Not sleeping because of pain*? Lack of sleep making your pain worse? Or, probably, both?
Quality sleep is completely integral to your health. But even more so when you have an ongoing issue with pain. It is one of those pieces of the pain puzzle, which, if you ignore it, leaves a gaping hole in your potential for recovery.
Life just feels a lot harder when you are short on sleep. Pain is like a constant insidious drain on your batteries, so you need to be rested enough to deal with it. Tired people are grumpy and more likely to overreact. Your nervous system is the same: it is more likely to overreact to the same physical cause of pain if you haven’t had enough sleep. So, pain feels worse when you are tired, but also, it is harder to regulate your emotional response, so you feel less able to cope with it too.
And those self care things you promised yourself to do are often the first thing to go when you are shattered. So, making sure you get the quality sleep you need is essential to start breaking the cycle of pain.
Lack of sleep and pain is a vicious cycle
Of course, if pain is disturbing your sleep, then that might be something you have little control over. But then it becomes even more important to set yourself up to get as much quality sleep as you can.
If you are thinking now ‘oh I’m not an insomniac this doesn’t apply to me’. Many people know they are tired, but some people don’t realise how much they are running on empty. We can be surprisingly poor judges of whether we are sleep deprived! Ask yourself these questions: Do I wake up refreshed? Do I need to catch up with sleep on weekends or holidays? Am I relying on caffeine to function during the day? Am I a bit wired, always running on stress?
So what can I do?
1. The basic ‘sleep hygiene’ advice. Good stuff, and many of us don’t do it when it may make a big difference. But most advice on sleep stops there. What do you do when you do all the ‘right’ things and its not working?
2. Training your brain: Does your brain agree with you about what your bed is for?
3. How to respond to the problem of sleeplessness, especially if pain is the driver.
4. Setting yourself up for successful sleep during the day. Sleep is not just about when you get into bed, or even the hour before bed. You need rest as well as sleep, and attention to your state of being during the day: to make sure you haven’t got an insurmountable amount to unwinding to do in the evenings.
Yes, you have heard of these, but do you actually do them??
- Keep your bedroom for just sleep and sex (or at least the bed if you don’t have a whole house to use )
- Cool, quiet bedroom
- Dark at night and daylight exposure: these are both to help regulate melatonin, a hormone that is important in sleep. Blackout curtains or eyemask. At least a few minutes outside everyday, whatever the weather.
- Limit screen time before bed. And no, its not just because of blue light. Its probably as much to do with how stimulating interacting with your phone or laptop is. So, a blue light blocker isn’t the full solution. Try a screen time limiter that stops you using your phone an hour or 2 before bed if you can’t help yourself.
- Routine bed time and waking time. If you have to catch up at weekends that indicates you aren’t getting enough sleep in the week. Lie ins tend to make getting to bed at the right time on Sunday difficult, and so the cycle begins again.
- Short power naps of less than 20 minutes are fine for most people. Longer sleeps, or naps too late in the day are best avoided ( but see about rest in part 2)
- Avoid caffeine — especially in the afternoons because it lingers in your system.
- Avoid alcohol — yes its great at knocking you out, but it spoils your sleep quality.
But what if you are following these guidelines, and sleep is still an issue?
Train your brain to go to sleep
Think about what you are trying to achieve — ideally you want sleep to come when your head hits the pillow.
Our brains and body do what they are trained to do: Practice makes perfect with both good and ‘bad’ habits. We want our brain to associate lying down in bed with sleep. But when we have had trouble with sleep we can be in a ‘habit’ of being in bed worrying, ruminating on those deepest problems that choose to pop up on us in the middle of the night. Or we are ‘fighting’ with ourselves: we know we need more sleep and so we stay in bed wishing it would come, being frustrated with ourselves. This causes a release of stress hormones, which are all about being able to deal with danger and getting up and running away, so have the complete opposite effect to sleep!
Like Pavlov’s dogs associating hearing a bell with sleep is a (admittedly a bit more complex) conditioned response to lying down in a bed. If we lie in bed doing other stuff, be it scrolling through our phones, working on a laptop, or just lying there worrying we are training ourselves that that’s what we do in bed.
This conditioning is partly why you want to have a routine — for instance a bath/shower, then an hour reading, check the doors are locked, clean your teeth, go to bed, always in that order and at roughly the same time. These are cues to your brain to get ready for sleep. If you can establish a successful routine then it is like a chain with each link leading towards sleep.
If this sleep/bed association has been broken for you then it can be rebuilt. It just takes some persistence. There is an excellent explanation of the nuts and bolts of retraining yourself to sleep here
But essentially its important to NOT spend time in bed NOT sleeping.
If you aren’t falling asleep with in 20-30 minutes then get up, do something that isn’t too stimulating ,eg reading, somewhere else. It can just be a chair in the same room, but get out of the bed.
If pain wakes you up and sitting isn’t a comfortable thing to do– go and have an Active Rest . Treat yourself to extra padding underneath and make sure you are warm enough. It may be you need a comfortable place to rest (but not sleep) set up ready while you are retraining your sleep patterns, so that you aren’t tempted to stay in bed awake.
While you are lying on the floor you could listen to a guided audio (I have one in my free email course), or if you need to stay out of bed for a while, then maybe an audiobook.
When you feel sleepy, try again. It can be hard at first, but it is essential to train as best a sleep/bed association as you can for your circumstances.
How to think about sleeplessness
We can’t force sleep, we can only ‘get out of the way’ to let it come.
This where practising Alexander Technique (AT) can have benefits : ‘getting out of your own way’ is a familiar phrase to those practising AT. Let the body and mind get on with what it knows how to do, and interfere less. Often, we force, and expect our bodies to comply. We think this way about ourselves when it comes to everything we do during the day, from sitting at a desk to doing exercise. If we are avoiding taking breaks that we need, ignoring our pain and tension, it can be very hard to then to switch this attitude just when it comes to sleep.
Cultivating an accepting, curious, understanding attitude to our body and mind makes dealing with sleeplessness (a tiny bit) easier.
Its important not to blame yourself for sleeplessness or expect to just have ‘mind over matter’- that will just trigger frustration or upset with yourself. Whatever the cause for your sleep issues, be it pain, or worry, or even slipping into habits like using your phone, you haven’t chosen to not be able to sleep! This is where taking the focus away from your busy brain to calming the body by using Active Rest AT thinking or progressive relaxation techniques can be helpful. Thinking through your body, undoing tense muscles, noticing your breathing and letting it come steadily and easily sends soothing feedback to the brain. This can make it easier to switch off anxious thoughts or a busy mind.
I like to think of setting myself up for success to sleep rather than counting the hours of sleep as an outcome: setting the scene is the bit I can control (mostly!). This is the physical scene of the bedroom (dark, quiet etc), my mental ‘scenery’ – making sure I’m turning the dimmer switch down on my mind some time before bed, and my overall level of sympathetic drive during the whole day.
But we can only do our best to set the scene for sleep. Worrying and micro-monitoring how many hours sleep we get is counterproductive (btw don’t trust what a phone app is telling you, how you feel is more accurate). Yes, this can be a difficult balance to strike!
As Derk-Jan Jijk says “Take sleep seriously, but not too seriously.”
In part 2, I’ll talk about how regulating how much you are in a fight/flight state during the day is really important for sleep too.