We at Urban Home (The Sleep Experts) believe in supporting your Well Being.

Sleep a requirement for quality life.

The nature of sleep has always fascinated mankind. On average we spend a third of our lives sleeping. Sleep helps the body recover and it affects our health both physically and mentally. Sleeping problems are experienced by most people at some point in their lives. In today's society it is very common that our sleep is sometimes disturbed due to stress or relationship problems. Close to every fifth person suffers from some form of sleeping disorder. Our need for sleep is individual and changes throughout our lives. From needing to sleep almost around the clock as an infant, the need for sleep decreases with age, by the time when we reach 20-25 years of age, our sleeping period has stabilized and as we get older it decreases to 4-5 hours.

"Change your life by changing your night..."

Sleep affects our health in positive way, both short and long term. Good sleep stimulates our bodies in various ways.

The Body: By assimilating good sleep, both in a qualitative and quantitative way, the risk of contracting different cardiovascular disorders decrease. Good sleep strengthens our immune system and helps us to stay healthy and free from different types of infections.
Emotional Life: Individuals who sleep well are at less risk of becoming depressed.
Intellect: High quality sleep helps you feel less irritated and stay focused. It also decreases the risk of having memory problems. Feeling tired during the day due to lack of sleep leads to the risk of falling asleep, which increases the risk of traffic accidents.
Aging: By trying to avoid negative stress and creating positive circumstances for good sleep you run a lesser risk of developing cardiovascular diseases. This affects your life in a positive way, both qualitatively and quantitatively.
Beauty: During sleep, especially when we dream, the muscles that we steer by willpower relax. This along with other factors prevents us from getting wrinkles.

Our night sleep is divided into different sleep cycles. Every sleep cycle lasts for about 90-120 minutes, and contains different types of sleep stages, which are connected to a specific type of brain activity (see table below).

During the night, you go through 4-6 sleep cycles while you sleep. In the 3-4 sleep cycle (NREM - non-rapid eye movement sleep) you sleep very deeply. Today we know that this sleep is very important for the body's recovery. In stage 5, the so called REM-sleep (rapid eye movement) is the sleep where you dream, but dreams may also occur during the deep sleep cycle.

"A fantastic ballet of neurotransmitters"

The brain produces different neurotransmitters that regulate our sleep and wakefulness. During the second cycle serotonin is secreted, which is the sleep's neurotransmitter. When we dream during the REM sleep, noradrenalin and dopamine are secreted, which activates the cerebral cortex. Our ability to wake up is directed by the presence of the neurotransmitter acetylcholine, in other words a beautiful ballet.

The best measurement for good sleep is not for how long we sleep, but when we get to sleep throughout the night without recurring periods of wakefulness. Furthermore it's important that the sleep contains the right amount of deep sleep and dream sleep. For most adult individuals, sleeping seven to eight hours per night is enough to feel fully rested.

To reach optimal sleeping quality it is important to live a healthy life during the waking hours. You need to think about what you eat and drink, exercise regularly and that your sleeping environment is surrounded with solid routines at bed time. In other words, to create a good sleeping hygiene plan.

The Sleep Cycle in Tabular Form.
Wakefulness	Active wakefulness Beta Waves	30 Hz
Wakefulness	Passive Wakefulness Alpha Waves	8-12 Hz	5 times higher amplitude than beta waves
Cycle 1	Falling asleep Theta waves 5% of sleeping time.	6-7 Hz		The brain does not always perceive this cycle as sleep, it sometimes takes 20-30 minutes of sleep for us to understand that we have been asleep.
Cycle 2	Steady sleep Sigma waves Sleep spindels 50% of sleeping time	5-6 Hz 3 Hz 12-14 Hz		In cycle 2 it is more difficult for you to wakeup, demands up to approx. 45 dB.
Cycle 3-4	Deep sleep Delta waves 20-25% of sleeping time	2-4 Hz	5 times higher amplitude than the alpha waves	In this sleep cycle it takes approx. 60-65 dB to be awakened, in this sleep cycle sleep walking occurs (somnambulism).
Cycle 5	REM sleep (or paradoxical sleep) Resembles beta waves 20-25% of the time.	30 Hz		In this sleep cycle we dream, during this sleep even will-powered muscles become temporarily paralyzed. During this cycle it takes close to 80-90 dB to be awakened.

"Most people spend their lives going to bed when they are not sleepy and getting up when they are."
(C. Adams)

According to Greek mythology, the God of sleep is Hypnos. Greek philosopher Aristotle was of the opinion that sleep was lack of wakefulness. Human beings and animals must sleep to survive. As long as there have been human beings on Earth, they have probably been wondering about why we need to sleep and what happens when we dream. Since the mid 1950's modern sleep research has made great progress when it comes to our knowledge of the basic physiology of sleep, and the different forms of sleep disorders and their respective treatment methods.

Milestones within sleep research:

When we sleep the brain produces specific electrical signals which are registered using EEG (electro-encephalography). It was not until the 1920's, when German psychiatrist Berger was able to capture this electric activity. The brain waves change with the degree of alertness and the depth of sleep. The deeper we sleep, the more of the slower waves are produced.

When we dream, another type of brain activity occurs, which is based on fast brain waves and specific periodic eye movements (rapid-eye-movement), so called REM periods.

It was not until the mid 1950's, when sleep researchers Eugene Aserinsky and Nathaniel Kleitman noted these regularly displayed recurring eye movements in small children during their dream sleep.

The movements showed a pattern that would indicate wakefulness in spite of the relatively deep sleep, therefore the name para-sleep or paradoxical sleep. Gradually it was discovered that adults also had these REM periods that coincided with periods during the night when they were normally dreaming.

Function and purpose of sleep:

The purpose of having to sleep as much as we do has always intrigued mankind. Today there are four hypotheses regarding the function of sleep. They are:

1. Sleep means recovery for the body cells, especially in the central nervous system.
2. By sleeping we wear and tear less on the human organism, for example through a decrease in metabolism.
3. When we sleep, sleep substances are broken down and eliminated.
4. During sleep, information is being processed and stored.

How much sleep do we need to feel good? Most adults need approximately seven to eight hours of sleep. However, there are "short sleepers" that only need five to six hours while "long sleepers" need ten to eleven hours of sleep the feel rested. As infants we need a lot more sleep, often as much as 18-20 hours per day. The adult's requirements for sleep is established after puberty. When we get older we need less sleep compared to when we were younger, it is common that older people do not sleep more than five to six hours per night.

The sleep stage's allocation, percentage wise, is also changed during life. Right after birth and during our first years the amount of REM sleep is high. It later stabilizes to approximately 20-25 percent during the rest of our lives, and is slightly reduced later in life. The high amount of REM sleep in early childhood is felt to play an important role in building structures in the small child, as REM sleep is associated with the production of proteins.

However, a striking change of the amount of deep sleep is noticed throughout life. In our 20's we sleep approximately 20-25 percent of deep sleep (NREM). For the rest of our lives this share is reduced and in our 70's and 80's it only reaches 5-10 percent. This partly explains why old people's sleep is not as deep and continuous, as they often wake up several times during the night. Older people having lower quality of sleep is also due to the fact that the corpus pineal that produces the sleep hormone melatonin is calcified during life. This results in lower levels of this sleep hormone and thus lower quality of sleep.

Regulation of sleep - wakefulness:

Sleep and wakefulness are regulated by an interplay between our biological clock that directs our circadian rhythm of approximately 24-25 hours, RAS (Reticular Activation System) that consists of nerve cells inside the part of the cerebral cortex which is called hypothalamus, and the corpus pineal where the hormone melatonin is produced.

The melatonin content in the blood is controlled and directed by the light that falls into the eye. Through nerve-paths from the eye's retina impulses are sent to the biological clock, the corpus pineal and the cerebral cortex. The more light that hits the eye, the less content of melatonin in the blood. This means that we are low in melatonin content during the day and high at night when there is almost no light.

Today melatonin is regarded as a sleep hormone whereas the higher levels during the evening and night makes us tired and puts us to sleep.

