Sleep is a common problem for people with persistent pain and having a good night sleep can help with improving mood, recovery, energy and overall pain. There are a number of reasons besides pain that can interfere with sleep including increased stress and anxiety, reduced sleep pressure during the diet, food and drink before bed, poor sleep hygiene, unhelpful thoughts and beliefs about sleep, and sleep environment.
To help with improving sleep, it takes time to build up habits and routines to improve sleep. A good starting point is to complete a sleep diary for a week. The following link has a worksheet you can start to track your activity pre - bed and in - bed. Filling this out can give a snapshot of your week and then help your clinician have an idea of your sleep patterns to start identifying areas to improve sleep.
Your sleep diary can tell us about your sleep efficiency, which refers to the percentage your are asleep versus awake while you are in bed. If you spend a significant percentage in bed while awake, this can create habits that encourage alertness. Some strategies to help with this includes the following:
If it takes you more than 30 minutes to get to sleep, then aim to push your bed time later. For example if you get into bed at 10pm and don’t fall asleep until 11:30pm, then move your bed time to 11pm. When you fall asleep under 30 minutes, you can start to shift your bedtime earlier if your goal is to wake up earlier in the morning
If you wake up at night, and it takes you longer than 30 minutes to get back to sleep. Try to do some deep breathing exercises, stretch, or listen to a sleep meditation. If you are still alert unable to get back to sleep, then get up and reset your bed time routine. This can include grabbing a drink, reading a book, listening to a podcast, or doing a gentle boring activity like folding clothes, and when you are getting tired, try going back to bed.
When you wake up in the morning, avoid staying in bed and get up. If you would still like to rest while away, move away from the bedroom. The aim is to keep the bedroom strictly for sleep to help associate the space only for sleep.
If you find clock watching is impacting on your sleep, move it out of the bedroom. If you are having challenges with the above strategies, have a discussion with your clinician to help tailor a plan.
Improving sleep involves habits during the day and the following are some tips you can start to work on:
Getting early morning sunlight at least 15-30 minutes, and another round of light in the afternoon for 15-30 minutes to help with regulating melatonin and your circadian rhythm for sleep at night
Increasing sleep pressure which involves doing activity to help increase end of day fatigue to help with sleeping at night. This may involve reviewing pacing, graded activity and exercise with your clinician if you have challenges with this due to your pain
Eating food 4 hours before bed time
Avoiding alcohol, nicotine, caffeine 4 hours before bed
Improving sleep routine and hygiene strategies that can help contribute to better sleep and the following are some things to start implementing:
Create a sleep routine which involves winding down, for example, dimming lights at night, showering, brushing teeth and getting into pyjamas, meditation, reading/audiobook, listening to a podcast/music, doing a puzzle, or stretches before bed
Avoiding screen time before bed
Creating an ideal environment for sleep including a temperature of about 15-20 degrees, quiet environment, and dark room
You can start working on 1-2 habits and start stacking them as you get the hang of the routine. Working with your clinician can help identify any obstacles with sleep and tailor specific strategies to your needs. It takes time for sleep to improve and working at these strategies over a period of weeks is sometimes required to notice a change in your sleep. Don’t be discouraged if you don’t notice a change immediately and any rest is still a benefit to your overall wellbeing. Also sleep fluctuates and you may have good and bad nights, which is normal and you are working on reducing your distress connected with your sleep to help with overall stress and improve your ability to rest.
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