Some of these are tried and true for most people, but when you have chronic pain, insomnia seems to be part of the package and is an entity all unto itself. We’re talking chronic insomnia here. It’s not your average insomnia. Sometimes it’s the pain itself keeping you awake or waking you up or keeping you from falling into a deep restful sleep. And then you wake up more tired than when you went to bed, right? I hate it when that happens. Not the way I like to start the day.
Other times, it may be the side effects of the medications you’re taking to deal with the pain or another condition you may have. Sometimes it’s none of those things. It could be something you ate (or didn’t), anxieties over something to come, too hot a sleeping environment, playing with your e-devices to close to sleep time or even overexhaustion! Yes, you can be too tired to sleep.
The fatigue from sleep deprivation is no joke and has been documented. It can also contribute to a heightened sensation of pain and other uncomfortable sensations. Do you get cranky when you’re tired? If so, then what do you think happens when that goes on for days or weeks? Not helpful.
Your mission, Insomnia Detective if you choose to accept it (apologies to Mission Impossible creators) is to figure out what the culprit is, maybe with the help of someone you trust and/or your physician. That process will involve going through what you’ve been doing around the hours before you cut out the lights–eating, activities, thoughts, sounds, medication, pain or other discomforts. You will determine what your sleep hygiene is.
You will have to rule-out what these sleep interruptors might be and the process of elimination may take a couple of weeks or more. Be prepared to perservere in your detective work—no one cares about this as much as you do! One night of trying something may not be enough to determine that “this is it!” and you will need to keep being a detective to try a number of things before you find the thing(s) that help or hinder your sleep.
Things you may need to stop doing/conditions you may need to change can include:
- Exercising vigorously too close to bedtime. This can be a stimulant and keep you going for hours.
- Eating foods that upset your stomach or stimulate you (caffeinated drinks and sometimes alcoholic drinks) can do that
- Taking medications too late in the day if they are supposed to help with your sleep or if ‘somnolescence’ (making you sleepy) is a side effect.
- Trying to fall asleep when you’re already in pain
- Trying to sleep with cold feet
- Trying to sleep with too many lights on, once you’ve turned off the main lights. What??? Electronic appliances and devices often have colored LED lights that illuminate chargers or power switches. Even your digital alarm clock has LED lighting. Are they too bright once you’ve turned out the lights?
- Sleeping with the TV or radio on–are you still ‘listening’ even though you’ve fallen asleep?
- Other life demands causing you to not get enough rest, e.g., shift work, noisy neighbors/roommates
Some remedies for the situations listed above:
- Stop exercising vigorously within three hours of your regular bedtime. Your body needs time to cool down and relax.
- Eat your last meal no more than 2 hours before bedtime–and that’s a caloric risk if you’re trying to lose weight. You won’t have time to burn off those calories before resting for the next several hours (= making fat). No caffeinated beverages within two hours of bedtime.
- Talk to your doctor about adjusting medications that may affect your sleep, whether there is an intended effect of somnolence or a side effect. An adjustment by an hour or several may be needed so that you are getting sleepy at your intended bedtime. The other medications that we haven’t discussed are those that may keep you awake as a side effect or intended effect. Could you perhaps switch those to early in the day, so that you can take advantage of them for alertness when you need to be most alert?
- Let’s assume that your pain medications are sufficient for controlling your pain. Are you taking them early enough and regularly enough so that they work for you in quelling the pain before it blooms out of control? If you can take your medications on a sliding frequency–like every 3-4 hours, don’t wait until 4hrs to take it. That may be too late. Take it at 3hrs–you’ve already been given permission by virtue of the prescription to take it that often. Do yourself a favor and let the medicine do its job!
- Bright LED’s in your bedroom–try dimming the clock’s display until it’s almost not detectable. Use room darkening curtains if you have to sleep during the day (shift workers) or street lights that shine in. Cover the LED power switches with some black electrical tape or change your bed position, so that they aren’t directly in your line of vision (shining in your face). A little light is stil light and when it’s dark, even a little bit of it may be too much to allow you to sleep peacefully. Sleep with a mask over your eyes. Cheap, easy and doesn’t require you touching electrical stuff.
- TV and radio ‘white noise’…some people just can’t fall asleep without it, but make sure that it’s not the thing keeping your brain awake in the conscious world. Your mind is supposed to operate on another level when you’re sleeping.
Ok. Your ‘detectiv-ity’ (yes, I just made it up!) was successful and you found the cause(s)–yes, more than one or two things may be contributing. Next Steps:
- Learn what works for you and try not to compromise on that. For example, if you need a warm bath at 8:53 every night, then let people know to be out of the bathroom by 8:40 and that you are unavailable after 8:45 for the next xx minutes. Sit down with your roommates/neighbors (if they’re approachable) and tell them what your problem is–it’s your problem, not theirs. Let them know what you’d like to have happen and try to work something out that both of you can live with. Give them some feedback after a few days if it worked or didn’t. Reinforce your request if it didn’t, like this, “Remember, I need the house to be quiet after 9:30 so I can get enough sleep. I have to get up at 5:oo AM. Thanks so much.”
- If a family member brings an urgent problem to you that they can otherwise handle, ask them to do so and to let you know how things worked out. Try not to get sucked into the games people play when you are trying to change how things are done in the house. Usually they will try, because your change may be their discomfort, and it’s emotionally easier to stop you than change how they think about it!
- Do self-soothing things before bed and include in your nighttime ritual, a.k.a. sleep hygiene. Self-soothers are things that calm you down, make you feel safe and snug and in regards to this, help to induce sleep
- Reserve your problem-solving for earlier in the day. If an idea pops into your head while you’re trying to fall asleep, write it down and let it go. Keep a pad and pen/pencil on your nightstand if this happens frequently.
- Warm (not hot) bath, just before you go to bed
- Nighttime yoga poses (less strenous and calming)
- A cup of chamomile tea before bed
- Adjust the temperature of your room, by adding a fan or a heat source
- Wearing socks if your feet tend to get cold
- Read something–this is almost a guarantee for me! Once I nod and wake up 2-3 times, then I know it’s time for lights-out
- Have sex
- Have earplugs or white noise to block out sounds in the house (people that stay up later than you), neighborhood (loud cicadas, barking dogs, early-rising cheeping birds)
- Pray or meditate or both!
Websites for additional information (you should find slightly different and additional information on these sites:
- WebMD’s Sleep Disorder Health Center Page
- Mayo Clinic Insomnia Definitions
- Sleep Foundation
- Spine-Health.com’s page on Chronic Pain and Insomnia