TMJ Dysfunctions Systemic Implications and Postural Assessments: A Review of Recent Literature


by Sergio Sambataro 1Gabriele Cervino 1Salvatore Bocchieri 1Rosario La Bruna 2 and Marco Cicciù 1,*1Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, Messina University, 98100 Messina, Italy2Private Practice, 89100 Reggio Calabria, Italy*Author to whom correspondence should be addressed. J. Funct. Morphol. Kinesiol.20194(3), 58; 19 June 2019 / Revised: 9 August 2019 / Accepted: 16 August 2019 / Published: 19 August 2019(This article belongs to the Special Issue TMJ Dysfunctions and Systemic Correlations)View Full-TextDownload PDFBrowse FiguresCite This Paper


Cases of correlations between posture and the temporomandibular joint have long been reported in the literature. In particular, occlusal anomalies, and therefore malocclusion, could have negative implications for the spine. The objective of this study was to review the literature and bring to light any correlations between temporomandibular joints (TMJ) and posturology. The literature search was conducted in the PubMed and Embase scientific search engines with the aim of obtaining the most possible results in the initial search, the number of results initially obtained was 263. Subsequently, the inclusion and exclusion criteria were reduced first to 83 and subsequently to manual analysis of the articles, those included remained only 11. The results show a correlation between anomalies of the TMJ and dysfunctions of the vertebral column. Not all the articles considered are in agreement with each other regarding epidemiological data, but surely this study can represent an important starting point for a much more careful evaluation of the dental patient and at the same time for the request for counseling by a dentist in case of postural abnormalities. View Full-TextKeywords: TMJspinal cordcervicalvertebradentistrymalocclusionorthodonticgnatologicphysiotherapyorthopedic▼ Show Figures

Figure 1This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Sleepless in Silicon Valley

Sleepless in Silicon Valley

Interesting article on th Economist Why the techie obsession with sleep technology makes perfect sense

BusinessMay 16th 2019 edition

May 16th 2019

  • Fit blackout blinds in your bedroom. Eat dinner at 4pm, and do not eat or drink anything after 6pm. Put on your blue-light blocking glasses at 8pm. Set your bedroom temperature to 67ºF (19.4ºC) and your electric blanket to 69.8ºF (21ºC). At 8.45pm, meditate for five to ten minutes. Switch on your deep-wave sound machine. Put on your Oura sleep-tracking ring. You are now, finally, ready for slumber. This may all sound a bit over the top. But this is the “sleep hygiene” routine described in a recent blog post by Bryan Johnson, who sold his previous company to eBay for $800m and is now chief executive of Kernel, a startup developing brain-computer interfaces. He admits that his sleep routine has “decimated my social life”, and that his partner sleeps in a different room, but says all this trouble is worth it, because it has boosted his level of “deep sleep” by as much as 157%. He has bought Oura rings for all his employees.

Mr Johnson does not expect other people to copy his routine, but made it public to encourage the sharing of sleep habits and tips. Like many other techies, he regards sleep hygiene as an effective way to maintain mental health, boost cognition and enhance productivity. In its most recent funding round, backers of Oura, the Finnish maker of the high-tech ring, included the co-founders of YouTube and Twitch, along with alumni of Facebook, Skype and The ring’s most famous user is Jack Dorsey, the boss of Twitter, whose unusual wellness regime—which also incorporates near-infrared saunas, radiation-blocking Faraday tents, fasting and cryotherapy—prompted the New York Times this month to dub him “Gwyneth Paltrow for Silicon Valley”. For tech tycoons, it seems, sleep is the new fitness.null

Those who want to monitor and improve their sleep have no shortage of gadgets to choose from. As well as electric blankets and mattress-chillers, sound machines and smart rings, there are also smart pillows, sleep-tracking watches and bracelets, intelligent sleep masks, brain-stimulating headbands, bedside sleep sensors and countless sleep-monitoring apps. The market for sleep technology was worth $58bn in 2014 and is expected to grow to $81bn by 2020, according to Persistence, a market-research firm. Big companies in the field include household names such as Apple, Bose, Nokia and Philips. After Mr Dorsey’s enthusiastic endorsement, the Oura rings are back-ordered by four to six weeks.

