Painfully Tired

As I slowly and carefully moved from my bed down to the yoga mat on the floor, I realized that this little routine I’ve used for years to cope with sciatic pain flare ups has actually minimized my risks of ending up in the vicious cycle of insomnia, anxiety and depression.

I’ve struggled with back pain for 20 years and I know first-hand how frustrating it is to feel exhausted and unable to sleep because of physical discomfort. One bad night’s sleep can lead to a miserable day; a miserable day will melt into an anxious evening and an anxious evening will result in another sleepless night. This is an unhealthy cycle that so many pain sufferers find themselves in. I’ve personally experienced sleepless nights and feeling depressed from pain , so it’s not surprising that sleep complaints are present in up to 88% of chronic pain disorders and that 1 in 3 of people with chronic pain also meet the criteria for clinical depression. The National Sleep Foundation states that “there is an unquestionable link between sleep and pain, but emerging evidence suggests that the effect of sleep on pain may be even stronger than the effect of pain on sleep.” Being the sleep conscientious, self-proclaimed "sleep geek" that I am, I’ve been incorporating strategies to safeguard my sleep during back pain flare ups for years. And since back pain and sleep problems are extremely common, I’ll share my blueprint for when pain tries to steal my sleep.

First and foremost, follow the pain management plan your doctor has set out for you, but keep in mind pain and sleep have a complex relationship that requires a multifaceted approach to optimally manage it. Often we will just accept that sleep loss is the collateral damage from chronic pain and not something that we have control over. Prioritizing sleep is always important to maintaining good sleep hygiene and preventing sleep loss, but when pain becomes all-consuming, keeping healthy sleep behaviours top of mind is crucial.

I love being in control of having a good night’s sleep and follow a few strict rules about my sleep, but admittedly, I am not always an example of ‘sleep perfection’ and have a tendency to push my limits now and then with screen time, late night chocolate snacks, and irregular exercise. But when that tight, deep muscular and nerve pain kicks up, so does my sleep hygiene practice. I instantly start putting my phone away 2 hours before bed, wearing my blue light blocking glasses religiously in the evening, dimming the lights on a militant schedule and practicing relaxation techniques like I'm preparing for a meditation retreat with the Dalai Lama. I am adamant about getting enough sunlight in the morning and throughout the day to support my sleep-wake cycle. If I’m able to and the weather cooperates, I’ll go for a slow walk outside without my sunglasses on, or just sit outside if I’m unable to walk due to the pain. When it’s too cold outside, I’ll sit by a window or my therapeutic bright light lamp to make sure I’m getting that daylight.

If you listen to the Sleep Works podcast, you already know I'm a proponent of a relaxing hot bath as part of a regular bedtime routine but in a period of pain; that activity has been imperative for me to be able to initially fall asleep. A hot bath or shower 1-2 hours before bed improves circulation and allows our bodies to cool down so we can fall asleep. I tend to make the water extra hot, add 2 cups of Epsom salts, light candles, turn off the lights and practice more relaxation techniques and deep breathing to stay relaxed and to prevent activating my body’s stress response.

The strategy that took me several years to learn and many failed attempts before I was proficient at is this: don't stress about it. Easier said than done when pain is literally a signal from your body telling you there’s something wrong, but the ‘mind over matter’ mindset has given me more relief than anything from a pharmacy. A poor night’s sleep is inevitable now and then when you experience chronic pain and reminding myself that a poor night’s sleep is not the end of the world has actually helped me sleep better. By recognizing when I’m having negative thoughts or anticipating a rough night’s sleep, I can replace those anxious thoughts with positive sleep thoughts and actually short circuit the psychophysiological response that would normally keep me awake.

Finally, my routine of getting out of bed and laying on a yoga mat is a tactic I’ve used to prevent a single sleepless night from turning into a chronic problem. When I find myself tossing and turning from irritating discomfort, I’m aware that my brain could be associating my bed with that feeling of frustration and anxiety about not being able to sleep. So, I climb out of my bed and onto the mat (the firm surface offers some relief too) until I either drift off briefly on the floor or feel sleepy enough to get back into my bed and fall asleep. Sometimes this little routine happens 15 times a night, sometimes it’s once or twice, but I never stay in my bed awake for longer than 20 minutes. It’s likely the main reason I’ve escaped the downward spiral of pain and chronic insomnia.

By making sleep a top priority to solving chronic pain, the effectiveness of other treatments for pain will be better too, setting up the trajectory for healing through growth hormone that’s released while we sleep. Pain can certainly try to rob us of a restful night but when we put sleep at the forefront of our pain management plan, we are optimizing our body’s ability to heal and cope better with daily pain. Good sleep prevents one problem from having a snowball effect on our health and when we practice healthy sleep habits, we are also practicing pain management. Pain doesn’t have to be a life sentence that labels you as "a bad sleeper" and by taking control of our sleep, we are taking control of our quality of life and our future selves. After all. sleep is healthcare and self-care.