Dr. Heather Martarella shares the role of good sleep in recovery.
Arun: Heather, welcome! I’m really excited to chat with you today. Maybe we can start simple, how did you get interested in chronic pain?
Heather: My interest started after a bad adventure accident in Costa Rica, in 2012. I left with severe injuries and over time, developed chronic pain. That changed my purpose. One of my core values is really being of service to others, so the focal point of who I’m going to serve, shifted.
Arun: That’s incredible. I love meeting people who have their own stories and can really relate to what their patients are going through. Before I ask you more about the Costa Rica experience, I’d love to understand how your medical career changed after that?
Heather: I did a second post-doc at Kaiser California and started seeing patients who had chronic pain. It was not in a pain management program, it was actually in a mental health program. Many of the patients who were being referred to this mental health clinic had chronic pain conditions. One patient in particular pops to mind who needed to have her knees replaced.
We talked about how pain impaired her quality of life, marriage, sexuality, self-identity, and sleep. She thought it was helpful for her, and I thought so too somewhat. Years later, after I had my own injury in 2012, I realized the extent to which pain really impacts a life.
Arun: Could you take us through the chronology of your early life, your injury, and what happened after that? As much as you feel like sharing.
Heather: There had been some challenges I faced in early life. If I take the Adverse Childhood Experiences questionnaire, my number is high. As I was going through my young life, I felt like a survivor and was rather confident in my ability to take care of myself. At the same time, my nervous system was primed because of the traumas, and even though I felt like I had managed them at the time, I learned later that I hadn’t sufficiently managed them. I would shove them under. There’s a book by Bessel VanDerKolk called “The Body Keeps the Score”. I think the body was storing it up for me.
Then I had the injury accident.
I was on an adventure tour in Costa Rica. On the second to last day of the trip. I was rappelling down a waterfall and swung into the waterfall to kick-off, but there was a cave behind the waterfall. As I went in, the water hit me on the face while the belay guy on the ground watched looking up.
Apparently, it was his third day on the job. He panicked when he saw me flailing around with the water on my face, and he dropped the rope. I fell onto the rocks below. I have a picture that a friend who was up at the top that I was traveling with, took of me down below. It’s this blurry picture of me sprawled out. The pain ballooned from there.
Arun: Wow. That’s scary. Can you describe why you developed chronic pain, knowing what you know now?
Heather: There were other emotional stressors at the time. One part – it wasn’t only me who was thinking I was damaged. I was in a relationship with someone who felt that we couldn’t do what we used to do. They were understanding, but other friends fade away because I wasn’t doing the activities I had done previously. I hear from a lot of patients that “my spouse is wanting to divorce me” and other similar effects.
Mine wasn’t so extreme, but it was impacting my work and the way that I presented myself, I used to be someone who went to work in high heels daily, now I was forced to shift to comfortable clothes I didn’t feel comfortable in. I started a standing desk because it was hard to sit. It also really impairing my sleep.
I didn’t want to acknowledge these losses at the time. So I just kept really busy and focused on other things instead of dealing with them.
It wasn’t really until I transferred to the hospital work at that point, working only with people with chronic pain, the pain management program that I was really seeing good improvement at that point. At this point, I haven’t had a flare-up in quite some time.
Arun: Wow. Going from such a scary accident, where that picture kind of looking down on you, to recovering. It is possible for a lot of people that you see? What are some of the important skills you teach?
Heather: I think mindfulness is a big piece of this. Understand how we go about our day-to-day life and look at how trauma may be expressed now by our body.
Another component really is looking at people’s sleep because if your sleep is poor, your pain receptors are just more reactive. Poor sleep leads to an increased inflammatory response. On top of that, there’s the emotional distress related to poor sleep. We know that’s a huge part of not being able to sleep is the anxiety, the worries, all the what-ifs.
So we’ll focus on sleep since it seems to be one of the cornerstones in getting better.
Arun: What education or tools do you share with your patients?
Heather: One of the first things I want to find out is if people have sleep apnea. If they’re not getting enough oxygen to the brain, that is going to impair sleep quality and sometimes sleep quantity. That’s going to impact their pain and their thinking process.
And then I’m going to ask people about the type of sleep impacted for them due to physical pain. A lot of people have difficulty falling asleep, is it because they can’t get physically comfortable in bed or the thoughts that they have in bed. The brain starts going, I have to get to sleep, if I’m not able to sleep, I’m not going to be able to function tomorrow at work. I’m not going to be able to regulate my mood. I suggest interventions that can be used for each of these because getting out of our heads is going to be important at that point.
Arun: It’s interesting to hear that you can target the sleep to improve both and suggest certain tools and, and interventions people to use.
Heather: That is correct. I don’t generally care for the zero to 10 scale of pain, but what I tend to see is if we do improve sleep, there’ll be at least a two to three-point drop in their experience of their physical pain.
For some people it’s as simple as doing a gratitude practice, maybe listening to a sleep story before bed, something that gets them out of their head and into their physical sensations, not focusing necessarily on pain. There are apps like calm, insight timer, and free podcasts, that people can hear sleep stories.
There are mindfulness meditation practices that you do focus on those pain sensations. I also recommend a body scan practice, also known as passive muscle relaxation.
When I was working at this intensive outpatient pain management functional restoration program, we’re seeing decreases like this. So working on sleep is a pretty important piece and it helps stop that cycle of increasing pain because of impaired sleep, too little sleep, and then pain is amplified.
Arun: Is there anything else that we didn’t touch upon, or advice, that you’d want to give to anyone who’s listening?
Heather: There is so much we didn’t touch upon because chronic pain is such a massive, a massive thing. But I think this is this has been great. I appreciate you having an interest in all of these areas and looking to help so many people by providing information for them. The quickest thing I could say is that someone in pain should find the right interdisciplinary group of people that you can really talk to.
Arun: I love this advice. It’s really straightforward and simple. Heather this has been a pleasure, thank you for sharing your wisdom and patient experience with us. To listen to Heather’s full interview, check out our podcast Navigating Pain.