Tips For Avoiding Back Injuries at A Desk Job

main stretching backSitting at a desk all day while on the job may not seem like a risk for acquiring a back injury. The truth is that it’s not just those who work at physically demanding jobs who end up with bulging discs and spinal stenosis. Even typing on a computer for hours by its sedentary nature can put you at risk for back troubles. Here are a few tips for avoiding back pain if you sit most of the day at a desk.

Learn Proper Sitting Posture: If your back, ears, shoulders, and hips aren’t properly aligned, you may experience back strain. Sit with these body parts evenly lined up and be sure you keep your feet flat on the floor and not crossed over one another. You can either sit back in your chair this way or move forward to the chair’s edge; as long as you stay aligned and don’t slouch.

Move Around: It’s important not to just stay in your chair for hours at a time. Get up every 30 minutes. Get a cup of coffee, visit the restroom, or just walk in a circle around the office. The important thing is to change it up every so often and prevent slumping in your chair.

Look Over Your Workspace: Make sure your desk chair is at the right height so you can use your keyboard without hunching over your shoulders. The computer monitor should be at eye level and right in front of you so you don’t have to turn your neck. The same is true of the distance of the monitor from your body. If it’s too far away, you may be stretching your neck to see it, which is not good. Move everything you use regularly on your desk to within comfortable reaching distance so you can maintain your posture. You’ll want to adjust your chair, the computer monitor, the telephone, and whatever else you need nearby to do your job.

Have The Correct Equipment: If you know your back isn’t feeling comfortable in the chair you have, you may need more back support. Perhaps your feet aren’t properly aligned and you need a small footstool. If your monitor is too low for your eye level, it may need to be raised. Whatever your situation is, make you get the right equipment to lessen your risk for back injuries. Speak with someone in your human resources department to see if the items you need are already available. If not, ask for help in obtaining what you need to do your job well and cut down on doctor and insurance costs in the long run.

Suffering from back and neck pain can occur, even at a desk job. If you are suffering from chronic pain, call Dr. Solomon Kamson, MD, PhD, at the Spine Institute Northwest today to schedule your consultation. Dr. Kamson will be able to accurately diagnose your issues and provide you with alternative solutions that are minimally invasive in nature. Contact the Spine Institute Northwest in Bothell, WA, at 206-496-0630 for more information.

Get Relief from Back Pain and Sciatica – Part II

If you suffer from back pain and/or sciatica, you’ll be happy to know that Sol Kamson, MD, at the Spine Institute Northwest, is always on the lookout for the most up-to-date ways to offer patients relief. Dr. Kamson is a skilled surgeon who utilizes minimally invasive surgical procedures to relieve your discomfort and have you back to performing your normal everyday routines in a short period of time. Aside from procedures such as endoscopic decompression, interbody fusion and facet fixation, Solomon Kamson at the Spine Institute Northwest, offers other treatment modalities that can help you feel better without having to undergo invasive surgery.

Ease Nerve Pain with Radio Frequency Neurotomy

This minimally invasive procedure works to deaden the nerve that is causing your pain. A radio frequency neurotomy can provide you with pain relief for months, and some patients report having no painful symptoms for a year or even longer.

Using a fluoroscopy, a kind of X-ray showing live images as he works, Dr. Kamson can guide radio frequency needles to the area from which pain is originating. When the needles are in the exact spots they needs to be, Dr. Kamson then applies thermal energy. In this way, the radio waves interrupt the nerve impulses that tell the brain to feel pain.

This is a quick procedure that can be completed in less than an hour. A radio frequency neurotomy is done in the outpatient surgical center, with a short recovery period before you are then sent home. Some patients of Sol Kamson will need a second treatment after six months or up to a year later, while others experience relief for longer than a year.

After Dr. Kamson performs this procedure, you will likely feel soreness at the insertion site of the needle and heat energy infusion. Patients are advised to rest for the next 24-48 hours, after which they may go back to their normal routines in most cases.

Relief Using Endoscopic Nerve Excision

Dr. Kamson also performs endoscopic nerve excision, which is similar to radio frequency neurotomy, with the difference being the use of an endoscope to help in removing the nerve rather than just deadening it. The main cause of your pain, such as a bulging disc, will not be removed, but the nerve that is causing you to feel painful symptoms will be excised in order to halt discomfort.

