Most acute back pain goes away on its own, whether or not you treat it with medication or other therapies.

But sometimes it doesn’t.

You might think that if you have chronic low back pain — pain that lasts longer than about six to eight weeks — that you’ll need medication, surgery, or both to help get relief.

But there are dozens of alternative treatments for chronic back pain that don’t involve taking medication or having an operation. And many of them are much more popular.

“Americans spend much more out of pocket for alternative pain therapies than they will for traditional treatments,” says Barry Cole, MD, director of the American Society of Pain Educators. “People value these treatments enough to pay cash!”

Some alternative approaches to back pain are more established than others, and some have more scientific evidence supporting them. Here is an overview.

Physical Therapy for Back Pain
The right kind of physical therapy can often curb chronic back pain.

“When you visit a physical therapist, there are a number of things they might do,” says Sam Moon, MD, MPH, of Duke Integrative Medicine, part of Duke University Medical Center. “They might use machines or traction, they might put you through stretching exercise, or they might use hands-on techniques.”

Moon says the types of physical therapy shown to be most helpful for chronic back pain are hands-on soft tissue mobilization — in which the therapist moves the soft tissues of your back — and education about posture and home exercise.

Effective physical therapy should always include learning what to do at home — and then doing it.

Getting physical therapy twice a week and then sitting in your usual bad posture, or avoiding exercise, won’t help. Physical therapy should be goal-oriented and “shouldn’t go on forever,” Moon says.

Chiropractic/Spinal Manipulation
Doctors of chiropractic use their hands, and sometimes other tools, to manipulate the joints of the body — particularly the spine — to help relieve pain.

Studies have shown that chiropractics can be effective in relieving acute (sudden) and chronic back pain, although there’s more evidence to support its use in acute back pain.

“Chiropractic is generally considered to be as good as physical therapy, and as good as patient education, in relieving back pain,” Moon says. “And, like physical therapists, chiropractors can be very good educators about back health.”
Acupuncture for Back Pain
Acupuncture for back pain involves inserting very thin needles into specific points on your body. This traditional Chinese therapy is thought to balance the flow of energy in your body.

Acupuncture is generally considered to be very safe, and Moon commonly recommends acupuncture for back pain.

“There is definitely some evidence that it’s effective, although the evidence is even better for other pain conditions, like knee pain from arthritis and tennis elbow,” Moon says. “When I recommend acupuncture, I start the patient out with a series of four to five initial treatments, just to see if this person is an acupuncture responder.”

Therapeutic Massage for Back Pain
Certain types of massage can help relieve back pain.

“I think there’s enough [evidence] to advocate its use to help with low back pain,” Moon says. “I wouldn’t recommend it by itself, but combined with other approaches, I think it can be useful.”

Mind-Body Therapies for Back Pain
Techniques fit under the umbrella of mind-body therapies for back pain, including:

Guided imagery
Hypnosis
Biofeedback
Relaxation therapy
Talk therapy
Some are harder than others to test scientifically, and it’s hard to pinpoint if one type of mind-body therapy is more effective than another. But in general, research has shown that these kinds of therapies can be effective in treating back pain.

“For persistent back pain, I almost always recommend some type of mind-body therapy,” Moon says. Which kind? It depends on what kind of therapy appeals to you, as well as what’s most easily available in your area.

Mindful Movement
Another category of treatments for back pain is called mindful movement.

These therapies include common options found in many gyms, like yoga and t’ai chi, and other movement-based therapies like the Alexander technique and the Feldenkrais technique. All involve using different positions and types of movement to help relieve your back pain.

“The jury is still out on these techniques,” Moon says. “There are some studies that say that they do help with back pain, and some that say they don’t. But there is no strong evidence against them, and I have seen these techniques be effective, especially for people who have habits of moving their bodies in ways that can lead to pain.”

Finding Treatment
If you want to try chiropractic, biofeedback, massage, or yoga for your back pain, referrals are the best way to find help, Cole says.

