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Painfully Tired

Marlee Boyle, Sleep Therapist on Cyno

As I slowly and carefully moved (for the third time in a night) from my bed down to the yoga mat on the floor beside my bed I realized, this little routine I’ve used for years to cope with sciatic pain flare ups has minimized my risks of ending up in the pain, insomnia, anxiety, and depression cycle. I’ve struggled with back pain for 20 years and I know first-hand how frustrating it is to feel exhausted and unable to drift off 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 and perpetuate 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 1 and that 1 in 3 of people with chronic pain also meet the criteria for clinical depression.2. 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 person *sleep geek* that I am, I’ve been incorporating strategies to safeguard my sleep during flare ups of back pain for many 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 and require 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 a fair amount of 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 behaviors 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. However, 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!

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 keep my mind and body relaxed 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 it, is to ‘not 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 next to my bed 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 when the discomfort is irritating me, 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 and it’s likely the main reason I’ve escaped the downward spiral of pain and chronic insomnia. This is a technique based in cognitive behavioral therapy for insomnia, called stimulus control.

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 taking care of our future selves because sleep is healthcare, and selfcare!

  1. Finan, Patrick H et al. “The association of sleep and pain: an update and a path forward.” The journal of pain vol. 14,12 (2013): 1539-52. doi:10.1016/j.jpain.2013.08.007



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