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The Rollin' RN's

New Year: Healthier You!

It’s the start of a new year and always a good time to reflect on how we can make it even better than last year. A good place to start is with you. When we take special care of ourselves, we have the capacity to be our best in other areas of life. So with that in mind, the Rollin’ RNs have given you a few areas to consider. Improve in all areas or pace yourself to concentrate in one area a quarter. That’s the beauty. It’s all up to you.

If you don't snooze, you lose (and not in a good way!)

Sleep plays a vital role in good health and well being throughout your life. Getting enough quality sleep can help protect your mental health, physical health, quality of life, and safety.

Objective sleep quality refers to how difficult it is for a person to fall asleep and remain in a sleeping state, and how many times they wake up during a single night.

Sleep helps your brain work properly. While you're sleeping, your brain is forming new pathways to help you learn and remember information. Sleep also plays an important role in your physical health. For example, sleep is involved in healing and repair of your heart and blood vessels. Ongoing sleep deficiency may be linked to an increased risk of heart disease, kidney disease, high blood pressure, and stroke.

Sleep deficiency may also increase the risk of obesity as sleep helps maintain a healthy balance of the hormones that make you feel hungry or full. Sleep also affects how your body reacts to insulin, the hormone that controls your blood sugar level. Sleep deficiency results in a higher than normal blood sugar level, which may increase your risk for diabetes.

Your immune system relies on sleep to stay healthy. If you're sleep deficient, you may have trouble fighting common infections.

So how much sleep is recommended? The American Academy of Sleep Medicine (AASM) recommends 7-8 hours of sleep for adults 18 years and older. For people with SCI, it can be a challenge to getting a good night’s sleep.

Some common reasons include:

  • Needing to awaken during the night to do intermittent catheterization (IC)

  • Repositioning in bed to protect the skin

  • Spasticity

  • Pain that may make it hard to fall asleep or stay asleep

Some ways to deal with these challenges:

  • Empty your bladder right before bedtime, and even better if you can get your feet up prior to this time to get the extra fluids out of your feet and legs and into your bladder.

  • Use a pressure-reducing surface on your bed and avoid wrinkles in your sheets and bed clothing that can cause discomfort or skin breakdown.

  • Try to schedule your turning time and IC time for yourself or your caregiver to have the least amount of interruption as possible.

  • If spasticity and/or pain are preventing you from getting good sleep at night make an appointment with your healthcare provider to discuss types of medication that may help. Stretching exercises at bedtime may also calm spasticity for some.

Other ways to improve your sleep:

  • Maintain a regular sleep schedule—this will help in resetting your internal clock.

  • Develop a comfortable pre-sleep routine to help calm your nervous system down before sleep.

  • Avoid naps if possible so you’re more likely to be sleepy at bedtime.

  • Avoid large/heavy meals and alcohol as well as strenuous exercise within a couple of hours of bedtime.

  • Watch your intake of caffeine and other stimulants, especially in the afternoon.

  • Don’t watch TV or read in bed. Use the bed for sleep.

Reaction To Stressors

Stress is different for everyone. What stresses you out may not bother someone else and vice versa. Still, your bodies react the same to stressors. That’s because the stress response is your body’s way of dealing with tough or demanding situations. It causes hormonal, respiratory, cardiovascular, and nervous system changes. For example, stress can make your heart beat faster, make you breathe rapidly, sweat, and tense up. It can also give you a burst of energy known as the “fight-or-flight response.”

The problem with stress is that it's cumulative. If you don't have a healthy way of responding to stress the constant exposure to stress hormones can overload the body. When stress levels increase, it results in an overproduction of stress hormones that weaken the immune system. This can lead to physical and psychological problems.

Stress symptoms vary greatly from one person to the next, but the most universal sign of stress is a feeling of being pressured or overwhelmed. Chronic or long term stress can cause symptoms such as headaches, anxiety, trouble sleeping, depression, high blood pressure, digestive issues and can even lead to dependency on drugs and alcohol. Studies show that the hormones associated with chronic stress are linked to increased fat in the abdomen, which can increase the risk of chronic and serious illness such as diabetes.

