“A well-spent day brings happy sleep.”
-Leonardo da Vinci

Time warp…mid-1800s:  You live in the country—no electricity, and lamp oil is a valuable commodity. So, when the sun starts to go down, you begin to relax and prepare for bedtime. Your brain starts producing sleep hormones. You then fall asleep and stay that way until the sun comes up in the morning. This is how it was done before the invention of the light bulb.

The 21st century: You get home from work and rush to get things done. You barely notice the sun going down because your home is full of artificial light. You keep going until you just want to sit down‒a natural reaction to being up for 16+ hours. So, you plop down in front of the TV. Finally, you force yourself to bed, and hopefully sleep.  

Unfortunately, a high percentage of us—especially when we live with chronic illness—struggle with getting to sleep and staying asleep. Here’s why:  sleep is regulated by the production of sleep hormones, such as melatonin, and enhanced by other internal logic that relaxes our conscious mind and body for a good night of sleep. The brain doesn’t start the production of melatonin until it is dark and the body is relaxed—up to a two-hour process. Consider how a typical routine—of rushing and working hard before “relaxing” in front of the TV’s blue light, high-throttle programming, and news full of the latest world and local woes—impacts your ability to sleep.

Sleep deprivation affects behavior, mood, ability to cope, thinking, the immune system, and our experience of pain. While adequate sleep is essential just for us to feel good, it also allows the body to produce substances that fight infection and inflammation. It is during our sleeping hours that many body functions are renewed and supported—even the production of chemicals that enhance deep sleep and communications with organs such as the stomach (a connection that helps prevent mindless eating and food cravings during the day).

Jim Horne, PhD (Director of the Loughborough University sleep research laboratory), notes that complex brain work, such as updating working memory, planning, attention, sense of time, and verbal fluency, are functions most likely to suffer with sleep loss. “…what seems to be happening is that the functional part of the brain appears to be working even harder …to no avail.”

In order for the nervous system to work properly, it needs to be restored each night.  When we get too little sleep, we are less equipped to deal with stress.  We can be irritable, get drowsy during work hours or while driving, have difficulty concentrating, become forgetful, and lose physical coordination.  If sleep deprivation goes on long enough, it can cause wild mood swings and even hallucinations.  

Adequate sleep is essential to the management of chronic pain.  If your night is during the day, your challenges to good sleep are more complex.  Routine, a cool darkened room, and undisturbed sleep are must-haves.  You may find that white noise (a fan or a recording of water, wind, or rain) overrides the sounds of traffic and others in the house, available in the form of machines and smartphone apps.

How much sleep do we need?  Consider how much sleep it takes for you to:

□  feel rested

□  concentrate and stay focused

□  get out of bed easily

□  maintain a happy mood

□  avoid drowsiness the next day

Schedule 

Consistent Sleep Schedule: Our bodies are regulated by a circadian clock‒a timepiece that requires regularity to maintain its rhythm. The more regular your schedule, the stronger your clock will be. Going to bed at the same time each night and waking at the same time every morning provides regular production and utilization of melatonin.  

Naps: While there are benefits to napping, those who have trouble sleeping at night may find that napping only makes regular sleep more difficult. If you need a nap, limit it to 10-20 minutes (as your sleep schedule improves, you can cut back on napping until you no longer count on it as a supplement). If you experience ongoing problems getting to sleep, avoid naps altogether.

Environment and Activities

A Relaxing Ritual: We get so busy that it’s easy to keep going until we hit the bed.  To prepare for sleep, try winding down with some reading (from a book instead of an electronic device), listening to soothing music, or light stretching 30+ minutes before bedtime.  Reduced light and a calm atmosphere prepare our bodies to produce melatonin, which in turn, helps us sleep.  Make a list of things that relax you, and avoid the TV and computer (the light and the stimulation keep the brain from relaxing) an hour or two before bedtime.

A Relaxing Place: It’s important to keep stress out of the bedroom. It should be a welcoming, restful space—ideally cool and dark. The best rule: nothing but sleep and sex in the bedroom.  

Planned Worry: If worry is something that keeps you awake, make a plan for taking care of those thoughts before bedtime. Try keeping a pad of paper and a pen handy, then write your worry list just before turning out the light. Or, if a worry pops into your head when you’re trying to sleep, write it down and promise to deal with it the next day.

Exercise: If you don’t feel like you are able to exercise due to your illness, don’t sweat it.  Your coach has probably already offered to share his or her courage with you until you’ve built your own. In the meantime, learn everything you can about what your body can handle and keep an open mind on how to lessen its impact on your life. If exercise is something you’d like to try, start slow and easy. Talk to your doctor or physical therapist, and work with your coach to set goals and track successes.  Read more.

Eating and Drinking

Caffeine: Caffeine can cause a disruption in your sleep, since it can stay in your system for 8-14 hours, affecting both the amount of sleep you get and the quality of your sleep.  Side effects of caffeine include anxiety, depression, and sleep disturbance.

Alcohol: Alcohol is categorized as a depressant.  While it may initially promote sleep onset, it is known to cause awakenings later in the night.

Nicotine: Nicotine is a stimulant known to cause nighttime and early morning awakenings. 

Eating before bedtime: The goal is to have a quiet body. Eating revs up metabolism. Drinking a cold beverage will do the same, as the body must produce energy to warm it up. 

If you experience less pain when you get adequate sleep, you are joining the ranks of many people who experience less diffuse muscular pain when they start sleeping well.