There is a wide variety of different
techniques that promote a normal, high quality night’s
sleep leading to full alertness and energy during the
day. Just as one might practice good dental hygiene
in order to keep teeth and gums in good shape, sleep
hygiene is designed to keep sleep healthy and restore
energy for the following day’s activities.
Sleep hygiene involves engaging in a
number of practices and behaviors that improve sleep. As
chronic pain develops, it is not uncommon for patients
to develop bad habits relative to sleep hygiene without
even realizing it. An example of poor sleep hygiene
habits includes such things as varying the time that
one goes to bed and awakens in the morning, taking
naps during the day, engaging in stressful activities
such as paying bills while laying in bed, staying in
bed most of the day, among other things. Good
sleep hygiene habits include the following:
Adopt bed time techniques to spur
sleep
Do not go to bed unless sleepy. If
an individual does not feel sleepy at bed time, then
he/she should engage in some activity that might help
to relax. This might include such things as listening
to music, reading a book, or practicing some relaxation
exercises. It is important to engage in some
activity that is relaxing and not stimulating at bed
time. Often, watching the evening news can be
distracting, but certainly not relaxing.
If one is not asleep after 20 or 30 minutes,
then get out of bed. It is important not to
lie in bed and “try to fall asleep” for
hours and hours. This simply creates a more and more
stressful situation making it less likely that an
individual will fall asleep. Instead, one should
find something to do that will help them feel relaxed
and ready to fall asleep. Often, it can be helpful
to get out of bed and return to a relaxing activity
such as reading a book until they once again feel
sleepy. In this manner, patients are training their
bodies that a bed is a place to relax towards the
goal of falling asleep.
Develop rituals that help with relaxation
each night before bed. Often times, it can be
helpful to develop “rituals” that one
complete just prior to going to bed and getting ready
to fall asleep. This might include such things as
taking a warm bath, having a light snack, listening
to a few minutes of music, or reading. Engaging in
the same ritual each evening prior to going to bed
can actually train the body that it is time to fall
asleep.
Keep a regular schedule to establish
a better sleep cycle
Try to go to bed at the same time each
night. Going to the bed at the same time each
night helps the body develop a healthy sleep-wake cycle.
Wake up and get up out of bed at the
same time every morning. It is important to
establish a consistent sleep-wake pattern, seven
days a week. Again, this helps to train the body
that it will fall asleep at a certain time each evening
and awaken and get out of bed at the same time each
morning. Getting up and out of bed at the same time
each morning is important to avoid disrupting the
sleep-wake cycle. This is important even if one had
difficulty falling asleep or awakened through the
night. One of the most common disrupted sleep-wake
patterns for the chronic back pain sufferer is to “get sleep when I can.” Therefore,
if the individual happens to not fall sleep until 2:00
a.m., he or she might compensate by “sleeping
in” until noon. Once this pattern gets
established, the routine sleep-wake cycle becomes
more and more disrupted.
Avoid naps during the day. Another
bad habit with sleep disruption is the tendency to
take naps during the day. Although this may seem
like a good idea when one has experienced a night of
non-restorative sleep, it can actually make the situation
worse over the long term by continuing to disrupt a
routine sleep-wake cycle.
Keep a regular schedule. As much
as possible, attempt to maintain a routine schedule
throughout the day as well as activities prior
to bedtime. If someone has a chronic back pain problem
and is continuing to work, maintaining a routine
schedule is much easier. However,
even the individual with chronic back pain that
is on disability should attempt to maintain as much
of a routine during the day as possible. This might
include such things as eating meals at the same
time throughout the day, engaging in other distractive
or volunteer activities at regular times, and completing
the pre-bedtime routine as discussed previously.
Avoid stimulants that can cause insomnia
Stop caffeine, stop/limit alcohol, and
avoid nicotine prior to bed time. In individuals
even without a chronic pain problem, research has
demonstrated that caffeine use exceeding 250 mg
per day increases the likelihood of interference
with slow wave/deep sleep. In a person with a chronic
back pain problem, this situation is likely to
be even more significant. Thus, it is recommended
that caffeine consumption be eliminated, or at
the very least restricted, with the caveat that
no caffeine be consumed after noontime. Alcohol
has been found to be disruptive to a good night’s
sleep and should either be avoided or limited in
consumption. If a limited amount of alcohol is
consumed, it should only be done 4 hours prior
to bedtime. Nicotine has also been found to be
disruptive to sleep and, again, should be avoided
prior to bed time.
Avoid vigorous exercises within four
to six hours of bedtime. Regular exercise
can promote good sleep, but vigorous exercise just
prior to bedtime can be disruptive. Any type of
vigorous or cardiovascular exercise should be completed
at least six hours prior to bedtime. Relaxing exercises
such as yoga can be done prior to bedtime in order
to help initiate a restful night’s sleep.
Of course, regular appropriate exercise is also
helpful for a chronic back pain problem.
Make the bedroom a restful place. The
sleep environment should be pleasant and relaxing.
The bed should be comfortable, based on choosing the
appropriate mattress and pillow, and the room should
not be too hot or too cold, as well as not being too
bright. Of course, any distracting sounds that might
make it difficult to fall asleep or cause awakening
during the night should be eliminated.
