There are a wide variety of different techniques and sleep aids 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 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.
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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 the best pillow for your sleep position, 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.