Different transmitters are involved in this interplay and the regulation of sleep/wakefulness. The secretion of stress hormones decrease during the night. The levels of growth hormones in the blood increase, especially during the deep sleep. The male hormone testosterone increases during the REM periods where erections occur.

The electrophysiology of sleep:

When we are awake and when we are asleep the brain produces different types of electric activities. These activities can be measured if electrodes are placed on the head using a technique known as EEG (electro-encephalography). In order to measure sleep as a whole, a polygraphic technique is used, which means that several parameters from the brain's activity are being registered along with important bodily functions. Besides the EEG, eye movement is measured with FOG (electro-oculography), muscle activities are measured with EMG (electro-myography), the electric activity of the heart is measured with ECG (electro-cardiogram), body movements, blood pressure, pulse frequency, the air flow from the nose and mouth and the oxygen saturation in the blood.

In certain cases the existence of different substances in the blood can also be measured, like the sleep hormone melatonin. Looking at wakefulness in an electro-physiological way, it differs a lot from sleep. When we are awake the basic activity of the brain reaches approximately 8-12 Hz. When we fall asleep, the electrical activity falls as the sleep gets deeper. The deep sleep (NREM sleep), which dominates the first third of the night, shows an EEG rhythm of 2-4 Hz while brain waves are high.

When we sleep and dream (REM sleep) the elements of fast waves (8-15 HZ) are greater while the brain waves are significantly lower in comparison with the deep sleep. Furthermore, during REM sleep the muscle activity in those muscles that are steered by will power is low and there is also periodic elements of rhythmic eye movements. The REM sleep recurs in intervals of 90-120 minutes and is dominant during the latter part of the night. REM sleep is also called paradoxical sleep since EEG displays a pattern that almost indicates wakefulness. However it is difficult to awake someone who is dreaming, as it takes nearly 80-90 dB to arouse a person from REM-sleep.

Normal sleep consists of five types of sleep cycles (cycle 1-4 and REM-sleep), which are determined by the electric appearance of the sleep.

A normal night starts with superficial sleep (cycle 1) that gradually gets deeper and is followed by a shorter period of REM-sleep.

During the night the sleep goes through four to six sleep cycles that each consist of all the five different sleep stages. Every sleep cycle has a duration of about 90-120 minutes. During the night we all experience short periods of wakefulness, often in connection with changing sleep stages.

The deep sleep dominates the first third of the night while the REM-sleep has its longest periods during the later part of the night.

How does the body and the brain react when we sleep?

When we sleep several different functions in the brain and body experience changes. During sleep we move nearly 5-10 times per hour, especially as we shift sleep stages. The body movements have physiological importance as they relieve the body so we don't sleep laying on the same side too long.

The metabolism goes down and the work of the nerve cells inside the brain decrease when we sleep.

The blood flowing through the brain increases during sleep. Some 4-25 percent of the blood flow is increasing during NREM sleep compared to when we are awake. This is the result of the increase of carbon dioxide during sleep, as respiration is reduced.

When we dream the blood flow inside he brain increases and the metabolism reaches the same levels as when we are awake.

Other functional rhythms that change during sleep is heart activity, respiration and body temperature. When we fall asleep the blood pressure falls approximately 10-30 Hg and the pulse frequency of the heart is reduced. The blood vessels in the skin expand as the blood flow increases. Respiration frequency goes down as a result of the respiratory center's sensitivity to carbon dioxide being reduced.

When we dream (REM sleep) circulation and respiration quickens while bowel activity slows down. REM sleep dominates the early morning hours. As it makes blood flow to the genitals, some men may experience erection when they wake up.

When we go through deep sleep the blood pressure is lowered and heart frequency and respiration is deeper.

Our sleep is of great importance to our physical health. Reduction of melatonin levels that normally occur when light shines into our eyes has been noticed in people who suffer from depression. Another example of the interplay between body and mind is that the share of REM sleep differs with women's menstrual cycles. The share of REM sleep is at its lowest after menstruation and at its highest just before. The large share of REM sleep just before menstruation is believed to be connected with premenstrual syndrome (PMS) when many women feel more irritated, depressed and tired.

Different types of sleep disorders.

Our sleep can be affected in many ways. Most of us have noticed that our sleep is affected in a negative way by living an unhealthy lifestyle or working irregular hours. However, these occasional sleep disturbances are not to be regarded as a sleep disorder as they usually go away as soon as their cause has been eliminated.

When defining different sleep disorders they are usually divided in to four major groups:

1. Insomnia
2. Hypersomnia
3. Circadian disturbances
4. Parasomnia

Insomnia:

Insomnia can be summarized as lack of sleep. Insomnia means the inability to sleep. Insomnia patients often complain about how it takes a long time for them to fall asleep, that they often wake up at night without being able to go back to sleep, and that they wake up too early in the morning. That in itself may be a sign of underlying depression. To be diagnosed with insomnia the patient must also experience problems with fatigue and have a hard time functioning well in the daytime.

Hypersomnia:

The hypersomnia group consists of different conditions where the patient feels a general need for more sleep. These individuals never feel truly rested even though they sleep a lot more than most people. Often they also fall asleep during the day. Hypersomnia conditions are often regarded as a result of insomnia. One example of a hypersomnia condition is sleep apnea syndrome. These individuals are often men in their 40's to 60's and are overweight. They exercise to little while they often also smoke and/or drink too much. They often experience problems with snoring in combination with cessation of breathing while they sleep. This is an effect of the soft tissues of the throat collapsing and stopping the air flow, causing apnea. This phenomenon is often discovered during REM sleep when the throat muscles are physiologically relaxed. Drinking and smoking intensifies the effect and contributes to respiratory interruptions.

Normally, all people have short interruptions of breathing when we sleep, especially when shifting sleep stages, but individuals who suffer from sleep apnea syndrome (OSAS) may during one single night experience hundreds of breath interruptions. This causes them to wake up, their sleep is interrupted leading to feelings of fatigue the following day. These breathing interruptions cause severe alterations in the pulse and blood pressure and variations in the oxygen levels in the blood. All combined this can lead to a higher risk of contracting cardiovascular diseases.

Earlier these patients often had to undergo surgery where surplus tissue in the throat was removed to facilitate breathing. The patients often got better but as new tissue developed in the throat within a few years their problems returned. Today these patients are advised to lose weight and given restrictions on smoking and drinking. They are also offered a breathing machine that uses CPAP-technique (Continuous Positive Airway Pressure) that helps them keep their respiratory system open while they sleep.

Circadian rhythm disorders:

Circadian rhythm disorder makes up a large group of sleeping disorders. A common denominator is a disorder in the biological clock. One example is jetlag which occurs when you have traveled by air between different time zones. Jetlag depends on that it takes time for the brain to adjust to the new circadian rhythm.

Parasomnia:

The parasomnia group are also called sleep related phenomenon that consist of conditions that aren't real sleep disorders, but more close to normal physiological processes in connection with sleep.

This group consists of night fright (pavor nocturnus) which is a common condition during childhood, especially at ages 2-5, when the child can suddenly wake up terrified and anxious only to fall asleep again after a short while not remembering what has happened. This condition always occurs during deep sleep and is connected to a general immaturity in the nervous system. These problems go away as the child grows older.

Another condition in this group is the so called sleep jerks that occur as you are about to doze off. This is normal and due to the fact that the brain relinquishes control of muscle tension when we fall asleep. When these jerks happen suddenly you may wake up with the impression that you are falling.

Teeth grinding (bruxism) is another sleep related phenomenon. It can happen during either of the sleep stages and may cause damage to the teeth.

To talk in your sleep (somniloquy) is common in children and can occur at any time during the night. The sentences are often fragmented and short and do not contain any meaningful message.

