It’s a fact – CRPS and difficulty sleeping go hand in hand.
Allodynia, body movement and bed sheets/duvets are all unhappy bed fellows. Even when sheer exhaustion makes sleep inevitable, that sleep is often broken by the pain caused by subconscious movement.
At periods whilst we are asleep we experience what is known as rapid eye movement (REM) sleep, which alternates with non-REM sleep. During REM sleep the body is in full on healing mode, physically and mentally. Deprivation of REM sleep serves to entrench the pain cycle deeper, worsening the pain and so the cycle continues.
One of my clients told me that she believed she could adapt to living with her pain if only she could get a good nights sleep each night. Despite that, and perhaps not surprisingly, the use of sleeping tablets among CRPS sufferers seems unpopular. As the same client told me “on top of everything else I have to take and with all of the other side effects, feeling groggy the whole time because of the sleeping tablets is just as bad as being tired through lack of sleep.”
Representing CRPS sufferers and others suffering chronic pain as I do, their nightly turmoil is brought home to me daily when, first thing each morning, I check my email inbox. Inevitably, emails arrive from clients throughout the night.
Losing your mind
Many people with CRPS feel they are losing their mind as their short term memory evaporates and they lose their ability to concentrate on anything. One of my clients has such difficulty remembering when (or whether) she last took her medication that each morning she places her tablets in clusters on a laminated sheet marked with times of the day.
On top of the downward spiral of pain, lack of sleep leads to impatience and irritability. Not only does that have an increasingly negative effect upon your own mental health, but those closest to you begin to bear the brunt of your worsening mood. In some case that inevitably begins to drive a wedge between you and your loved ones. The most common regret I hear expressed by people with CRPS is the negative effect the condition has on their children. It’s not just their reduced ability to play and interact with them that causes deep anguish, it’s the regret of having snapped or shouted at a child; telling a child to go away, to keep the noise down; the tears, the glare from a spouse or partner.
Originally developed in the late 1970’s to help people suffering from insomnia, the ‘tools’ of sleep hygiene are increasingly being recognised as being of benefit to people suffering chronic pain.
Sleep hygiene is simply following a number of practices and routines aimed at maximising the prospect of having a good (or at least a better) night’s sleep. The following are not exhaustive and can and are adapted by individuals to suit their own lives and situations. However, common ideas on maximising sleep hygiene include:
- No matter how tired you feel during the day, try to avoid napping. If you feel yourself dozing off try to get some fresh air, even by just opening the window. Try to engage in some activity to stimulate the brain: watch a TV drama, open the puzzle book, work on a jigsaw puzzle; even play a computer game – it doesn’t matter if you lose!
- Only use your bedroom for sleeping so that your mind begins to associate that room exclusively with sleep. Your bedroom should also be a good environment in which to sleep. Ensure it’s dark enough, that it’s the right temperature and, as far as possible, do anything you can to reduce noise in the room. Even an ‘old fashioned’ ticking clock can provide an unwelcome focus for your mind as you lay in the dark.
- Avoid caffeine for at least 8 hours and nicotine for at least 3 hours before bed. Both are stimulants are certainly won’t help you sleep. Also, whilst alcohol may help you get to sleep initially it disrupts your sleep cycle which means you will wake more often in the night.
- Develop a routine for going to bed. This is aimed at slowing down your mind and getting into sleep mode. The routine may begin an hour or two before your usual bedtime by engaging only in more relaxing activities in order to help slow down your mind. It’s now time to avoid those stimulating activities mentioned earlier – TV dramas, computer games, the book in which you are engrossed. Also, doing things in the same order each night helps to develop that routine.
- Once in bed, if you can’t sleep, get up and do something quietly until you feel more sleepy; practice a relaxation technique or perhaps read something factual. Return to bed, but if you still can’t sleep, get up again and return to the quiet activity. Whilst in the short term this may actually reduce the overall amount of sleep you achieve, it is all about developing good sleeping habits and research has shown that as time goes by you should eventually be falling asleep sooner.
- A good sleeping routine means getting up at the same time every morning, no matter how tired you feel. Again, this will initially prove incredibly difficult but should eventually help you to sleep at night.
- As we all know, for many reasons exercise is good for us. Clearly, if you have mobility issues that becomes more difficult but a physical therapist can work with you to develop a regime tailored to your ability, even just exercises you can perform from your chair. Exercise both tires you and reduces anxiety, both of which help you to get to sleep. However, avoid exercise immediately before bedtime as that may keep you awake.