How do we know the baby has a headache?  

Experienced paediatric osteopaths palpate thousands of heads each year, in all ages. We see the child who is four years old and able to point to an area of their head and say it hurts, the two year old who may be able to put a hand on their forehead and give a tired look. This gives us clues to what a headache feels like under our trained hands, in a non-verbal baby or child. Using our hands very gently we are able to palpate the strains in the membranes that surround the bones of the head in all ages and diagnose and very gently treat those strains, utilising the body’s self healing mechanism.

Without gentle osteopathic care, what is the baby with a headache going to do? They will want to suck more often as pressure on the hard palate, the roof of their mouth, can help (via the vertical vomer bone), to relieve the tightness in the membranes around the sphenoid bone, which sits across the front of the head, right behind the eyes.

If this situation of a sore head and excess sucking is combined with a mum with lots of milk, the baby may get so much milk that they will start vomiting up the excess. They want to suck to get pain relief, but don’t actually need extra milk. Then the use of a finger, turned upwards so the soft pad is available for the roof of the baby's mouth, will certainly help. Of course, parents do need a rest or to be hands free from the baby at times, so they can eat or have a shower. This is when the soother can be a helpful tool.

Research shows that babies under the age of 4-6 months are not able to be sleep trained, their nervous system is not able to form the memories required, so in the early months, I recommend parents do whatever they can to help their new baby’s nervous system be calm and happy. Babies need cuddles, milk and sleep, lots of it. You may have heard of the ‘fourth trimester’ - the stage where your baby would still be in your uterus if they could be, however they would be getting too big for the mum to move around or to birth. So instead, as parents you need to provide the snuggles, jiggles, warmth and a variety of white noises just like they would have had in your uterus, so your baby can be really relaxed and get enough sleep. ​

​Melanie Young
B.A., BSc.(Clin Sc.) B.Osteo Sc. MONZ
Reg Osteopath
​Director City Osteopaths
Wellington
​New Zealand

​Phone 04 4991439

http://www.cityosteopaths.co.nz

Time-restricted eating (TRE)

Under TRE everything you eat in a day (including any snacks) should be confined to a specific, more or less consistent, interval followed by a period of fasting of at least 12 hours. Water is fine to drink at any time, however, beverages like black coffee or tea can reset our clocks so if used, should ideally be consumed within your chosen time window. The issue of caffeine is a complicated one with many factors to consider and researchers don't have all the answers. But for circadian eating it is recommended to consider caffeine consumption as breaking the fast. Being a stimulant that takes a long time to be cleared out of the system (it has a quarter life of 12 hours, meaning a quarter of the cup you drank in the morning is still in your system in 12 hours), it's also not going to help healthy sleep. As we get older, we also become more sensitive to caffeine and its sleep disrupting effects, as we take longer to process and clear it out of our system. It is worth noting that polyphenols even in decaffeinated coffee have been shown to enhance autophagy (the self-recycling process in our cells) so you should not necessarily give it up altogether. But the timing of intake is crucial so if used, caffeine is best reserved for the morning.

Allowing at least 12 hours of not eating seems to be the absolute minimum for the body to recover and repair. As mentioned above, people with metabolic syndrome can benefit from shrinking their eating window further to 10 hours a day. Dr Panda's data suggests that for weight loss, eating within 8-9 hours is beneficial, whereas eating within 11-12 hours is best for weight maintenance.

While a defined consistent eating window is clearly more beneficial than eating for over 12 hours a day, eating earlier in the day has even more health benefits. It is more in alignment with our circadian rhythm especially in some metabolic processes. Eating earlier in the day improves blood sugar control while eating late worsens glucose tolerance. It is recommended to leave at least 2-3 hours between the last bite and bedtime. One of the reasons for that is because the evening rise of melatonin (normally 2-4 hours before your habitual bedtime) reduces the pancreas secretion of insulin. So eating late in the day will produce a longer blood sugar spike and some might even be diagnosed as prediabetic if tested. Late eating and also eating most of the calories later in the day slows down weight loss efforts and leads to a more modest weight loss.

