Sleep

Sleep and Pain

We have come to understand that there is a very close link between pain and sleep. Pain disrupts sleep by not allowing full cycles of light and deep sleep that are most important in providing us the restorative properties of sleep. We also know that frequent sleep disruption leads to poor pain tolerance. This is a vicious cycle that is important to stop to allow for proper brain, psychological and pain management health. If you are struggling with sleep, together we will explore good sleep hygiene, home remedies for sleep, prescription medications and controlling certain medical conditions to help better manage sleep and pain.

Sleep Hygiene

Whether you suffer from trouble falling asleep (sleep initiation) or staying asleep (sleep maintenance), adopting good “Sleep Hygiene” practices can be very helpful in either case.

Stimulus Control

It is important to set up a sleep routine and to coordinate it within your average daily schedule. When setting up a sleep routine, keep in mind the following:

Wake and sleep at the same time each day
Aim to get at least 7 or 8 hours of sleep each night
Avoid caffeine in the afternoon and evening
Keep your bedroom at a cool comfortable temperature for sleep, and try to keep it quiet, relaxing and as dark as possible
Avoid electronics, like the television, tablets, computers or cell phones

You should coordinate your sleep routine with trying to go to bed when you feel sleepy. If you don’t fall asleep within 20 minutes, get out of bed and find a quiet activity that does not have much light exposure. Only use your bedroom for sleep, sex, and dressing. Whenever possible, try to maintain this same sleep routine on the weekends and during vacations.

Lifestyle Management

Adapting your diet and lifestyle to better suit your sleep needs is also very helpful in getting better sleep. This includes:

Regular exercise
Eating a healthy diet
Avoid alcohol before bedtime
Avoid eating large meals before bedtime; if you are hungry, resort to a light healthy snack to avoid sleep disruption
Reduce fluid intake before bedtime

Being aware of and making changes to the way we think about sleep and especially not sleeping, can have a very large impact on our ability to get to sleep and get back to sleep when awakened at night. Have a paper and pencil at the bedside to allow you to write down ideas, thoughts or to-do lists while you are in bed so you can let them go. Making use of calming auditory records, music, or physical relaxation techniques can help relax your body while also allowing your mind to let go of the thoughts and worries of the day.

Cognitive Behavioral Approaches for Sleep

It is common to experience difficulty with sleep, as well as to worry about the lack of sleep. Working with a pain psychologist on Cognitive Behavioral Therapy for Insomnia (CBT-I) can help you change these patterns so that you do not lay awake worrying about the consequences of not getting enough sleep. Working with a psychologist on these issues can have a profound effect on your ability to sleep and get back to sleep. We have partnered with Joy Simpson, LPC, a pain psychologist with MindYourPain, to offer our patients trusted and comprehensive access to these types of services. Joy can assist you in developing the right mindset, routine, and relaxation strategies to improve your insomnia.

Home Remedies for Sleep

Insomnia is a very common problem and a multitude of home remedies have been tried over the centuries. However, very few of these are well-studied, utilized, and currently promoted. Some of these include supplements such as:

Magnesium – The glycinate form can be taken in doses of 250mg twice a day to assist with sleep. It may have an added benefit with respect to pain and anxiety.

Melatonin – This can be tricky to dose as there is significant product variation. The goals, duration of use and side effects should be discussed with your provider.

Combination products – Includes Magnesium L-theanine, Melatonin L-theanine, and Gaba, all of which have been shown to be effective in initiating and maintaining sleep, as well as improving the quality of your sleep. An example would be Calm by Natural Vitality.

Valerian and CBD – These are commonly used but do not yet have conclusive evidence to support their use. They are, however, reasonable to try.

Aromatherapy – Utilizing lavender oil has been shown to be helpful in inducing sleep, although the oral forms have not been shown to be as effective.

All of these supplements, as well as over-the-counter sleep aids can have side effects, drug interactions, or adverse effects, so it is important to discuss with your provider prior to initiating any of these remedies. The providers at the Denver Spine and Pain Institute will explore these options and counsel you on which may be most effective and safe.

Prescription Medications for Sleep

There are different types, or classes, of prescription medications that can used to assist with helping you get to and/or stay asleep, even in the context of pain. Selecting the right medication for you involves a complex and shared decision-making process between you and your provider. We will discuss your personal medication history and any associated problems that may also be treated by a sleep medication, such as anxiety, depression, muscle spasm or neuropathic pain. Your provider will also discuss any potential side effects, proper dosing, and alternative medications, while also screening for medical conditions that may impact the quality of your sleep.

Medical Conditions and Sleep

Some medical conditions can impact your ability to sleep, or your quality of sleep. Lack of sleep, or frequent awakenings from sleep by medical conditions can worsen your tolerance of pain. Some of these conditions include:

Restless leg syndrome can be diagnosed by your clinical history and further evaluated and treated to reduce symptoms.

Pinched nerves at the neck (cervical radiculopathy), low back (lumbar radiculopathy), stenosis, pinched nerves at the wrist (CTS) or elbow (ulnar neuropathy) can all cause nighttime awakening and make it difficult to return to sleep. These need to be addressed medically in order to enhance the quality of your sleep.

Sleep apnea is a common disorder that causes frequent nighttime awakening and disruption of sleep. It can have a very substantial negative impact on cognitive function and general health. It is important to diagnose and treat sleep apnea, not only to improve your sleep but also to make it safer to utilize some sleep medications. Your provider can help screen for signs of sleep apnea and recommend further diagnostic testing or appropriate referral.

Exceptional Treatment for Insomnia

At the Denver Spine and Pain Institute, we understand how poor sleep can negatively impact many areas of your life, including how you respond to pain. We are committed to offering you with safe, effective treatments to help you fall asleep and stay asleep, as well improve your quality of sleep. Our goal is to help you get back to living your life to the fullest.

Our exclusive Connected Care Approach™ has been developed specifically to help you utilize a combination of treatment approaches. The best combination of treatment options will be explored with you to maximize the benefit you see in your sleep. As part of this approach, you can also expect:

A comprehensive discussion of care options, including lifestyle and behavioral changes, supplements, medications, and other treatments.

Tailored care plans designed to specifically address your unique needs.

Caring and therapeutic relationships with our team to provide you with the highest quality care.

Shared decision-making between you and your provider to ensure long-term success and satisfaction.