Possible causes for poor sleep

Options to try

Daytime naps

• Pain is exhausting so a brief nap of 15 minutes may make it easier to get through the rest of the day.
• A long daytime nap will interfere with your night sleep.

Too much rest during the day

• Keep generally active, physically & mentally, during the day. See energy management and pacing.
• Maintain an exercise routine – but not before bed time.

Worries, stressful thoughts

• Keep a notepad on the bedside table to write them down worries or reminders to address tomorrow.
• Use relaxation or distraction techniques.
• Don’t stay in bed if you’re awake. Get up & do something peaceful until you feel sleepy & ready for bed again.

Medication

• See your GP for medication that may help with persistent pain & could also improve ability to sleep.
• If you stop some types of medication it can take a few days or a week or so before they are out of your system. Remind yourself that these effects will pass & that you are ok.

Stimulants before bed

• Replace tea & coffee with warm drinks which don’t contain caffeine.
• Small carbohydrate based snacks eg crackers can make you sleepy.
• Protein eg nuts, meat etc tend to make you more alert.

Persistent Pain, discomfort

• Pace your activities during the day. Your pain will not usually be as bad as when you overdo things, so you may prevent some of the pain.
• Often pain seems to be worse at night, partly due to fewer distractions to focus on.
• Neuropathic pain & other pain can be delayed pain & intense at night.
• Take medication at the same time each night if prescribed for night time.
• Use your breathing & relaxation techniques to feel relaxed & calm.
• Some people find a TENS machine, electric warm pad or hand held massage device nearby to apply to the painful area can reduce pain levels.

Alcohol and nicotine

• Alcohol may help you get to sleep but can lead to disturbed sleep in the second half of the night.
• Nicotine is a stimulant & may make it harder to fall asleep.

Psychological distress

• Psychological distress such as anxiety & panic attacks can increase worry at night. Try distraction & positive self-talk to cut off unhelpful & obsessive thoughts.
• Seek medical intervention for feelings of helplessness & hopelessness.

Going to bed too early

• Don’t have a fixed bed time. Despite what many ‘sleep advice’ articles say this can increase anxiety about not sleeping, if, when you get to bed you can’t get to sleep. Guess what? Then you feel more anxious about not sleeping.
• Go to bed when you feel sleepy, ‘nodding off.’
• Having a bed time routine/ritual helps your body learn when you are getting ready to go to sleep.

Sleeping late in the mornings

• Try to get up about the same time each day, regardless of how you feel.
• Expose yourself to outside light soon after getting up.

Engaging in activities that stimulate your mind late at night.

• Plan to avoid these types of tasks if possible. At times it will be unavoidable, but this should be minimized.
• Reward yourself with relaxing & pleasant tasks last thing in the day e.g. magazines, reading, puzzles, music.

Difficulty switching off

• A warm bath/shower is physically relaxing & by changing your body temperature a little & affecting your body clock it may improve sleep quality.

Clock watching

• If you are a ‘clock watcher’, put the clock out of reach & sight. It also means you have to rise to turn off the alarm in the morning, helping establish a morning routine.

Difficulty ‘dropping off to sleep’

• Chamomile & fruit teas don’t contain caffeine.
• Lavender oil - either in a bath or a few drops on the pillow is a soothing scent.  

Noise intolerant

• Have ear plugs handy in your bedside table within easy reach.
• Test ear plugs for comfort first or speak to a pharmacist.

Unpleasant sleep environment

• A fan slowly whirring away can be quite soporific & circulate the air to avoid stuffiness.
• Comfortable & cozy pillows, bedding & mattress.
• Wear natural fibres which allow air circulation & reduce feelings of sweatiness.
• An eye mask can simulate a ‘black out’ bedroom.

Nightmares

• Some medications produce unpleasant dreams.
• Other medication can produce nightmares if you stop taking them. If you think this may be the case talk to your GP.

All techniques have been tried over a period of weeks/months without success

• Have realistic expectations of sleep eg some people only need 5 hours sleep.
• For medical assistance keep a daily record of the following:
  • Bedtimes
  • number Times & times of waking at night
  • Activity/exercise
  • Food & drink
  • Getting up times
  • List of  all medications including herbal preparations & dose times