Eating late can contribute to acid reflux so if you suffer from this uncomfortable condition, shifting your last bite to an ealier time could have another positive consequence. A great number of people are taking medications to suppress acid production, often for years, as when they try to come off them, their symptoms return, sometimes with a vengeance. Long-term use of these medications is not without downsides. TRE on the other hand could offer a chemical-free solution.
​
Starting TRE can seem daunting and it's almost certain that making drastic changes in your eating window is not going to work, or be easy at the very least. Stopping evening snacks or starting with 12 hours to allow the necessary hormonal changes (for example, regulating hunger and satiety) to happen may be a better approach. Most people would do just fine on a 10-12 hour eating window without needing to narrow it down further but those needing to lose extra weight or who are prediabetic, may want to experiment with a shorter window e.g. 8 hrs. More research is needed for those taking medication (especially for diabetes). While it can be a useful adjunct to treatment, doing it under a doctor's supervision with regular bloodwork is needed to do it in a safe manner for these people.

Giving yourself the recommended minimum 8 hour sleep opportunity (i.e. time spent in bed) will hopefully allow you to get at least 7 hours of sleep that we need to function well. Getting enough sleep helps balance ghrelin and leptin, the hormones of hunger and satiety, making it easier to not need to eat all day. TRE itself has a positive effect on sleep so it works both ways.

TRE is a lifestyle, not a diet. Dr Panda compares it to brushing and flossing your teeth – a daily habit that keeps your teeth healthy, whereas longer fasts of e.g. 2 and more days are like a deeper clean by a dental hygienist. There are certainly those for whom these longer fasts are contraindicated but TRE can be practised indefinitely by most healthy people.


This post was inspired by the work of Dr Satchin Panda, one of the leading circadian biology researchers and the author of The Circadian Code, and Dr Matthew Walker, professor of neuroscience, the sleep diplomat and the author of Why We Sleep. I encourage everybody reading this to look into their work for more insights and inspiration to change your lifestyle and take your health into your own hands. Both have spoken extensively on their respective areas of research in various interviews and talks and their books are a wealth of eye-opening information and practical suggestions.

References:

Panda S. 2018 The Cricadian Code, Lose Weight, Supercharge Your Energy and Sleep Well Every Night, Ebury Publishing, London

Walker M. 2017 Why We Sleep: The New Science of Sleep and Dreams, Penguin Books, London

Wilkinson MJ, Manoogian ENC, Zadourian A, Navlakha S, Panda S, Taub PR. Ten-hour time-restricted eating reduces weight, blood pressure and atherogenic lipids in patients with metabolic syndrome. Cell Metabolism, 2020, 31(1): 92-104
https://www.ncbi.nlm.nih.gov/pubmed/31813824

Marinac CR, Nelson SH, Breen CI, et al. Prolonged Nightly Fasting and Breast Cancer Prognosis JAMA Oncol. 2016;2(8):1049–1055.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982776/

Jamshed H, Beyl RA, Della Manna DL, Yang ES, Ravussin E, Peterson CM. Early Time-Restricted Feeding Improves 24-Hour Glucose Levels and Affects Markers of the Circadian Clock, Aging, and Autophagy in Humans. Nutrients. 2019;11(6):1234.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627766/

Poggiogalle E, Jamshed H, Peterson CM. Circadian regulation of glucose, lipid, and energy metabolism in humans. Metabolism. 2018;84:11–27.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995632/