To sleep walk is a well-known and far more common phenomenon than you may realize. Nearly 15 percent of children ages 5-12 walk in their sleep. The walking always occurs during deep sleep. The condition is more common in boys; it has a genetic connection and is believed to depend on an immaturity in the nervous system. It is not possible to talk to sleepwalkers, but they can sometimes give inadequate answers when being addressed directly. Never wake a sleepwalker as this may cause anxiety. It is important to try to protect a sleepwalker (somnambulist) from objects that may cause injury. Try to persuade and help him or her back to bed.

Bed-wetting (enures) happens to about five to ten percent of children before ages ten to eleven. Urination occurs in all the different sleep stages and is considered an immaturity in the nervous system. The condition goes away by itself but it may be embarrassing to the individual, especially when staying over with friends.

Nightmares are relatively common (about 25 percent). The nightmare creates a threatening situation and is often connected to anxiety-ridden periods in life. Nightmares also occur during infections and after drinking and barbiturates.

Snoring is not to be regarded as a sleeping disorder, it is a normal phenomenon that still needs attention as snoring causes problems for some people as well as other members of their family. Habitual snoring occurs in men of ages 30-60 (approximately 10-15 percent). Snoring is a result of the throat being to narrow due to, for example swelling of the mucous membrane, fatness or inborn respiratory problems. Snoring is a result of vibrations that are created concurrently with the breathing as the soft tissues of the throat relax and are sucked together due to under-pressure in the throat. Consumption of alcohol, barbiturates or smoking contributes greatly to snoring. Obstructed air flow in the nose due to colds, adenoids or the mucous membrane swelling during pregnancy creates an over-pressure in the throat, which makes the snoring worse.

Snoring can be dealt with in different ways. Simple tricks that may help are turning over in bed, buying a more comfortable bed or avoiding alcohol, cigarettes and barbiturates. For over weight people, losing weight is also important as it reduces the amount of throat tissues, which facilitates air flow. In certain cases, an operation will do the trick.

Causes of sleeping disorders:

Sleeping disorders are more common in women and often hereditary components are contributing factors. The most common reason for a sleeping disorder is when the individual feels stressed or when problems that cause worries occur. Negative thoughts regarding guilt, betrayal or an unfulfilled need for acknowledgement can easily make a person enter a bad circle of anxiety, bad sleep and impaired ability to function well in daily life. Another common cause for sleeping disorders are aches and pains, especially for individuals who suffer from problems with connective tissue, muscles or joints. Infections, pains and cardiovascular diseases may also disturb the sleep.

Medicines like diuretic drugs, that are used for heart diseases, may lead to the individual having to get up at night to go to the bathroom, which of course disturbs the sleep. Anti-hypertensive drugs may also have a negative effect on sleep.

An important cause of sleeping disorders is abuse of alcohol or psychopharmacologic (psychoactive) drugs, especially older types of soporifics that are addictive and where long term usage can lead to problems with sleep.

Shift work, especially at night is very non-physiological to the body. It takes a long time for the body to correct disturbances in the bodily functions. Night shift workers often experience problems with their stomachs and intestines.

Soporifics and treatment of sleeping disorders:

Research and the development of new types of soporifics continues to produce the ideal sleeping pill without any side effects or risks of becoming addicted.

A lot has happened since the 1920's when bromine compounds and later barbiturate acid preparations were introduced. The 1960's saw the introduction of benzodiazepines, which later have been further developed. Unfortunately all types of medicines in this drug group have several more or less serious side effects, along with a great risk of becoming addicted during long term use.

Soporifics of benzodiazepine type influence our bodily functions in different ways. The ability to relax is affected due to muscle relaxation. Effects on circulation and respiratory system have also been noticed. Large dosages of soporifics, especially in combination with alcohol, produce a life threatening situation with risk of respiratory arrest.

Large dosages of soporifics also contribute to feeling tired during the day, with speech and attention being slowed down.

Older types of soporifics of the benzodiazepine type are the general reduction of deep sleep and REM sleep. After having used benzodiazepines for some time, a "rebound effect" can be noticed as the brain recaptures the lost parts of REM sleep. The REM sleep increases considerably and the effect is usually linked to more nightmares and irritability during the day.

Soporifics that are used during surgery affect the wakefulness center of the brain stem, the Reticular Activating System (RAS). RAS receives impulses from all supplying pathway systems and sends wake-up impulses to the cerebral cortex via the thalamus. When RAS is inhibited or blocked, the activity in the cerebral cortex is reduced, resulting in unconsciousness. The RAS block lasts for various lengths of time depending on the drug type. All these drugs have a suppressant effect on the normal functions of the brain during sleep.

Current soporifics are not completely free from side effects, common ones are drowsiness and problems with diarrhea or nausea.

There are two main roads to choose from when it comes to treatment of individuals with sleeping disorders - either using medications or not. The most important thing to consider when helping individuals with sleeping disorders is to try to find the real cause of the problems. The patient is not helped by a doctor who only subscribes soporifics. Temporarily sleep may be enhanced but the real problems remain.

When choosing the pharmacological path, a golden rule is to try and minimize the period of taking the drugs in order to prevent future addiction. Soporifics should only be taken for shorter time periods in order to get back on track, for example in periods of worries, concerns or life crises when sleeping disorders naturally may occur. In connection with long flights, which may cause problems with jet lag, using soporifics may be necessary for a few nights.

Today's modern soporifics have short efficiency time but there is still a risk of addiction if used more then four weeks. However, modern soporifics don't reduce the amount of NREM-sleep and REM sleep as much as the old preparations did.

Negative health effects due to poor sleep:

When we don't get enough sleep we become tired and inefficient. The brain is very good at recapturing lost sleep. But extreme sleep depravation is harmful to human beings. If people were completely stopped from sleeping during longer periods of time, they would die from failed cardiovascular functions. The body's regulation of temperature and the immune system is impaired by extended periods of poor sleep. Long term sleep depravation reduces nerve cell activity in the cerebrum and thalamus, which may lead to memory and attention disturbances and states of confusion and depression.

In recent years sleep research has shown that chronic sleep depravation is linked to an increased risk of different types of cardiovascular diseases, diabetes, premature aging and dementia.

The wonderful world of dreams:

Our knowledge of dreams can be divided into three stages; the pre-scientific, the psychoanalytic and the present, which is based on modern dream physiology and dream psychology. The latter stage began in the early 1950's with the discovery of REM sleep.

1. The pre-scientific stage: Human dreams were the object of many thoughts, strange myths and interpretations. The earliest documents of mankind date back to thousands of years B.C. and they contain several interpretations of dreams. It was believed that dreams were linked with supernatural powers. The Gods sent dreams to people. Dreams were said to be able to predict the future.

In the Iliad, Homer describes how various people's dreams affected the course of events in the Trojan War. Hippocrates, the father of medicine, claimed that dreams indicated how diseases could be cured. For centuries, people have been writing books about dreams and their interpretation. Even today many people attribute great value to interpretations in dream books.

2. The psychoanalytic stage: The perception of dreams was entirely dominated by Sigmund Freud and his work.

In his major work on how to interpret dreams he states how the interpretation of people's dreams is a pathway to understanding a person's unconscious mind. His teachings are based on dreams being meaningful even if though the meanings aren't always clear. Freud described what is known as the manifest dream sequence; the fact that the latent meaning of dreams can be reached by means of associations when people later on describe their dreams while awake. This type of interpretation takes place with the help of a psychoanalyst.

Freud stated that dreams were a way of processing what had happened during the day, a perception which is also found in modern theories. Today's main criticism of Freud's dream theory is that it was based only on the late night dreams, the so called "morning dreams". More recent sleep research has shown that we forget most of our dreams. Freud's theory that discussing a morning dream can illustrate people's unconscious mind can therefore be called into question.

3. Dream physiology and dream psychology: The discovery of REM sleep in the mid 1950's became the start of research into the physiology and psychology of dreams. The objective with this research was to establish exactly when a person has REM sleep or NREM sleep.

Dreams should be viewed as a kind of information processing function in the central nervous system. Neuropsychological dream researchers are attempting to define the difference between:

1. Thoughts and experiences (cognitive activity) during the day when we are awake and conscious, and ....
2. Activity during the night when we sleep and dream.

