Chronic Pain and Sleep
Pain is considered to be 'chronic' when it lasts for a long period of time or returns frequently. Any type of pain can be stressful, but the prolonged nature of chronic pain can make it particularly so. Over time, this stress can take a toll on your physical and mental health. If you have chronic pain it is important to learn as much as you can about how to manage it effectively.
- 'Control Your Pain (1996)' by Robert H. Phillips, Ph. D. - This easy to read booklet offers 144 concrete strategies for reducing and managing the pain of lupus. Available from the LSA Lending Library
- 'Living With Chronic Pain - Second Edition (2009)' by Jennifer P. Schneider, M.D., Ph.D.
Take the time to visit the following websites to find excellent information about dealing with your chronic pain:
- Canadian Pain Coalition
- Chronic Pain Association of Canada
- The American Chronic Pain Association
- The American Chronic Pain Association - Using Opioids Safely
- The American Chronic Pain Association - Consumer Guide to Pain Medications and Treatments (2011)
- Making Sense of Pain Relief
- American Pain Foundation
- The National Pain Foundation
GOOD QUALITY SLEEP
We tend to think very little about our sleep patterns unless they become disturbed. Most people face problems with sleep at some point in their lives. If sleep is disturbed frequently or over long periods of time, however, it can have a major impact on your physical and mental health.
Normal sleep occurs in cycles throughout the night. A non-rapid eye movement (non-REM) phase begins right after falling asleep. This phase has four cycles, each of which lead into deeper sleep. During non-REM sleep the eyes are still, the body is very quiet, brain activity is slow and regular and the five senses shut down. The non-REM phase lasts about seventy to ninety minutes. The final stage of non-REM sleep, called "delta sleep", is the deepest and most restorative type of sleep.
The next phase of sleep is called the rapid eye movement (REM) phase of sleep. This phase typically lasts between ten and thirty minutes. During REM sleep, dreams occur, eyes move quickly behind closed eyelids, pulse and metabolism speed up, and breathing becomes faster and more irregular. Brain activity also speeds up and becomes irregular. This phase appears to be most necessary for psychological health. When the REM sleep phase is complete, the sleeper moves back into non-REM sleep and the cycle begins again.
The full cycle of non-REM and REM sleep is needed to feel well rested and alert. When sleep is interrupted, feelings of fatigue and irritability may be present the following day.
Below are a number of things to consider to help you get the amount and quality of sleep that your body needs to regenerate and for you to feel restored each day.
- Good sleep is vital to good health.
- The amount of sleep a person needs varies from person to person. The right amount of sleep is whatever leaves you feeling rested and alert. As a general rule, babies require about 16 hours a day, teenagers about 9 hours, and adults about 7 or 8 hours of good quality sleep to feel refreshed.
- Find ways to reduce any pain or discomfort that prevents you from having a good night's sleep. Explore some non-medication strategies for reducing pain such as massage, gentle stretches, supportive pillows and positions, etc. If you require medication for pain, take it so that it will be working when you are trying to fall asleep. Some people find a massage with one of the over-the-counter pain creams is effective for night time pain relief.
- Some people find that they fall asleep more easily when lying on their back.
- You will find it easier to fall asleep if you keep a fairly regular sleep routine. Take the time to unwind and engage in some relaxing activities before bedtime whenever possible. Just before bedtime follow the same 'ritual' that indicates that this is 'bedtime' for you (e.g. drinking a small glass of warm milk, brushing your teeth, massaging aching muscles or joints.)
- For the most part, wake up and go to bed around the same time each day.
- If you find that your mind tends to becomes active as soon as your head hits the pillow:
- You may find that the regular practice of mindfulness meditation (about 20 min a day) can help you develop a different relationship with your thoughts - learning to merely observe them without getting so caught up in them
- Keep a pen and paper next to your bed so you can quickly jot down those things you are worried you will forget to get them 'off your mind'.
- To increase your natural level of melatonin (a hormone that tells your body that it's time to sleep), avoid bright lights in the later part of the evening and during the night. It's important to keep your bedroom as dark as possible - make sure you have heavy blinds or curtains and cover the display on your digital clock. Have a low light option in the bathroom rather that turning on bright lights (or wear sunglasses to the bathroom).
- Avoid excess fluids close to bedtime and during the night to reduce trips to the bathroom.
- Use earplugs or a 'white noise' source such as a fan to block out noises that can disrupt your sleep.
- If your partner snores, have them take steps to prevent snoring such as using adhesive strips that open nasal passages, anti-snore pillows, sleeping on their side rather than the back, etc. If none of these remedies works, you may want to consider having a separate room available that you can escape to if the snoring is disrupting your sleep. Separate sleeping arrangements is more common than you might think (1 in 4 couples) and many new homes are being built with two 'master' bedrooms.
- Use your bedroom for only sleep and sex. Other activities such as watching TV, reading and work should be done elsewhere so you come to associate you bedroom with sleep.
- Make sure that your bedroom is cool. A drop in body temperate at night is one of the signals that tells your body you are ready for sleep. Some people find that having a hot bath just before bedtime sets the stage for this drop in temperature and helps with relaxation.
- Avoid nicotine and caffeine in the evening as these are both stimulants. Sources of caffeine include: coffee, tea, chocolate, caffeinated sodas.
- Regular exercise generally helps people to sleep better. But avoid heavy physical activity or exercise later in the evening as this can disrupt your sleep.
- If you wake during the night, avoid looking at the clock. Counting the minutes and hours will only increase your level of stress.
- If you can't get to sleep, don't roll around in bed endlessly. After about 20 minutes, get out of bed and do a quiet activity like reading in dim light till you begin to feel sleepy and then try again. Repeat this as many times as necessary - it may take a few nights of this to 'retrain' yourself to sleep when you go to bed.
- If you have to nap during the day, keep the length short (about half an hour and not later than the afternoon.
- Drinking alcohol before bed is not a good idea - you may find that it helps you to fall asleep, but it reduces the quality of your sleep and many people find that they wake during the night.
- If, in spite of these suggestions, you have difficulty falling asleep or staying asleep on a regular basis, discuss the matter with your doctor. Sleep disturbances can sometimes be a symptom of illness such as clinical depression and should not be ignored. Some over-the-counter sleep medications and herbs or prescription sleeping medications may be helpful for short term sleep disruptions, but these products should not be used for longer periods of time without direction from your doctor.
- If you find that you are waking frequently during the night and not feeling refreshed in the morning, you may want to explore the possibility of having a condition called 'sleep apnea' - See: Public Health Agency of Canada - Sleep Apnea.
Recommended reading: 'Get to Sleep! How to Sleep Well Despite Lupus - 1995' by Robert H. Phillips, PhD. - available from the LSA Lending Library