T​iming is everything. The vast majority of what is happening in living cells and organisms is not random or haphazard but undergoes specific fluctuations throughout the day or 24 hours. Genes switching on and off, hormone secretion, metabolism, cell and DNA repair, blood clotting, immune function, digestion, physical performance, mood and mental acuity etc. – everything is governed by the circadian rhythm. It is aligned with the light and dark cycle that our planet experiences every 24 hours or so. Having a strong, healthy circadian rhythm is undoubtedly associated with health and longevity, as we are beginning to realise. Unfortunately, industrialisation has led to a profound disruption of the normal circadian rhythm which has been linked to many chronic diseases including obesity, diabetes, heart disease, dementia and certain cancers. In fact, shift work is now recognised by the WHO as a probable carcinogen. Quite possibly, all this has to do with the effects of a disrupted circadian rhythm on sleep, the fundamental pillar of health on which the other two pillars (nutrition and exercise) rest. Circadian biology is asking more and more questions and future research will even explore ways to “drug the clock” which will be helpful for the sizable proportion of shift workers in the society. However, if you are not a shift worker, you are likely to sabotage your circadian rhythm every day, often without realising it. Nevertheless, for most people restoring balance may be easier than we think.
 
​But first it might help to understand how it all works. There are "clocks" in every cell and every organ. The master clock called the suprachiasmatic nucleus, or SCN, is located in the brain. This tiny structure sits in the hypothalamus which happens to be the link between the nervous and the endocrine system and oversees many physiological functions.
 
The clock is running all the time. Even in the absence of external cues from the environment every process in our body would continue to ebb and flow in a diurnal pattern with precision (and in fact, a 2017 Nobel prize in Physiology or Medicine was awarded to three scientists who figured out the molecular basis of that). But there are certain environmental signals that reset our circadian rhythm. The two main ones are light and food. Both used to be reliable indicators of whether it was day or night. Not anymore, which is probably why circadian rhythm disruption is so prevalent.
 
We will look at each of these signals in more detail, including how to use them to reset and sync up our clocks, focusing on light first. We will cover food in the next post. But before moving on, it is very important to realise that sticking to a routine, both daily and weekly, is key. Waking up and going to bed at the same time during the week and at the weekend, eating within a consistent time window are quite naturally fundamental to the success of addressing a circadian rhythm disruption. Sleeping in at the weekend can be tempting if you are chronically sleep-deprived but that just exacerbates instead of addressing the problem (which could be avoiding accumulating a sleep debt by getting enough sleep every day). It destabilises the circadian clock in the same way as jet lag and for every hour (or time zone) that our rhythm shifts we need a day to adjust. Now imagine doing it every week for months or years... Could it be that chronic disease and accelerated aging is just the accumulated damage of this constant tug of war?
 
Light and the master clock
 
The master clock receives information about light from a relatively small number of cells in our eyes and determines whether it's day or night. These cells are scattered among standard rods and cons in the retina, and what sets them apart is that they have a light-sensing protein, melanopsin, that is activated by blue light. Melanopsin was discovered about 20 years ago by a few labs around the same time, including the lab of Dr Satchin Panda, whose work on uncovering the significance of melanopsin in relation to our circadian clock has forever changed the way we look at how light (and lighting) affects us.
 
Melanopsin is quite peculiar in that it is not a very good light sensor - it takes a lot of bright light to activate it. But it can potentially integrate even dim light over time making it a bad idea to spend long periods of time after sunset even in a dimly lit environment or look at even dim light sources. It is also possible that light of other wavelengths can activate these melanopsin-containing cells normally tuned to blue light, as all retinal cells are interconnected. So while blue light is particularly detrimental to a healthy and timely melatonin release (and melatonin is necessary to make us sleepy), too much any light in the evening is going to suppress it, therefore prolonging wakefulness and depriving us of good quality sleep.​

​Using light to restore a healthy circadian rhythm
 
Most of our day is usually spent indoors where it is not bright enough during the day. On the other hand, our evenings are brighter than they were even meant to be. This inversion of light exposure throughout the day is unnatural and is important to address to restore the normal circadian rhythm.
 