This information processing goes on while we are awake as well as during REM sleep and NREM sleep. If you wake people during NREM sleep, they can report simple dreams but to a lesser extent than if they are awakened during REM sleep. Then the reports more or less contain dreams that often are vivid, complex and somewhat hallucinatory.

However, it seems like most dreams are very trite. Dramatic dreams involving horror or with sexual or erotic themes are more rare than you might think. Most dreams are forgotten. To be able to remember our dreams we need to wake up, or be awakened, right after we have dreamed.

During REM sleep sensory impressions from the skin and hearing can affect different courses of events that dreams are made of. Surveys have been conducted to find if watching a horror movie would influence sleep. However, various experiments show that it's very difficult to affect the content of dreams by giving people messages of violence and/or eroticism.

Advice on sleep hygiene:

It is of utmost importance to live a good lifestyle and to take care of your body and health. Individuals who consult a doctor for a sleeping disorder have often lived in such a way that their sleep has been affected in a negative way.

There are several things to think about that directly or indirectly affect our ability to sleep and the quality of our sleep.

The sleeping environment is the most important. The bedroom needs to be dark in order to achieve high levels of the sleep hormone melatonin. Of course, the bed you sleep in should be comfortable, pliable, and large enough so that you can stretch out and turn without coming in contact with the edges of the bed. Using mangled (pressed) bottom sheets also helps cooling and channels away moisture. It is also important that the sleeping environment is quiet enough so that you are not awakened, since the best measurement of good sleep is a sufficient length of time free from disturbances. Try to go to bed and get up at the same time every day, since this is beneficial to the rhythm and the functions of the biological clock.

Avoid bringing the day's events and problems with you to bed, try solving them during the evening if possible.

Don't go to bed hungry as hunger has a stimulating effect on the brain's center of wakefulness. Eat something light, for example a glass of warm milk and a sandwich with a little honey or a banana. All these have sleep promoting effects.

If you can't fall asleep, get up and do something else that doesn't focus your thoughts on sleeping. In a short while the need to fall asleep will return.

Try to use the daylight as much as possible as this affects your biological clock in a positive way. By exercising regularly, preferably three times a week, you get physiologically tired. At the same time exercising helps produce sedative substances in your blood and it generates a deeper sleep, which helps you to wake up feeling rested. However, don't exercise too close to bedtime as it may make it harder fall asleep when you are not fully relaxed.

Avoid larger amounts of caffeine, which is found in tea, coffee and Coca-Cola. Caffeine stimulates the center of wakefulness in the brain, and high levels of consumption may lead to disrupted sleep. An average sized coffee cup contains approximately 100 mg of caffeine. Consuming more than 400-500 mg caffeine (4-5 cups) per day makes it harder to fall asleep. You may also wake up several times during the night and wake up to early in the morning.

Try to keep consumption of alcohol and nicotine products down as these affect the sleep pattern in a negative way by reducing the periods of NREM sleep and REM sleep.

Avoid using soporifics for longer periods of time as this may lead to addiction. Always consult with your doctor if you need help in finding what causes your sleeping problems.

Only about 20 percent of us never suffer from back pain. However, as long as we don't have pain in the back, we don't give it much thought. This section is for those of you who would like to have an overview of various back problems and what can be done about them.

Too many people wake up in the morning with a stiff and aching back. Usually, they go to work and deal with it the best they can.

The first question you should ask yourself when you have back pain is: Do I sleep in a good bed? You need a properly constructed bed that really suits your body.

Back problems are common. Approximately 8o percent of all people suffer from back pain at least once in their lifetime. Most people stand a good chance of recovering in about a week, while some more persistent problems may last for several months. Luckily, it is rare that back pain is caused by some actual disease.

Back pain is one of the most common causes of sick leave in Sweden. Lumbar back pain, like pain in the lower part of the back, is the most common type of back pain.

It goes without saying that proper rest and sleeping well is particularly important. Not only for avoiding back problems but for you to function satisfactorily during the day.

Currently, exercise is considered the best remedy for most types of back problems. Inactivity and long periods of rest can actually worsen the pain and delay recovery.

Many people retire early due to back pain. Back pain causes both human suffering and huge costs. The cost to society because of these problems may seem less serious than when compared to, for example, heart problems etc., but it amounts to several millions+ per year.

Preventing back problems through regular exercise and choosing the right bed could result in considerable savings.

Back problems are one of our most common health issues. But contrary to what many people believe, most types for back pain can be avoided and easily cured. Of all the people who call in sick due to back pain, more than one half recover within a week. Seventy percent recover within three weeks, and ninety percent within two months - irrespective of what type of treatment they receive!

Manipulation:

Scientific research has recently shown that most people with common back problems who undergo, what is called manipulation of the spine, have recovered more rapidly.

Patients with back problems who are not showing improvement after four to six weeks, and who are still experiencing reduced ability to function in the work place, should consult a doctor.

Among those who experience back pain for a week, the doctors find an underlying disease in only 2% of the cases, like slipped disk, infection, rheumatism or spinal instability due to wear and tear.

For those who have been suffering for more than six weeks, an underlying cause is found in approximately 10-15% of the cases. And for those who have suffered from back pain for more than twelve weeks, some 25% show symptoms of an underlying disease.

So 75 percent of the patients with long term, chronic back problems do not suffer from any underlying disease, which would explain their pain.

What causes the pain?

Roughly, back pain can be divided into two types: Pain in the lower part of the back and back pain where the pain radiates down into one leg or sometimes into both legs.

"Lumbago" means a sudden sharp pain in the lower part of the back. Lumbago can be caused by lifting incorrectly or some other strain, for example, a wrong movement caused during sports activities etc.

It is not unusual for people to wake up with lumbago. This occurs all too often because the back, which gets strained during work or exercise etc, does not relax sufficiently during sleep. A suitable bed is essential for allowing the back to relax properly.

Back pain has many causes.

The causes of pain are numerous and explanations differ widely, depending on who you ask. The most common explanations for acute back pain in orthopedics are small tears that occur in the different muscles, tendons and ligaments.

Very little is known about this type of injury, as the damage can not be shown with the usual X-ray methods. The explanation you usually receive when asking specialists who treat back problems by manipulation (Naprapaths, Chiropractors as well as Doctors trained in Orthopedic Manual Therapy - OMT and Physiotherapists), is that back pain is caused by restrictions of movement and tense muscles.

Back problems are common in pregnancy. Approximately half of all women get back pain at some point during their pregnancy. The pain is believed to be partly due to pressure on the back that changes during pregnancy, and partly due to hormonal changes. Many hospitals offer special exercise classes for pregnant women, designed to strengthen the muscles of the back. There are also exercise classes for new mothers.

Disc injuries:

The discs are found between the vertebrae. A disc consists of three separate components:

• A soft jelly-type core, which is enclosed by
• a tough ring of cartilage and outermost ...
• a ligament-type layer, which holds the disc in place.

The discs have a shock-absorbing function and distribute the pressure between the vertebrae so that the spine can bend and turn without damage.

The discs are the part of the back which first show signs of aging. The direct blood supply to the disc's cartilage ceases at around the age of 20.

Therefore, the cartilage in the disc does not easily recover from damage, since the factors that govern recovery are found in the blood.

We know that smoking for example, strongly impairs the disc's nutrient supply while exercise has a positive effect. Sometimes a slipped disc occurs, which is one of the few definitive pathological changes that are clearly linked to a certain type of back pain.

While lying in bed, the pressure on the discs is at its lowest and it is therefore important to give some thought as to whether the bed you sleep in is properly constructed.

Natural filling materials offer the pliability required. It is also important that you choose the right model and level of firmness.

Why is back pain so common? Is there something wrong with the human back? Does our two-legged, upright posture put too much strain on the back?

The human back is well constructed. Although our upright posture creates a large strain on various structures in the spine, the back is built to cope with this.

