Part 2: Optimising sleep + Sleep and pain

If the previous sleep information hasn’t put you to sleep yet, let’s really nail it on the head now. A set of strategies to improve you sleep hygiene can make a dramatic difference to your quality of sleep.

 

“Sleep Hygiene” – Top tips in order to optimise our sleep naturally (5).

1. Enhance routine: go to bed around the same time every night and rise around the same time. The effects of this will help set your “body clock” and keeping your awake vs. sleep hormones in check.

 

2. Length of time in bed: aim for your age duration (or just the time that you know works for you!). Too much will lead to poorer quality and fragmented sleep habits. If you take a long time to get to sleep, try going to bed a little later.

 

3. Bed is for sleeping, not entertainment: this can sometimes even include reading in bed! Say no to technology one hour before bed. Stay away for social media and the infinite scroll! Some phones have an option called ‘night-time’ that you can set for the previous hours (3-4) before bedtime. This lowers the ‘blue light’ to a more yellow light, for even less stimulation.

 

4. Wind down time/relax prior: Slow things down and set aside some time for relaxation. This may be reading, reflection of the day, deep relaxed breathing techniques or guided meditation (Head Space, Mindfulness Meditation, 1 Giant Mind, Smiling mind). Sometimes it can be helpful to write a ‘Ta Da list’ listing the moments in your day that you enjoyed and your accomplishments.  If anything pops up in your thinking during an active mind episode, a great way to move on is to write it down.

 

5. Exercise or alternative therapies is a great way for mental and physical release and can really help with sleeping. Mind body movement such as yoga, qi gong and tai chi have also been shown to be very effective in enhancing sleep. Other therapies can include sensory art therapies (aromatherapy, music therapy, etc.), spiritual therapies, psychoeducational interventions and hypnotherapy.

 

6. Environment: comfortable, lower temperature (our core body temperature drops throughout the night) and a fan on for white noise can help to blur out other noises.

 

7. Alcohol, caffeine & cigarettes: alcohol may assist getting to sleep, but can disrupt your quality of sleep. Caffeine and cigarettes have stimulative effects, so try to minimise your intake.

 

8. Naps: if you need to take a nap, ensure its more than 4 hours before your normal bedtime. Naps should be for a special reason, otherwise usually aim to completely avoid napping.  A nap can interfere with normal sleeping habits and prevent a good night sleep. You are then also more likely to need a nap the following day and the annoying cycle begins.

 

9. Avoid being too aware of time: avoid looking at the time to prevent worry of being able to sleep. This will take the pressure off yourself that you must fall to sleep.

 

10. Light exposure during the day: it’s important to be outside for a part of the day.

 

11. Avoid sleeping pills unless extreme circumstances: they are not addressing the cause of being able to sleep. It’s also easy to build a tolerance and a reliance on them.

 

12. Seek professional help.  

 

Sleeping and Pain  

Problems with sleeping and chronic pain are often interrelated. Recent studies have found that sleep can have a more negative effect on pain than the reverse. When in pain it can both make it harder to get to sleep and to remain asleep. It is normal to wake up for a very short period between each sleep cycle, but we are often not aware of it. When in pain, we are more likely to notice these awake stages and notice our pain as our nervous system is more sensitive.

For those who sleep poorly, the day after consequences of poor sleep can also change how we feel about our pain and how we interpret it (making us more sensitive to pain). This can then continue along this vicious cycle (5).

Reframing how we think and feel when being awake when trying to get to sleep and our reactions to waking throughout the night, can dramatically change how well we sleep. Sleep hygiene strategies are even more important when in pain.

 

Use of Pillows

Propping with pillows can be a helpful way to offload a sore body part. For example, if lying on your side and you are experiencing hip or knee pain, it can help to have a pillow between your knees. Similarly a pillow under your knees when lying on your back can relieve pain. A pillow in front or behind your body in side-lying can help to alter the angle and be more supportive.

A commonly asked question from someone experiencing neck pain is should I have a large or small pillow. The size of the pillow is usually related to your sleeping position and the need to fill the space between your head/neck and the bed to keep your head in neutral. If you’re lying on your side, you generally require a larger pillow and significantly smaller pillow if on your back or front. Memory foam and contoured pillows can often be helpful to increase support and comfort.

 

 

 

Great resources for sleep:

https://www.sleephealthfoundation.org.au (general)

https://www.sleepfoundation.org/articles/pain-and-sleep (pain)

https://painhealth.csse.uwa.edu.au/pain-module/sleep-and-pain/ (pain)

http://www.themotionmechanic.com/2018/09/28/blog-post-2/ (exercise)

 

 

~ Lucy Bowden

References:

1. Bergman, S. (2007). Management of musculoskeletal pain. Best Practice & Research Clinical Rheumatology, 21(1), 153-166. doi: 10.1016/j.berh.2006.10.001
2. Ezenwanne E. (2011). Current concepts in the neurophysiologic basis of sleep; a review. Annals of medical and health sciences research, 1(2), 173–179.
3. Neuendorf, R., Wahbeh, H., Chamine, I., Yu, J., Hutchison, K., & Oken, B. (2015). The Effects of Mind-Body Interventions on Sleep Quality: A Systematic Review. Retrieved from http://dx.doi.org/10.1155/2015/902708
4. Pain and Sleep | National Sleep Foundation. (2019). Retrieved from https://www.sleepfoundation.org/articles/pain-and-sleep
5. (2019). Retrieved from https://painhealth.csse.uwa.edu.au/pain-module/sleep-and-pain/
6. S Assefa, S., Diaz-Abad, M., M Wickwire, E., & M Scharf, S. (2015). The Functions of Sleep. AIMS Neuroscience, 2(3), 155-171. doi: 10.3934/neuroscience.2015.3.155
7. Sleep Health Foundation – Australia’s Leading Advocate for Healthy Sleep. (2019). Retrieved from https://www.sleephealthfoundation.org.au