Bright natural light in the morning
 
Expose your eyes to bright daylight in the first half of the day, starting as early after waking as you can. This might be a short walk outside (with no sunglasses), sitting in the garden, on a porch or balcony or even just next to a large window with sunlight streaming in. Apparently even on a cloudy day there is enough blue light and brightness to stimulate our eyes and to reset our clock, although sunnier days do make it easier so it is a good idea to make the most of sunny mornings. If you are curious about actual brightness levels, you can turn your phone into a meter with a free app called MyLuxRecorder. The average person needs upwards of 1000 lux for at least 30 minutes a day to reduce sleepiness, increase alertness and boost mood (on a side note, to treat depression or seasonal affective disorder at least 10000 lux for 15-60 mins a day is necessary). But even a shorter exposure (10-15 mins) is still beneficial and doing it early in the morning is vital for a robust circadian rhythm. To be fully activated, melanopsin needs at least a few minutes of bright light. Dr Panda recommends having breakfast by a big window (although you have to be quite close to flood your eyes with enough light of sufficient brightness) and not wearing sunglasses on your morning commute, of course avoiding looking directly at the sun.
 
A note for older adults: our circadian rhythm changes throughout life and in our later years everything shifts to earlier in the day. So over time we tend to wake up earlier and feel sleepier earlier in the evening. To help mitigate this, Dr Matthew Walker, professor of neuroscience and a sleep researcher, suggests wearing sunglasses in the morning during any outdoor activity but then going back outside in the late afternoon, this time without sunglasses, and get plenty of sunlight exposure, thereby shifting the resetting of the clock to a later time. It may help counteract early evening sleepiness which often causes older people to nap in the evening and in turn makes it harder for them to fall asleep when they do eventually go to bed.
 
Less light in the evening
 
This applies to both digital screens and indoor lighting. Ideally you would want to avoid screens for 2-3 hours before bedtime. Most would agree that staring at a bright light source inches away from our eyes in the evening will never be natural. But it may be the hardest thing for a lot of people to give up initially, or some of us have to work late. The good news is that it may still be possible to make changes that will support rather than disrupt our circadian rhythm. However, it should be noted that all these workarounds should not be considered as full protection against harmful effects of evening light exposure on our circadian clock and sleep. In a study that looked at the effects of reading on an iPad during 4 hours before bedtime compared to reading a book, e-book readers were less sleepy at night and took longer to fall asleep but were sleepier in the morning and took longer to feel fully awake the next day. Their melatonin levels were found to be lower and peaked later. Their REM sleep amount was also significantly decreased. All this reinforces advice on reducing screen time in the evening as much as possible due to its devastating effects on sleep quality. Dr Walker recommends avoiding all screens at least in the last hour before bed.
 
So what can we do to mitigate some of the unhealthy aspects of light in the evening?
 
The night shift or mode on smartphones, tablets or computers is now a standard feature (in recognition of the importance of a normal circadian rhythm). You can take it a step further with software that desaturates the screen even more, such as f.lux or Iris.
 
Brightness is an important factor to consider. There is a way to reduce your screen brightness even below minimum, by either tweaking the Zoom feature in the Accessibility menu on iOS devices (YouTube has some good tutorials on that) or using third-party apps or software for Android or Windows.
 
A different way to approach the issue of digital screens we use in such proximity to our eyes (which is another cause for concern) is to use blue light blocking glasses. These have been shown to help avoid significant melatonin suppression by evening light exposure. There are models that block almost 100% blue light and would be ideal for any unavoidable screen time in the evening.
 