Even four-legged animals suffer from age-related changes in the back, and amongst certain species (for example bulls, horses and dogs) slipped discs are just as common as amongst human beings.

It is our lifestyle that worsens our backs. Scientists have shown that smoking and sitting still increase the risk of back pain. In other words, inactivity is not good for the back. Also inappropriate movements that are repeated, for example lifting with a bent back, may cause injuries, especially to the discs.

Occupational groups at risk:

Various scientists have shown that back pain is more common in certain occupational groups, for example forest workers, butchers, construction workers and bricklayers etc.

Back pain is also over-represented amongst women in so-called male-dominant trades, such as garage mechanics, engineers and welders. But there is no concrete proof that heavy work and unsuitable working positions cause back pain, or that chronic back pain is caused by straining.

Some studies challenge the theory that back pain is, to a large extent caused by strain. Many studies have shown that people with, what is generally considered heavier, manual jobs suffer less from back problems than people with lighter jobs.

On the other hand, we know that back pain can be made worse by certain movements and tasks. People whose job requires them to lift heavy loads and stand in awkward positions remain on the sick list for longer periods of time if they suffer from back pain. Those who can avoid arduous tasks can, of course, return to work earlier after having time off with back pain.

Research studies:

One of the most comprehensive studies conducted regarding back pain involves aircraft manufacturer Boeing, which employs 3,000 people at their facilities in Seattle. This study was conducted over a four year period.

Enjoyment of their work and getting along well with their co-workers and management seemed to be determining factors as to whether workers came down with acute back problems or not. Disharmony and lack of influence in the workplace greatly increased the risk of back problems. Other factors were smoking and occasions of earlier back problems.

On the other hand, the study showed that heavy lifting, an individual's muscle strength, mobility, age or sex had no real bearing. For those that reported long term back problems, in other words, back pain that lasted more than three months, it was shown that lack of job enjoyment, smoking and overall bad physical condition were some of the most common risk factors.

The fact that enjoyment in the workplace as well as a good home environment were important factors for avoiding back problems was also supported by results from several other studies conducted in other countries.

A Canadian study attempted to minimize work absence caused by back pain among nursing assistants. The study was conducted by observing two different groups. One group was provided with comprehensive training on proper lifting techniques, among other things. This training program did not affect the work absence rate at all. In the other study group, concentration was placed on improving the psycho-social situation in the working environment. In this group, absence from work rates because of back pain were reduced by 70 percent!

Avoid long term rest:

In contrast to earlier belief, it has been scientifically proven that long periods of rest and inactivity delay the recovery process and back pain actually increases. The pain caused by acute back pain, for example, lumbago, can be so intense that a person can become incapacitated. In this case, rest cannot be avoided, but only for short periods of time, and of course in a proper bed.

In the case of acute back pain that does not radiate down into the legs, it has been shown that a period of two day's bed rest, is significantly better than longer periods of bed rest. Periods of bed rest longer than a week have been shown to be harmful.

It is not dangerous to move around somewhat, even if you experience a bit of back pain. However it is important to get the 7-9 hours per day of sleep that the body needs. Properly rested muscles give the body more capacity to heal and rejuvenate itself.

It is usually bad practice to recommend long periods of rest and long sick leave for a back patient. We know that inactivity is bad for the body, but it is also bad for the soul as well. Inactivity reduces muscle mass (strength) as well as bone mass, which causes overall physical condition to rapidly deteriorate. All back tissue such as bone, cartilage, muscles, tendons and ligaments need activity to heal properly and return to normal function. This is true regardless of what caused the initial back pain.

Few effective treatments:

There are many forms of treatment used for back pain cases, but only a few are really effective. Some of these methods are used by licensed medical practitioners, while others come from so-called "alternative medicine".

Because back pain is so common and the prognosis is good, nearly 70 percent recover within three weeks with or without treatment, it is not surprising that almost any kind of treatment is considered successful. According to scientific, controlled studies, treatment by manipulation has been shown to be most effective during the first four to six weeks of the onset of acute back pain.

Published information and back clinics recommend strengthening exercises and bed rest for up to two days also have shown to be effective. Methods showing no effect, or methods showing negative effect, included bed rest of more than seven days, radio therapy, short wave therapy and ultrasound, among others.

In summation, we can say that the advice on avoiding bad movement, increased activity and a well built bed used in a pleasant and comfortable sleeping environment gives the best recovery results.

Chronic back pain:

In a few cases, back pain is more or less chronic. Despite the fact that a relatively few number of people are effected, chronic back pain places a large strain on health care resources. Doctors can diagnose back disorders in approximately one quarter of these people, but cannot find a specific reason for the pain in the remainder. These people suffer from chronic back pain with no known cause.

Long periods of sick leave can contribute to the development of chronic back problems:

Long term sick leave not only affects the physical side of the coin, but it has psychological ramifications as well. People on long term sick leave run the risk of losing contact with their work colleagues and therefore lose an important part of their social involvement. Various studies have also shown that long periods of inactivity are important contributing factors to incidence of chronic back pain.

It is also known that the sooner a person returns to work, the less risk that the back problem will reach the chronic stage. It has even been shown that a very active training regimen can actually break the chronic pain pattern, and get people back to work. Several studies have shown that an active rehabilitation program conducted at an early stage can reduce long term sick leave and early retirement.

Unnecessary early retirement:

Until recently, many people have chosen, unfortunately, to retire unnecessarily early as a result of back problems. Many did not have a genuine back disorder, but a chronic back pain condition. A proportionate number of these people were young. It is not a good practice to retire people early if they could be somehow rehabilitated. There is evidence they are worse off, and that the pain actually increases as a result.

Preventing Back Problems:

First and foremost, choose a bed that is comfortable and well constructed. The firmness level depends most of all on your weight. It was previously thought: the bigger the arch of your back, the softer the mattress. We now know better! There is no such rule! It is better that the bed is well constructed. Then each individual person can decide what level of firmness feels best to them. It is important that the entire back is supported, and that you are lying in the bed, not on top or deep inside.

When you discover that you no longer are aware of the bed then you have found the right one! Try it for yourself and you will know what we mean.

Lift near the body, in other words hold the object as close to the body as possible when lifting. This reduces the strain to the back.

Never twist the body when lifting! You should also not twist the back while you are bent over. Such movements place great strain on the discs of the back.

Vary your sitting and working positions often. Do not sit in the same position for too long.

Vary your working position. Sitting for long periods inhibits nutrients from reaching the discs in the back, while movement has a beneficial effect.

When pain subsides, strengthen the back and leg muscles. The goal above all is to strengthen the muscles that stabilize the back.

Tighten the stomach muscles, especially the lower portion when lifting. The muscles in the stomach also stabilize the lower part of the back, and therefore help when lifting. Support the back. The entire back must be supported when sitting and when you lay down. If you have a deeply arched back, use a support for the lower back. Also, if possible, make sure your arms are supported when you sit and work.

Don't smoke! In addition to many other negative health effects, smoking reduces the supply of nutrients to the discs. Smoking also impedes removal of certain waste products from the discs. Several different studies have shown the slipped discs and other forms of back pain are significantly more common among smokers when compared to nonsmokers.

Get moving, for example ride a bike, swim, jog or walk more. Exercise leads to better overall physical condition and strengthens the back. Exercise also counteracts calcium loss from the bones and improves the nutrient supply to the discs. It has been shown that exercising for 30 minutes, three times a week is enough to keep the back in good shape, benefiting the muscles, bones, tendons, ligaments and cartilage.

Acute back problems: Try to find a pain free position if possible. You can, for example comfortably lay down on your back and put your legs up on a chair, the so called Psoas position. An adjustable bed can be minutely adjusted to just the right position. Alternate rest with periods of activity. Sit as little as possible.

Place ice packs on the area that hurts and move about with your back in a prone position. You can also alternate ice packs with heating pads. This method has also proven to be quite effective at relieving acute back pain.

If the pain is intense you can try to stretch the back, try hanging from your arms in a door way or lying in the Psoas position.