It’s important to identify what is causing your stress. Some of those things you can change; others you can’t. Focusing on the things that you cannot change only creates more stress, so work on those things that you think you might be able to do something about.

To lessen the effects of stress try to fit in some exercise. An aerobic workout, stretching, or weight lifting can really help to make you feel better. Relaxation is also helpful. Focusing on slow, deep breathing or guided imagery might help. Don’t forget about the stress-reducing effects of just listening to quiet music, reading, or going to a movie. Take a trip and get away. There’s nothing wrong with taking some time to do something for yourself that totally takes your mind off of the source of your stress. Finally, let go of things. You don’t have to be perfect every minute of every day. Your house doesn’t need to be spotlessly clean. You don’t need to accept every invitation you receive or agree to volunteer for every thing that comes along. Set more realistic goals and find easier ways to do things. Learn to say “No!”

Your Optimal Weight

Weight is important for everyone. Being overweight can put everyone at risk for conditions such as:

  • Heart disease

  • Stroke

  • Diabetes

  • Increasing cholesterol levels

  • High blood pressure

But for those of us with Spinal Cord Injuries (SCI) it becomes even more of a big deal for these reasons:

  • Increased work load on arms to remain mobile

  • Increased cost for special equipment to accommodate increased body size

  • Risk for skin breakdown due to:

  • Increased skin pressure due to excess weight

  • Skin rubbing wheelchair

  • Reduced ability to reposition in bed or chair

  • Increased skin fold flaps allowing increased moisture for skin breakdown

  • Increased needs for proper hygiene

So what is the ideal weight for someone with SCI? People with SCI tend to have a much lower percentage of muscle mass, therefore healthy weight guidelines for the general public like the Metropolitan Life Desirable Weight Tables need to be adjusted. Individuals with paraplegia should weigh 5-10% less while those with quadriplegia should weigh 10-15% less.

Next, what are the calorie needs for someone with SCI? People with SCI tend to burn fewer calories since they have lower muscle mass. Therefore, they need fewer calories. General guidelines suggest that persons with paraplegia need about 28 calories per kilogram (kg) of their ideal body weight. Those with quadriplegia need about 23 calories per kg of ideal body weight (the weight you should be). To determine your weight in kg, divide your weight in pounds by 2.2.

As an example, if you are a quadriplegia and your ideal weight is 175 lbs., divide that number by 2.2, which equal 79 kg. Multiply 79 kg by 23 calories, and you get about 1,800 calories per day.

You will need to make adjustments based on your own experience with gaining or losing weight. Ideally, sit down with a health professional to help determine your appropriate weight.

Get Moving

There are so many reasons to include exercise into your routine. Regular exercise may help reduce your risk for developing a wide range of health problems such as heart disease, high blood pressure, high cholesterol, type 2 diabetes, arthritis and many types of cancer. It can also help improve cognitive function, mood, and energy level and promote better sleep. Exercise can help prevent excess weight gain or help maintain weight loss. When you engage in physical activity, you burn calories.

Individuals with SCI that exercise have a lower risk of developing secondary complications such as urinary tract infections, pressure sores and respiratory illness. Physical activity can also help you better manage problems such as spasticity and chronic pain. It can help improve your strength and endurance, which in turn can improve your ability to accomplish everyday tasks such as transferring and pushing a manual wheelchair. Plus, studies have shown that people who are physically active are less likely to experience feelings of anxiety, loneliness and depression.

Exercise for individuals with a spinal cord injury can be divided into three broad categories:

  • Aerobic exercise to maintain cardiovascular health.

  • Strength-based training to maintain the ability to perform activities of daily living and mobility, as well as preventing injury from muscle weakness or imbalance.

  • Flexibility training to improve range of motion and reduce spasticity. The Department of Health and Human Services recommends at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. Strength training for all the major muscle groups should be included at least twice a week.

As always, check in with your health care profession before starting a new exercise program, especially if you haven't exercised for a long time

This probably isn’t the first time you’ve thought about these topics nor will it be the last, but this time, you're wiser and you're working to bring to life a better version of yourself.

It’s all good so keep on rollin’

Roberta, RN and Patty, RNC



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