Importance of Sleep When Living with Chronic Pain

Sleep Hygiene | Techniques to Fall Asleep | Specific Sleep Issues

Sleep affects pain. You may have noticed that when you sleep poorly and are tired your pain tends to be worse. Research shows that one of the most important predictors for pain intensity is the number of hours slept the night before. Bottom line: if you sleep poorly, your pain will be worse the next day.
Medication management should include sleep as well as pain. As sleep improves, the need for pain medications will decrease. Eventually the need for sleep meds will also decrease.

Sleep Hygiene

How Much Sleep Do We Need?

The amount of sleep each person needs depends on many factors, including age. For most adults, 7 to 8 hours a night appears to be the best amount of sleep, although some people may need as few as 5 hours or as many as 10 hours of sleep each day.

If you feel drowsy during the day, especially during stimulating activities, you haven't had enough sleep. If you routinely fall asleep within 5 minutes of lying down, you probably have severe sleep deprivation, possibly even a sleep disorder. Micro-sleeps, or very brief episodes of sleep in an otherwise awake person, are another mark of sleep deprivation. In many cases, people are not aware that they are experiencing micro-sleeps. This may be a cause of accidents both on the road and at work. It will certainly reduce your ability to perform at your full potential.

Unfortunately many medications including those that are given for pain can interfere with normal sleep patterns. These include antidepressants, opioids and anti-anxiety medications, even those given as sleeping aids.

Obesity worsens sleep and increases the risk of snoring and sleep apnea (pauses in breathing while you sleep). Chronic lack of sleep also increases the risk of obesity by changing the level of certain hormones. In a study of American adults who slept fewer than 6 hours, 33% were obese compared to only 22% of those who had 6-9 hours of sleep.

Reaching a Pre-sleep Brain State

(Techniques to get asleep and stay asleep)

The brain state associated with meditation or self-hypnosis is much like the pre-sleep brain state. A pre-sleep brain state can be brought on by mental activities that involve experiencing absorbing sensations and images instead of planning or worrying.
Reaching a pre-sleep brain state will increase the chance that you will fall asleep.
You can use these methods when you first go to bed at night, or if you wake up in the middle of the night.

The 3-2-1 technique:

• Get into a comfortable position, mentally checking your body to make sure that every body part is as comfortable as possible.
• Listen for and note three sounds, any three sounds.
• Note three neutral or comfortable body sensations, any three sensations.
• Allow three images to appear in your mind’s eye, and note them.
• Note two sounds, two sensations, and two images.
• Note one sound, one sensation, and one image.
• Note three sounds, three sensations, and three images.
• Note two sounds, sensations, and images.
• Note one sound, sensation, and image.
• Keep repeating until you drift off to sleep.

Relaxation by mental scanning:

• Get into a comfortable position, mentally scanning your body to make sure that every body part is as comfortable as possible.
• Starting with one foot, note relaxing feelings and sensations in the foot, and allow those sensations and feelings to grow and spread.
• Systematically allow those feelings to move into each area of your body (one foot, lower leg, upper leg, other foot, other lower leg, other upper leg, one hand, that arm, other hand, other arm, shoulders, etc.)
• Pay close attention to feelings of relaxation and “letting go”.
• Enjoy and become absorbed by those feelings and sensations until you drift off to sleep.

Using imagery (your imagination) to go to a relaxing and absorbing place in your mind:

• Get into a comfortable position, mentally scanning your body to make sure that every body part is as comfortable as possible.
• Select a place that you would like to go to in your mind’s eye. A place where you can feel safe, very relaxed and comfortable.
• Imagine being in that place and just notice what is around you and how relaxed you feel. Notice the colors, the smells, the comfortable breeze.
• Keep imaging the details of this place (and your own comfort) until you drift off to sleep.

Sleep Restriction therapy

• Use a sleep diary to keep track of your total hours of sleep at night.
• Get up at your usual time but go to bed later so you are only in bed for as long as you are currently sleeping. For example if you find that you are only sleeping about 4 hours a night and you normally get up at 7 a.m., go to bed at 3 a.m.
• Do not lie in your bed or sleep during the day.
• Gradually increase length of time in bed by 30 minutes until you are getting a full night’s sleep.

Specific Sleep Issues

Some specific sleep problems may need specific treatments

• Sleep apnea: Observers say you snore loudly and often hold your breath while sleeping. It may make you grumpy, impatient, irritable, forgetful, or fall asleep while being active. You may experience hard-to-treat headaches. It tends to make obesity, depression and leg swelling worse.
• Restless leg syndrome: You feel a creeping, crawling, aching, or tingling sensation in your lower legs worse at night-time. It may last for 1 hour or longer. Sometimes it also occurs in the upper leg, feet, or arms. You feel an irresistible urge to walk or move your legs, which almost always relieves the discomfort.
• Periodic leg movement: This is a repetitive cramping or jerking of the legs during sleep.
• Depression and anxiety: These are also associated with poor sleep. These can be helped by non-medication methods as well as medications.

A restful night’s sleep is one of the top priorities in solving your chronic pain. The effectiveness of your other treatments is limited until you are regularly experiencing a full night’s sleep for at least six weeks. Usually medications are required for a while in the presence of pain. As your pain diminishes so will your need for sleep medicines.

No major additional treatment decisions should be made until this goal is accomplished.

Steps to Get There

Keep a regular sleep routine

• Go to bed at the same time, each night. Wake up at the same time. Ideally, your schedule should remain the same (+/- 20 minutes) every night of the week.

Avoid naps if possible

• Each of us needs a certain amount of sleep per 24-hour period. We need that amount, and we don’t need more than that.
• When we take naps, it decreases the amount of sleep that we need the next night – which may cause broken sleep and lead to insomnia.

Don’t stay in bed awake for more than 5-10 minutes

• If you find your mind racing, or worrying about not being able to sleep during the middle of the night, get out of bed and sit in a chair in the dark. Let your mind race while you are in the chair until you are sleepy, and then return to bed. No TV or internet during these periods! They will just stimulate you more.
• If this happens several times during the night, that is OK. Just maintain your regular wake time, and try to avoid naps.

Don’t watch TV or read in bed

• When you watch TV or read in bed, your brain associates the bed with being awake.
• The bed is saved for two things – sleep and sex.

Do not drink caffeine after 12 noon

• The effects of caffeine may last for several hours after you drink it. It can break up sleep as well as make it harder to get to sleep. If you use caffeine, only drink it before noon.
• Remember that many sodas and teas contain caffeine as well.

Avoid substances that may interfere with sleep

• Cigarettes, alcohol, beta-blockers (medications given for blood pressure), antidepressants taken in the evening and many over-the-counter medications may cause poor sleep.

Exercise regularly

• Exercise before 2 pm every day. Exercise helps continuous sleep.
• Avoid heavy exercise before bedtime. It may increase hormones, which may disrupt sleep.

Have a quiet, comfortable bedroom

• Set your bedroom thermostat at a comfortable temperature. Generally, a little cooler is better than a little warmer.
• Turn off the TV and other noise that may disrupt sleep. Background ‘white noise’ like a fan is okay.
• If your pets wake you, keep them outside the bedroom.
• Your bedroom should be dark. Turn off bright lights.

Clock watching

• If you are a ‘clock watcher’ at night, hide the clock.

Have a comfortable pre-bedtime routine

• A warm bath or shower.
• A warm milk drink without caffeine.
• Meditation, or quiet time.

Resources

• Exercises to treat sleep apnea - Download the free attached online video supplement