The mania for sleep technology makes perfect sense for the tech industry, combining as it does several existing trends. For a start, it fits with the industry’s metrics-driven worldview. Techies obsess about okrs (objectives and key results), kpis (key performance indicators) and digital-analytics dashboards showing the performance of specific products and features. Applying similar techniques to sleep and other aspects of their personal lives—an approach known as the “quantified self”—seems a logical step. As those in the startup world like to say, channelling Peter Drucker, a management guru, “what’s measured improves.”

Sleep-tracking also aligns neatly with Silicon Valley’s cult of productivity, and the constant search for “life hacks” that will make entrepreneurs more effective, efficient and successful. This ranges from wearing the same clothes every day, Steve Jobs-style (thus avoiding wasting time deciding what to put on), to fastidious fitness routines and complicated diets. Elaborate sleep regimes slot right in, because they promise clarity of thought and improved cognitive performance. They also let people extend their quantified-self and life-hacking efforts into the one part of the day that was previously untouched: shut-eye. Relentlessly pursuing productivity only while you are awake is for wimps. Sleep-tracking means you can do it round the clock. Oura describes its sensor-packed ring as a “secret weapon for personal improvement”—another way to get ahead.

Never mind that a study published in 2015, by researchers at Massachusetts General Hospital and Harvard Medical School, found that sleep-tracking devices could not accurately measure sleep, and that claims made about them were long on hype and short on solid evidence. Ignore the fact that another study, published in 2017 by researchers at two medical schools in Chicago, warned of the dangers of “orthosomnia”, defined as a “perfectionistic quest for the ideal sleep in order to optimise daytime function”, as obsessive users of sleep-tech devices self-diagnose sleep disturbances based on dodgy data, or stay awake all night worrying that they are falling behind by not sleeping as efficiently as rivals.

It is hardly surprising that techies are not getting enough sleep, given the industry’s culture of long hours, and the widespread notion that for a true entrepreneur, everything else in life is secondary to succeeding at work. The enthusiasm for sleep-tech also fits a larger pattern of using technology to fix problems that the industry itself has created. Is your smartphone too addictive? Here’s an app to help you monitor and track your usage. Are the streets of your city clogged with Ubers? Try an electric scooter instead. Seen this way, the embrace of sleep-tracking is an indictment of the whole culture: it tackles the symptoms of sleep deprivation, but not the disease.

Sleepwalking into the future

But resist the temptation to dismiss all this as batty. Sleep-tracking is at exactly the stage that fitness-tracking technology was at a decade ago. Now fitness trackers (including the Apple Watch) are mainstream and nobody bats an eyelid when people share details of their morning runs on Facebook. The same could easily happen with sleep-tech. A series of previous examples—including the use of email, the embrace of online shopping, hailing a car with an app, or renting a room in an unfamiliar city from a complete stranger—are a reminder that the seemingly crazy things that Silicon Valley types do today, everyone else may end up doing in a decade’s time. In this case, in their sleep.

Back Pain Caused by a Pinched Nerve or Degenerated Disc?

Back Pain Caused by a Pinched Nerve or Degenerated Disc?

Excellent review By Louis Chang, MD

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When back pain is caused by a spinal disc problem, the source of the pain is either from a nerve being irritated by a protruding disc, or from the disc itself. Differentiating between the two can cause confusion, as doctors may use a variety of terms to describe the problem, such as a slipped disc, protruding disc, pinched nerve, and/or degenerated disc.

Lumbar Herniated Disc


A herniated disc can irritate nerves and cause pain, or pain may be in the disc space itself. 
 Herniated Disc Video

Read on to learn more about what essentially happens when you have a pinched nerve or a disc problem.

Pinched nerve pain

When a spinal disc causes mechanical compression, irritation, or inflammation of a nearby nerve root, it’s not the disc that hurts—it is nerve pain due to intrusion by the disc. Pain from a pinched nerve root in your lower back can radiate along the path of the nerve into your leg and foot. Neurological problems, such as numbness, weakness, tingling, and/or a pins-and-needles sensation may also occur.