“If you have a good relationship with your primary care doctor, they’ve seen thousands of patients a year and they learn about resources in your community,” he says. “Or ask your neighbor, or someone at your gym. Someone else who might not come to mind right away: a hospital social worker. They know a lot about resources in the community. And they can at least tell you who not to go to — bad news travels fast!”

Just as with physical therapy, chiropractic care for back pain should involve learning exercises to do at home to strengthen your back, and treatments shouldn’t go on forever.

“They should be teaching the patient how to take care of themselves,” Moon says. “I won’t write an open-ended prescription for chiropractic; generally, I think it should be done for a month or two before re-evaluating how the patient is doing.”

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Symptoms & Types
Font SizeA A A Sneezing, difficulty breathing, cramps, and vomiting–all are allergy symptoms. Learn the types of allergies, specific allergy symptoms, and emergency warning signs.

Symptoms
What Are Typical Allergy Symptoms?
Learn the difference between mild and severe allergy symptoms.

Related Web Site: Severe Allergy Symptoms – Know What to Watch For
The reaction will depend on the body part involved and the severity of the reaction. Here’s what to look for.

Types
Hay Fever (Allergic Rhinitis)
Alllergic rhinitis, also known as hay fever, is an allergic response to pollen or other microscopic substances.

Hives (Urticaria)
Find out what causes hives and how to treat them.

Poison Ivy and Plant Allergies
Many people think poison ivy is contagious. Find out if that’s true and the best way to prevent poison ivy and other plant allergies.

Bee Sting Allergy
A normal reaction to a bee sting is different from a bee sting allergy. Do you know the difference?

Pet Allergies: What You Can Do
An allergy specialist shares her tips on dealing with pet allergies. And she should know. She has a cat, a dog, and many family members who have dog and cat allergies.

Latex Allergy
Learn about latex allergy symptoms and what to do in case of a severe reaction.

Mold Allergy
Mold is present in most indoor and outdoor spaces, and in many foods. Find out more about mold allergy symptoms and common food sources of mold.

Cosmetic Allergies
Are you allergic to certain cosmetics or makeup?

Drug Allergies
How do you tell the difference between a normal side effect a drug allergy? Find out here.

Eczema (Atopic Dermatitis)
This itchy skin rash, common in children and infants, affects some people all their lives.

Eye Allergies (Allergic Conjunctivitis)
How can you tell the difference between pink eye and eye allergies? Get started here.

Understanding Food Allergies
Do you get a reaction when you eat nuts, shellfish, or other foods? Learn what’s causing those food allergy symptoms.

Milk Allergy
Many unsuspecting products contain milk or milk products. Check our list.

Egg Allergy
If you have an egg allergy, check this food list for potential problems.

Nut Allergy
A nut allergy can become very serious, even fatal, rapidly. This food list will help you identify potential problems.

Fish Allergy
Some unexpected foods contain fish. If you’ve got a fish allergy, these tips will help keep you safe.

Shellfish Allergy
For most people with shellfish allergies, all shellfish must be avoided. Check out this list to learn which foods to avoid.

Soy Allergy
This allergy is most common among infants. By age two, the majority of children outgrow it. Find out more about the symptoms and how to avoid soy products.

Sun Allergy
Learn more about photosensitivity – an allergic response to sunlight.

Wheat Allergy
Knowing which ingredients to look for is key to avoiding a wheat allergy. Check this list for unsuspected products that contain wheat.

Aspirin Allergy (Salicylate Allergy)
How to recognize and treat salicylate allergy, or aspirin allergy.

Sulfite Allergy
About 1% of people have a sulfite allergy. This article has a list of foods that may contain sulfites.

Fall Allergies
Learn more about what triggers allergies in the fall season.

Warning Signs
Severe Allergies
A severe allergic reaction can be life-threatening. Learn more about the reaction called anaphylaxis so you can be prepared.

Complications
Allergies and Asthma
Allergies are a main trigger for asthma attacks. See what an asthma attack looks like in the lungs and learn the early warning signs.

Related Guide: Children, Allergies and Asthma
How can you tell if your child’s allergies are causing asthma? Find out how to spot the symptoms and learn how asthma is treated in children.

