 you’re if you so stop snoring,
42:42 tea, tired, oh observe, has
42:46 anybody ever observed you stop
42:48 breathing, choking, or gasping
42:49 for air during your sleep? If
42:52 you’re being treated for high
42:53 blood pressure or if you have
42:54 high blood pressure, if you
42:56 have a BMI over thirty-five, if
43:00 you’re older than 50 years old,
43:02 if you have a large neck size,
43:04 so 17 inches for a male or 16
43:07 inches for a female, 43
43:09 centimeters, 41 centimeters,
43:12 and if you have a male. So, if
43:13 you score anywhere from three
43:18 and up, you have an
43:19 intermediate to high risk of
43:21 having obstructive sleep apnea
43:23 and it would qualify you for
43:25 getting a sleep study but that
43:27 needs to be ordered by your
43:28 family doctor and you go to
43:31 this clinic and they put all
43:32 these pliers on you and you go
43:34 to sleep and and they check
43:37 your brainwaves while you’re
43:39 sleeping and see how well you
43:41 are able to get to sleep, how
43:43 fast you need to sleep, how
43:44 much you sleep, and then a
43:46 sleep doctor who’s a specialist
43:48 will look at your readings and
43:50 then let you know what’s going
43:52 on with your sleep. Okay, so
43:53 other than sleep apnea, does
43:55 sleep study give us any other
43:58 insights, any other conditions?
44:00 Oh, yeah, I can. Um but it, you
44:04 can ask them, you have access
44:04 to a sleep doctor he can see
44:07 how much Rem sleep that you’re
44:08 getting and he can see how much
44:10 how deeply you’re able to get
44:13 two sleeps. So, it can give you
44:15 some insight. Okay. Um Larissa
44:19 is saying that she doesn’t fall
44:20 into any of these categories.
44:23 That’s the the Larissa is the
44:26 person who did ask the question
44:28 and noone can find an answer
44:30 for time. Everyone makes it
44:32 seem like it’s so easy to
44:33 change things and that’s what I
44:35 hear all the time. But I feel
44:36 like I’ve tried everything. Um
44:39 and I hear this all the time.
44:42 Like I I I hear it from
44:44 patients all the time saying
44:45 I’ve tried everything. And
44:47 Rachel is this why you’ve
44:48 decided to have an actual
44:49 program? Because Yeah. Yeah.
44:51 That’s why because people like
44:54 if you talk to somebody who has
44:55 chronic problems with sleep.
44:58 They’re going to know what
44:59 sleep hygiene is. They’re
45:01 going to know all these steps.
45:03 But this particular type of
45:05 program breaks it into six
45:07 steps. And again you can
45:08 there’s that book that’s
45:10 available. That’s written by by
45:12 Judy. Um that’s really useful.
45:15 But the the whole point of
45:18 having this program is to gain
45:19 some personal insight for the
45:22 patient into their sleep. And
45:24 if you don’t give data. So if
45:26 there is no sleep diary then
45:30 you can’t really truly look in
45:32 to see how you can help with
45:33 the sleep. So Sleep Diaries are
45:35 very important. Because you can
45:36 look at and see where you can
45:39 make improvements and changes.
45:40 So I have another question
45:44 here. Thank you very much. I
45:46 have a question around anxiety
45:49 and having a lot of anxiety. My
45:53 anxiety surrounding my that’s
45:55 Larissa. Larissa is saying my
45:56 anxiety surrounding my migraine
45:58 Migraine s has gotten so severe
46:01 that I’m afraid to go to sleep.
46:02 I’m already going to therapy.
46:04 I’m an anti to anxiety. She’s
46:06 asking if anyone else can
46:08 relate to this and I can see a
46:09 lot of people are relating to
46:12 this. But what about what about
46:18 anxiety and sleep? Yes. Well,
46:20 the circular thinking is
46:23 precipitating factor. Uh
46:24 generally, being hyper aroused.
46:27 Um all are precipitating to
46:29 having or can help bring on
46:32 this insomnia. Um so, in a
46:35 sleep therapy program, you’re
46:37 learning ways to help manage
46:40 anxiety and look at your
46:42 thoughts from like the outside
46:45 and analyze your thoughts from
46:46 the outside. Some of the things
46:48 you would do is like a fat
46:51 dump. So, if you’re the type of
46:52 person who’s mind is just
46:53 always going, have a little pad
46:55 of paper, sit down, write out
46:58 everything that you have that
47:00 is bothering you or running
47:02 through your mind. Just catch
47:04 all those little thoughts and
47:05 put them in on a sheet of paper
47:06 and then look at those thoughts
47:09 and categorize your thoughts
47:11 into things that are in your
47:12 control and things that are out
47:15 of your control. And if they’re
47:18 out of your control, you’re
47:19 just going to have to release
47:20 that from just don’t receive
47:23 that negative energy and if
47:25 it’s in your control, then,
47:26 make a plan to help tackle
47:28 them. Uh what types of things
47:31 should we track in a sleep
47:33 diet? Oh, so if you go to My
47:37 Sleep Well. CA, they have Sleep
47:40 PDF files of Sleep Diaries.