This type of pain is medically termed as radiculopathy. When radiculopathy occurs due to the irritation or compression of specific nerve roots in the lower back (L4 to S3), it is commonly referred to as sciatica

Pinched nerves can be caused by:

While less common, a pinched nerve may also be caused by other conditions, such as a tumorinfection, or spondylolisthesis.advertisement

Degenerated disc pain

If the source of your back pain is the intervertebral disc, it is called discogenic back pain. A spinal disc may degenerate due to wear and tear or trauma and cause pain by the following mechanisms:

  • Inflammation. As the disc degenerates, inflammatory proteins may be released into the disc space. A degenerated disc may also herniate, causing its inner inflammatory contents to leak out. These inflammatory agents may irritate or inflame nearby nerves, causing pain.13 Herniated discs can also cause pinched nerve pain as described above.
  • Shrinkage. Degeneration may cause dehydration within the disc, resulting in loss of fluid content and shrinkage. The degree of disc shrinkage can cause narrowing of the spinal canal, leading to radiculopathy.
  • Motion segment instability. Disc degeneration can also cause the spinal segment to become unstable and not be as effective in resisting the motion in the spine.1

As the body attempts to counteract the inflammation, instability, and pain, the muscles in the area may spasm, which can cause sharp, shooting pain, worsening the back pain. Pain from a degenerated disc may be localized or may radiate into your leg (radiculopathy). 

See Causes of Degenerative Disc Disease Pain 

Focus on the cause of your pain

By focusing on the underlying cause of your pain, as opposed to only symptom relief, you will have the best chance of finding an appropriate treatment plan for long term relief. An Osteopath can conduct relevant clinical and diagnostic tests to confirm the exact cause of your pain and formulate an accurate treatment plan.

Get Active

Get Active


Advice on physical activity

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We all know that getting active is good for our bodies, our minds and has many benefits.  It can improve your mood, give you more energy, and significantly reduces your chances of serious health conditions such as dementia and certain forms of cancer.

Despite this, only about two thirds of men and around half of women meet the minimum recommended national levels for physical activity and this can have a hugely negative impact on your health, and on our society.

When you visit an osteopath they will often provide advice on keeping active so you can stay healthier for longer and fend-off those aches and pains!

Not sure where to begin? Our osteopath provides advice on how much physical activity you should be aiming for, how to get started or become more active and about the positive influence that physical activity can have on your health.

For an appointment Call 07841576335 or email

Advice for physical work

Advice for physical work


If your work involves lifting or more physical activities you need to be careful that you are not putting yourself at risk of injury or long-term health problems.

One of the biggest causes of back injury at work is due to lifting incorrectly.  Additionally, continuous repetitive activities, or staying in the same position for extended periods of time, can also lead to pain and discomfort. Being aware of how to move correctly when at work can keep you healthy for longer and keep you safe from injury.

Lift safely

  • Before you lift any object, try to establish its weight and if you can indeed lift it safely. If in any doubt, don’t attempt it.
  • Check your destination. Make sure you know where you are going to deposit your load and you have no obstructions in the way.
  • Lift in stages.  See if you can phase your lift. For example from floor to table and then to destination. Once at the destination can you lift it in stages to its desired location?

The golden rule of lifting – Bend at the knees and not your back! 

  • Remember do not bend forward from your back to lift an item.
  • Before you start to lift make sure your footing is stable, keeping a wide stance.
  • Get a good hold of the item and keep the item close to your body as you move up, using your legs to straighten up.
  • Avoid twisting your back/body when lifting or positioning a load.

Awkward places and repetitive movements

If your work involves getting into awkward places or repetitive movements for extended periods of time, this can also put additional stress and strain on your muscles, joints and associated tissues. Overhead movements when decorating, working under cars, on knees fixing carpets or leaning over to fix pipes, are all examples. The demands of your job will often dictate what can you do, but you may want to consider:

  • Rotating jobs. If you’ve got a number of things to do, try and rotate from one activity to another after a shorter period of time so you don’t get stuck in one position or activity.
  • Take regular breaks. Short regular breaks that allow you to move into different positions can be helpful
  • Keep a healthy lifestyle. With a physically demanding job its important to make sure you are eating healthy, and still keeping your body fit for work. Dependant on your job you may want to consider doing other physical activities for fun that will either build strength or your cardiovascular stamina.

How your osteopath can help

Hopefully you can keep healthy at work by introducing the above advice but if you do find yourself suffering from aches and pains such as back and neck ache, elbow or wrist pain, Speak to us at where we will be able to provide further advice on healthy working habits and treatment if necessary to get you back to work.