Sinus Infection (Sinusitis)
Hay fever allergies can cause sinus blockage and infection. Learn how to spot sinus infection symptoms and how to treat the problem.

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Are you still trying to manage your heartburn and GERD by drinking milk by the gallon and popping antacids by the fistful? Chances are you’re not getting the relief you want. But the good news is with the right GERD treatment you can find relief.

“We’re more aggressive about treating GERD today,” says Lawrence Cheskin, MD. Cheskin is a gastroenterologist and an associate professor at the Johns Hopkins Bloomberg School of Public Health. He tells WebMD there are two reasons for the change. One is that GERD treatments are better. And the other is that the long-term risks of untreated gastroesophageal reflux disease are better understood.

Who Needs GERD Treatment?
There are many good reasons to treat GERD. First, GERD treatment makes you feel better. Living with uncontrolled GERD — the pain, the cough, the sleepless nights — can be tough.

“GERD puts quite a burden on a person’s quality of life,” says Goutham Rao, MD. Rao is a board member of the National Heartburn Alliance and an associate professor at the University of Pittsburgh School of Medicine. “GERD,” he says, “can be truly debilitating.”

Second, GERD poses some serious long-term health risks. Over time, the damage to the esophagus can cause complications. One of those is a condition called Barrett’s esophagus, which is associated with a small but significant risk of esophageal cancer. Fortunately, GERD treatment can prevent Barrett’s esophagus from developing.

How do you know if you need treatment for GERD? What’s the difference between harmless heartburn and more serious GERD? It’s not so much the severity, experts say, but the frequency.

The usual recommendation is that anyone with symptoms two or more times a week should see a doctor. Cheskin is more cautious. He says that even symptoms that occur just once a week should be checked out. “Over the years,” he says, “even that level of heartburn can cause damage.”

Sometimes the most obvious sign of trouble is how often you use over-the-counter (OTC) treatments for heartburn relief.

“For me, it got to a point where I was using Tums like they were going out of style,” says Carmen Butschlick of Milwaukee, who was diagnosed with GERD in 2006. “And I was still having symptoms. That’s when I knew I had to go see a doctor.”

GERD Treatments: Medications
Medications — both prescription and over-the-counter — are the most common treatment for GERD and heartburn relief. Here’s a rundown of your options.

Proton pump inhibitors (PPIs). If you have GERD, the odds are you’ll be prescribed one of these. This class of drugs — which includes Aciphex, Nexium, Prevacid, Prilosec, and Protonix — is now the standard GERD treatment. Not only do they help block the production of acid in the stomach, they also protect the esophagus from damage and allow it to heal.
GERD Treatments: Medications continued…
“The proton pump inhibitors are a terrific class of medications,” says Rao. “They’re very effective, and they appear to be quite safe.” They’re even helpful in diagnosing GERD, Rao says. If they work, you probably have GERD. If they don’t, you probably have something else.

Like any medication, they can have side effects. There’s some concern that they may cause a small increase in the occurrence of weakened bones in older people. While the benefits of well-controlled GERD generally outweigh this risk, you should discuss it with your doctor.

H2 blockers. These come as prescription and OTC medicines. They include drugs like Axid, Pepcid, Tagamet, and Zantac and were once the standard treatment for GERD. But they’re not used as often now. “They’re perfectly good medicines,” says J. Patrick Waring, MD, a gastroenterologist at Digestive Healthcare of Georgia in Atlanta and a board member at the International Foundation for Functional Gastrointestinal Disorders (IFFGD.) “But H2 blockers just aren’t as powerful as the proton pump inhibitors.”
Some doctors still recommend them as GERD treatment, at least for mild cases. They’re also sometimes added to PPIs to help treat occasional breakthrough symptoms. Cheskin tells WebMD that H2 blockers may have one significant advantage. Because most are generic, they can be less expensive than PPIs.

