It’s common for patients who suffer from chronic pain and who aren’t getting good, consistent rest to believe that their physical discomfort is interrupting their sleeping patterns, says Dr. Ann Romaker, director of the University of Cincinnati Medical Center Sleep Medicine Center. New research published in November in the journal BMC Musculoskeletal Disorders suggests that the relationship between sleep disorders and chronic pain is more complicated, Romaker says. The findings supplement a number of studies that suggest poor sleep is associated with a raft of health problems, including increased risks for cardiovascular disease, diabetes, cognitive difficulties, mood disorders and even cancer, she says.
Here are three strategies to improve your quality of sleep:
— Develop better sleeping habits.
— Get a doctor’s assessment.
— Try cognitive behavioral therapy.
Sleep and Chronic Pain
The recent study suggests that an array of sleep problems — including difficulty initiating and maintaining sleep, early awakening, non-restorative sleep and fatigue — are “important predictors for the future development of (chronic widespread pain)” both over a five-year and an 18-year span. Researchers gathered data from 1,249 Swedish people to analyze the five-year results and 791 Swedes to assess the findings over 18 years. The study suggests that the association between fatigue and chronic widespread pain is explained by pain sites (in the body) and possibly disturbed pain systems rather than mental health issues or sleep problems. The research underscores the the importance of getting a proper sleep evaluation if you’re suffering from chronic widespread pain, says Dr. Jerald H. Simmons, a sleep disorders neurologist and founder of Comprehensive Sleep Medicine Associates, which has locations in Houston and Austin, Texas. Fatigue and sleep problems were both important predictors for the onset of chronic widespread pain over five and 18 years, researchers concluded.
“There are tens of thousands of regulators in the body that determine your pain experience,” says Dr. Houman Danesh, director of the Integrative Pain Management Program at Mount Sinai Hospital in New York City. “Our bodies can filter experiences, including pain. If you have a broken bone in your leg and someone yells ‘Fire,’ you’ll find a way to run out of that building. Your body filters every signal that comes into your brain, whether it’s a pain signal or a pleasure signal. Getting a full night’s sleep improves your filter.” The new research underscores how poor sleep is associated with fatigue and more chronic widespread pain, says Dr. Sheldon C. Yao, chair of the Department of Osteopathic Manipulative Medicine at the New York Institute of Technology College of Osteopathic Medicine. “Patients suffering from chronic pain should be screened for sleep disturbances by a physician,” Yao says.
Common Sleep Disorders
Poor sleep can be caused by a number of disorders, including:
— Sleep apnea, which occurs when your upper airway becomes repeatedly blocked during sleep, according to the National Heart, Lung and Blood Institute.
— Insomnia, in which people have trouble falling asleep, wake up often without going back to sleep and have symptoms such as fatigue, mood problems and sleepiness.
— Restless leg syndrome, a sleep disorder that causes an intense, often irresistible urge to move the legs during resting times, like while lying down in bed, according to the Cleveland Clinic.
Getting good sleep is crucial to your overall health, Danesh says. Experts recommend these three strategies to improve your sleep:
1. Improve your sleeping habits.
Adhering to a good sleep hygiene regimen can help you attain better and more consistent sleep, Danesh says. For starters, refrain from looking at any bright screens at least an hour before your bedtime. That means you should stop watching TV and using your cellphone or computer at least 60 minutes before you want to hit the hay. These devices emit a light that activates your brain rather than settling it down so you can go to sleep, Danesh says. Also, avoid drinking caffeine after the early afternoon and try to exercise at minimum moderately six days a week for at least 30 minutes daily. Also avoid eating excessively salty foods that can make you wake up thirsty, and disrupt your sleep cycle. Limiting or forgoing alcoholic beverages is also helpful, he says. Drinking alcohol may help you get to sleep, but it will make it harder to achieve deep, restorative sleep, Danesh says.
2. Talk to your primary care doctor.
If you’re not getting enough sleep, talk to your primary care physician, Romaker says. Your doctor could help you develop better sleep habits or suggest cognitive therapy. If those strategies don’t work, your physician could refer you to a sleep center accredited by the American Academy of Sleep Medicine. At a sleep center, doctors who have studied and treated sleep disorders can provide a diagnosis and a treatment strategy. Most general practitioners don’t have much training on sleep disorders, Simmons says.
Physicians at a sleep center would take a detailed sleep history, do an exam and perhaps conduct a sleep study. The latter would seek to determine the cause or causes of your disrupted sleep. For example, if the problem involved your airway, the treatment could be a dental appliance to keep the airway open or a mask that administers air. In some cases, surgery or orthodontics to open the upper airway might be necessary, Simmons says. You can participate in a sleep study at your home or at a sleep clinic. If you do a home test to study, for example, sleep apnea, your physician will provide a sleep apnea test device to collect data on your sleep; it involves attaching sensors from the device to your body. You may be asked to keep a sleep log or press a button on the machine when you get into bed, according to the American Alliance for Healthy Sleep.
3. Consider cognitive therapy.
Many people in the U.S. are sleep deprived. About a third of the country’s population have insomnia at any given time, research suggests. What’s more, 10 percent of the population has chronic insomnia, which lasts three months or longer. Research suggests that cognitive behavioral therapy to treat insomnia provides better long-term outcomes than other treatments, like medication, says Dr. William W. Chow, a board-certified neurologist and an attending physician at Cedars-Sinai Medical Center in Los Angeles. Cognitive and behavioral therapy includes techniques such as meditation, exploring beliefs and attitudes about insomnia with a therapist or using self-study guides and stimulus control therapies, says Dr. Bennet Davis, director of the pain recovery program at Sierra Tucson, a residential treatment center in Tucson, Arizona, that treats trauma, depression and other disorders. Stimulus control therapies involve reassociating your bed with sleep and adopting habits like limiting sleeping during the day and restricting the use of electronic devices before bedtime, Davis says. “Cognitive behavioral therapy also includes tips that help you sleep better, (like) ways to wind down an hour or two before bedtime and sleeping in a quiet, cool room,” Davis says. If these therapies don’t work, your doctor could prescribe sleep medication, Romaker says.
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