Tips For Improving Sleep With Chronic Pain

BY: Felicity Talbot

Why is a wonderful night’s sleep so elusive? I’m not sure why performing a basic physiological function is so difficult for so many people, but it has definitely become an epidemic.  It definitely seems like every person with chronic pain also has chronic issues with insomnia and poor sleep quality.  The people who need it the most are begrudged a full night’s rest because of their pain and other symptoms.   

Most chronic pain conditions come with a huge side helping of fatigue as well, so the terrible night’s sleep worsens the fatigue and then adds stress and anxiety.  As the person starts to worry even more about whether they will be able to sleep, that stress and anxiety amps up the sympathetic nervous system, making it even more impossible to get a good night’s rest.  It’s a cruel and exhausting cycle!

Fortunately, there are ways to help improve your sleep and decrease that cycle of stress and anxiety. One of the most important things you can change is your sleep hygiene.  Sleep hygiene isn’t about brushing and flossing before bed (although you should definitely do those); it’s about following certain guidelines that have been proven to help overall sleep quality. 

We all know that looking at screens (phones, TV) is bad to do before going to bed because it decreases your melatonin production, but actually putting down your phone and turning off the TV can be quite difficult for a lot of people.   I am guilty of being addicted to both!  The general rule is to stop looking at both about an hour before you want to get ready to go to bed.  Start to turn down the lights in your house as well.  

You can do some calming activities like reading, listening to music (not hardcore metal), doing puzzles, meditating, or just hanging out with your dog.  There are blue-light blocking glasses, but it’s not just the light that’s hurting your sleep.  It is also the stimulating content of what you’re watching.  There should absolutely be no looking up your ex on social media or reading posts about volatile subjects (like politics) before bed!

Another important part of sleep hygiene is turning down the AC and making it nice and chilly.  Your core body temperature drops naturally when you sleep, so this just helps that along. It may also help stimulate the parasympathetic (rest and digest) nervous system as well. Splashing cold water on your face before bed can also stimulate the PNS. 

Sticking to a consistent sleep schedule is very important because your brain likes and recognizes routines. You can alter this routine a little bit on the weekends if you want to stay up a little bit later, but for the most part, you should try to stick to the same schedule every day.  

Make sure you have a comfortable room set up that’s not only nice and cool but super dark. Even the tiniest bit of light can actually disrupt your sleep patterns. It can stimulate your sympathetic (fight or flight) nervous system, and it can actually reduce the amount of deep, restorative sleep that you get.  You can either use electrical tape to cover those tiny lights on your smoke alarm and other electrical devices, or you can wear an eye mask.  Blackout blinds are amazing, especially if you have security lights on outside.  You should not have an alarm clock facing you because of the light it emits, and also so you are not clock-watching and counting how many hours of sleep you’re missing.  

It is absolutely imperative that you restrict your caffeine intake to mornings only. Caffeine has a half-life of five to six hours, which means that if you drink your last cup at noon, you will still have half of the amount of that caffeine in your body at 6 PM, and a quarter still left in your body at midnight. Even though you might think you’re sleeping well and that the caffeine does not affect you, it is definitely affecting your brain waves and the quality of your sleep. 

Daily exercise is extremely important to help tire out your body and give you a better night’s sleep. Just don’t do it right before bed; make sure it’s at least a few hours before your bedtime. Managing your stress is crucial to sleeping well at night (which exercise also helps with). If you have too much on your mind, your brain is not going to stop thinking and worrying about things just because it’s time to lie down and go to sleep. In fact, it seems to do the opposite and makes you ruminate on every bad part of your day (or your entire life).  So if you have a lot going on in your life, try to write down some things that are bothering you at least a few hours before bedtime, just to get them out of your brain and down onto paper. When you’re trying to go to sleep, you can just tell yourself that you’ll look at that list tomorrow and worry about it then. 

Adding in some sort of meditation and mindfulness practices during the day and at night can be extremely helpful. You don’t want to practice this only at night before bed or when you’re stressed because you want to train your brain to be more calm throughout the day and make it more responsive to meditation when you actually really need it.  Diaphragmatic breathing (deep belly breathing) also stimulates the PNS and is a great way to soothe your nervous system.  Again, this should be done during the day as well as the nighttime to train your brain so it knows how to relax.  I love to listen to a guided meditation with PMR (progressive muscle relaxation) to help me fall asleep.  I use this every single time when I wake up to go to the bathroom to help me get back to sleep. Insight Timer is a free app that has tons of great sleep meditations and music.  Don’t forget to stop drinking fluids 2-3 hours before your bedtime so you’re not up peeing all night! 

Taking a warm shower before bed can help to relax your muscles and can also help with stress. If you’re still not tired after your bedtime routine, try reading some fiction.  Reading fiction promotes relaxation and helps you wind down by shifting your focus away from the stress of the day. It’s less stimulating to the brain than other types of reading material and is a great way to escape your own worries and racing thoughts.  It actually increases theta and alpha brain waves, which are present during the light stages of sleep and deep relaxation or meditation.  Make sure to only use an amber book light or a dim bedside lamp.  E-readers are terrible before bed, so don’t use those. 

Limit daytime naps to 20-30 minutes, even if you didn’t sleep much the night before.  You will not “make up” for that lost amount of sleep; you will only decrease the amount of sleep for the next night.  Other than cleaning or taking a short nap in your bedroom (or having sex), you should stay out of it during the day. This helps train your body and mind to associate your bedroom with sleep only.   

Medications should be discussed with your doctor, but be aware that some medications, like benzodiazepines and certain antidepressants, can reduce the quality of your deep sleep.  Even certain specific sleep medications like Ambien can reduce REM sleep stages. THC also reduces your REM sleep. Pain meds like opioids will decrease the quality of your sleep as well and may even cause some issues with sleep apnea. 

The key to a successful night’s sleep is consistency with these practices.  It may sound like it’s a lot to do, but sleep is so critically important for your brain and overall physical and mental health.  The brain is not only processing the day’s information, but it is also clearing out toxins.  Your body is repairing itself during this time as well.  Hormones are being regulated, and sleep is also boosting your immune system and making you less susceptible to certain diseases.  

Obviously, people with chronic pain have significant differences in their ability to get a good night’s rest.  Pain disrupts your sleep cycles and can keep your mind wired in a state of fight or flight.  Sadly, there is no magic cure or pill that will fix that.  All you can do is try to set yourself up for as much success as possible by improving your sleep routine and trying not to stress out about it.  

Felicity was diagnosed with Rheumatoid Arthritis when she was just 18. When she was first diagnosed, they did not have biologic medications as they do now. She has had it for 32 years and continues to fight. She was on methotrexate and Prednisone. She participated in the trials for Humira. She also lives with Central Sensitivity Syndrome as well. Formerly a veterinarian, she is now a stay-at-home dog mom! Learn more about Felicity on Our Contributor’s page!