Antacids. The old standbys from your grandparents’ medicine cabinet — tablets like Tums and Rolaids and liquids like Maalox and Mylanta — can still play a role in controlling GERD. These heartburn remedies aren’t suited for regular, long-term use. But their main advantage is that they work quickly, unlike more powerful GERD medications.
“If you’re suffering with heartburn after drinking or eating a big spicy meal, a proton pump inhibitor is not going to help,” Cheskin says. “But an antacid will.” Just as antacids offer heartburn relief to people without GERD, they can help GERD sufferers who have occasional breakthrough symptoms.

Prokinetics. These prescription drugs — like Reglan and Urecholine– help speed up the emptying of the stomach. While they’re often mentioned alongside other GERD treatments, experts say that they’re rarely helpful. They might be of benefit to people who have GERD on top of another condition that’s slowing down their digestion. At the same time, prokinetics can have serious side effects.
Many potent drugs that were once only available by prescription — like H2 blockers and the PPI Prilosec — are now available over the counter. Experts say it’s fine for a person with occasional heartburn to use them, provided he or she follows the directions. Generally, they should never be used for more than two weeks.

GERD Treatments: Self-Care Tips
While drugs are often the main GERD treatment, there’s a lot you can do on your own. Here are some lifestyle tips for heartburn relief.

Avoid trigger foods. Changing your diet can yield big benefits. Classic GERD triggers include chocolate, coffee, alcohol, peppermint, citrus juices, and tomatoes. The exact food triggers vary from person to person.
GERD Treatments: Self-Care Tips continued…
The prospect of life without coffee or chocolate may seem terribly depressing. But you don’t necessarily have to give them up entirely. “It’s about how much of these foods you eat,” says Cheskin. “So you can probably still have a half cup of coffee without a problem. The trouble starts if you’re having the coffee after a spicy meal.”

Butschlick says she misses chocolate the most, but she still eats it on occasion. “I just try to keep it to a small piece,” she tells WebMD, “and I’m prepared with some Tums for afterward.”

Eat smaller meals. It’s not just what you eat, but how much. So avoid stuffing yourself. Instead of eating three big meals a day, try more frequent smaller meals.
Don’t eat before bed. Waring says you shouldn’t eat two to three hours before bed. Not eating gives your stomach time to empty before you lie down.
Loosen your belt. Tight belts or pants can aggravate your GERD symptoms. Wear looser clothing, especially at night.
Prop up the bed. When you stick blocks under the head of your bed and raise it 6 to 8 inches, gravity will prevent the acids in your stomach from flowing into the esophagus during the night. While this used to be common advice, not everyone can do it. “Sleeping on an elevated bed just isn’t very comfortable,” says Waring.
Lose weight. The heavier you are, the higher your risk of GERD. How much weight do you need to lose to control your symptoms? No one knows for sure, Rao says. But if you’re obese, aiming for a 10% weight loss is always a good idea.

Evaluate your other medications. Many common medications — aspirin and other NSAID painkillers, along with some drugs for high blood pressure — can make GERD worse. Talk to your doctor about possible alternatives that may not worsen your symptoms.
Stop smoking. Some experts believe that smoking may aggravate GERD symptoms. Add it to your list of good reasons to kick the habit.
Take your GERD medicine as prescribed. GERD symptoms may come and go, but the underlying condition remains. Once you’re feeling better, you may be tempted to stop your long-term medication. That’s not a good idea. “Even if you’re not having symptoms, the GERD could still be causing damage,” Cheskin says. “You may feel fine right up until the acid bores a hole in your esophagus.” Never stop taking your medication unless you’ve talked to your doctor.
Can lifestyle changes be a person’s onlyGERD treatment? Experts disagree. Some believe that lifestyle changes can be enough on their own; others think that they should be added to medication. Talk to your doctor about the best approach in your case.

Some people opt for lifestyle changes because they don’t like the idea of being on lifelong medication. Al Kenny, a GERD sufferer from Englewood Cliffs, N.J., says he prefers to control his GERD with a better diet instead of his PPI. But it’s hard to find the motivation.

