Pain and sleep

While not a great deal is known about sleep one thing that we do know is that sleep is important.  With a lack of sleep people find themselves feeling run down, tired and out of sorts, have difficulty maintaining attention or concentrating, have memory difficulties, become more irritable than usual, and have more trouble dealing with the day to day hassles of life.

If you are having difficulty with sleep it is important to try and identify why your sleep is disrupted. Some common causes for poor sleep include:

•           Stress and worry
•           Not enough activity during the day
•           Too much rest
•           Daytime naps (disrupts the bodies natural sleep cycle)
•           Stimulating activities in the evening
•           Irregular bedtime
•           Low mood
•           Medication
•           Stimulants – coffee, teas, sugar, nicotine etc.
•           Discomfort (including pain)
•           Alcohol in the evenings

Once you have identified some of the reasons that your sleep is disrupted it is important to address these to improve you chances of sleeping.

Stress and worry

Stress and worry are the most commonly identified reasons for people having difficulty getting to sleep or being woken up in the night.  This is because we often feel helpless in our ability to deal with problems at night.  If you are having difficulty sleeping due to worrying thoughts get out of bed and move to another room.  Write down the problem and any potential solutions. If it is something that can be addressed at this time then address it. If it is not then make a plan with your self to address it at a time when you can.  Only return to bed once you have made a plan for solving the problem.

It can be helpful to set aside some time each evening to try and think of what things are bothering you and problem solve.  Do this well before you go to bed each night, and it should reduce the chance of engaging in worrying thoughts in bed.

Some people find that they are having difficulty sleeping because they are worrying about their sleep.  They tend to hold quite catastrophic beliefs e.g. “if I don’t get to sleep right now I will never be able to function tomorrow”.  Examine your thoughts and beliefs about sleep.  Are you being realistic?  If not, what is a more realistic way to think about sleeping?

Lack of activity during the day

Increasing you activity levels during the day will help you to fall asleep at night. It will also increase the chance of a deeper, more rested sleep. This can include both mental and physical activities.

Too much rest

Too much rest during the day makes it more difficult to sleep at night. Resting during the day can disrupt the sleep/wake cycle. Try and restrict the amount of resting time each day by engaging in more activities.  Doing more during the day will increase your chances of sleeping at night.

 Daytime naps

People sometimes think that if they can catch up on sleep during the day they, will feel better. Sleeping during the day disrupts your body’s natural sleep/wake rhythm, making it more difficult to sleep at night. Therefore it is important to avoid sleeping or napping during the day.

Activities in the evening

Avoid strenuous activities for about 3-4 hours before bed, this includes exercise. Strenuous activities tend to stimulate you and wake you up. While it is important to increase your activity levels to help with sleep, ensure that all exercising is done earlier in the day.

It is also important to use your bedroom for sleep and sex only.  Restrict all other activities (including computers, television, discussions and telephone calls) to other rooms in the house. This way your body will learn to associate your bedroom with sleep.

Irregular bed time

Try and go to bed and get up at the same time each day.  Don’t try to catch up on sleep by lying in bed as this will disrupt your sleep-wake cycle.  It is also important to develop a bedtime routine. Start to wind down your activities about an hour before you want to go to sleep (e.g. warm bath, herbal tea, relaxation techniques, reading, quiet music). Make sure you do the same things each night so that you develop a pattern or sleep-time habit.

Low mood

When experiencing low mood, people tend to feel lethargic and drowsy, however they also report that they have difficulty sleeping.  Often this difficulty with sleep stems from worrying thoughts.  If you are having difficulty sleeping due to worrying thoughts get out of bed and move to another room.  Write down the problem and any potential solutions. If it is something that can be addressed at this time then address it. If it is not then make a plan with your self to address it at a time when you can.  Only return to bed once you have made a plan for solving the problem.

You may also wish to consult a professional who specialises in dealing with low mood. If so, ask your GP for a referral to a psychologist to help you to improve your mood. (also see the section on Thoughts, emotions and pain)

Medication

Some medications have side effects that interrupt your sleep. If you are having difficulty sleeping discuss the possible side effects with your Doctor.

 Some medications also have a sedative effect. If you are withdrawing from these medications they may interfere with your ability to sleep.  In this case it is important to utilise these strategies to avoid any bad sleeping habits from developing.

Stimulants

Avoid stimulants for at least 5-6 hours before you go to bed as they will still have an effect on your body. This includes caffeine (e.g. coffee, tea, chocolate, and some soft drinks), sugar and nicotine. It is also important to avoid heavy or spicy meals in the evenings. If you feel hungry before bead, have a light snack.

Discomfort

When people are in pain or discomfort, it can be difficult to get to sleep.  Often this is due to the distress that comes with pain rather than the pain itself.  It is important to remain calm and rational about your pain and discomfort to help you sleep. Look at the section on Stress and worry for some information on dealing with this.

Alcohol

Although alcohol is initially relaxing it will actually lead to a disturbed night’s sleep. Alcohol disrupts the usual pattern of sleep stages and causes increased night-time waking.

All of the above suggestions are about improving you sleep habits. As with other changes in habits, they take time and dedication.  It is important that you stick with these behaviour changes to see their benefit.