To paraphrase Woody Allen – if you have insomnia, try not to lose any sleep over it.
For sufferers of painful conditions, bedtime can bring apprehension and anxiety. Physical discomfort, and the stressful feelings engendered by it, often leads to insomnia. Indeed, over half of chronic pain sufferers report their sleep being disturbed. This section will show you how sleep works and what happens when it goes wrong, as well as outlining tried-and-tested strategies for improving the quality of your sleep – even if you suffer pain.
Our brainwave patterns change during sleep as we pass through different stages, grouped into approximately 90-minute cycles.
• The first phase within each cycle, called the alpha stage, involves light sleep, also known as REM (Rapid Eye Movement) sleep. This is when we dream.
• The next two phases are known as the beta and gamma stages, in which our sleep becomes steadily deeper.
• Finally, we enter the delta stage, which is the deepest and most restful period of sleep. During this phase, growth hormones, which are instrumental in the repair and healing of the body’s tissues, are released by the pituitary gland.
Research shows that tissue-repair functions are most active between ten at night and ten the next morning. Therefore (assuming we don’t work the night shift), if sleep is disturbed, repair and recovery are likely to be delayed.
When delta-stage sleep was artificially interrupted in research volunteers, a number of symptoms appeared within a few days, including tiredness, poor concentration and short-term memory problems – collectively described as “brain fog”. When their sleep continued to be affected, the volunteers became withdrawn and felt pain in their muscles and joints. All of these symptoms disappeared when their delta-stage sleep was restored for just two nights.
There are many natural ways of improving your sleep pattern without taking prescribed medication. While they may increase overall sleep time, sleeping pills rarely address a deficiency in delta-stage sleep and they can be addictive. Try some of the following instead:
• Ensure that your bedroom is neither too hot nor too cold – research suggests that a temperature of around 62°F (16°C) is generally conducive to sleep.
• Have a small, easily digested protein-rich snack, such as a yogurt or whey protein drink, about an hour before bedtime (but not if you have problems digesting protein).
• Avoid all forms of caffeine (coffee, tea, cola), particularly 3–4 hours before bedtime.
• Avoid active exercise for 3–4 hours before bedtime, as this is stimulating and may delay sleep.
• If you are in the habit of taking a nap in the afternoon, make sure this is no longer than 30–45 minutes.
• Develop a bedtime routine to attune your body to expect sleep, ideally at close to the same time each night. This might include taking a shower or bath (using aromatherapy oils such as lavender), reading, listening to slow-rhythm music or performing breathing and relaxation exercises.
• For the hour before bedtime, reduce lighting levels and turn off the TV.
• If you wake during the night feeling alert, don’t toss and turn – get up, go to another room, do a short relaxation routine or read for a short while, then go back to bed.
Nearly half of all sufferers of chronic muscular pain (such as fibromyalgia) experience disrupted delta-stage sleep. They are also likely to have low levels of serotonin, a compound involved in the initiation and maintenance of restorative sleep. When we are in good health, we make serotonin in our intestines from digested proteins. However, if protein digestion is poor, or the synthesis of serotonin is somehow disturbed, the consequences include disturbed sleep, a slowing down of the healing process and heightened pain perception.
In addition to the natural strategies suggested in the box opposite, there are several safe and reliable herbal products and mineral supplements that can often assist in treating sleep problems. These should be taken only on the recommendation of a licensed healthcare provider. For example:
• A protein called 5-HTP (5-hydroxy-L-tryptophan) is said to encourage serotonin production, and is available in health-food stores.
• A combination of herbal products, such as valerian, hops and passiflora – or any one of these individually – can often ease sleep disturbances.
• Calcium and magnesium, taken together at night in a ratio of two parts calcium to one part magnesium, can alleviate muscular tension, and in so doing remove another obstacle to healthy sleep.
• A protein drink, such as one made with whey protein isolate powder, taken 20 minutes before bedtime helps many people to achieve a better night’s sleep. If you are sensitive to dairy products, blue-green algae or spirulina powder offer an alternative rich protein source.
NEUTRAL BATH
Another treatment that has been shown to relax the nervous system, and therefore promote better sleep and a reduction in perceived pain, is the “neutral bath” – a bath in which the water is at, or close to, body temperature. Neutral baths are also used to enhance kidney function, or for people who are suffering from anxiety, nervous irritability or insommnia. Note that this treatment is not suitable for people who have skin conditions that react badly to water.
The only special equipment you will need for a neutral bath is a water thermometer. Before going to bed, run a bath as full as possible, with the water temperature close to 97˚F (36.1˚C) – and certainly no higher. When you get into the bath, the water should cover your shoulders. The effect of immersing yourself in water at this neutral temperature should be profoundly relaxing and sedating. Rest your head on a sponge or a towel. Keep an eye on the thermometer – the water temperature should not drop below 92˚F (33.3˚C). To adjust the temperature, top up the bath with warm water, but ensure that the temperature does not exceed the 97˚F (36.1˚C) limit.
The duration of the bath is up to you – anywhere from 30 minutes to two hours is recommended. The longer you spend in the bath, the more relaxing it is likely to be. Afterwards, pat yourself dry quickly and get straight into bed.
The way you lie in bed can have profound influence on how well you sleep, and can directly affect pain – particularly spinal or neck pain, which can severely disturb sleep. Ensure that you have a firm mattress and that your pillows are appropriate for neck support – neither too hard nor too soft.
The commonest sleeping position is lying on the side, with legs and hips aligned (one on top of the other) and flexed. However, because this position leaves the upper leg unsupported, the top knee and thigh have a tendency to slide forward and come to rest on the mattress, twisting the lower spine in the process. To prevent this, it is helpful to place a pillow between the knees and thighs before going to sleep.
If you choose to sleep on your back, a pillow placed under the knees helps to maintain the normal spinal curve of the lower back. A small, rolled towel under the small of the back can provide additional support. Of course, also ensure that your neck is well supported by a pillow.
Some people choose to sleep face down, which can place a great deal of strain on both the neck and back. If this is the only way you can sleep you can reduce the strain by placing a pillow under the pelvis and lower abdomen.