Unfortunately, sleep difficulties often go along with chronic pain. Even in people without pain, occasional sleep problems are common—75% of people report occasional sleep problems. But for people with chronic pain, sleep problems can be worse, for reasons which include…
- Pain. Falling asleep can be difficult because pain keeps you awake, or pain can wake you up in the middle of the night.
- Decreased activity. If you aren’t able to do very much during the day, you might not be tired as night.
- Anxiety and worry. These 2 notorious culprits can make falling asleep difficult if you worry about things when your head hits the pillow. Or, if you wake up during the night, you might start worrying about things and not be able to get back to sleep. Things unfortunately often look worse in the wee hours of the morning. You might wake up earlier than you’d like to and not be able to fall back to sleep.
- Depression. This often accompanies anxiety and worry. And actually, one of the symptoms we look for to diagnose depression is sleep problems, especially waking up earlier than you’d like. We call this “early morning awakening.”
- Sleep problems as part of your medical disorder. For example, difficulty sleeping or sleep that doesn’t refresh you (“non-restorative sleep”) is part of the disease of fibromyalgia.
- Medication. Although most of the medications that are used to treat chronic pain are sedating, a few can cause sleep problems.
To start, try some basic changes that can help you sleep better. These are often called “sleep hygiene techniques.”
How to Get Better Sleep
1. Use your bedroom only for sleep (and sex). This is so your mind associates your bedroom with sleep, rather than work, TV, reading, etc.
2. Develop a “getting-ready-for-sleep” routine. Again, this helps your mind and body know you’re getting ready for sleep. Do relaxing, calming activities the hour or 2 before bed. Then brush your teeth, wash your face, and turn off the lights. Even doing activities in the same order every night can help.
3. Go to bed only when you’re sleepy. It’s more likely you’ll be able to fall asleep, and you’ll avoid tossing and turning in bed because you’re not sleepy. But remember, you have to spend the hour or 2 before your bedtime slowing down your body and mind, so you naturally become sleepy. It’s unlikely you’ll begin to feel sleepy if you’re engrossed in a book, doing an online search, etc.
4. If you can’t fall asleep, get out of bed. The average time it takes to fall asleep is 5 to 30 minutes. To keep your bedroom associated with sleep, you don’t want to lie in bed unable to sleep (which can also make you start worrying about when you’re going to fall asleep). So if you’re unable to fall asleep after 20 minutes or so, get out of bed and do a quiet activity—perhaps a relaxation exercise or quiet reading—and then return to bed when you begin to get sleepy. You may then fall asleep, but if not, get out of bed again, and do this as many times as you’re unable to fall asleep. Again, the first few nights you do this, you may not sleep very much at all, but keep at it. You’re working on establishing good sleep habits! And the next night, you’ll be more likely to fall asleep sooner.
5. Get up at the same time every morning. This helps to establish a sleeping routine. You might be tired, or even very tired, the first few days you do this, but you’ll then be ready for bed at night. (On weekends and vacations, you can change this a little bit, but get up no more than 1 hour later than your usual getting-up time, and don’t do this until you’re sleeping well.)
6. No naps. Again, this goes against the sleep routine you’re trying to establish of sleeping at night, and confuses your body. If you find yourself tired, try exercise, getting fresh air, or some other alerting activity. (Again, after you’re sleeping well, if you still find you get tired, a brief—½ hour—nap in the early afternoon may be ok, especially for older adults.)
7. No alcohol before bed.
No caffeine within 8 hours of your bedtime.
No tobacco within 3 hours of your bedtime.
No, this isn’t to take away things you might enjoy—it’s because all of these disrupt your sleep! Caffeine and nicotine are stimulants—what you don’t need at bedtime. Alcohol disrupts your sleep cycles, especially deep sleep. While is may help you get to sleep, you’ll wake up more often.
8. Exercise regularly, but not right before bedtime. Exercise tires your body and decreases anxiety, in addition to all the other good reasons to exercise. Just don’t do it right before bedtime, when it can wake you up.
9. Make your bedroom a good place to sleep. Be sure your bedroom is not too hot or cold. Make sure it’s dark enough, even as the sun starts to come up. And make sure sounds don’t disturb your sleep—you can try a fan or white noise machine.
Remember, everyone experiences occasional sleep problems. But if you regularly have sleep problems, try these techniques all together. If after trying them, you’re still unable to sleep better, talk to your doctor about other options. Good sleep is very important—for your mood, for healing, and to reduce your pain.
Special Thanks to Dr. Whitman (Source)