The soreness and recovery time period for undergoing endoscopic nerve excision is just a few day’s rest longer than what you would need following a radio frequency neurotomy.

These two procedures may be very helping in relieving the pain associated with a facet disease. Call Solomon Kamson MD at Spine Institute Northwest in Bothell, WA, to schedule your appointment for a consultation. There is no need to live with chronic pain, as Dr. Kamson can provide you with many alternative treatments so you can live an active life once again.

Spine Institute Northwest’s YouTube Channel: How We Helped Patients

Dr. Solomon Kamson at Spine Institute Northwest invites you to listen to patient testimonials and discover more about minimally invasive surgical techniques that can help relieve your persistent back pain. It’s time to get back your life and stop living in pain. The relief you seek is close at hand, without months of lying prone during post-surgical recovery.

Tune in to SpineInstituteNW on YouTube to hear about our actual patients’ experiences and satisfaction after undergoing a number of different treatment options with Dr. Sol Kamson, a Spine Institute Northwest physician.

Real Patients Tell You Their Stories

Once you meet with Sol Kamson, you will understand that you have chosen the right path for finding a solution to your chronic pain without having to endure invasive open-back surgery. Before or even after meeting with Dr. Kamson, though, take a look at the many YouTube videos our patients have made to share their stories and the success they’ve found with the help of Solomon Kamson MD PhD.

One recent patient, Anita, is a 44-year-old dental assistant who has endured neck and arm pain for the last 15 years. After trying weekly massages, acupuncture, and meeting with a surgeon who recommended she undergo three fusion surgeries, Anita decided she did not want to go this aggressive type of treatment. Nor did she want to continue with treatments that weren’t helping her pain in the long run. Instead, she met with Sol Kamson, who recommended decompression with stem cell therapies to help her get her life back on track.

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Work-Related Back Pain in Heavy Equipment Operators and Delivery Drivers

Dr. Solomon Kamson of Spine Institute Northwest (SINW) in Bothell, Washington frequently treats patients who have suffered back injuries from performing work that taxes the body, especially the lower back. These workers, which include delivery drivers and heavy equipment operators, are exposed to more risk factors that may lead to back pain and musculoskeletal disorders such as extended hours sitting in awkward positions, exposure to vibration, and being in non-natural positions for hours at a time. Work-related injuries (such as back disorders) are seen as more common in the construction industry for these exact reasons. The National Institute for Occupational Safety has conducted studies to assess the impact of risk factors for workers operating heavy equipment. Traditional open back surgery, while effective at treating injuries, would mean extremely complicated procedures requiring extended recovery times. Using state-of-the-art minimally invasive techniques, the Spine Institute Northwest can significantly reduce patient downtime after their procedures. Minimally invasive back surgery requires only very small incisions and can be performed in outpatient settings, not requiring extended hospital stays.

Read these testimonials of five different cases where minimally invasive surgery helped them get their lives back when traditional back treatments could not.


Heavy Equipment Operator Penny Schwegel Gets Relief From Sciatic Pain

Penny, who operates the largest excavator for a mining firm in Alaska, believes her sciatica, which had been giving her trouble for nearly a decade, was made worse by the constant vibration from sitting in the machine for more than 12 hours at a time.

Cortisone shots were effective at managing the pain at first, but over time their efficacy wore off. A lumbar fusion procedure at SINW in December 2016 finally gave her the relief she was looking for.

Truck Driver Braun Hudson’s Battle With Paralyzing Back Pain

Braun, a truck driver from Washington who worked 6-days a week doing deliveries, finally felt the effects of his job on his body one day in 2015 when he found that he could not move his legs at all.

Being very skeptical of the merits of continuing pain medications just to manage his pain and traditional open back surgery, he opted for treatment at the SINW instead where Doctor Kamson recognized the gravity of his situation immediately.

“Dr. Kamson was surprised how I was even walking,” Braun recalls. After a lumbar decompression, the pressure on the nerves of his spine was relieved which completely addressed the pain.

Daniel Schamlzried: Herniated Disc Fixed

Years of working tough jobs including logging ,ranching, labor work, mining and truck driving took a heavy toll on Daniel’s back.  Told by doctors that open back surgery was not even a option for him at his age, he did some research on laser spine surgery instead. Diagnosed at SINW with degenerated disc that was causing his pain, a spinal fusion was performed on Daniel’s back.

