Sleep is important for both physical and mental health and improves your overall quality of life. We know that living with a chronic condition and chronic pain can cause problems with sleep, including having problems falling asleep, staying asleep and also having good quality sleep. It is common to wake many times a night during the night. Most people go back to sleep without even realising it. When you are in pain, however, you may wake and notice your pain which leads to an increased activity in your nervous system that then needs to calm down all over again to fall back to sleep. Lack of sleep can, in turn, can make your experience of pain worse thus becoming a vicious cycle.
Good sleeping habits and practices are often referred to as sleep hygiene. Sleep hygiene involves a combinations of many things that can help you get a better night’s sleep.
• Be as consistent as possible with the times that you go to bed and get up – this helps you regulate the internal clock and hormones that control your sleep patterns
• Wind down time – also helps the body recognise that it’s bedtime and make associations between your bedtime ritual and sleep. Relax for an hour before going to bed and make it the same or similar every night (in the same order). This could include a warm bath or shower, light stretching, meditation, listening to music or reading – whatever helps you relax
You should try and create a sanctuary that will calm you down and promote the sleep ritual.
• Darkness (light tells your brain it’s wake up time) – use block our curtains, face masks, limit lamps/night lights etc
• Quiet with little or no noise – close your door, use ear plugs, avoid sleeping with pets & children as they may wake you without you realising it
• Sleep in a cool temperature (around 18 degrees) with warm blankets if needed is optimal
• Bed and bedding – ensure they are comfortable and comforting
• Reserve your bedroom for sleep only – don’t have a TV in your room and avoid working, eating and being on any devices (phone/computer etc). Also try not to be in your bedroom during the day, even for rest, you should link your bed with sleep (& intimacy) only.
Worry & sleep
Worrying about getting to sleep or other things also increases the activity in your nervous system which makes getting to sleep and staying asleep more difficult. Here’s some tips to help you decrease your stress and worry at bedtime.
• Don’t watch the clock –remove the clock from your room if you can or turn it around so you can’t watch the time ticking over
• Slow down your mind – try to stop thinking about what you need to do tomorrow or repetitive churning of thoughts – get it down on paper – write down your thoughts or a list of what you need to get done and put it aside and out of the bedroom – writing things down often allows you to clarify and release the thoughts for now
• Mindfulness is useful – it helps you let go of thoughts and relax. By focusing on the moment and not repetitive thinking, your body will start to relax. This can be done through breathing exercises or guided meditation. We recommend watching the ABC Catalyst program that aired on mindfulness – see the link in the Further Reading section below
If you wake up during the night – don’t stay in bed struggling – get up and do something else in another quiet room (perhaps read) for 20 mins and then go back to bed – no devices, activities/eating drinking during this time.
Things to do during the day to help sleep at night
• Exercise – even small amounts of exercise (10 minutes at a time) has shown to improve poor sleep. Being more physically active during the day should organically make the body more fatigued and hunger for sleep at the end of the day. Get natural daylight (as well as darkness at night) – the greater the difference between daytime light and night time darkness, the more melatonin your body will produce. This is the hormone that promotes sleep and helps with your internal body clock. Getting daytime light is especially important if you normally don’t spend a lot of time outside
• Try not to nap too frequently in the day. This will disrupt your body clock and make it harder to sleep in the hours typically reserved for sleep.
Go for a walk in the sunshine and tick off both of the above!
Things to avoid before bedtime
• Avoid LED lights (from screens) for 1-2 hours hour before bed – the blue light emitted from these devices (TV/phone/computer) interferes with the brains natural sleep rhythms
• Avoid stimulants for a few hours before bed – caffeine, sugar (soft drink, chocolate, cola) & cigarettes
• Alcohol – although it may help you fall asleep, it disrupts REM and may wake you up more frequently
• Eating – avoid going to bed on a full or empty stomach and foods that can also cause indigestion – such as fatty, rich foods or spicy meals
How long should you sleep?
Don’t spend too long or not enough time in bed – 7-8 hours is good – don’t get into habit of drifting in/out of sleep for more than 8 hours or so. For some it may be better to go to bed later at night to reduce your wake time in bed. With regard to naps, short naps during the day are OK, but limit them to a maximum of 20-30 mins. Naps close to bedtime or dozing in front of the TV should be avoided – even for 5 mins!
Medication can assist in helping you to improve your sleep but are not recommended as a stand alone treatment. Many sleep medications are indicated for short term use only as your body builds up tolerance to them. Sleep problems associated with pain are not often short term problems. Many of them do not give you a sleep that is the same to natural sleep, which may mean still feeling tired. In addition they can also have unhelpful interactions with some pain medications that you may be on such as opiates. However, some medicines can be useful for short term use to reset your sleep habits and to break a problematic cycle such as napping. There are some medications that are better for sleep when chronic pain is also present.
See your GP or rheumatologist to discuss potential medications.
Anxiety and depression
Low mood (or depression) and anxiety often start with chronic pain. Both also impact on sleep, but in different ways. Depression can often result in early morning awakening, much earlier than you would like and you cannot get back to sleep. Often it is associated with a racing heart and thoughts that won’t switch off. For anxiety, it can be difficult to fall asleep initially, with thoughts that don’t want to switch off. If you receive treatment for depression and anxiety, it is likely to have a positive impact on your sleep as well as your mood and pain.
Cognitive behavioural therapy (CBT)
If you’re dealing with depression or chronic pain in addition to sleep issues, regular visits to a psychologist may be helpful. Using CBT, a therapist can help you identify and replace problematic thoughts and behaviours affecting your well-being with healthy habits. For example, your thoughts about sleep itself could be causing you anxiety, making it hard to fall asleep, thereby worsening your anxiety. CBT can be used to address sleep disorders, depression, or chronic pain. Ask your doctor about finding a psychologist that can help you.
Different things work for different people, find what works for you and try and stick to it as best you can. Try not to fight against it and accept that you have sleep difficulties. Use the tips to gain some control and make some positive changes to improve your sleep. If nothing works talk to your doctor, they may discuss your medications, what is causing your sleep issues and could refer you to a pain or sleep specialist.
Sources & Further Reading
Sleep Disorders Australia – Resources
Catalyst Program – The Mindfulness Experiment – mindfulness to treat chronic pain, anxiety and stress (scroll down)
NPS Medicinewise – How to Sleep Right
Healthline – Natural Sleep Therapies
WA Dept of Health – Sleep & Pain
Healthline – Tips for Ending Sleep Pain Depression Cycle