Chronic pain and insomnia are an unhealthy combination. According to the National Sleep Foundation, chronic pain disturbs the slumber of one in five Americans at least a few nights a week. Whether it’s from a bad back, arthritis, or headaches, chronic pain puts you in double jeopardy: the pain robs you of restful sleep and makes you more fatigued, and thus more sensitive to pain.
But you can start to break this vicious circle. “For chronic pain conditions, what you need is good sleeping habits from the beginning — things that will last,” says Dr. Padma Gulur, a pain medicine specialist at Harvard-affiliated Massachusetts General Hospital. That means relying on the brain’s natural sleep drive as much as possible.
Try “relaxing distraction” Dr. Gulur recommends “relaxing distraction” to her patients. Some relaxation techniques use basic rhythmic breathing meditation; others focus on guided imagery, in which you imagine being in a calm, peaceful location. Find something that appeals to you and helps you fall asleep. You might look for these exercises on CD or consider group or individual training and sleep education.
Getting back to sleep. For some people, chronic pain not only makes it harder to fall asleep, but can also interrupt sleep. Simply shifting position in bed can trigger pain from a back condition or arthritic knee.
One approach is to take your pain medication right before bed. Check with your doctor to be sure that fits into your treatment plan. If pain does wake you in the middle of the night, first try meditation, visualization, or whatever relaxing distraction you favor. But if it doesn’t work, getting up to read a book in a quiet room with low light can help you to get back to sleep. Avoid loud sounds and bright light (that means TVs, smartphones, tablets, and computers).
Staying on a regular sleep schedule is also important. Go to bed at the same time every night and, no matter how the night goes, rise the next day at the same time and remain awake until your planned sleep time. This helps to set your internal sleep clock and enhances the natural sleep drive.
Try simple lifestyle changes, recommends Dr. Hadine Joffe, associate professor of psychiatry at Harvard Medical School. Two good ones to start with include avoiding caffeine and sticking to a regular sleep schedule. If these steps don't help, it's worth a call to your doctor to see if a medical condition — such as thyroid problems, anemia, sleep apnea, menopausal hot flashes, heartburn, incontinence, or depression — are affecting the quality or the quantity of your sleep. Treating the health problem may take care of the sleep problem.
The guide below can help you establish a sleep routine to promote restful nights. Your Daily Sleep Guide. This morning-to-evening, sleep-promoting schedule may help you get the rest you need.
Morning
7:00 a.m.
Wake up at the same time each morning, even on weekends.
8:00 a.m.
Limit yourself to just one cup of caffeinated coffee at breakfast, or drink decaf. Too much caffeine in the morning can stay with you until bedtime. (If you're used to drinking several cups of coffee a day, wean yourself off it gradually over a few weeks.)
9:00 a.m.
Get outside for a 30-minute walk. Both exercise and morning sunlight can help you sleep better.
Evening
6:00 p.m.
Eat a light dinner. A heavy meal can lead to heartburn, which can keep you awake. Avoid caffeinated tea, coffee, and soda, as well as alcohol and chocolate.
9:15 p.m.
Turn off your TV, computer, cell phone, and tablet at least 30 minutes before bed. They stimulate the brain. Read a book (not on a tablet), take a warm bath, or listen to soft music to help your body and mind unwind before bed.
9:45 p.m.
Get your bedroom ready for sleep. Dim the lights, close the curtains, make sure the temperature is cool and comfortable, and cover your alarm clock so you can't see the time if you do wake up in the middle of the night.
10:00 p.m.
Use the bathroom.
10:15 p.m.
Lights out. Try to go to bed at the same time every night. If you can't fall asleep in 15 minutes, leave the bedroom. Sit somewhere quiet, like the couch, and read a book for 15-20 minutes or until you get sleepy. Then go back to bed.