Call 07841576335 or email

Advice for working at your desk

Advice for working at your desk


If your work is office or computer based you can spend a significant portion of your day seated at a desk which can lead to host of problems for your health.  But with a few changes and addition of good habits, you can keep productive at work and keep healthy.


It is really important when working at your desk that you are mindful of your posture and your equipment is correctly set-up.  Things to look out for include;

  • Is your screen is at eye level? If your monitor does not have height adjustment try elevating it with a riser, or even some old books!
  • Keep your mouse close.  It’s easy for your mouse to drift away from you when working, make sure you are not over-stretching to reach it
  • Keep your keyboard close.  You should be able to sit up in your chair, have your elbows in an L-shape and still be able to reach your keyboard. If you are overstretching to reach it, you will need to make adjustments
  • Adjust your chair. You should be able to sit right back into your chair, so your lower back is supported while still comfortably accessing your equipment
  • Feet to the floor. The height of your chair should allow your feel to easily reach flat to the floor. Use some form of riser if needed
  • Avoid crossing your legs. It can cause circulation problems and puts unnecessary strain through your lower back.

If you are unsure about your desk or workstation set-up, ask your employers to provide a workstation assessment.

Regularly re-set your posture

While you may start off in the correct position it can be very easy to drift into slouched position as your desk.  Try putting a sticker on your monitor as a reminder to re-set your posture every time you see it.

Take regular breaks

It is recommended that you should take a break from your desk every 30 minutes for at least one or two minutes. Try building in some of these good habits into your working day.

  • Stand-up and move around for a few moments around your desk
  • Use a break to get a drink of water, which also helps you keep hydrated.
  • Rather than phoning an office colleague, can you walk over to talk to them?
  • When taking a call, can you take the opportunity to stand-up rather than sit?

On the phone

If your work involves making lots of calls, avoid tucking handsets between your neck and shoulder. Consider getting a headset so you are not battling with the handset, keeping your hands free and able to maintain a healthy posture.

Laptop working

Increasingly we are working directly off laptops, particularly if you are a mobile or remote worker or hot-desking across offices.  However the same rules apply and even more so  if you don’t have the luxury of an adjustable chair or monitor.

  • If you are mainly working off a laptop you may want to consider getting wireless keyboards and/or risers so you can optimise your work posture.
  • Also consider where you work – your dining room table may be convenient but if of an incorrect height, extended working may cause shoulder, neck or back pain.

How theOsteopath can help

Hopefully you can keep healthy at work by introducing the above advice but if you do find yourself suffering from aches and pains such as back and neck ache, elbow or wrist pain, visit where we will be able to provide further advice on healthy working habits and treatment if necessary to get you back to work. Call 07841576336 or email

Sit less for health

Sit less for health


Although being active is good for us, there is increasing evidence that sitting down for prolonged periods of time can have negative effects on our health, independent of how much exercise we do.

Many adults in the UK are inactive for 7 hours or more each day, and this tends to increase as we get older to 10 hours or more. This might include watching TV, sitting at a desk, playing computer games or commuting.

It is thought that excessive sitting slows the metabolism, which affects our ability to regulate blood sugar and blood pressure, and metabolise fat, and may cause weaker muscles and bones. This in turn has been linked to the development of diabetes, some forms of cancer and early death.

Take a break from your desk

It can be difficult during a busy working day to consider taking long breaks from your desk or computer.  However advice suggests that to reduce our risk of ill health from inactivity, you only need to move around for 1 – 2 minutes every half-an-hour.  If you can, take a walk to speak to a colleague rather than use the phone, get up to go for a drink, or try standing rather than sitting, if you need to take a telephone call.

Take a break from the TV

In your attempt to sit less, also consider how much time you may spend sitting watching TV or on computer games.  This can be a particular problem for children as new evidence suggests that sedentary behaviour in the early years is associated with being overweight, as well as slower mental development.  If you have children, the advice is to reduce the time that toddlers spend in front of the TV or strapped into their buggies.

For more advice

For some useful hints and tips on ways to sit less, visit the NHS Livewell website.