“My medicine lets me eat almost anything, which is the good news,” Kenny says. “But the bad news is that it works so well that I’m really not too careful about what I eat. So I can’t stop taking the drug.”
GERD Treatments: Surgery
Surgery for GERD can be effective. But because PPIs control symptoms so well, Rao says, rates of GERD surgery in the U.S. are falling rapidly.

Still, some patients — Rao estimates less than 1% of all people with GERD — might need it. Experts say that candidates for GERD surgery are people who

Get some relief from medication, but still have symptoms anyway
Can’t or won’t take GERD medication
Already have complications, like Barrett’s esophagus, from GERD
Considering that the surgery does have a small risk of serious complications, it’s crucial that you get a correct diagnosis. You’ll need an endoscopy and probably other tests to make sure that you really do have GERD. To be certain, you may also want to consider a second opinion.

Finally, when finding a surgeon, choose someone with a lot of experience doing the specific operation you need. Waring recommends that he or she have a track record of at least 200 procedures.

The Importance of GERD Treatment
If you have GERD, there are a lot of effective ways you can control it. While newer, powerful over-the-counter medicines are one option, Cheskin notes a serious downside.

“These drugs provide such effective relief that there’s much less incentive for people with undiagnosed GERD to seek medical help,” says Cheskin.

That’s a problem. Self-diagnosis and self-treatment aren’t smart. If you have GERD, you need a doctor’s help. Together you can sort out the best GERD treatment — and make sure that you don’t have another condition altogether.

GERD sufferer Chuck Alkin, 75, agrees. “My advice to people is to get treatment early,” says the New York City resident. He developed GERD about 45 years ago, and more recently, Barrett’s esophagus. Now, he’s concerned about his increased risk of cancer.

“It took me 20 years to get a diagnosis, and I regret that,” Alkin says. “If I’d been diagnosed earlier, and gotten treatment, I don’t think I’d be in this situation now.”

* Some patient names have been changed by request.

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Pain Management: Neck and Shoulder Pain

Neck and shoulder pain can be classified in many different ways. Some people experience only neck pain or only shoulder pain, while others experience pain in both areas.

What Causes Neck Pain?

Causes of neck pain include:

• Abnormalities in the bone or joints
• Trauma
• Poor posture
• Degenerative diseases
• Tumors
• Muscle strain

What Causes Shoulder Pain?

The shoulder is a ball and socket joint with a large range of movement. Such a mobile joint tends to be more susceptible to injury. Shoulder pain can stem from one or more of the following causes:

• Strains from overexertion
• Tendonitis from overuse
• Shoulder joint instability
• Dislocation
• Collar or upper arm bone fractures
• Frozen shoulder
• Pinched nerves (also called radiculopathy)

How Are Neck and Shoulder Pain Diagnosed?

• X-rays: Plain X-rays can reveal narrowing of the space between two spinal bones, arthritis-like diseases, tumors, slipped discs, narrowing of the spinal canal, fractures and instability of the spinal column.
• MRI: Magnetic resonance imaging is a noninvasive procedure that can reveal the detail of neural (nerve-related) elements.
• Myelography/CT scanning: Sometimes used as an alternative to MRI
• Electrodiagnostic studies: Electromyography (EMG) and nerve conduction velocity (NCV) are sometimes used to diagnosis neck and shoulder pain, arm pain, numbness and tingling.

How Are Neck and Shoulder Pain Treated?

The treatment of soft tissue neck and shoulder pain includes the use of anti-inflammatory medication (such as Aleve or Motrin) and/or acetaminophen (Tylenol). Pain also may be treated with a local application of moist heat or ice. Local corticosteroid injection is often helpful for arthritis of the shoulder. For both neck and shoulder pain movement exercises may help. For cases in which nerve roots or the spinal cord are involved, surgical procedures may be necessary.

Reviewed by the doctors at The Cleveland Clinic Neuroscience Center.

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Poor sleep is nothing to yawn at—it takes a toll on everything from your job performance and sex life to overall health. And in women it’s been associated with feelings of hostility, depression, and anger, as well as higher risks of diabetes and heart disease. Here, real ways to get the z’s you need.

