The Ever Elusive Sleep
Written by Nevada Advanced Pain Specialists staff
It is very common for people living with chronic pain to have sleep problems including difficulty falling asleep and/or staying asleep. According to Dr. Michael Lewandowsi, “There are many ways chronic pain contributes to sleep problems. The most common include the injury itself, nighttime pain, medications, decreased daytime activity, inconsistency in schedules and routines, weight gain, and problems with mood and anxiety” (2006). Furthermore, when sleep is inadequate and interrupted, our bodies lose out on necessary opportunities for physical and psychological repair and restoration. Not surprisingly, poor sleep affects other aspects of our lives such as difficulty regulating emotions, mood disturbance, difficulty making decisions, and poor motor control, all of which can result in a number of other complications and stressors.
It is enormously important to be an active participant in your treatment and consequently, your life. While working with your physician to address issues with pain, you can also work to integrate some behavioral strategies to assist with difficulty sleep. Changing behaviors is not easy, so commitment and reinforcement are essential to developing new patterns of behaviors. Thinking of the three P’s, patience, practice, and persistence when you are focused on behavior change can be helpful. Following are nine common behavioral strategies suggested to assist people in developing more effective sleep (Resource: sleepfoundation.org):
1) Commit to a regular sleep schedule – Waking at the same time every day, no matter how little sleep you’ve had.
2) Wait to go to bed until you are sleepy. Feeling sleepy is different than feeling tired!
3) Identify the difference between pain and associated fatigue and being sleepy. Living with chronic pain causes fatigue, which is different than being sleepy. People often make the mistake of going to bed when they are fatigued or tired, but not actually sleepy.
4) Engage in calming activities such as reading, taking a hot bath/shower, drinking a cup of herbal tea, deep breathing exercises , listen to calming music and dimming the lights before bedtime. Try to avoid stimulating activities such as TV, loud music, games, exciting conversations, and using mobile devices.
5) Talk to your doctors. Share your sleep difficulties. Review your medications and medication routine with your physicians. This will help ensure medications are taken in an optimal manner for symptom management and encourage effective sleep, as some medications interfere with sleep and others induce it.
6) Get moving. Regular activity (i.e. walking, physical therapy exercises) is recommended for both pain relief and sleep.
7) Eat regularly and watch your dietary intake. Your body requires energy (food) to sleep. If you are not eating enough through your day, your body will not have the energy to sleep. On the flip side, eating a heavy meal or spicy meal just before bed can impede sleep. Avoiding alcohol and consuming caffeine wisely are also important practices. (Resource: How what you eat affects how you sleep - www.nbcnews.com)
8) Avoid napping. Fatigue and daytime drowsiness is common with chronic pain for many reasons. Even with fatigue, avoiding naps can help create a more effective nighttime sleep pattern.
9) Bed is for sleeping only. Avoid spending time in your bed outside of your nighttime sleep. Many people, especially those living with chronic pain, will spend hours in their bed watching tv, checking phones, emailing, playing computer games, eating, etc.; this is an important pattern to break.
If you think you need to seek additional help for your sleep problems, psychiatry and mental health can also help. Please contact the office to make an appointment with me at (775) 284-8650 and we can decide the best next steps for your chronic pain and sleep patterns.
Lewindowski, Michael J. (2006) The Chronic Pain Care Workbook; A self-treatment approach to pain relief using the behavioral assessment of pain questionnaire. New Harbinger Publications, Inc., Oakland, CA.