Visit theOsteopath website, call 07841576335 email

Health at work

Your health at work


Are you fit for work? Musculoskeletal conditions (problems with the muscles, bones, joints and associated tissues) are a major contributing factor to work place absenteeism. The Office for National Statistics reports that 30.8 million working days are lost each year due to musculoskeletal issues, such as back, neck and upper limb pain, in the UK alone.

Habitual poor posture can contribute to daily aches and discomfort in the workplace and beyond. Whether you work at a desk or have a more manual occupation, your job may expose you to stresses and strains that can cause you pain.

Common causes of strain in the workplace can include:

  • Prolonged sitting at a desk
  • Driving long distances
  • Awkward lifting and carrying
  • Overstretching
  • Bending
  • Extended periods of repetitive motion
  • Using a computer without taking breaks

These can lead to various aches and pains, and other common musculoskeletal conditions such as sciatica, carpal tunnel syndrome and tennis elbow. Furthermore, workplace stress can increase the amount of pain you feel by causing muscle tension and spasms.

Keeping healthy at work

These simple tips can keep you healthy at work and avoid unnecessary strain on your muscles and joints:

  • Frequent short breaks away from the computer may help avoid back, neck and eye strain.
  • Ensuring that your chair and computer display are appropriately adjusted so that the top of the screen is at eye level, may be more comfortable for your upper body and neck.
  • When lifting, judge whether you can do this safely alone or need help (don’t be afraid to ask for assistance). Always keep the item you are lifting close to your body. Bend your knees and make your legs do the work. Try not to twist your back – turn with your feet
  • When driving make sure you are positioned comfortably, and take regular breaks on long journeys, at least once every two hours.

How can your osteopath help?

Osteopaths are highly trained, healthcare professionals, experts in the musculoskeletal system (joints, muscles and associated tissues) and its relationship to other systems of the body. Osteopathic care is based on the individual needs of the patient and so varies depending on your age, fitness levels and diagnosis. Your osteopath can provide you with a fit note if you do need to take time off from work. You can discuss with your osteopath the impact work may have on your body and agree on an appropriate course of action that may help. Along with hands-on osteopathic treatment, your osteopath may also offer advice on posture, lifting and workplace ergonomics.

For more information visit the website:

Call 07841576335 or Email for appointments

About Sleep, when working shifts

Sleep when working shifts

If you are working a changing shift pattern, getting a good sleep routine can be difficult to say the least.  We know that working night shifts disrupts our natural body clock, known as your circadian rhythm, which regulates many of our physiological processes.  This is affected by environmental cues such as sunlight and temperature, which if you are working a changing and/or night shift pattern, are altered from the the natural rhythm and may affect your health. 

Research* has shown that if you experience significant sleep loss, due working nights shifts for example, it may increase your risk of accidents at work, weight gain, type 2 diabetes and heart issues to name a few.  

Setting an appropriate routine for getting good quality sleep is therefore vital to keeping healthy.  Below is advice to help you get the best sleep pattern possible:

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Optimising sleep for night shifts

Based on the latest research* below you will find advice to optimise your sleep when working night shifts.

Day of first night shift – Minimise your sleep debt

Wake naturally, avoid a morning coffee and take a nap in the afternoon.

working shifts

During your nigh shift – Improving your performance

Stay active during your shift, eat lightly and build in checks during your shift to make sure your critical tasks are not affected if you are feeling less alert.

Last few hours and on your way home

Try to avoid caffeinated drinks or smoking late into your shift or on your way home.  Try to avoid sunlight by wearing sunglasses, even if its cloudy.  Think twice about driving if tired. Opt for public transport if available.

On the days between your night shift – minimise your sleep debt

Try to get to sleep as early as possible and avoid sleep disruptions such as bright screens, alcohol – see also tips on improving sleep. Any sleep is better than none so don’t worry if it is broken sleep or short naps.

Resetting after night shifts – re-establishing a normal sleep rhythm

Try and get a nap immediately following your night shift then go outside when you have woken up.  To get back into normal rhythm go to bed as close to a normal time and avoid napping during the day.

(* Research and supporting advice originally published by the British Medical Journal. March 2018)

Good Sleeping habits

Good sleep habits

sleep small

Here are some useful tips and advice from theOsteopath to help you to get a good night’s sleep:

Create a routine

Try to get up in the morning and go to bed at the same time each day, even at weekends. You may need to set an alarm. Creating a sleep routine will help your body make the chemicals that control sleep. Having a sleep routine such as listening to soothing music or doing stretching or relaxation exercises before bed can also remind the body that it is time to slow down and sleep. Taking a warm bath before bed may help you to feel relaxed and sleepy, and try to avoid using your bedroom to watch television or work so that when you do go to bed, your body knows that it is time to sleep.

