Is pain causing trouble with your sleep?

There are lots of components that contribute to how we experience pain, how that pain relates to sleep and how we think and behave around sleep. All of these need to be considered and managed to get the best outcomes. Expecting a single pill to be a ‘cure all’ and get rid of pain as well as ensure 8 hours of un-interrupted sleep is unrealistic. What is realistic is to expect that by managing lifestyle factors, keeping healthy, moving and working on our emotional response to pain and sleep, that both pain and sleep can be improved.

In this post and the next I’ll expand on this concept and outline strategies for managing sleep in persistent pain.

Managing sleep involves looking at what we do throughout the day

An important part of sleeping well when we have pain, is not about sleep at all. It’s about what we do throughout the day. Maintaining a healthy lifestyle by keeping moving, ensuring good nutrition and an engaged mind are all keys to both reducing pain and getting the most out of sleep.

1. Movement: There is good data to support the role of exercise in promoting good sleep. It doesn’t have to be vigorous exercise, in fact, most studies have been of gentle exercise such as walking, yoga or tai chi. These same exercises have been shown to also be important in managing pain. So, keep moving.

2. Nutrition: What we eat and when we eat can have a major impact on our general health and on how we feel. If we already have the challenges of pain and poor sleep, we need everything else in the body working as well as possible, so need to ensure our nutrition is good. Freshly prepared meals with good quality ingredients and a balanced diet, together with regular meal times are an important part of keeping the body well and reducing the impact of pain and poor sleep.

3. Be engaged. Often, if we are sleeping poorly or in pain, we can tend to withdraw from activities that we usually enjoy. Things like going out with friends, or other social activities, or taking time out for ourselves to do a favourite activity. If we withdraw from these connections with the outside world, the effects of poor sleep and pain, can seem overwhelming. Although at times we may not feel like it as we are tired or sore, it is important to continue to be engaged in activities we enjoy and to maintain our social connections.

Medications and sleep

When using medications to help with pain and sleep, it’s important to recognise the limitations of medications. We don’t have a perfect medication that can act right through the night and still allow us to wake up feeling refreshed. So it’s important that we don’t expect too much out of medications, otherwise we can end up continually increasing the dose trying to get the effect we are after, and that just leads to a greater risk of side-effects. So when using medications in pain and sleep my general principles are:

1. See medication as part of an overall management strategy, so always use non-drug strategies to address lifestyle factors and how people think and behave around sleep in addition to medication.

2. Match medication choice to other symptoms or conditions people have. For example if there is neuropathic pain and poor sleep I would tend to use drugs like gabapentin or pregabalin.

3. Make sure the patient and I are clear on the outcomes we are trying to achieve with medication and that they are realistic.

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Check the SleepHub FAQs or take our Sleep Wellness Quiz for a free assessment of elements that may be keeping you from a good night’s sleep. Click through to the Quiz here.

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