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Chronic Pain And Sleep

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Chronic or persistent pain is something that can affect every aspect of a person’s life. It can be there every time you move throughout the day - and the night. This can affect a person’s ability to get a full night of restful, good quality sleep.

From dripping taps to crying babies, most of us can relate to what it feels like to have a single night of poor quality, broken sleep. Now extend that to every night week after week and you can start to imagine the negative effect this would have on someone kept awake by chronic pain.

As a physiotherapist I deal with people in pain on a daily basis. More and more I find part of my overall management plan is advising them on good sleep hygiene.

Scientifically, it is well recognised how important sleep is to the human body. We need it to rest, relax, rejuvenate and recharge our bodies so we can be ready for the next day. Poor sleep has a detrimental impact not only on our physical state but also our emotional state. Intelligence agencies use sleep deprivation as an interrogation tactic for one reason - it is very effective.

There are a number of non-medication strategies chronic pain sufferers can use, however, that can help them better manage their sleep.

  1. Day time is for being awake, night time is for sleeping. Unless you are a shift worker (or a vampire) you need to try and keep your sleep cycle as regular and as normal as possible. Avoid napping. People will often say they need it to catch up from restless sleep the night before. Others will use a strategy whereby they stay up until 3 or 4 am so they are simply exhausted and more likely to fall asleep. Neither of these are long term viable options.

  2. Be active throughout the day. Not only is activity beneficial for chronic pain but you need to burn off some energy so you are actually tired when it comes to bedtime.

  3. No stimulants. If a hot drink is part of of your ritual prior to bed make sure it’s a beverage that does not contain stimulants like caffeine.

  4. Avoid alcohol in the evening. Trying to drink yourself to sleep is definitely not the answer. Plus for many chronic pain sufferers on strong pain killers, most of those medications do not mix well with alcohol.

  5. Allow your brain time to wind down. This is particularly important in our digital age. You must try to limit any screen time (TV, computer, smart phone) before bed. You can try reading or listening to music instead.

  6. Following on from Tip #5, your bedroom needs to be a sleep sanctuary. It is not a place for texting, e-mailing or watching movies. It needs to be dark. It needs to be quiet. It needs to be the place you escape to relax and sleep. And do NOT have your phone in bed with you. The world will not stop turning if you miss your drunk friends’ social media post at 2 am.

  7. Establish a bedtime routine. Just like when you were three years old it prepares you for sleep. It could include brushing teeth, turning off the TV or dressing for bed. If you are able to go to bed and get up at the same time each day this will help to restore a more normal sleep cycle.

  8. Don’t let anxiety build. If you go to bed and you can’t sleep don’t then be angry with yourself for not being able to sleep. If you are dwelling on things from your day, get up and write them down so you can deal with them in the morning. If your pain is keeping you awake don’t lay in bed becoming more and more distressed. It’s OK to get up for 20 minutes or so. Move around, stretch or do whatever you know usually helps to take the edge off your pain. Stay relaxed while you are up and then return to bed and try again.

  9. Warm feet. Trust me, it works.

The final piece of advice for those whose pain keeps them awake on a regular basis is even if you struggle to achieve a good quantity of sleep (usually 6-8 hours for most adults) at least try to have some good quality sleep. Most people will tell you 4 hours of deep, relaxing sleep feels better than 5-6 hours of broken, poor quality sleep.

For chronic pain sufferers the day to day grind of persistent pain can wear them down very quickly. Often the only relief they have from their symptoms is when they are asleep. If that is also taken away then it leaves them with no respite whatsoever. The importance of a good night’s sleep cannot be overestimated.

Hopefully these strategies can help. Do not expect them to work overnight (pun intended) but persist with them and you should see some positive results down the track.

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