Against the odds and against the outcomes predicted by other physicians, Daniel was able to find lasting pain relief for his back problems thanks to minimally invasive surgery.

Darrel Lewis – Sciatic Nerve Problem

Repetitive motions from his driving and delivery job such as lifting, pulling, and just getting off and on the truck, coupled with sciatica gradually made Darrel’s pain worse and worse. It got to a certain point where Darrel knew he had to do something, as the pain was affecting his relationship with his family and his ability to be effective at work.

This prompted Darrel to reach out to Spine Institute Northwest where he underwent a minimally invasive procedure for his back. Much to his surprise, the procedure only required a very small incision.

Chris Catron – Years of Intensive Labor Wrecked My Back

Doing heavy labor work while young and supporting a family ate away at Chris’ quality of life. Like many of the other patients at Spine Institute, Chris Catron ignored his back pain until it was too late. And as with other patients, he tried to address the pain through painkillers and physical therapy. His search for a permanent solution led him to Spine Institute Northwest and minimally invasive surgery where Dr. Kamson was able to fix his back through minimally invasive surgery.

Mark Tidball: Two Decades of Pain

Mark had been dealing with pain for almost 20 years prior to his procedure at SINW. His back pain he attributes to a job he held long ago that required some heavy lifting. Having witnessed the good work that Dr. Kamson had performed on his wife, Mark set up an appointment to have his own back looked at.

The source of Mark’s problems turned out to be a collapse of the discs in his lower back – essentially his vertebrae were grinding against each other (bone on bone). A lumbar decompression procedure at SINW addressed his back pain. Of the outcome of his procedure Mark says, “My pain is pretty much non-existent now.”

 

It Was Unbelievable! The Wyatts on Back Surgery

Don and Betty Lou Wyatt’s experience with Dr. Kamson at Spine Institute Northwest was, in their own words, life-changing. Don had been struggling for more than a decade with back pain from a pinched nerve that caused him tremendous pain which interfered with his walking. Read the transcript of their testimony and how their lives have changed for the better after undergoing minimally invasive treatment. Watch the full testimonial on YouTube here: https://www.youtube.com/watch?v=LHLroiq2WHw . Read my latest blog posts here.


testimonial for Dr. Kamson

The Wyatts are extremely thankful for the care they received at Spine Institute Northwest.

Betty-Lou: Our experience at Spine Institute Northwest could not be any better. It’s been a total blessing. We have experienced life-changing surgery here.

The moment we walked in the door we were completely welcomed and everyone was calm and collected – we have had a really hectic morning getting here, we had some trouble at the airport and when we got here, every problem that we had they took care of. It was just super relaxed and comfortable. Dr. Kamson is amazing.

I did tons of homework looking for just the right surgeon for my husband. He’s had back surgery before, he’s got a blood disease that we are dealing with. After much, much, much homework, Spine Institute is where we ended up and what a blessing.

Don: Hi, my name is Don. I’ve been living in this pain. I had back surgery in ’99 and ever since I haven’t been right. I’ve had trouble in my back. About a year ago I slipped at work deicing and caught myself and it twisted. Ever since then I’m in a lot more pain. I went to the doctor and they gave me some injections to try to see if that would help and they helped a little bit but it didn’t take care of it and I was going to go back to the surgeon and he wanted to fuse my back and I did not really want to do that with my blood disease because of the bleeding and the hemorrhaging and so we started researching.

My wife really researched all around just trying to find a laser or anything that would be less invasive and she found Spine Institute Northwest. It’s been just unbelievable. When I came in here, I was in so much pain my right leg.  I had that herniation and it was pinching that nerve and it was shooting pain down my leg all day long, couldn’t sleep nights.

When I cam in here, I couldn’t even hardly stand to fill out the paper work. It was hurting so bad and I was so glad to get in. When they got me in everyone here was just wonderful just like family. Walked in they knew who we were asked us if they could help us went over the procedures with us told us exactly what to expect. I got my blood drawn, came back, had the MRI  the doctor went over everything with me and showed me what he was gonna do and when I went in, I was even awake through the procedure.

