Sleep is Essential
Consecutive hours of high-quality sleep are essential for most adults. It is not just about maintaining good health when you have arthritis; it is about healing.
If sufferers wish to maintain good health and be able to perform well all of the tasks that they have throughout the day, sleep is vital. Studies have shown that those who do not get enough sleep are as impaired as drunk drivers when it comes to performing even simple tasks.
If you have osteoarthritis (OA), the pain and swelling in your joints can cause you to toss and turn as you struggle to get comfortable. At least half of people with OA have trouble falling asleep or staying asleep throughout the night. Science shows that people with hip and knee OA are likely to have both insomnia and daytime sleepiness than people without OA.
Pain and Sleep Connection
Pain is an essential part of the equation, but researchers are finding that the connection is more complicated. It might be coexistent, that is, occur at the same time due to the underlying causes of OA, such as inflammation.
A study in the journal SLEEP researched the sleep quality in people with OA. The pain level that people were in before they went to bed had little to do with how well they slept.
But the person’s quality of sleep at night predicted how much pain they would be in the next day. Those who slept badly experienced more pain the next day.
In addition to the inflammation connection, a lack of sleep makes you more susceptible to feeling pain, changing your perception of it. On a pain scale of 1 to 10, for example, a score of 3 might turn to a worsening 5 or 6 after a miserable night’s sleep.
Chronic arthritis pain interferes with circadian rhythms. A Japanese study found a relationship between a person’s body clock and arthritis symptoms. More specifically, researchers discovered that specific genes affecting circadian rhythms might activate a molecule that begins inflammation in people who have arthritis. The relationship between the TNF-alpha molecule and circadian rhythms could explain why people with arthritis have worse joint pain in the morning.
Why Does Your Pain Seem to Worsen at Night?
Tracey Marks, MD, author of Master Your Sleep: Proven Methods Simplified, believes, “Pain is a sensation you feel when nerves are stimulated to an intense degree. This stimulation activates the brain, which keeps you awake.” Ah, if it were only that simple.
Pain seeming to worsen is due to different factors. Those factors include levels of the anti-inflammatory hormone cortisol lower at night. Staying in one position may cause joints to stiffen up. Your experience of pain may change biochemically in the early hours. The perception of pain can be more pronounced at night, or your pain thresholds are lower at night. The daily stimuli that are pain distractors are no longer present at night.
Sleep problems and chronic pain seemingly go together. When in chronic pain, find it difficult to fall asleep or have disrupted sleep with long night awakenings. Even if you get the right amount of sleep, you can still feel exhausted in the morning. With interrupted sleep, the quality of sleep is often poor. Because of this, you want to address sleep issues as part of pain reduction.
With a miserable night’s sleep, you may feel more pain-sensitive. Pain and sleep are linked with impacts on each other. A reciprocal relationship is when pain during the day affects the quality and quantity of that night’s sleep. The poor quality sleep increases pain levels the next day. The latest findings point to sleep affecting pain levels more significantly than the other way round. Research continues to identify ways that pain causes insomnia.
Pain at night disrupts sleep architecture.
Each stage of sleep is needed to both feel rested and for good memory imprinting. These stages of sleep include; light sleep, deep sleep, and REM (rapid eye movement) sleep. People usually have four to six cycles of these stages each night. But then pain wakes you and spend too much time in light sleep. This reduced sleep, in particular, shortened REM, may increase sensitivity to pain.
Nervous system effects
In order to drop off to sleep, the nervous system has to calm down. When you have chronic pain, you have a much more active nervous system. The nervous system can interfere with how quickly you fall asleep and how deep you sleep.
Mood and sleep
Even small drops in our mood or attitude increase the pain signal. While not everybody with chronic pain gets depressed, ongoing pain affects moods. Your mood, how you feel, when you have persistent pain can lower. A depressive mood is a common experience for pain sufferers. But it’s not good to let it stay. A continuous depressed mood can delay your recovery from pain.
Pain affects sleep position
Joint and muscle pain usually results in problems staying asleep (called sleep maintenance insomnia) rather than falling asleep (called sleep onset insomnia).
Pain medications interrupt sleep
Often the medications prescribed for pain, such as codeine and morphine, can cause insomnia. Opioid pain medications can induce apnea, which is the brief pauses in breathing, during sleep. Opioid painkillers, like oxycodone (OxyContin), affect the brain in a way that can disrupt rapid eye movement (REM) sleep. REM helps the body produce other hormones needed for tissue repair. Those who take these medications for chronic pain are at a higher risk for sleep problems. Rethink your pain medication. Make sure your medicine doesn’t worsen sleep. Some over-the-counter (OTC) pain medications, such as aspirin and ibuprofen, promise to assist with sleep and pain, but they can increase the time to fall asleep. That is possible because they inhibit the sleep hormone melatonin. When it comes to medications, tell your healthcare professional about the sleep problems you have as a result of your pain. Check the many other alternatives, including herbs.