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Napping: Helpful or Harmful? The Pros and Cons of Daytime Resting

Getting some sleep, even a short afternoon nap, may seem like a good thing for people with sleep disorders. But for those with insomnia and an already decreased desire to sleep at night, midday shut-eye can actually be counterproductive. So before you curl up on the couch this afternoon, consider whether your quick fix might backfire when you lay down in bed tonight.

Naps can get you through the day…
If you don’t usually have a problem getting your Z’s at night, a quick nap can work wonders to pull you through an exceptionally tiresome or sleep-deprived day.

In fact, a 2008 City University of New York study found that a 45-minute daytime nap can improve memory function. And previous studies have found that short afternoon siestas can lower blood pressure, and even seem to reduce the risk of death by cardiovascular events.

Those who suffer from narcolepsy or shift-work syndrome—where your sleep-wake patterns are out of sync with everyone else’s—may also benefit from daytime naps, says James Wyatt, PhD, director of the Sleep Disorders Service and Research Center at Rush University Medical Center in Chicago. “Fifteen minutes can keep you going for hours,” he says.

…But not if you have trouble sleeping at night
If you’ve got insomnia, however, naps present a problem. Assuming you even feel sleepy during the day (insomniacs often don’t), napping reduces your chances of sleeping a full night. Even for people with temporary sleep issues caused by stress, illness, or even jet lag, napping during the day can perpetuate bad sleep habits, confuse your internal clock, and send your insomnia into a chronic spiral.

“Even just a little bit of a power nap reduces your nighttime sleep drive,” says Ralph Downey III, PhD, director of the Sleep Disorders Center at Loma Linda University Medical Center in California. “The nap becomes nothing more than another episode of fragmented sleep.”

If your schedule allows for it and you don’t mind splitting up your sleep between day and night, an afternoon snooze is fine, says Wyatt. Older adults and retirees—or those who are self-employed—for instance, may enjoy napping if they have time to spare during the day, and don’t mind being up at night. “But for most of the population, there’s no napping with insomnia,” he says. “Not if you want to get all of your sleep at night.”

The urge to nap could also be a warning sign
If you’re constantly fighting (or giving into) the urge to sleep during the day and falling asleep instantly at night, you might have obstructive sleep apnea, a condition in which you stop breathing while you sleep.

In this case, naps won’t help; in fact, you’ll wake up just as tired, since your lungs are deprived of oxygen anytime you doze off. By wearing a continuous positive airway pressure (CPAP) machine that flows oxygen through your nose, however, you’ll likely sleep more soundly and wake refreshed—whether from a good night’s rest or a quick catnap.

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Home Treatment

• Rest and protect an injured or sore area. Stop, change, or take a break from any activity that may be causing your pain or soreness. When resting, place a small pillow under your knee.
• Ice will reduce pain and swelling. Apply ice or cold packs immediately to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day.
  • For the first 48 hours after an injury, avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages.
  • After 48 to 72 hours, if swelling is gone, apply heat and begin gentle exercise with the aid of moist heat to help restore and maintain flexibility. Some experts recommend alternating between heat and cold treatments.
• Compression, or wrapping the injured or sore area with an elastic bandage (such as an Ace wrap), will help decrease swelling.
  • Don’t wrap it too tightly, since this can cause more swelling below the affected area. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage.
  • Don’t expect the bandage to protect or stabilize a knee injury.
  • Talk to your doctor if you think you need to use a wrap for longer than 48 to 72 hours; a more serious problem may be present.
• Elevate the injured or sore area on pillows while applying ice and anytime you are sitting or lying down. Try to keep the area at or above the level of your heart to help minimize swelling.
• Reduce stress on your sore knee (until you can get advice from your doctor):
  • Use a cane or crutch in the hand opposite your painful knee.
  • Use two crutches, keeping weight off the leg with the sore knee. You can get canes or crutches from most pharmacies. Crutches are recommended if a cane causes you to walk with a limp.
• Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain.
• Try the following exercises to maintain flexibility:
  • Hamstring stretch
  • Knee-to-chest exercise
• Avoid high-impact exercise, such as running, skiing, snowboarding, or playing tennis, until your knee is no longer painful or swollen.