47:41 Basically, you want to put down
47:43 in your sleep diary. When you
47:45 wake up, how long you stayed in
47:47 bed after you woke up? So, if
47:49 you’re a lounger, like how long
47:52 you spent? And then, you want
47:54 to also record if you took a
47:56 nap throughout the day and how
47:56 long you took a nap and then
47:59 the evening time, you want to
48:00 put down what time you went to
48:02 bed and what time you think you
48:03 fell asleep and then, if you
48:05 woke up anytime during the
48:05 night and how long it helped,
48:07 it took you to go to sleep. So,
48:09 that way, we can calculate how
48:11 much sleep you had throughout
48:12 the a twenty-four-hour period
48:13 and we can calculate your sleep
48:16 efficiency.
48:19 And
48:20 eh you said that you can
48:22 download it. Mhm. From as it
48:24 said. My Sleep Well. CA. They
48:27 have under the resources. Yep.
48:29 My Sleep Well. CA. Okay. Um I
48:34 also had a question that was
48:37 not related to sleep but I
48:38 think is very valuable the
48:41 nausea. Oh. Sometimes it’s the
48:44 nausea that affects sleep. Um
48:46 what can the the question is
48:49 what can I take to help with my
48:53 nausea? What what can help me
48:55 with nausea? So with nausea
48:59 having like the saltine
49:01 crackers or goldfish crackers
49:02 like just little bits and sips
49:04 of water or chewing on ice
49:06 chips. Can be useful. Some
49:08 people like ginger. If you’re
49:10 looking for a natural root. The
49:11 problem with taking grappol for
49:14 nausea is that it has a side
49:16 effect to help with sleep. But
49:18 it gives very poor sleep
49:19 quality. So it will in
49:22 negatively affecting your
49:23 sleep. The grogginess, right?
49:25 It’s that grogginess in the
49:27 morning, like, is, is sometimes
49:30 disabling. You feel like you’re
49:32 walking like a zombie. Well,
49:34 and like there’s other side
49:35 effects with it, like, can
49:36 cause constipation, it can
49:38 cause urinary retention. So,
49:39 feeling like you can’t really
49:41 let go of everything in your
49:42 bladder and you pee, but you
49:44 still feel like there’s
49:44 something in there. So, I don’t
49:46 like grab all as a drug for
49:47 that reason, especially when it
49:49 comes to sleep Um for nausea,
49:53 if you can have ginger ale,
49:57 salty crackers, those types of
49:58 things that can be useful and
50:00 as a last resort, you can take
50:01 gravel. And the you see, if
50:05 you’ve just joined us or if
50:07 you’ve been listening to us,
50:08 you can see that pharmacists
50:09 always want you to try natural
50:11 things but of course, if you’re
50:13 nausea is at a level that is
50:16 very you know, difficult that
50:18 you’re throwing up, you might,
50:19 it’s it’s it’s also affecting
50:22 the absorption of other
50:23 medications that you need to
50:25 abort your migraine. There are
50:27 medications that have also been
50:30 proved to help not only with
50:32 your migraine headache but but
50:35 also with that nausea and with
50:38 the absorption of other
50:40 medications. So we are talking
50:41 about things like
50:42 metochlopramide, undencitron,
50:45 there’s there’s a whole bunch
50:46 of them that is available by
50:49 prescription and we do
50:50 encourage you if your quality
50:52 of life is affected by how
50:54 nauseated you if you’re really
50:58 in a lot of discomfort, it’s
51:00 always a good idea to have a
51:03 toolbox. Is is a a small box
51:08 that you can pick and choose
51:10 when you need something a
51:11 little bit stronger than a
51:14 ginger ale or or ginger or
51:16 whatever. You have it handy.
51:17 You don’t it doesn’t mean you
51:18 have to take it every time. But
51:20 when you’ve reached the point
51:22 you’re really need something
51:24 then that’s a good idea to have
51:26 that. Um and if natural works
51:32 best for you, continue with
51:33 natural. I love ginger tea. I
51:36 love I’ve just also discovered
51:40 ginger drops. That are a
51:42 Canadian product that I and it
51:45 is amazing And I’m in love with
51:47 this product. And it’s
51:49 available not very expensive.