Co-Regulation and pain
If you have a spouse or partner, your pain becomes theirs. Your poor quality of sleep will make their sleep less refreshing too. Tossing and turning, for example, leads to a lack of sleep in both partners. But there are other behaviors as well, which might be interfering with a good night’s sleep. To learn more about co-regulation read more.
Worry, rumination and sleep
When you worry about not sleeping, that increases the activity of your nervous system. An active nervous system makes it difficult for you to fall asleep. Clock watching is one of the things that can increase your anxiety about not sleeping. Removing the clock from your bedroom can help. When you need an alarm to wake you, turn the clock so you can’t see the time.
Fighting is the wrong paradigm
When you can’t sleep, it can be helpful to remember that this is a natural side effect of pain. Fighting against pain and sleeplessness makes things worse. Accepting you have sleep difficulties will reduce the distress that you may otherwise feel. Calm and soothing helps not fighting.
Thoughts churning around in your head can keep you awake. Often this happens at times of high stress. Relaxation here can also help. In particular, mindfulness is a useful technique. Mindfulness involves letting go of thoughts. When you practice mindfulness, don’t try to stop having thoughts. Instead, refocus the brain’s attention on the here and now. As you redirect your attention, the mind lets go of other thoughts, and the body starts to relax.
Write down your thoughts while assuring yourself that you will address them soon. Addressing those thoughts in the morning builds self-trust. It can be useful the following day to write your thoughts on paper again. Often thinking cycles, repeating, chase themselves in circles. Writing helps clarify and structure your thinking processes, which can help to come up with solutions to your problems.
Lack of movement
People with chronic pain may have trouble moving. Lack of exercise leads to weight gain. The excess weight then restricts activity, which leads to weight gained. This is a vicious cycle that can lead to sleep apnea. Preventing a restful night’s sleep is sleep apnea or interruption.
People more sensitive to pain when they are sleep deprived. A study in the Sleep Journal showed that normal, healthy individuals are more vulnerable to pain when low on rest. The reasons why sleep deprivation leads to pain aren’t known as of yet. Some studies show that sleep deprivation causes increased production of inflammatory chemicals in the body called cytokines.
So it is essential to try and give yourself the best chance of having a good sleep as possible.
Ending the pain which interrupts sleep
To reduce the pain, use the Pain Processing Process, which reduces anxiety and depression, improves sleep, and makes for a better overall quality of life.
As a long-time user of sleep studies, I recommend people with sleep problems undergo a diagnostic sleep study. At least you will find out if you have interrupted sleep or even sleep apnea.
How to Get the Sleep You Need
The Pain Processing Practice will help you retrain your brain. Scientists have found that people who believe their pain will keep them awake all night. Preventing them from sleeping are more likely to suffer from insomnia. That is a self-fulfilling prophecy. When you believe something will happen, likely it will. Instead of thinking, tonight is going to be a bad night, or I am in too much pain to sleep, think and even say, tonight I get to sleep well.
Finding a positive attitude when you go off to sleep while in pain can be hard. When you are afraid of the pain, it increases. Calming and soothing yourself with prayer, meditation and other relaxation techniques allow you time to get out of your pain cycle.
When done effectively, only 10 minutes of daily meditation or prayer can help your mind distract from your pain. There are many different meditation practices, including tai chi, guided meditation, and yoga. Prayer also has many types, usually depending on religious traditions. All of these practices and so many more are in the toolbox of pain processing practice.
You can also improvise without learning a whole new tool. The pain processing practice teaches useful techniques like; deep breathing exercises, create your happy place, smile and say good-night to your body parts, or focusing on an object or scene.
There are many cognitive-behavioral therapies, which can help you deal with patterns of behavior that don’t allow you to sleep. They can also help reinforce a positive, practical mindset.
Relaxation techniques like progressive muscle relaxation
For your body to drop off to sleep, the nervous system needs to calm down. This calming can achieve through involvement in calm non-stimulating activities, or relaxation. Those techniques are particularly helpful when you are worried about not being able to sleep or about your pain level. However, for calming to work when it is needed, it needs to be practiced regularly. Practiced regularly to bring down the background level of nervous system activation. Then use it when dropping off to sleep.
Gentle massage is beneficial for insomnia as well as chronic pain. In the International Journal of Neuroscience, study participants who had two 30-minute massages a week for five weeks experienced better sleep and less back pain.
How can I improve my sleep?
Only head to bed when sleepy
Your sleep cycles throughout each night. Your energy levels also go in cycles throughout the day. It is essential to go to bed when the energy level is in a dip. Look for signs of sleepiness.
Utilize these recommendations for sleep and pain.
If you find you have no fun nor energy daily and you are irritable a lot of the time, then your mood might sour. Making a daily plan to do the things you care about is helpful. This caring list gives you structure and certainty to your day. Do a little each day, pacing yourself and taking breaks. Not everyone with a pain issue gets depressed, but people with pain usually have a lot to deal with, which puts pressure on their mood. When your mood drops, it has a direct impact on pain; it’s another thing that turns the pain’ volume control’ up.