Below we describe slipped discs, Spondylitis and other back disorders for those of you who would like to know more:

Back pain is the most obvious symptom of slipped discs, Spondylitis and constriction of the spinal canal. Displacement of a vertebra, Scoliosis and brittle bone disease are reasons for back pain, and these are possible to diagnose. As mentioned in the previous section doctors using current diagnostic methods can only find specific causes for back pain in approximately 25 percent of the cases Treatment for these cases is different from treatment of the "unspecified" back problems.

Slipped discs:

The disc consists of a core with a jelly like substance surrounded by a tough ring of cartilage. On the outside a ring acts as a ligament to stabilize the disc. Even people in their 20's can experience age related problems, so called disc degeneration. This, in combination with more physical strain such as twisting, bending forward or faulty lifting technique can lead to a slipped disc. A slipped disc means that the core is forced outwards and damages the outer ring of cartilage.

If the slipped disc presses a spinal nerve pain can radiate out into one or both legs. This is commonly called Sciatica. The spreading of the pain depends on the location of the slipped disc. A slipped disc is usually located between the lower vertebrae (4th and 5th lower vertebrae). A slipped disc can be diagnosed with special X-ray examinations, so called Myelography, MRI or computer Tomography. Slipped discs cannot be diagnosed with ordinary X-rays however, because ordinary X-rays only show damage to the skeletal structure.

Slipped discs can be treated by relieving pressure using a support belt or girdle and various forms of stretching.

If the slipped disc is situated so low that it interferes with bladder or rectal functions surgery is required without delay. However, recent research has shown that slipped discs that do not greatly impact nerves often heal themselves over a period of time. Many people have slipped discs without even being aware of it. This new knowledge is in part thanks to ever more effective X-ray technology.

Spondylitis:

Spondylitis is a rheumatic disorder that tends to affect younger people. It is also know as Ankylosing Spondylitis or Pelvic Spondylitis. The disease is characterized by an inflammation of the sacral vertebrae. Doctors and scientists previously believed that this condition primarily affected males. But research has shown that females are equally prone to the disease, but tend to get a milder form.

The cause is generally unknown but we do know that heredity plays a role. Nearly all sufferers of this disease have cells of a special tissue type (HLA B27). This type of tissue is found among other people but significantly less frequently.

The primary symptom is back pain. Generally a dull ache in the small of the back which often radiates down towards the buttocks. The symptoms frequently worsen over a longer period of time. The pain is generally most pronounced in the latter part of the night and morning stiffness is common. The pain increases when the patient is inactive and seems to improve when they move around. The symptoms are caused by inflammation of the sacral vertebrae but all large joints and the back itself may be affected. Sometimes the bone is ossified between the vertebrae, resulting in so-called bone-bridges. The ligaments of the spine at the front and back may calcify, which causes increased stiffness in the back.

These changes can be observed using ordinary X-rays. The symptoms may also be seen in other parts of the body, for example inflammation of the iris or the prostate gland.

Treatment usually begins by using anti-inflammatory drugs. Physical therapy or home exercise programs are also very important measures to counteract stiffness and retain movement in the joints.

For the most part, the disease is relatively mild and the prognosis is good. Pain usually alternates with periods of remission, when patients are more or less symptom free.

Spinal Stenosis:

Spinal Stenosis is a narrowing of the spinal canal due to changes in the spine. The disease is rare and usually affects elderly people.

Typical symptoms include pain in the lower back, hips and thighs. These symptoms can occur after an ordinary walk, walking down a flight of stairs, standing for an extended period of time or bending backwards. The pain usually increases during the day but can disappear when leaning forward, for example when sitting.

Spinal Stenosis often exhibits changes that can be seen with ordinary X-rays, but Myelography, Tomography or MRI is required to properly diagnose some cases. If the condition is very painful, surgery may be required. This involves removal of several of the vertebral arcs, which can relieve the pain.

Spondylolisthesis:

Spondylolisthesis is a displacement of a vertebra. The 5th lumbar vertebra (usually) slides forward, which is thought to be a defect in the vertebral arc. The results are that the vertebra slides forward in relationship to the other vertebrae. This displacement usually occurs in the 10-16 year age group, and is seldom seen after age 25. This is also a common problem among active gymnasts.

It can be diagnosed with regular X-rays. The forward displacement does not necessarily cause pain, but in up to half the cases patients experience symptoms such as dull lower back ache, tiredness and even Sciatica. The symptoms often improve with therapy and controlled exercise. If this treatment is not effective, surgery to stabilize the spine can be performed.

Scoliosis:

Scoliosis refers to a sideways curvature of the spine. This pathological condition often occurs during puberty and is seen in girls four times as often as in boys.

Scoliosis is in some cases hereditary. In the past polio was often a common cause. Scoliosis in some cases can result in fatigue and pain in the back.

Children with Scoliosis can sometimes be treated with a corset of some kind. This treatment only begins when the changes reach a certain point. The purpose of the corset treatment is to prevent increased side wards curvature.

Other treatments may involve physical therapy and controlled exercise. Severe Scoliosis that is not successfully treated with therapy often requires surgery. This usually requires a procedure that renders the affected area of the spine rigid.

Osteoporosis and compressed vertebrae:

Osteoporosis is a condition in which the bones become brittle and bone mass is reduced, which normally occurs in the elderly. A person of 70 years of age has approximately one third less bone mass than a 30 year old. The condition takes place somewhat sooner in women than in men.

Lack of calcium, hormones and too little exercise are considered to be contributing factors for Osteoporosis. Certain diseases, including alcoholism and long term cortisone treatments can also lead to Osteoporosis.

When bone mass decreases, the bones become brittle, making it easier to break certain bones in the body.

This may cause spontaneous vertebral compression, in other words the vertebrae are compressed without the patient having suffered any traumatic injury. Fractures and vertebral compression can cause severe back pain. Treatment involves pain killing drugs and pressure relieving methods.

The best way to prevent Osteoporosis and prevent decalcification is a regular exercise routine and a balanced diet. In some cases, especially for the elderly, treatment can include calcium tablets, vitamin D, sodium fluoride tablets and estrogen in low dosages.

Infections and tumors:

The spine can also suffer from infections, but this is very rare.

So called Septic Spondylitis indicates that one or more vertebrae have become infected via the blood flow. Symptoms include fever, chills, nausea and soreness near the affected vertebrae.

Previously, Tuberculosis was a common cause of Spondylitis, but nowadays the most common cause is staphylococcus bacteria. This condition is treated with high doses of antibiotics.

In rare cases the cause of back pain can be caused by some form of tumor in the spine. This usually involves metastasis from another form of cancer in another part of the body, for example the prostate, lung or breast cancer. Tumors can also grow in the bones, or bone marrow. In very rare cases, this can involve a tumor in the spinal cord itself.

Metastasis and bone cancer can usually be detected with regular x-rays or using so-called isotope X-rays.

Spinal cord tumors are diagnosed with the aid of Myelography or Tomography. Treatment for spinal cord tumors include radiation, cytostatics and in some cases surgery.

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Sven-Ake Ostman, Reg. Naprapath gives advice on choosing a bed.

Sleeping well is more important to health than you may realize. Sleeping well helps prevent back and neck problems, and it enhances your immune system, improves your healing capacity, your memory, your condition and your ability to learn. And it makes you feel happier. - Today many people suffer from neck and back problems. A good bed and a good pillow prevents such problems, says Sven-Ake Ostman, Reg. Naprapath.

Sven-Ake Ostman runs his own practice in Jarna, outside of Stockholm, Sweden, and has worked as a naprapath for 13 years. He has been appointed Naprapath of the Year, and has also been chairman of the Swedish Naprapath Association. SvenAke Ostman has great experience of patients with back and neck problems. He states that it's the national disease of our time. Higher levels of stress, a greater workload, sedentary work and general inactivity contributes to back and neck problems.

Many people move too little and sit too much in their daily work. Preventative measures to counteract back pain are therefore becoming more important. A good night's sleep is one of the most important things you can do to guard against back problems and for your health in general. A good bed prevents and offers relief.