51:51 And it did it does work. But it
51:53 doesn’t mean that it would work
51:54 for everybody. Um someone said
51:56 price cakes in the house when I
51:59 want planned food. Yeah, rice
52:02 cakes. Another good idea.
52:05 They’re they’re easy and they
52:07 do have. Um someone said,
52:09 Larissa asked again, do you
52:11 know, would you know if the
52:12 data gathered from an Apple
52:15 Watch would help supplement a
52:17 sleep diet? It can but how
52:21 accurate that is. You don’t
52:23 know because it always needs to
52:24 be in contact. I have a watch
52:25 that also tracks my sleep. I
52:27 don’t find it that accurate. Um
52:30 so, if you write it down, that
52:32 would be the most accurate. Uh
52:34 is it like I have a Fitbit that
52:37 also looks at you know stages
52:41 of sleep. Mhm. And to start
52:44 with the first time I I saw my
52:46 readings I was appalled. I was
52:48 like oh my there’s something
52:50 wrong with me. Right? All this
52:53 data I wasn’t able to really
52:55 interpret it. Mhm. But this
52:57 time I saw that there is a
52:59 pattern and it’s you need the
53:01 data over time to to be able to
53:04 see if there’s a pattern and
53:06 see if there’s something that’s
53:07 happening. Um when you’re
53:10 sleeping, how many times you
53:12 wake up as well? Like if you
53:13 wake up many times to use the
53:14 washroom, that is an
53:17 interruption in your sleep.
53:18 Yeah, and sometimes you need to
53:19 see a pelvic floor therapist
53:21 for help or you need to take
53:22 care of your bladder issue
53:24 before you can help with your
53:27 sleep. Exactly. So, that is
53:29 another thing is it’s good to
53:32 have these extra you know, data
53:35 collectors and and senses but
53:38 you to be able to collect
53:42 enough data and find a pattern
53:45 that you can also address.
53:47 Yeah. Because the idea if if
53:50 it’s data that I cannot
53:51 utilise, I cannot do anything
53:52 with it. It’s really useless.
53:55 Um any other questions I see
53:58 someone has said I use a Cpap
54:01 Jodi said I use a CPAP which
54:04 helps my quality of sleep
54:06 greatly and that is
54:10 Sleep apnea is a big trigger
54:13 for migraine and might make
54:16 migraine management very
54:17 difficult And might mean that
54:20 the migraine or the headache
54:21 symptoms that you have might be
54:24 secondary to your sleep apnea
54:25 as well. Right. Yeah. And the
54:29 thing with sleep apnea when you
54:30 have sleep apnea is that it’s a
54:32 big contributor to inflammation
54:35 in your body And so in and if
54:40 it can affect your quality of
54:44 pain. So, and decrease your
54:46 pain threshold. So, you might
54:49 just start to experience pain
54:52 quicker than what would be
54:54 typical because of the poor
54:55 sleep but Cpap machine, if you
54:57 can tolerate it, it’s great for
54:58 sleep apnea treatment. I have
55:01 Melanie Owen Schneider asking
55:03 us on any tips for dry mouth as
55:07 a side effect from certain
55:08 migraine meds. Yeah. So anytime
55:12 that you can see lemons, even
55:15 if you have a pitcher of a
55:16 lemon, even if you have lemons
55:18 in a bowl, even me just talking
55:21 about lemons causes my celiary
55:24 glands to like respond. Um so,
55:26 that can be useful. Any type of
55:29 gum that has xylitol in it or
55:30 even now they have lozenges and
55:33 you can get a dry mouth spray.
55:34 You can even get a dry mouth
55:37 gel. So, at the height of my
55:38 dry problems due to chronic
55:42 pain, then the gel worked
55:43 really well to help keep my
55:46 mouth moisturized. The only
55:48 problem with xylitol stuff is
55:48 that if you have an animal,
55:50 make sure the animals look good
55:51 because alcohol is can be very
55:54 dangerous and toxic to dogs. Uh
55:57 but yeah, those things are
55:59 great. All great for dry mouth.
56:00 Um I don’t know if you have
56:03 anything else to add. Small
56:05 sips of water. Yeah. Yes. Yeah.
56:08 Double win. You know. We need
56:10 to ensure that we’re very well
56:12 hydrated. So small sips of
56:13 water. Keep us a glass of water
56:15 next to you, next to your bed
56:17 stand. If you feel that you
56:19 have dry mouth, take small
56:20 feet. You can’t have gum in the
56:21 middle of the night. But a
56:23 small sip of water at night
56:24 might help. Uh having a spray
56:26 next to your body. Alright.