A key to managing your mood and pain are observing the parts of your pain condition you can address. Noticing patterns of which are the primary triggers for your pain. You may like to draw a chart and allocate (mood, depression, anxiety, fear, distress, poor coping, anger, frustration) anything that is part of your pain condition.
Rather than tackling all patterns at once, set small goals then focus on one or two achievable goals at a time.
Establishing a good sleep and movement routine is vital for helping to get you back on track. Developing a regular sleep time and habit will reduce your pain. Sleep means less pain, thus allows you to undertake the carefully paced activity and movement.
Activity helps to engage your body’s own pain control medicine chest and boost your mood and immune function.
Changing to your parasynthetic nervous system will calm and decrease pain. De-sensitizing your nervous system means you can effectively turn the pain’ volume control’ button down. Rather than a single approach, like medications to control your mood, coupled simple sleep strategies. This combined or ‘multimodal’ approach can make a big difference to your pain over the days and weeks.
Rise at the same time each morning regardless of the sleep you had the night before.
Head to bed around the same time nightly.
Spend half an hour moving daily, at least. An active person may need longer than this before going to bed.
Do similar things in the same order nightly, e.g., get things ready for the next day, brushing teeth, showering or bathing to relax, changing into pajamas then read a book.
This routine trains the body to learn to expect sleep and prepare for it. The final activity in your nightly routine must be quiet and relaxing. This is a calming wind-down time.
Make a robust association between bed and sleep
You make associations all the time so that you can live out of your unconscious. Your mouth salivates when you smell your favorite dinner. You learned that soon after smelling food; you get to eat it. Create a strong association between bed and sleep, not with other activities. Not a place where you stress about not sleeping, nor associate bed and pain. Only use your bed for sleeping and sex, no reading, watching videos, resting. Find somewhere other than your bed to rest during the day.
That means no tossing and turning in bed or feeling frustrated about being awake. If it has been more than 15-20 minutes and you have not fallen asleep, get out of bed and do a non-stimulating activity, until you feel sleepy and try again.
Hygiene means managing those things that you do during the day that can affect sleep. Sleep hygiene is defined by the National Sleep Foundation as “a variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness. “
Even low levels of exercise or movement are beneficial to sleep
Don’t exercise before bed end movement 2-3 hours before bed, as it will increase your heart rate and body temperature making it harder to sleep
Light and dark
The more significant the difference between day time light and evening darkness means higher production of “melatonin” in the body, a hormone that promotes sleep. Reduce light in the bedroom. Increase sunlight exposure during the day. Remove all light-producing appliances from your bedroom, like computers.
Ensure a quiet environment. Or run a fan or other non-specific white noise machine in your bedroom to dampen street and other sounds. Or lull yourself to sleep with relaxation mp3s, CDs that play a babbling brook, gentle waves, or different soothing sounds.
Learn the best sleeping position and pillow strategy for you. It depends on the situation and on your condition. For example, sleeping on your stomach could worsen back pain, yet elevating your feet or sleeping on your back with a pillow under your knees can improve rest. Contoured pillows or full-length body pillows can help.
The core body temperature falls as you sleep. A warm shower or bath before sleep is helpful because it increases the body’s surface temperature initially. In sleep, there is a cooling of your body temperature, so if the room is too hot, sleep is difficult.
A nap during the day impacts the quality of sleep during the next night, making it lighter and more easily disrupted. Napping often increases the desire for a rest the next day, thus creating a cycle of napping. Only nap during the day as a one-off, for a special reason, not routinely. If you have to nap, take a short nap in the morning when you will have a night of lighter sleep, that will have less of an impact on the next night’s sleep.
Avoid eating heavy, fatty, or sugary foods before bed. Heavy meals can cause heartburn or other digestive upsets that disturb sleep. You need to wait 2-3 hours after eating before you go to bed. Once you lie down, acid can come back up. Late-night snacks are to be avoided. For those who aren’t sensitive to dairy, have some cottage cheese, yogurt. Drink milk if you are not lactose intolerant as it is sleep-promoting. These light foods contain tryptophan; an amino acid considered a natural relaxation aid. Have enough protein to keep blood sugar stable throughout the night. Avoid caffeine, coffee, coke, and chocolate four hours before bed.
The effects of drinking cocktails quickly backfire, disrupting sleep cycles a few hours into the night. Abstain from alcohol at night; it may help you fall asleep.
A poll reported 95 percent of people with arthritis wished they slept better each night and with the Pain Processing Practice.
Research is beginning to understand the complex nature of sleep, and new links made all the time. While we don’t yet know exactly how sleep and pain are connected, it’s clear that a relationship exists.
Adopting good sleep hygiene and habits, plus using the Pain Processing Practice will end sleeplessness. Before problems become chronic, discuss pain early in arthritis treatment can help keep minor issues from developing into chronic sleep issues. That will prevent the vicious cycle of sleep and pain from robbing your healing.
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