Sleep and Chronic Pain
People with chronic pain have an enormous problem with their sleep pattern; they tend to turn their days into nights and their nights into days. This is because muscles fatigue and tighten all day long, so when one gets into bed, tightened muscles cause increased pain, and therefore the person can’t sleep.
If a person is unable to get into a restorative sleep pattern, which they won’t in that case, then the muscles are going to be even worse the next day; they will be tighter than before bed which perpetuates and in fact exacerbates the problem. As a result of this cycle of lack of sleep and muscle tightening, I often see people going to bed at 4:00 or 5:00 in the morning and expecting to get up early, and it’s just not possible.
Sleep and Anxiety
Anxiety has a significant effect on sleep because the more a person worries about whether they are going to get a good night’s sleep, the more their muscles are going to tighten as a stress response. Tightened muscles cause more pain, which causes more anxiety and the person won’t be able to sleep; it’s a vicious circle.
To the question, “is there a right position to sleep in?”, I wouldn’t say there is a right position, but I can most certainly tell you that there is a wrong position, and that is: stomach sleepers. When one is sleeping on their stomach, they are going to have to sleep with their head rotated which is going to cause pulling in the neck and arching in the low back, so they often end up with low back pain as well. Since the head is rotated, the SCM muscle will be affected which is going to affect the vagus nerve. This will in turn activate the brain and prevent restful sleep.
Some people think there might be an advantage of back sleeping over side sleeping, but this isn’t really true. If you are comfortable on your back, that’s wonderful, but you want to make sure you have a very thin pillow to keep your neck straight. When you are on your side, you want to have the support of a pillow so your head doesn’t sag to one side. It is very important to keep your head in a level plane.
Sleep and Mattresses
If a mattress is too soft, it doesn’t provide support and the body will sag and alter the position of the spine – this will most certainly create more pain. The same goes for pillows; if it doesn’t give adequate support then, once again, you are going to have more pain.
People do need their sleep, they have to sleep for the postural muscles of the body to relax, otherwise they are going to have a tremendous amount of pain. The problem is that most sleeping pills don’t put you in the right stages of sleep, they sedate you so you’re unconscious but they don’t promote restful sleep. You have to go into stage 3 of sleep if you are going to have a restorative sleep such that the muscles actually relax.
Sleep and Tryptophan
Tryptophan works very well for a lot of people, which is quite interesting because we’ve all heard the old wives tales about a warm glass of milk before bed. Now, warm anything going into the stomach alters the blood flow to the stomach and away from the brain, which makes you sleepy. Dairy and poultry are both very high in tryptophan such that after they are ingested, the tryptophan is converted to serotonin in the gut which induces sleep.
Some people are dairy intolerant so they can’t have have milk, but some dairy intolerant people can have cheese, because the lactose hasn’t been converted at that point. So when you are looking to have some tryptophan before bed, cheese works, yogurt works and nuts work. Nuts are very high in tryptophan, so you can have peanut butter on toast, or something like that before bed.
Sleep and Habits
The most notable bad sleep habit in today’s society is watching the television or cell phone screens shortly before bed. Screens are backlit for clarity but they are at a frequency that actually activates the brain, so it is difficult to get into a normal sleeping pattern. It is best if you shut down about an hour before you plan on going to bed so that the brain can settle down and you can relax.
You also want to avoid exercise within about an hour of going to bed. Some people think that going to the gym will make them come home tired, but they often find themselves wide awake because their epinephrine (adrenaline) is sky high, so it is very difficult to fall asleep.
It is best to avoid caffeine right before bed since it is a stimulant. Coffee is obviously very high in caffeine but most colas, and actually most soft drinks, have lot of caffeine as well. Caffeine is added to make soft drinks more addictive, and to trick people into thinking they feel refreshed. Therefore you should certainly avoid coffee and soft drinks within a few hours of sleep, because it actually takes quite a while for caffeine to get out of your system.
Tea does have caffeine as well but the tea leaves have more caffeine than the actual drink itself. Now the warmth of tea can help promote sleep so it may be beneficial to try an herbal tea; many of them are well known to induce sleep and there are many different varieties available that are caffeine free.
Alcohol is an interesting substance; initially it’s a sedative so it makes the person feel drowsy. Later, it turns into a stimulant which means if the person does fall asleep under the influence of alcohol, they won’t have a restorative sleep, and they will wake up with their muscles feeling much tighter. It is not uncommon for people with muscular or chronic neurological pain to self medicate with alcohol but this only perpetuates the cycle of pain and lack of sleep.
It is best to get into the habit of shutting down your evening about an hour before bed. You can read, or even listen to music as part of your routine. Just ensure that there is not a television in the bedroom, that is one of the greatest mistakes you can make. It is easy to think that if you watch T.V. then you will fall asleep, but even if your eyes get tired and you drift off, you likely will not have a restorative sleep because of the background noise.
I would highly recommend following a very routine pattern. Before bed, you can go lie down and read, brush your teeth, brush your hair, whatever. If you continue to do the same thing before bed each night so that it becomes a pattern and the brain doesn’t have to think, it just has to follow the pattern of winding down and you will get a good night’s sleep.