It was unbelievable. I thought I’d be out.  I was kinda in and out but I heard him , I felt everything, talked to him and it was unbelievable. When I got out they wheeled me out and I don’t think I was out maybe a half hour talking, drinking water, going over everything, got up and walked out and it’s been just a life changing experience. Unbelievable. I am so thankful for everybody here. I’m so glad I did it and I wish I could have gotten it done back in 1999 because I would’ve lived a life like I wanted to. I really love the outdoors and now I’m getting it back.

Betty Lou: I have my best friend back.

Din: I can walk upright, walk with no  pain. I’m very, very happy. I recommend this to anybody. I just wish that everybody would look at this instead of wanting to get cut open and taking their chance. The recovery time is gonna be so much shorter. I’m expected to be off work next week and relax and get walking around and I’m going back to work the following week.

successful-spine-surgery

“He ate half a pizza last night.” “Please don’t tell Dr. Kamson about that!”

Betty Lou: When I saw him stand up out of that wheelchair..he stood up and he stood straight for the first time since I can’t even remember and walked. He used to drag his leg and now he just walks like a regular person. That in itself is just amazing. That’s the day after the surgery. That was hours..not even an hour after the surgery he stood up like that.

So I can, and will tell everyone that I meet that this is where they need to be. If they’re tired of pain, if they’re tired of living in pain, if they’re tired of their quality of life being very minimal, I will tell them this is where they need to be.

Don: I was out for 6 weeks during my first surgery and everyday I was just walking real easy shuffling my feet because it hurt so bad getting up and getting down. And they wanted me to walk and do things I did walk but it was hurting so bad still and this here I can’t believe it – when I walked out last night and went back to the motel room it was unbelievable. Slept good. I got up this morning. Today I got up and it’s what – 1 o’clock in the afternoon and (I’m) walking around – no pain! Thank you again,

Betty: That last thing I want to say is God bless Doctor Kamson and his staff and the Spine Institute Northwest.

 

Can Back Pain Really Be Genetic?

Back pain being genetic? Unheard of, right? Well, research shows that pain-related issues can be passed down genetically – the most common being a herniated disc. In fact, people with an immediate family member who have experienced pain from a herniated disc are four times more likely to experience a similar problem.low back pain causes

Know your family tree

Knowledge is power! It’s always a good idea to have a general knowledge of any family illnesses or diseases so that you can take preventative measures. You should at least be aware of health problems in your immediate family: Parents and siblings. The further out on the family tree you can get, however, the more forewarned you’ll be — grandparents, your parents’ siblings, and your cousins can also provide telling info. It’s not important to track every cough and cold; you just want to know about major illnesses and chronic conditions.

Know your options

Although an injury or just simply poor posture may cause back pain, take the time to see is your medical condition runs in your family. If you know, for example, that you have a parent and a grandparent who suffer from chronic back pain, it’s important to rule out non-genetic elements that could be the root of the problem. For example, working at a physically demanding job isn’t something that’s hereditary (well, maybe unless you inherit the family farm). Other health issues that can contribute to back pain, like obesity, can be addressed with preventative measures. Learning about health problems that “run in the family” can help you determine whether there are other factors you have that may increase your chances of developing one of these problems.

Be sure to mention your family history when you consult with Dr. Kamson, especially if it relates to back issues. Osteoporosis, arthritis, or even a bum knee are important to bring up as well. Knowing what health issues you may be more likely to face — even if they aren’t causing you trouble now — can help to determine a course of action that will better help you to find relief from pain.

Children’s Health and the New School Year

No parent wants his or her child to experience pain or discomfort, let alone a recurring or chronic pain that is interferes with the child’s happiness. But as the school year starts up, many parents will no doubt soon hear complaints about back, neck, and shoulder pain as kids readjust to the pressure of carrying a backpack (plus armfuls of books, lunches, and more) to and from school.

Dr. Solomon Kamson notes that the problem of an excessively heavy backpack can actually present a very real health risk for kids. According to specialists, a child’s backpack should weigh no more than 20% of their body weight (or to be on the safer side, 10%). But with lots of heavy books and notebooks to carry, it’s easy for a backpack to quickly exceed this cutoff.