56:31 That’s another, that’s another
56:33 option. So,
56:37 Jodi said, my dentist
56:38 recommended Zali Mel. So,
56:39 anything that has xylitol. I
56:41 know there’s even the
56:42 toothpaste. Yeah. That does
56:44 have the same ingredient and
56:46 that does help with dry mouth.
56:48 So, if you brush your teeth
56:49 before you go to sleep, using
56:51 this the the the spray the
56:55 other thing is as you said is
56:57 just think of lemons. Just
56:58 talking about lemons now. I
56:59 can’t. I can’t. Say things
57:02 right but the other thing that
57:05 I always say is a a medication
57:09 that gives you a side effect is
57:13 it tolerable? Is it working? Do
57:15 you can you reduce the dose?
57:17 Because sometimes you’re on the
57:18 dose for so long that we don’t
57:20 know if it’s or if you’re okay
57:21 to reduce a little bit. And see
57:23 if that gets better. Um that’s
57:27 one of the things. We that’s
57:29 not what we go for first but
57:32 just to keep in mind that maybe
57:33 that those is something that
57:34 you can have a discussion with
57:35 you then what happens if I did
57:38 use the at those a little bit?
57:39 Do I still get control but less
57:41 of the side effect? And that’s
57:43 a general rule for all
57:45 medications. If you’re on a
57:46 medication and you’re getting
57:48 side effects, maybe it’s time
57:49 to see what happens if I reduce
57:50 the dose. Do I still get the
57:52 same results but less of the
57:54 side effect? What do you think
57:57 Rachel? Or is this too early to
57:58 say? No, no, no. I think that
58:01 is always good to reevaluate
58:03 medications and whether they’re
58:04 needed and if the doses are
58:05 appropriate it. Okay. I I think
58:08 we have a couple of minutes and
58:09 I didn’t want to have this as
58:10 the last thing to ask but what
58:13 about when nothing else works
58:16 and someone needs a prescribed
58:21 a prescribed sleeping pill.
58:22 What do you think of that? So
58:24 there are some medications.
58:26 They’re all meant to be used
58:27 short term. Um there’s
58:29 prescription medications like
58:30 and Davego that can be used to
58:33 help sleep. Um again, we always
58:36 would recommend that you try
58:37 these non-drug measures to help
58:39 with sleep and give you self
58:42 grace to really give a college
58:45 try to them. Um research shows
58:47 and on my Sleep well. CA, they
58:50 have a PDF where it can
58:55 compares a sleep high sleep
58:58 therapy program with taking
59:00 medications and the pros and
59:01 cons of both and it’s a good
59:04 reminder of why these types of
59:06 programs are so effective
59:09 without having the side
59:10 effects. Okay. Um we’re almost
59:15 at time. It’s it’s almost like
59:18 45 seconds I think is all I
59:20 have. Uh I would like to thank
59:22 Rachel for the amazing
59:24 information that she I will put
59:28 in the chat ah the I’m I’m
59:32 going to try and put the
59:34 information for you to contact
59:36 her. Um hoping to see you next
59:40 time. Uh thank you very much
59:42 Rachel. Um you can book with
59:44 Rachel. She does have a virtual
59:46 service. If you need to get you
59:50 know advice on your ah sleep or
59:53 to book for a consult. She does
59:57 provide the first 15 minutes
01:00:00 free. So take full advantage.
01:00:01 Talk to her. See if this is
01:00:03 something that you’re
01:00:04 interested in doing. We are
01:00:05 also still offering my you know
01:00:08 migraine consults online. I’m
01:00:11 also going to put that in the
01:00:13 private chat where we do have
01:00:15 the virtual I do see you on
01:00:17 virtual consult So, also if you
01:00:21 do need to get a consult for
01:00:24 your migraine with a
01:00:26 pharmacist, Rachel does this
01:00:27 but I also do this virtually
01:00:29 and I’m putting this in our
01:00:31 comments. Um the last thing I
01:00:34 wanted to tell you, someone
01:00:36 asked me about the migraine
01:00:39 link. I will also or the
01:00:40 migraine training for
01:00:41 Pharmacist Link. I will put
01:00:42 this also in our chat. Thank
01:00:45 you very much for joining us
01:00:47 tonight. I hope you stay warm
01:00:49 and safe and I hope that we
01:00:51 were able to answer your
01:00:53 questions. Rachel, I wish you
01:00:54 the luck and I hope that you
01:00:58 continue to take care of people
01:01:00 living with migraine and now
01:01:01 also sleepless people living
01:01:03 with migraine and all the best.
01:01:06 Thank you very much and thank
01:01:08 you Migraine Canada for giving
01:01:10 us the opportunity to share all
01:01:13 this knowledge with people
01:01:17 living with migraine. Thank
01:01:20 you. Thank you.