SLEEP

Proper sleep is one of the most important aspects of life. It is a time of rest and rejuvination for your body and with respect to your muscles, it is a time when they should be completely relaxed and healing at their most rapid rate. When we don't get enough sleep or the right kind of sleep, problems develop rapidly. The interesting thing about chronic musculoskeletal pain is that inadequate sleep can cause muscular problems and muscular problems can also result in insomnia or difficulty sleeping.

The most common pattern of sleep that I hear about from patients with chronic musculoskeletal pain is that they often can fall asleep although sometimes they have difficulty getting into a comfortable position to fall asleep. When they do fall asleep, they sleep for two to four hours and then they wake up and toss and turn for the rest of the night, not really achieving any deep sleep and waking up stiff, sore and unrefreshed. Does this ring a bell with you?

Sleep has been researched intensively at may sleep clinics, but perhaps some of the most ground breaking work was done by Dr. Moldofsky in Toronto. He found that almost universally, people with musculoskeletal pain suffer from the same deep sleep deprivation pattern of sleep. They almost universally describe the same sleeping pattern that I have already described as found in-patients that I have interviewed and treated. Furthermore, it was found in healthy normal volunteers who were deprived of Stage III, deep sleep. In a few days they started developing musculoskeletal pain syndromes. In addition, they developed fatigue patterns that exacerbated their experience of pain.

I am not a physician who immediately goes to the prescription pad to treat patients. In fact, I try to stay away from prescribing medications as much as possible. All medications have detrimental effects and the risk to benefit ratio must be weighed carefully for each individual patient. However, there is one medication that has been particularly helpful over the course of my career in helping people with chronic musculoskeletal pain to improve their sleeping patterns. That medication is cyclobenzaprine (Flexeril). You might want to discuss this medication with your physician to see if it would be appropriate for you, if this sort of sleeping problem is a usual event.

There are things that you can do to improved your sleeping pattern and we refer to these as sleep hygiene. I will innumerate some of the aspects of this process to improve your sleeping patterns. Bad sleeping patterns become habitual over time so education and retraining with daily practice is necessary to break these bad habits and improve your sleeping pattern:

  1. The bed is for sleep, don't go to bed until you are tired and ready to go to sleep.
  2. Stop trying to fall asleep. Read or play Solitaire, but don't watch T.V. to fall asleep.
  3. Don't do anything that does not relax you when you are in bed.
  4. Don't take naps during the day if you are not able to sleep at night, and don't resume taking naps until you have reestablished a more normal sleeping pattern.
  5. Prioritize the selection of your pillow and mattress. There are so many options available you need to investigate these to find the mattress and the pillow with the right support to help you comfortably relax and fall asleep.
  6. Sheets are available of various types including satin, flannel and cotton percale. Some people find one or another of these more soothing and relaxing.
  7. The ideal room temperature for sleeping is generally between 64 and 68 degrees Fahrenheit. Experiment with this and see what works best for you.
  8. Keep your bedroom quiet. Use earplugs and eyeshades if you need to.
  9. Using sleeping medication is not usually a good idea and can become somewhat habit forming even though it becomes less and less effective when used more than a relatively few days. It should only be used from a few days to a week at the most. While it may help you sleep somewhat, it generally does not help to reestablish a normal sleeping pattern, and as I have said, it becomes less and less effective requiring more and more as the days roll on.
  10. Alcohol probably is not a good idea and in fact, interferes with normal sleeping patterns if consumed in more than limited quantities. Avoid all caffeinated drinks within a few hours before bedtime and feel free to try warmed milk.
  11. A light snack before dinner can prevent hunger pangs from waking you in the middle of the night.

Your sleeping pattern is extremely important to your overall health and well- being to say nothing of your chronic pain syndrome. You must give it adequate consideration and I recommend investigating what books are available to help educate yourself appropriately.