What’s a conscientious parent to do? For some, the best option is to switch to a backpack alternative like a rolling backpack. In many schools, rolling backpacks have been banned due to tripping hazards. Another good alternative is to rely on the use of lockers. In fact, in many cases, kids aren’t really meant to be carrying as many books as they do. Sure, for the average middle school or high school kid who takes six or eight classes, the textbooks pile up, but kids are meant to take advantage of their lockers throughout the day to lighten the load. Why aren’t more kids taking advantage of this option to decrease the burden on their backs? In most cases, children feel they can’t take better advantage of their lockers either because they feel their lockers are too far away to reach between classes or they don’t have enough room in their lockers. In fact, many schools have reported a problem of too little locker space and access, which can be directly correlated with these reports from kids.

In some cases, parents are able to get special permission to lighten the load their kids have to carry. For example, you might be able to get special permission for your child to use a rolling backpack or to get two sets of textbooks for your child, one for the classroom and one for home. However, this kind of special permission is often reserved for kids who have a special need like an injury or a physical handicap. Depending on your school district, you may be able to have your child use digital versions of various textbooks, which would get rid of the need to transport books at all. However, if the school is not actively implementing e-readers for all students, these permissions may be limited.

No matter what, keep in mind that you always have the right to advocate for their children’s health! Before your child goes to school everyday, check their backpack to see how heavy it is. If it’s exceeding the recommended amount by a huge margin, it may be time to take matters up with the school. If it exceeds it only by a little, start to look for objects you can remove to lighten the load. For example, send your child to school with an empty, reusable water bottle to refill rather than a full one. Remove unnecessary papers from binders and folders. And make sure to listen up any time your child complains about pain! Preventative measures can literally help to keep a minor inconvenience from becoming a major pain.

Advice on Aging from Dick Van Dyke

In a recent interview with NPR about his new book, Keep Moving, famed comic actor Dick Van Dyke offered some great advice about keeping fit and in good health as you age: “Do not start going down the stairs sideways. It feels good on your knees but it throws the hips out and the back starts to go out, the next thing you know, you’ve fallen down and broken your hip. So even if it hurts a little, go down the stairs front-ways.”

Van Dyke’s tip draws attention to the problems that can be caused by allowing your body to compensate for one issue. In fact, doing something like favoring one knee over the other, or leaning to one side of your hip can actually lead to very serious problems. The reason for this is that favoring one side or part over the other can cause the underused side to weaken. That makes it much easier to get an injury or sprain in that weakened part when putting it under mild stress. In cases of injury, you can actually cause the injury to heal incorrectly — potentially causing more problems down the line — by favoring the other side.

And of course, this is a compounding problem. Once you’ve caused one knee or one side of your hip to weaken, or once you’ve started to allow your posture to go, it becomes much more difficult to break the habit. It also makes it much more difficult to get back into an exercise and activity routine once you’ve let your good habits slide.

What else does Van Dyke recommend? For him, the answer is to keep singing and keep dancing, and he recommends the same for just about everyone. Dr. Kamson points out that, even though you might not be partial to song or dance yourself, this advice highlights the point you’re much more likely to stick with an activity routine if it’s something that they enjoy! When you’re trying to think of ways to stay active, think about what kinds of activities you’ve always liked. This might include activities like swimming, taking walks, playing tennis, or even just playing active games. Not only does this help you stay active and build up a routine that you can easily maintain, it also helps you keep your spirits up.

There is good medical evidence to show that a positive outlook can make a huge difference on the likelihood of a good outcome for a procedure. It also helps you maintain a good quality of life. Participating in fun and silly activities like singing with your spouse (as Van Dyke does) can help keep your mood high, which is more likely to keep you feeling good and maintaining positive habits.

Conservative Back Pain Treatment Options

When it comes to managing something as individualized as back pain, it can take many attempts at different kinds of therapies to find a solution that really gives a patient noticeable pain relief. But what should you do if some of the treatment options that you’d like to explore aren’t covered by your insurance? Spinal health specialist Dr. Solomon Kamson notes that there are many reasons a patient may want to try options outside of the traditional doctor’s office, and that being unable to pursue different treatment options can give patients a feeling of powerlessness about their own health. If you’re in this situation, it’s important to understand the benefits to pursuing these alternative kinds of care and what you can do if your insurance won’t cover it.

A recent article published by NPR drew attention to the problem of using opioids as a first response when dealing with chronic pain problems. Back pain is one of the most common types of chronic pain, so the use of opioids as a treatment option is likewise common. However, especially in situations where patients are dealing with intractable chronic pain, it’s disturbingly easy for patients to become addicted to opioids.