It is important that you sleep in a bed that provides proper support for your back. You should feel that your entire back is supported and that you are lying in the bed, not on top or inside. If you already are experiencing pain, naprapaths state that both the vertebrae and the musculature are involved. This often requires treatment.

A good bed cannot guarantee you will not have back pain, but it will definitely help to prevent and minimize trouble that may arise in the future.

Naprapaths emphasize the importance of testing different beds, as all beds have different properties. You will know which bed suits you best by laying on it.

The combination of bed and pillow is important:

Sven-Ake Ostman points out the importance of having the right combination of bed and pillow. Those that suffer from back and neck problems need to choose the right pillow with the right bed. In collaboration with Sven-Ake Ostman, an anatomical pillow has been developed made completely of natural materials. This anatomical sleeping pillow is made with quality, design and naprapathic knowledge in focus. At first it looks like any ordinary pillow, but inside is a detachable cylinder that relieves pressure and supports the neck. The cylinder is available in different firmness levels to suit each individual's needs. The pillow is made of cotton and down. The down blend inside the pillow shapes after each individual and it lets out the body's humidity. The sleeping pillow's fabric is made of 100 percent cotton so that the feathers can't escape. At the same time cotton allows air to pass so that the pillow "breathes". This Anatomical Sleeping Pillow is recommended by the Swedish Naprapath Association.

A good way to prevent back pain is to stretch those muscles that cause problems. Below you will find a description of two exercises that you can perform on your own. The exercises should be performed every morning and night, it only takes a few minutes each time.

The so called hip flexors and the gluteal musculature may cause back pain. It's when these muscles become shortened that they may feel tired resulting in a dull pain in the back. To stretch these muscles, do exercise 1.

The pectoral muscles often become shortened and tense, which affects the posture in a negative way. This affects the other neck and throat muscles so that they become "stressed". This may result in various symptoms, like pain the neck and shoulders, tension headache and dizziness. To stretch these muscles, do exercise 2.

Exercise 1: Stretching the gluteal muscles:

Starting position: Lay on your back, and put a pillow under your head. Put the right foot on the left knee. Hold the left leg right below the knee bend. Do the following:
1. Pull the left leg towards your chest until you feel a stretch in the right buttock or in the back of your right thigh. Hold for 10 seconds.
2. Tighten the right buttock by pressing the right foot against the left knee. Use only a few percent of your maximum strength. Hold for 10 seconds.
3. Repeat 1-2, twice.
4. Finish by stretching the muscle for 10 seconds.
Then do the same exercise in the same way, but put the left foot on the right knee.

Exercise 2: Stretching the pectorals:

Starting position: Stand so you are facing a corner. Place your hands on the walls so that your upper arms are bent 9o degrees. Move one foot closer to the corner. Do the following:
1. Lean towards the corner until you feel a stretch in the chest. Hold for 10 seconds.
2. Tighten the muscles by pressing your hands and lower arms towards the wall. Use only a few percent of your maximum strength. Hold for 10 seconds.
3. Repeat 1-2, twice.
4. Finish by stretching the muscle for 10 seconds.

Good advice from the chiropractor:

Olav Erik Bjolstad, Reg. Chiropractor. Born in New York, and raised in the Norwegian village of Andalsnes. For many years he has had his practice at Tulegatan in Stockholm, Sweden. Every day he meets many Stockholmers that all share one major topic. Their bad backs.

It was natural for this meeting to take place, a charismatic meeting that was already predestined. A meeting between the CEO of our bed manufacturer and the registered chiropractor.

I, Olav Bjolstad, have been working as a chiropractor for 20 years and I have been talking about beds at least five times a year during all that time. I feel that I have gained genuine experience on the sleeping habits of back patients. That's why I called Jan Ryde, CEO to see if we could make a good product even better for the customer/patient. At this first meeting Jan proudly told me about how the noble art of high quality bed making had been handed down through generations. More than one hundred years of professional pride and the tradition of only using natural materials like cotton, wool, flax, wood, horsehair etc. to create a sleeping environment that is a friendly to people as humanly possible. A timeless piece of art that will withstand years of daily/nightly strain and still hold out for at least 30 years.

I soon realized how proud Jan is of every little detail that is a part of a Hastens mattress! Makes you wonder how he could be so proud over a mattress? But Jan Ryde believes that the bed is the most important possessions in a home. For thousands of years the bed has been an essential part of the home, where new lives have been born and old ones have said goodbye. A place where sick have become well and lovers have performed the most intimate acts of passion. A place where people after a day of hard work have rested and cared for their tired bodies and souls. That's why it's quite understandable why Jan is so proud of his family's heritage.

A sound mind in a sound body! This happens to be one of the corner stones of the chiropractic philosophy. About one hundred years ago modern chiropractic was founded by the American David D. Palmer. This is the science, art and philosophy built on the principle that the human body has a fantastic ability to cure itself. The normal condition for all cells in the body is health, and by caring for your body and giving it the right prerequisites, the body can heal itself.

After having told Jan this, we both realized that we had a lot in common, the CEO and the chiropractor. A major part of treatment and rehabilitation of a patient is to persuade them to let their bodies sleep, play and rest in a good bed. Perhaps by now you are thinking "That's easy for you to say. You get paid for it!" That may be true, but I still maintain that "a good bed is essential to everyone's general health".

To make the choice of mattress easier for the customer/patient I suggested that I could write an informational booklet on what to consider when choosing a mattress. I have done that based on the experiences I have gained through talking to thousands of patients. The way the chiropractor looks at it, this information does not only refer to Hastens mattresses, but also to other brands of mattresses. Jan liked the idea of having an outsider give his point of view. So here I am in front of the computer.

Many people have not yet realized the importance of sleeping well. Actually you could say "bad bed - bad back!" It's as simple as that. We take loans to finance a new stereo, a more expensive car etc, but allowing ourselves a bed of higher quality is placed a lot further down on the list of priorities. We often tend to bring our parent's old mattresses when we move away from home the first time. We spend five summer weeks of the year in the country house and then return to the city completely stiff. We sleep on a five cm thick foam mattress in a crowded sailboat and suffer from sciatica to the degree where we almost can't get off shore.

Now, start the day healthy and rested! If you feel tired and stiff in the morning or if you experience back or neck pain it is time to change your mattress. I do not declare that the more expensive something is, the better it is. You can find a good mattress for a moderate price, but always remember that a more expensive mattress lasts longer so it saves money in the long run.

Ok, ok, but how do I choose the right one?

"I'll get over it!"

Sooner or later 90 percent of the population will suffer from muscle and/or skeleton problems. It is the single highest cost in the Swedish public medical service that society has today, in the forms of treatment, rehabilitation, sick reporting and early retirement pension. The annual costs are astronomical. There are several causes for these problems. But the main reasons are too much sitting down, overweight, bad working postures and stress. As a chiropractor I believe that it's very important that the therapist and the patient both take the rehabilitation process of these problems seriously. The patient need to start to plan some form of daily exercise. Aeorobics, workouts, swimming and strength training are preferred forms of exercise and they often show fast results. Discipline is a key factor. However, you don't need to train like an elite athlete to obtain good results fairly soon. I dare say that one hour three times a week will go a long way. Athlete Arne Tammer's old advice "give me 15 minutes a day" is very realistic.

If you are someone who suffers from stiff neck, office shoulders, wryneck, headaches, lumbago etc, you shouldn't ignore these problems by saying "I'll get over it!"

Simply put, pain is a warning signal showing that something is wrong. Find out what it is and do something about it. The problem may have many causes but always demand an explanation to why you are having problems. Don's ever accept prescriptions for pain-killers from your therapist, medical leave and a slap on the back saying "nah, I'll get over it". This goes for doctors, physiotherapists, naprapaths and yes, even chiropractics. All these people will proudly say that they have a solution to your problems. As a patient you must demand that something positive will emanate from any treatment. Don't carry your pain around for weeks on end. A guiding principle is to have positive changes happen after having seen your therapist four to five times. If these don't occur, the therapist needs to send you to someone who can offer you adequate treatment. said goodbye. A place where sick have become well and lovers have performed the most intimate acts of passion. A place where people after a day of hard work have rested and cared for their tired bodies and souls. That's why it's quite understandable why Jan is so proud of his family's heritage.