When it comes to ambient lighting in the evening, blue light blocking glasses can help too, but simply switching off half the lights and only using what is absolutely necessary to safely navigate around is a huge step towards reducing  mistimed light exposure. Using dim orange lights as opposed to bright white LED lights is a lot more conducive to a timely release of enough melatonin to support sleep. Dim lights can also help you wind down before bed and feel sleepy. Smart lighting systems that are programmed to change throughout the day to mimic sunlight in both wavelength composition and brightness is one way to go about this. Alternatively, there are special light bulbs that emit no blue light and give off yellow/orange light that are perfect for evening lighting and those that are devoid of both blue and green light (these are essentially red lights) and are great to use as night lights if you have to get up in the night. Just like with digital screens, brightness matters: while most indoor lighting is not bright enough to keep us alert and happy over the long term (we need at least 1000 lux for a minimum of 30 mins during the day), it is way too bright for the evening and affects melatonin release and peak levels, keeping us awake. For the best chance of a healthy sleep it is recommended to keep the brightness level to less than 20 lux for 2-3 hours before bed, the lower the better. Using MyLuxRecorder to check the brightness levels where you spend the last few hours of your day can be quite revealing. Dr Panda also recommends using task lighting e.g. with a table lamp instead of overhead lights as another way to reduce your evening light exposure. However, it's worth noting that a mere 8-10 lux has been shown to significantly delay melatonin release. It's about time we reclaim our “right to darkness” in the evening (and to natural daylight during the day).

Restoring a healthy circadian rhythm might take time. Some of the ideas presented here might be more difficult to implement than others but the effort will be worth it. Dr Satchin Panda has put forth the circadian theory of health placing circadian rhythm disruption at the heart of the current wide spread of chronic disease. Everyday habits we don’t think much about do affect our health and longevity. I hope you will be inspired to find out for yourself how little tweaks in the right places can lead to great changes.

References:
 
Panda S. 2018 The Cricadian Code, Lose Weight, Supercharge Your Energy and Sleep Well Every Night, Ebury Publishing, London
 
Walker M. 2017 Why We Sleep: The New Science of Sleep and Dreams, Penguin Books, London
 
Kwoon Y. Wong, Michael P. Flannery, Andrew M. Lynch, Bright H. Kim; Prolonged Light Stimulation of Intrinsically Photosensitive Retinal Ganglion Cells (ipRGCs) Reveals Novel Properties of Melanopsin Phototransduction. Invest. Ophthalmol. Vis. Sci. 2011; 52(14): 5286.  
https://iovs.arvojournals.org/article.aspx?articleid=2357898
 
Gooley JJ, Chamberlain K, Smith KA, Khalsa SB, Rajaratnam SM, Van Reen E, Zeitzer JM, Czeisler CA, Lockley SW. Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans. J Clin Endocrinol Metab. 2011; 96(3):E463–E472. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047226/

Chang AM, Aeschbach D, Duffy JF, Czeisler CA. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proc Natl Acad Sci U S A. 2015; 112(4):1232–1237.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313820/
 
van der Lely S, Frey S,Garbazza C, Wirz-Justice A, Jenni OG, Steiner R, Wolf S, Cajochen C, Bromundt V, Schmidt C. Blue blocker glasses as a countermeasure for alerting effects of evening light-emitting diode screen exposure in male teenagers. J Adolesc Health 2015 Jan;56(1):113-9.
https://www.ncbi.nlm.nih.gov/pubmed/25287985


​

​What is temporomandibular joint dysfunction?​
The jaw is also known as the temporomandibular joint (TMJ). The joint is formed by the mandible (the main bone that we consider to be the jaw) and the temporal bones on either side (these form part of your skull). TMJ dysfunction is a term used to describe pain felt in and around the jaw.
​The masseter (one of the main muscles that controls the movement of the TMJ) is the strongest muscle in the body, relative to its size. There’s no wonder why tension held here can have a huge impact on other areas of the body too. Although some people will feel pain directly in or around the jaw, you may not necessarily be aware of the tension that you are holding there. However, tension or dysfunction of the TMJ can contribute towards neck pain and headaches. 

