The Sleep-Pain Connection

Sleep and pain are quite connected.  Disturbances in sleep patterns are either a symptom or cause of a problem.  With chronic pain, it is often both a symptom and a cause of increasing pain.

When I first began working with chronic pain patients I read about an interesting study where “normal volunteers” were awakened throughout the night over successive nights.  They were awakened such that their REM sleep was disturbed each time.  After a few nights, the volunteers developed symptoms of a chronic pain disorder called fibrositis.  Fibrositis is characterized by a variety of symptoms.  The primary symptoms are painful patterns of muscle points in the neck, shoulders, arms, back and legs and a feeling of fatigue.  Headache and related problems often accompany these fibrositis symptoms.

The neurochemical serotonin is involved in many things, including sleep, digestion, mood and pain.  We also have natural pain relievers called “endogenous opioids”.  Changes in serotonin levels participate in lowering the levels of these natural pain relievers which allows an increased reception of pain throughout the nervous system.  This pattern creates a change in sleep and mood.

After learning about this sleep-pain connection years ago, I made it a point to concentrate on sleep hygiene with all of my chronic pain and chronic illness patients.  If you are having difficulty sleeping, try some of these sleep hygiene techniques to see if they help you get a more continuous, restful night sleep.

During the Day:

• Remain as active as possible during the day without overdoing it.
• Avoid naps unless necessary for pacing.  If naps are necessary, keep them to 20 minutes maximum.  The more you sleep during the day the more difficult it will be to sleep at night.
• Limit caffeine, especially in the afternoon.
• Participate in regular exercise – whatever you can do: walking, swimming, etc.
• Take a hot bath or shower to relax yourself.
• Keep work out of the bedroom.  The bedroom should only be used for sleep and sex.
• Get out of the house and do something, even if you don’t have anything planned.

Evenings and Bedtime:

• Establish a bedtime routine: brushing your teeth, washing your face, changing into pajamas, etc.
• Engage in a relaxing activity such as reading or watching TV for a set amount of time.
• Avoid caffeine in the evening.
• Stop drinking fluids at least an hour before bed to avoid waking in the middle of the night to use the bathroom.
• Prepare for the next day.  Set out your clothes, write down things you need to get done, concerns you may have, etc.  That way, these thoughts won’t keep you up at night.
• Try some light stretching before bed.
• Go to sleep and wake-up at the same time each day.
• While in bed, engage in relaxation techniques, such as progressive muscle relaxation (if it is not painful for you), deep breathing or pleasant imagery.
• Keep your bedroom dark, quiet and comfortable. 
• Do not focus on sleep.  Thinking about how you need to get to sleep or worrying about not being able to sleep will only prevent you from sleeping.  Instead, focus on relaxation and deep breathing.
• Use thought stopping to keep yourself from thinking negative thoughts.
• Use a heating pad or ice pack to help relax your muscles.

Interrupted Sleep:

• Use relaxation techniques to help you get back to sleep.
• Stretch or change positions.
• Use whichever techniques helped you get to sleep in the first place.

Sweet dreams!

Relaxation Techniques and IBD

We all know that stress does not cause IBD, but that stress, along with anxiety and depression, can make symptoms worse. It is really important to find a way to cope with the psychological aspects associated with IBD. One way is to use relaxation techniques to calm your mind and body. So, next time you are feeling stressed, anxious or depressed try one of these...they really can help:

1. Slow breathing: This is probably the simplest thing you can do, but it really does work and the best part…you can do it anywhere. If you are by yourself, close your eyes. Then, relax your body. Take a deep inhale in, slowly counting to four or five. Hold the breath for a second, and then slowly exhale over four or five seconds. Rest for a second, and then repeat. While you are breathing, concentrate either on counting the seconds while you are inhaling and exhaling, or think of something peaceful, like the ocean. This works great if you are by yourself and can lay down and close your eyes, but it also works if you are out in public and start feeling some anxiety because it will make you concentrate on something other than what you are anxious about.
2. Progressive Relaxation: This is a great technique that works best if when you are alone. Start by either lying down or sitting in a comfortable chair and closing your eyes. Take a couple deep breaths. Then, tense the muscles in your feet. Hold the tension for a few seconds and then let it out. Move to your calf muscles. Tense the muscles and hold for a few seconds. Then release. Move to your quadriceps muscles. Tense your quadriceps muscles and hold for a few seconds before you release. You are going to repeat this procedure, moving all the way up your body including your buttocks, hands, lower arms, upper arms, whole arms, abdomen, chest, and facial muscles. After you have finished, tense your whole body, hold for a few seconds and release. Then take a few deep breaths.
3. Guided Imagery: Start by either laying down or sitting in a comfortable chair. Close your eyes and picture yourself in a peaceful, relaxing place. This could be either at the beach, lying in a hammock…anywhere you like. Look at your surroundings. Notice the colors and textures around you. Hear the sounds, smell the ocean or the flowers, feel the sun. Notice any other sensations. Relax and enjoy. The more you do this, the easier it becomes.

There are many other relaxation techniques, but these are the three I like the best. Remember, the less stressed, anxious and depressed you are, the better you will feel. Enjoy and remember they all take practice. I hope these help!