Sleep Series: Insomnia (Part 2)
In Sleep Series: Insomnia (Part 1), we talked about what insomnia is and how it can worsen chronic pain. This time we will be getting down and dirty with how to treat insomnia.
Good Sleep Hygiene
If you aren’t already familiar with the term “good sleep hygiene,” you must be new to insomnia. If you are familiar with it, bear with me. It’s good stuff to know and, in the right circumstances, relevant. Good sleep hygiene refers to the series of behaviors that encourage the body to fall asleep and behaviors to avoid that stimulate the body to stay awake. Most of these won’t be helpful if it’s pain that’s keeping you wide awake, but it’s good to be familiar with them. Last thing you want to do is have a pain-free night and then accidentally sabotage your sleep with that hot cup of coffee after dinner, am I right?
Do cool down your bedroom. A cooler environment (between 60 – 75F) encourages your body to slow down and fall sleep.
Do keep your bedroom dark. Light (sunlight in particular) is like an alarm clock for your body. It triggers the body to stop producing melatonin (a sleep-stimulating hormone).
Do take a bath. Not only is a bath relaxing, but the transition from hot water to cooler air also helps to chill the body down and promote sleep.
Do read a book or engage in any other soothing activity. Books, documentaries, magazines, knitting, coloring, crossword puzzles, podcasts, etc. are all good examples.
Do keep a journal or notepad next to your bed. Jot down any worries that are plaguing you and set those worries aside. Deal with them tomorrow, when you are supposed to be awake and worrying. You can also keep track of ideas or forgotten chores so that you aren’t tempted to jump out of bed.
Do keep on top of your medications. Nothing is worse than waking up in the middle of the night in excruciating pain because you forgot to take your painkiller before bedtime.
Avoid caffeine 4-6 hours before bed. It’s a stimulant. It’s designed to wake you up.
Avoid alcohol 3 hours before bed. Alcohol is a depressant (meaning it will make you sleepy), but as it metabolizes in your system it turns into a stimulant and you’ll be saying hello to 3am.
Avoid nicotine. Not only is it a stimulant, but research shows that smokers have more trouble entering deep sleep than non-smokers and are likely to experience withdrawal symptoms in the early morning (meaning your body will be trying it’s best to wake you up so that it can get it’s fix).
Avoid eating after dinnertime and avoid eating big meals. Simply put, your body needs to be awake to digest food. The whole metabolizing process also cranks up the body heat, which, as we’ve learned above, is bad for encouraging Zzzz’s.
Avoid blue light 2-3 hours before bed. Blue light decreases the production of melatonin in the body. Blue light can be found in most technological devices: TVs, computers, smartphones, etc.
Avoid emotional distress before bed. Argue with your spouse before dinner, not after. Don’t take the kids’ tantrums personally; they’re just as cranky as you are when you’re tired. Late night horror movies are another bad idea.
Avoid physical exertion 3 hours before bed. Research shows that exercising increases the overall quality of sleep. However, exercise itself is a stimulant. Want an easy, cheap, calorie-burning way to stay awake? This is it. Not so great for sleeping, though.
Medications for Sleep
At some point or another we all ask the question: is there a pill for this? The short answer is: yes. It’s the 21st century! Of course, there is a pill for insomnia!
Ah, but there are a few caveats:
Some sleep aids disrupt the body’s natural sleep cycle, decreasing REM and deep sleep periods while increasing light sleep. This decreases the overall quality of sleep.
Some sleep aids will increase your tolerance overtime and you will find that you need higher doses to get to sleep.
Some sleep aids can cause dependence, eventually making it impossible to fall asleep without them.
Never mind all of the side effects that come with medicines! Sleep medications can be helpful, but I highly recommend talking to your doctor if you are interested in long-term relief, especially if you are already balancing a personal pharmacy for all of your chronic pain and chronic illness needs. Most sleeping pills require a prescription anyway.
But what about short-term, over-the-counter (OTC) relief? There are quite a few options here too. Less effective than the prescription stuff, but then again there are typically less side effects too.
Antihistamines – most OTC sleep aids use antihistamines to promote a drowsy effect. Perhaps you’ve noticed it when taking a Benadryl for allergies or Dramamine for motion sickness? The best part here is that most people have antihistamines lying around the house, so it’s good in a pinch. However, the body quickly acclimates to antihistamines, so these are not good for long-term use.
Nausea medications – typically this is in prescription form, but when you battle chronic pain and illness, you will likely have some stashed in a drawer or cabinet. Many of these have an antihistamine component, so not good for long-term use.
Melatonin – a hormone your body produces to regulate sleep. It is available in synthetic form. You can also increase melatonin naturally by getting enough sunshine during the day (Vitamin D is necessary for producing melatonin) and avoiding blue light at night. Certain foods also contain natural sources of melatonin.
Valerian root – an herbal remedy that has been in use for millennia, although lacking in scientific research. It is available in tea, oil, or pill form. What little research is available suggests that valerian root works directly with neurotransmitters to induce relaxation and sleep. It is also renowned for having few, if any, side effects.
Painkillers – whether it’s NSAIDs or narcotics, the fact is if pain is keeping you awake at night, the best remedy is to decrease the pain. Don’t try to “tough it out.” As pain gets worse, painkillers become less effective. So if you feel a flare up coming on, take something for it now. Don’t wait until it’s bad. If you aren’t in pain, but it’s time to take your next pill, go ahead and take it for the night. It’s much better to skip your morning dose and evaluate your pain levels during the day than to skip your bedtime dose and be woken at 3am in agony.
Continued in Sleep Series: Insomnia (Part 3) — When Everything Fails