What can cause TMJ dysfunction?
During times of stress and anxiety, it’s common to clench or grind our teeth. This can often happen subconsciously, particularly at night when we’re sleeping, which is known as nocturnal bruxism. This could mean that you wake with headaches, neck pain or pain directly in the jaw. Sometimes, we can be more aware of this going on during the day. We may notice that our breathing has become shallow, we are holding tension in our shoulders and we are clenching our teeth, which will cause tension through our jaw.
Tension or dysfunction of the TMJ can also occur following direct trauma or dental work. Having to hold our jaw open for a period of time can create strain of a key ligament that helps to support the joint. TMJ dysfunction can also be caused by having an under or overbite ,and also if there is derangement of the articular disc which cushions between the two bony surfaces that form the joint.

How will I know if I have dysfunction of my jaw?
Structures in the body are intrinsically connected. The muscles and ligaments that attach to the jaw, also attach to bones in your face, head and neck. Therefore, pain or dysfunction originating in the TMJ could be felt in the jaw itself but could also be felt in the face, neck or base of the head. As well as pain, you may notice clicking or clunking in the jaw as you open and close it. If one side of your jaw is tight, compensatory patterns can occur and the two sides of the jaw can become slightly out of sync which contributes towards the clicking and clunking that you hear and feel. You may also feel a restriction of movement and not be able to open your jaw fully.

How can Osteopathy help?
​We can examine the movement that is occurring at the TMJ by asking you to do some simple opening and closing movements whilst we palpate the joint which is located just in front of your ear lobe. We can also palpate for tension in the muscles and ligaments that control the movement of your jaw. If there is dysfunction of the joint or tightness in the soft tissue structures, we can gently but directly treat these.
We can also work on other structures in the neck and head where the muscles of the jaw attach. The techniques that we use are often external, however we’re able to do intraoral techniques with your consent. Our patients often really enjoy treatment of the TMJ as it is common to feel the benefits immediately afterwards. They often feel that they can open their jaw further and feel less tense through the jaw, face and neck. 

What can I do at home to help?

Relaxation methods
Given that pain in the jaw is often caused by clenching or grinding the teeth due to stress or anxiety, managing this stress and anxiety can help to prevent us from holding tension in the body subconsciously. Diaphragmatic breathing is key, as effective breathing will physiologically help to calm the nervous system. Check out City Osteopath’s blog post by Becky on how to breathe effectively. Otherwise, relaxation can look different for everyone, whether it be meditation, yoga, listening to music, reading a book or heading out for a walk, the most important thing is for you to take the time to unwind.

Set a reminder to be conscious of tension that you may be holding
Write a note to yourself and have it near your screen or set a reminder on your phone to remind you to think about your posture, and tension that you could be holding. We often end up leaning over our computers, shallow breathing and holding tension in our shoulders, neck and jaw. It is important to make ourselves aware of this, so every 30 minutes, take a moment to sit back, relax your shoulders, take some deep breaths into your lower rib cage and allow your jaw to soften.

Apply heat
The application of heat will encourage blood flow to the area to promote healing, reduce muscle tension and therefore help to reduce pain. Be careful that the heat pack isn’t too hot and keep it on for just 10 minutes at a time. You can repeat this every 2-3 hours throughout the day.

Self-massage
To locate the masseter muscle, contact the space just below your cheekbones and about two fingers width in from your ear lobes. A good way to test if you are in the right spot is to gently clench your jaw and you will feel your masseter contract into your hands. (Try not to clench to test this too often; once you’re in the right spot you don’t need to keep clenching to check). You can use two or three fingers to apply gentle pressure to the muscle and use circular motions for one to two minutes on each side to increase blood flow and reduce muscle tension.
 
There are many other exercises that we can explain to you in further detail. It is best for a practitioner to examine and advise you directly to provide personal advice specifically for you.

We are now offering online consultations so please feel free to contact us for further advice.  
 
 
http://www.advances.umed.wroc.pl/pdf/2012/21/5/681.pdf?_ga=2.173678890.882744632.1585797841-837875174.1585797841
​

​Rhianna Smith 
DO M.Ost. Reg. Osteopath, MONZ 
www.cityosteopaths.co.nz
​Phone 04 4991439

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