Avoid blue light before bed

Electronic devices such as televisions, tablets and computers produce a certain type of light called “blue light”. Blue light interferes with a chemical called melatonin which helps us sleep, and it can also reduce a type of sleep called slow-wave sleep which is essential for us to feel rested.

Blue light during the day, especially in the mornings and after lunch can be useful because it can make us feel more alert, but if we have too much blue light before bedtime then sleep can be disturbed, so avoid using a computer for long periods or watching too much television just before bed. Getting more natural rather than artificial light by going outdoors as much as possible during the day can also help increase daytime alertness and improve sleep quality.

Do some regular exercise but not too close to bedtime

Regular exercise, especially aerobic exercise which gets your heart beating faster, has been proven to improve the quality of sleep and just being more active during the day can also help improve sleep and fight fatigue. If you exercise too close to bedtime though, the exercise may make you feel more alert and this may disturb your sleep. Try to do some exercise in the early evening so that by bedtime you are ready to sleep.

Try to keep your mind blank

Many people who lie awake at night find that their minds are too active, for example thinking about worries, things that they need to remember or things that they have to do the following day. Some people also find that worrying about not sleeping then makes the problem worse.

Clearing your mind is not easy but trying to be more relaxed about not sleeping can help. Try to concentrate on feeling calm and comfortable rather than thinking about getting to sleep. If a good idea is keeping you awake, keep a pad and pencil next to your bed and just write down the idea so that you can forget about it until the morning. Try some slow breathing and just concentrate on the action of breathing, perhaps counting your breaths as the air moves in and out or try some progressive muscle relaxation – tense and relax each part of your body in turn starting with the toes and working upwards. Try visualising a relaxing place such as a wood or beach. Learning meditation or mindfulness and cognitive behavioural therapy (CBT) may also help to calm your thoughts.

If you are still awake after 15 minutes or so, try getting up and doing a light relaxing task such as having a warm drink, reading or listening to an audio book or quiet music then go back to bed when you feel sleepy again.

Avoid stimulants and alcohol

Coffee, tea, cola, cocoa, chocolate and some medicines contain caffeine and other stimulants which can disturb sleep. The effects of caffeine can last for many hours in the body so consider switching to decaffeinated drinks or avoid caffeine apart from in the morning. Alcohol may help you feel sleepy at night, but overall it will interfere with the quality of your sleep and prevent you from feeling rested when you wake up.

Avoid eating large meals late at night

A heavy meal before bed or too much spicy food at night can make it difficult to sleep, so consider how much you eat before bed. Herbal tea or a milky drink may help you relax but don’t drink too much before bed as this may mean you have to wake to go to the toilet at night.

Make your bedroom cool, dark and quiet

Sleep quality can be improved by sleeping in a slightly cooler room—around 17C is comfortable for most people, so make sure that you have enough, but not too much bedding. Opening a window at night may help. If you are disturbed by noise at night, consider wearing ear plugs and if you are woken by daylight, try a blackout blind.

Try not to have a nap during the day

If your sleep is disturbed at night, you may feel sleepy during the day, especially in the afternoon. If you fall asleep during the day, even a short nap can then disturb your sleep at night. If you have to have a short sleep, make sure that you go to bed and set an alarm clock so that you don’t sleep for too long – 15 to 20 minutes maximum, and not later than the early afternoon. If you find yourself dozing in the afternoons or evenings, try to get up and do something, perhaps go for a short walk or do something active to make you feel less sleepy. Daylight and or blue light from a tablet or computer can also increase alertness if you feel sleepy in the afternoon.


In general, taking medicines for long periods to improve sleep is not a good idea and lifestyle changes are much more helpful. Although medicines that help us sleep, they are not useful for long periods because they can be addictive, can stop working after a few days, or affect sleep quality.

Some prescription medicines can also affect sleep, such as some antidepressants, painkillers and betablockers, so it is worth discussing changing your medication with your GP if your tablets seem to be causing a problem.