"Look well to the spine for the cause of disease" Hippocrates

Good advice from naprapath Sven-Ake Ostman:

You need to be careful and take your time when buying a bed. A good bed will provide you with many years of good sleep. It supports and relieves your body. Have in mind:

• Lay down in the bed for at least 10-20 minutes.
• Always take your shoes off when you are testing the bed.
• Try to relax and lay in the same way you would at home.
• Ask the staff to examine if your body is relieved when you are lying in the bed.

Stores with competent staff can determine if your body relaxes and gets the right support, in other words if the bed has the "right" level of firmness.

The right bed offers the body support and relief. Those parts of the body that stick out, like the shoulders, hips and knees, must sink into the bed while the rest of the body must be supported. The first thing you need to do is to book time with a registered naprapath or chiropractor whom can help you with your problems.

A good bed can not cure a bad back, but the bed is important for preventing problems and it promotes enhanced health.

Are there expensive beds? How much money do we spend on other things, such as adventures, holidays etc? How much money is invested in sleeping well? My advice is to prioritize good sleep. It's while you sleep that you rest and gain strength to be able to live a happy and healthy life.

I thinks it's all pretty simple; we all want to live well! We are concerned about being happy with our jobs, our spare time, our family and in other social parts of life. We are often good at creating good waking hours - but what about when we sleep? When we sleep we rest our body and soul, that is why it is important that we create a sleeping environment that provides us with the relaxation we all need and deserve.

Good advice from chiropractor Olav Bjolstad:

Personal service: Always start by going to a serious bed store. Preferably a smaller store that offers personal service and a good selection. I have visited many department stores where the selection is good, but where they lack in personal service. Personal service is a key factor when you are to make critical decisions on model, size, material and most of all, level of firmness. The sales person must be sensitive to your point of view!

Do not stress: Take your time. Do not stress. Take your shoes off and test the bed in peace and quiet. Again and again. Buying a mattress through mail order can become a very expensive experience. If you don't like the mattress, you can probably not return it to the manufacturer. You are stuck with a product you don't want. Test several types of beds with different levels of firmness. A good bed store always has a good selection of beds for you to test.

Materials: Decide on what materials you want for your mattress. In these times of allergies it is important that the material does not function as a hot bed for mite and other creatures you haven't even heard of! It is no exaggeration in claiming that certain plastic/foam materials are bad att allowing air to circulate and therefore become warm and sweaty. It's never nice to wake up in a sweaty bed. A spring mattress in natural materials allows air to circulate, and thus avoids this problem. Normally we sweat more when we sleep than when we are awake. Between o,5 and r liters of moist per night. At hotter temperatures we sweat more than that. The transpiration consists of 9o percent of water. That's why it's nicer to sleep in a bed with bed linen that channel away and makes the liquid evaporate. It's the only way to go for a drier and more comfortable night's rest.

Looking at it from an environmental aspect the choice of material is important. Mattresses made of one hundred percent natural materials will not burden Mother Nature and after more than 30 years usage, they can be thrown in the garbage only to become a part of the natural eco-cycle. Knowing this makes you sleep better at night!

You need to take responsibility when choosing a mattress. I hardly think a foam mattress is suitable for composting.

Size: Size does matter. You need to see to that you have a lot of room in the bed. Sleeping in a bed that is too narrow or too short will no doubt result in back problems. How many parents of small children have awakened in the morning, completely tired and stiff after having spent the whole night with two kids, a dog and a cat? The father of the house would have to bend over double to find some free space at the foot of the bed. After the kids have stolen the comforter, he is in for a cold night.

If you have small children, get a big bed! Anyone who has kids has experienced this cozy but yet rather painful dilemma.

Level of firmness: Once you have decided on an new, big bed with plenty of room for the whole family, it's a good idea to get separate lower sections or a double bed with different levels of firmness. Men and women seldom have the same feel for level of firmness. The level of firmness depends on the thickness of the spiral springs. If you sink too low in the bed, it's too soft and if you don't sink at all, it's too firm. Men often prefer a somewhat firmer bed than women. In the event of a separation in the future, at least you can rest assured that you will still have a good night's sleep on your side of the bed.

Should you be unsure about what firmness to choose, the general rule is to choose the firmer one. However, my experience tells me that it's difficult to generalize about a bed's firmness. I have met Anna - beautiful, slim and light-as-a feather - who preferred the firm mattress while heavyweight champion Rolf slept like Cinderella on the softer mattress! This proves the importance of no stressing and to have active communications with the sales people in the store.

Chemically clean: Unfortunately allergies have been on the rise during recent decades. There are several causes for these problems. That various forms of pollution is a contributing factor, is no exaggeration. That's why it is important to choose the most chemically clean bed. My mother taught me that food that smells bad must be thrown away! In the same way you need to use your nose and your common sense if a mattress gives off a chemical odour. Perhaps it is not a healthy sleeping place. I am not saying that you are supposed to smell your way around the store, but always ask the staff what stuff the bed is made of.

According to a 1997 report on general health from the National Swedish Board of Health and Welfare more than every third person suffers from allergic problems.

The children's need: Now that you have taken the time to read all this to find the right mattress for yourself, you need to start thinking of the well-being of your children. Many people seem to think that children can sleep anywhere. This is a dreadful mistake. Children should have the rights to the same comfort as adults. Therefore you need to make sure that your child's sleep is as comfortable as yours. Invest in a good bed for your children. It is a basic measure you as a parent can take to prevent future health problems. Give them a bed of high standard as well. As we all know, the children is our future.

Economy: Bed manufacturers often have several models to choose from. First, decide which models fit your body. Then decide which one fits your wallet. The right bed will not be noticed when you lay in it. You must also be able to get into and out of the bed easily.

The more expensive it is doesn't always mean that it's better. However, this is often the case. When building a bed the choice of materials stands for 8o percent of the cost. The more material that is put into the bed, the more pliable it is. More pliability means more sleeping comfort at night!

In recent years new adjustable beds with built in massage have cropped up on the market. These gadgets may seem completely needless, and that may be true. But for many older people it's a great relief to be able to raise the foot end as well as the head end of the bed. These functions are of great therapeutic value to people who suffer from osteoporosis, diabetes, rheumatism and lumbago. So don't save on investing in your home's most important piece of furniture.

Warranty/Durability: An important question when buying a bed is durability and warranty. Often price is an important factor for choosing a cheaper bed than you might like to have. This is fully understandable, but it can also be the main factor to stop you from achieving full sleeping comfort at night. A good bed should be so durable that it is guaranteed to last for many years to come, without losing shape or pliability. Unfortunately many beds look alike on the outside and they are often dressed in an appetizing fabric. Be aware! Ask to see a cross-section of the bed to be able to examine how the bed is built and the quality of the springs. Springs losing their firmness too fast is a major problem. This leads to you laying in a hammock, suffering your way through the night. After a short while, you need to buy a new bed. The fabric also needs to be so hardwearing that it won't tear with you ending up with a spring in your back. While you are in the store, be sure to ask about the manufacturer's warranty when it comes to frame and spring breakage and for how many years it lasts.

I made the wrong choice, now what?: Should you end up with the wrong bed, regardless of all this good advice, don't despair. This sometimes happen and it's never any fun. However, the problem can be solved. Contact the store as soon as you can and discuss with them what they can do for you. Probably they can't take the bed back, but perhaps they will give you a good discount on a new bed while you put out an ad to sell the bed you have bought. You'll be surprised at the size of the second hand market. You have a great chance of selling your bed for a good price. Trying to change the top mattress or desperately adding plywood to the bed is a bad solution. Change the bed!

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