Opioids provide pain relief, but they do not treat the underlying cause of back pain. This means that while a patient may feel some temporary relief, the pain is certain to return. At the same time, the longer a patient uses opioids, the more likely they are to develop a resistance to the drugs. The dose needed to treat the same level of pain will steadily increase until the patient is at risk of needing a dangerously high dose of an opioid just to make their pain manageable. Overdosing on pain medications can be fatal. This drug resistance can also potentially make it more difficult to treat future pain, whether from a new cause or an exacerbation of the original underlying problem.

There are many alternative therapies available to patients, including yoga, dietary management, acupuncture, and massage. While some people will find that one of these therapies does provide them with relief, it will frequently take trying several options before a person finds a good balance. This can get expensive, as most of these therapies are not covered by standard insurance. What are your options? Of course, if you can afford to do so you can at least try one of these therapies. You should start by asking your pain specialist or primary care doctor which therapy they recommend. For example, if your weight is contributing to your health problems, your doctor may think you should start with diet and exercise programs, perhaps by working with a trainer and/or a nutritionist.

However, to prevent patients from feeling frustrated by a lack of access to these services, it’s important to have a reasonable expectation on the benefits of these therapies. In most cases, the benefits of these kinds of alternative therapies are really a result of the general overall health improvement that they help you achieve. For example, yoga can help with strength, weight loss, and better mindfulness, which can lead to an overall health improvement. Patients who are concerned about lack of insurance coverage should consider trying similar at-home treatments to see if these help first.

Could You Be Hurting Your Back in Your Sleep?

If you’ve ever woken up with a stiff neck or a painful back, then you already know how much pain you can cause yourself from just one bad night of sleep. It’s actually possible for your spine to accumulate considerable damage when put through poor sleeping behaviors night after night, over long periods of time. While Dr. Kamson notes that it can be difficult for individuals who are experiencing back pain to get a good night of sleep, periods of restfulness are necessary for your optimal overall health. It’s in your best interest to not only stop any bad sleep habits that might be hurting your back, but also to prevent further problems.
sleeping habits
How Do You Sleep?
One of the most important things to consider if you think your sleeping habits may be causing you back trouble is your sleeping position. While it’s easy to get comfortable in certain positions that aren’t good for you, it’s important that you find a way to break the habit. The most common damaging position is sleeping on your stomach with your head turned to the side. What makes this a problem? Your muscles don’t simply stop working when you out your head on the pillow. In fact, you’re making them work over time supporting your neck all night in an awkward position. This can produce tenseness and discomfort when you wake up in the morning. It can also cause problems for your jaw, which you may experience through jaw pain, ear pain, or tooth pain. If you are inclined to sleep on your stomach, try to break the habit by sleeping with a pillow under your legs and under your stomach. This will help keep you from lying completely on your stomach. You may find it helpful to use a body pillow for this purpose.

How is Your Mattress?
A bad mattress can have a huge impact on your back and neck, as well as on the quality of your sleep. As mattresses age, they become less suitable for good sleep. Trying to save money by hanging onto a mattress that has started to hurt your back is going to cost you more money in the long term as you contend with poor back health. The lifespan of a mattress is generally 10 years. If your mattress isn’t too old but you think it is causing you some discomfort, try flipping it over.

It’s also important to make sure you’ve picked the right mattress for your needs. When trying to select a mattress, make sure you go to a store that provides good customer support to help you choose a mattress that will be suitable. Look at multiple different types and styles of mattress, and ask to try out each one or a comparable one. Make sure they also offer a good warranty policy in case you find that the new mattress proves to be uncomfortable.

How’s Your Sleep Quality?
If you aren’t sleeping through the night or your actual sleeping is very light and fitful, you are more likely to experience chronic pain. This can become a vicious cycle as the more often you feel discomfort; the more likely it is to worsen the quality of your sleep. If your back is hurting, it’s important that you address any underlying medical conditions that might be affecting the way you sleep. You should also consider other factors that might improve your sleep quality: Make sure you have a comfortable pillow and sheets, that your blanket isn’t too heavy, and that there isn’t too much light and noise disturbance. Minor changes like light blocking curtains or an electric fan can help you fall asleep and stay asleep. Some people also benefit from mild supplements like melatonin, which can help you fall asleep and are non-habit forming.