Has this ever happened to you? You’ve had a niggling pain which has been bothering you all day and will not shift. Perhaps this pain is always with you, the result of a chronic problem. A busy day has meant you had to push it to the back of your mind, but every time you stopped you were aware of it again.
You longed to get home, get warm and get into bed. “A good night’s sleep will sort this out,” you said to yourself as you got ready to curl up.
You shut your eyes and . . . that niggling pain seems to grow. You can almost see it, expanding like a great fat spider and taking over your body. The longer you lay there the worse it gets. Every time you feel yourself drifting off to sleep, it starts up again. The big fat spider is growing bigger. The longer it takes you to fall asleep, the worse thoughts you get and the pain itself seems to get worse. That pain spider keeps on growing. It might even start to have little spiders, and new sites of pain open up in different bits of your body. Sheer hell.
By now you are getting angry with yourself. Frustration has completely taken over. Those bad thoughts are running through your head at a faster and faster pace. You start to worry about the future. You feel sorry for yourself. “I have a rotten day, now I can’t sleep, this means tomorrow will be even worse . . . how can I do a full day’s work on NO SLEEP?”
As you lay there in the dark you have never felt so alone.
So, it might surprise you to know that this ‘pain gets worse when I go to bed’ experience is normal and explicable. And you can do something about it.
First let me explain what is happening here: many of my patients report that one of their main pain management strategies during the day is distracting themselves from their pain by being involved in various activities and staying busy.
When it comes to trying to fall asleep, there are no other distractions to focus upon. There is just their perception of their pain. So, it’s not surprising that the perception of pain actually increases when trying to go to sleep. And remember pain is about perception, it’s about how you feel about your pain. It’s your experience.
Consider your thoughts and feelings about your pain and how they affect your nervous system and this affects your mood and stress levels. Remember all those thoughts and feelings of frustration and worrying about tomorrow as you lie there are brain impulses too. As you have them, your brain is releasing the type of chemicals which will make you even more stressed.
But, just as you can turn these feelings and thoughts up, so you can also turn them down. You can stop the alert, threat chemicals and start the relaxing chemicals which will help you sleep. It is important to learn to manage your thoughts, feelings and your stress, so you can turn down the signals within the nervous system. This will help with your sleep, emotional wellbeing and can ease pain.
Turning down these unhelpful signals takes some practice. I recommend a structured programme which helps your general health, addresses your emotions and thoughts about your pain and your sleep and works to get you into new habits. (You can find out more about this in my book “Sleeping with Pain” http://ow.ly/Dhn4307AE7Z )
Remember sleep is not simply the absence of wakefulness; it is much more complex than that. Sleep varies across the night and for most of us throughout the night as well. Sleep varies with age and stages of development. Most importantly sleep varies from person to person! It is an active process with physical, mental and emotional components.
Here are some tips which might help.
Your sleep pattern is unique to you so some will be very effective for you and others less so. Be patient and systematic and see which work for you
- Establish a regular time for going to bed and getting up in the morning and stick to it even on weekends and during holidays.
- Use the bed for sleep and sexual relations only, not for reading, watching television, or working; excessive time in bed seems to fragment sleep.
- Avoid naps, especially in the evening.
- Exercise before dinner. A low point in energy occurs a few hours after exercise; sleep will then come more easily. If you exercise too close to bedtime, this may increase alertness.
- Take a hot bath about an hour and a half to two hours before bedtime. This alters the body’s core temperature rhythm and helps people fall asleep more easily and more continuously. (Taking a bath shortly before bed increases alertness.)
- Do something relaxing in the half-hour before bedtime. Reading, meditation, colouring, listening to relaxing music are all appropriate activities.
- Keep the bedroom relatively cool and well ventilated.
- Do not look at the clock. Obsessing over time will just make it more difficult to sleep.
- Eat light meals and schedule dinner four to five hours before bedtime. A light snack before bedtime can help sleep, but a large meal may have the opposite effect.
- Avoid fluids just before bedtime so that sleep is not disturbed by the need to urinate.
- Avoid caffeine or other stimulants, such as nicotine in the hours before sleep. A general recommendation is not to consume anything that might hinder your sleep 4-6 hours before your anticipated bedtime.
- Don’t drink alcohol before going to bed.
- If you are still awake after 15 or 20 minutes go into another room, read or do a quiet activity using dim lighting until feeling very sleepy. (Don’t watch television or use bright lights.)
- Give yourself a quiet time right before bed. Just before you retire, take a few moments to spend quietly relaxing and meditating.
Switch off your smartphone or tablet as they emit blue light which mimics daylight and can fool our internal body clocks.