Do not smoke. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Smoking.

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You snore when the flow of air from your mouth or nose to your lungs makes the tissues of the airway vibrate. This usually is caused by a blockage (obstruction) or narrowing in the nose, mouth, or throat (airway).

When you inhale during sleep, air enters the mouth or nose and passes across the soft palate (the back of the roof of the mouth) on its way to the lungs. The back of the mouth—where the tongue and upper throat meet the soft palate and uvula—is collapsible. If this area collapses, the airway becomes narrow or blocked. The narrowed or blocked passage disturbs the airflow, which causes the soft palate and uvula to vibrate and knock against the back of the throat, causing snoring. The tonsils and adenoids may also vibrate. The narrower the airway is, the more the tissue vibrates, and the louder the snoring is.

You do not snore when you are awake because the muscles of the throat hold the tissues in the back of the mouth in place. When you sleep, the muscles relax, allowing the tissues to collapse.

Snoring may be caused by:

• Enlarged tissues in the nose, mouth, or throat. Enlarged tonsils are a frequent cause of snoring in children.
• Blocked nasal passages, which make it more difficult to inhale. This affects the tissue of the throat, which may pull together during the extra effort it takes to breathe, which in turn narrows the airway. A blocked nasal passage can be caused by an upper respiratory infection (such as a cold), an allergy, or nasal polyps.
• A deviated nasal septum , which disturbs airflow in the nose.
• Loss of muscle tone in the throat, which makes it easier for tissue to collapse. This can be due to aging or lack of fitness.

Other things that may contribute to snoring include:

• Drinking alcohol, which depresses the part of the brain that regulates breathing. This can overly relax the tongue and throat muscles, causing them to partially block air movement.
• Obesity. Fat in the throat may narrow the airway.
• Medicines that relax you or make you drowsy, such as those taken for allergies, depression, or anxiety.

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 Get enough sleep — whatever that means for you — and you’re likely to ace that test, think more creatively, have better long-term memory and preserve important memories.

That’s the bottom line behind a spate of recent studies.

But why sleep has those effects and how that information can be used to your advantage are questions still under study, said Dr. Robert Stickgold, an associate professor of psychiatry at Harvard Medical School and director of the Center for Sleep and Cognition at Beth Israel Deaconess Medical Center in Boston.

“The sleeping brain is not stupid,” said Jessica Payne, an assistant professor of psychology at the University of Notre Dame in Indiana, who has researched the effect of sleep on memory. “It’s smart, and it’s making sophisticated decisions about which memories are important and should be held onto.”

Yet why sleep is so crucial for memories remains a big mystery, Payne and Stickgold agreed.

“It turns out we are not like TiVo,” Stickgold said, comparing humans to the video recording device. “TiVo is good at recording one station while it shows you another. We can’t do that. We can’t simultaneously take in information and process it.”

Rather, he said, sleep helps in the whole information-processing part of the picture. “It might be that sleep is an amount of time to give the brain a chance to go offline and shift into a different psychological mode that’s evolved to perform certain types of memory processing,” Stickgold said.

Though there’s still much to be learned, he said, research suggests that REM sleep — the stage of sleep involving rapid eye movement — seems to be the phase that resolves the issue, or tells you what to do with new information.

Someone who can’t decide whether to take a new job, Stickgold said, rarely says, “I’ll go out for a hamburger.” More often, they opt to sleep on it.

In her research, Payne said, she’s found that a good night’s sleep can lead to better inferential ability. In other words: “You may learn about a concrete relationship between A and B and B and C, but you don’t see there might be an A and C connection,” she said. “Our evidence suggests that when you sleep, you learn the hierarchy of information, you learn to extract the more sophisticated relationships.”

“Sleep is not only important for your ability to remember,” she said, “but it also helps you be more creative, find more interesting and distant connections and be more innovative.”

As for how to convince us that a good night’s sleep is a worthy goal? Payne said her list of pluses usually does it. People are tired of hearing, “Take this pill” or “Try this” to improve memory, she said.

