Pain Service - Sleep Hygiene

Sleep is an essential part of life and contributes to us feeling well and happy.

However, most people will experience problems sleeping at some point in their life. Sleep disruption is a common issue, especially for patients in chronic pain.

In fact, a recent audit of our pain clinic patient population has demonstrated that more than 66% of patients get poor quality sleep.

There is no set rule as to how much sleep you need – it varies from person to person. Some people may need 8 hours sleep each night, others may need more or less than this.

Sleep patterns can also vary with age, with older people often needing less sleep than younger adults.

What causes sleep disruption?

In general, sleep disturbance can be caused by a number of factors:

• Emotional factors – anxiety, stress, depression
• Change of daily routine – travelling, change in work hours
• Medical factors – pain, bladder problems
• Environmental factors – noise, light, temperature of bedroom 
• Drug and alcohol use

What is sleep hygiene?

Sleep hygiene consists of a variety of different practices which are necessary in order to have a normal, good quality night’s sleep and increased daytime alertness.

Why is good sleep hygiene important?

Good sleep hygiene is important in chronic pain patients because a lack of sleep will cause an exacerbation of pain and the pain will further cause lack of sleep, leading to a vicious cycle.

How can I improve my sleep hygiene?

The following suggestions are examples of good sleep hygiene and should help achieve a more restful night’s sleep.

Go to bed at the same time and get up from bed at the same time every day

Regular waking times leads to regular sleep onset and helps to “set” the body clock.

Reduce or avoid sleeping during the day

Staying awake during the day helps you fall asleep at night. Any naps longer than 30 minutes will increase the chances of having a disturbed night’s sleep.

Take regular exercise during the day

Exercise promotes more restful sleep but vigorous exercise should not be carried out within 3 hours of going to bed. Relaxing exercise such as yoga can be done before bed to aid sleep.

Limit or avoid caffeine, alcohol and nicotine before bedtime

Caffeine and nicotine are stimulants and so can cause difficulty in falling asleep, awakenings during the night and shallow sleep. Although alcohol may help people fall asleep more easily it causes disturbances later in the night.

Avoid going to bed hungry or too full

Food can be disruptive right before bed so avoid heavy meals before bedtime. Hunger can also disturb sleep.

Only use the bed for sleeping and sex

Avoid watching television, listening to the radio or reading in bed. This will help your brain to see the bed as a place for sleeping.

Don’t take your problems to bed

Worrying may interfere with sleep or cause shallow sleep. Try and plan some time earlier in the evening to work on problems or to plan for the next day.

Try to have a relaxing bedtime routine

Try muscle relaxation, a warm bath or a milky drink to help you unwind before bed.

Keep the bedroom quiet, dark and a comfortable temperature

This will reduce the likelihood of you waking up during the night. Carpets, earplugs and thicker curtains may help.

Don’t force yourself to try to go to sleep

This will only make your mind and body more alert.

Remove/hide any clocks from view so you are not constantly checking the time.

If you are unable to sleep within 30 minutes then get up, go to a different room and carry out a peaceful activity, then return to bed when you feel sleepy. Avoid exposure to bright light during this time.

Get regular exposure to natural light

This is particularly important for older people who may not venture out as frequently as children and adults. Light exposure helps maintain a healthy sleep-wake cycle.

Some of the medicines prescribed in the pain clinic, such as amitriptyline, gabapentin and pregabalin may help you to sleep, in addition to their painkilling properties. However, the use of medicines including benzodiazepines (eg:diazepam) and zopiclone is not advised.