But when they hear that a good night’s sleep comes with such substantial benefits, they listen, she said: “Everyone wants to be more creative, more innovative.”

Stickgold said that no one has “come up with the right ad campaign yet” to convince people to get enough sleep. Perhaps a good one, he joked, would be this: “If you aren’t getting enough sleep, you will become sick, fat and stupid.”

In truth, he said, sleep deprivation has been linked with obesity because it disrupts insulin regulation, in turn easing weight gain. And the sleep-and-illness and sleep-and-memory links are well known.

Though the amount of sleep needed does vary, Stickgold has an easy test to decide if you’re getting enough. “Watch what happens on the weekend if you don’t set an alarm,” he said. “If you sleep more than you sleep during the week, you aren’t getting enough sleep.”

He said that someone he recently spoke with was in a car accident caused by drowsy driving. His suggestion: “Try for one week to sleep for eight hours a night and see if things get better or worse.”

Stickgold suspects that anyone who does this will find that lots of daily tasks — driving and checkbook balancing among them — will become easier. And along with that might come the realization that getting an extra hour or two of sleep a night can pay big — and perhaps even life-saving — benefits.

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Most low back pain is triggered by some combination of overuse, muscle strain, and injury to the muscles, ligaments, and discs that support the spine. Many experts believe that over time muscle strain can lead to an overall imbalance in the spinal structure. This leads to a constant tension on the muscles, ligaments, bones, and discs, making the back more prone to injury or reinjury.

The causes of pain in the low back, or lumbosacral region, tend to add on to one another. For example, after straining muscles, you are likely to walk or move in different ways to avoid pain or to use muscles that aren’t sore. That can cause you to strain other muscles that don’t usually move that way.

The most common causes of low back pain are:

• Injury or overuse of muscles, ligaments, facet joints, and the sacroiliac joints.
• Pressure on nerve roots in the spinal canal. Nerve root compression can be caused by:
  • A herniated disc, often brought on by repeated vibration or motion (as during machine use or sport activity, or when lifting improperly), or by a sudden heavy strain or increased pressure to the lower back.
  • Osteoarthritis (joint degeneration), which typically develops with age. When osteoarthritis affects the small facet joints in the spine, it can lead to back pain. Osteoarthritis in other joints, such as the hips, can cause you to limp or to change the way you walk. This can also lead to back pain.
  • Spondylolysis and spondylolisthesis, vertebra defects that can allow a vertebra to slide over another when aggravated by certain activities.
  • Spinal stenosis, or narrowing of the spinal canal, which typically develops with age.
  • Fractures of the vertebrae caused by significant force, such as from an auto or bicycle accident, a direct blow to the spine, or compressing the spine by falling onto the buttocks or head.
  • Spinal deformities, including curvature problems such as severe scoliosis or kyphosis.
• Compression fractures. Compression fractures are more common among postmenopausal women with osteoporosis, or in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

Less common spinal conditions that can cause low back pain include:

• Ankylosing spondylitis, which is a form of joint inflammation (arthritis) that most often affects the spine.
• Bacterial infection. Bacteria are usually carried to the spine through the bloodstream from an infection somewhere else in the body or from IV drug use. But bacteria can enter the spine directly during surgery or injection treatments, or as the result of injury. Back pain may be the result of an infection in the bone (osteomyelitis), in the spinal discs, or in the spinal cord.
• Spinal tumors, or growths that develop on the bones and ligaments of the spine, on the spinal cord, or on nerve roots.
• Paget’s disease, which causes abnormal bone growth most often affecting the pelvis, spine, skull, chest, and legs.
• Scheuermann’s disease, in which one or more of the bones of the spine (vertebrae) develop wedge-shaped deformities. This causes curvature of the spine (rounding of the back, or kyphosis), most commonly in the chest region.

Your state of mind also has an effect on your level of pain and whether it becomes long-lasting (chronic). People who are depressed, under stress, unhappy in their work, or seeking money for an injury are more likely to have chronic back pain.

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