A wide variety of different techniques and sleep aids 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, good sleep hygiene is designed to improve the quantity and quality of sleep.
As chronic pain develops, patients may develop poor sleeping habits without even realizing it. These habits may include such things as varying the time that one goes to bed and awakens in the morning, taking naps during the day, staying in bed most of the day, or engaging in stressful activities—such as checking work emails while in bed.
Bedtime Habits that Help Improve Sleep
Consistently practicing good sleep hygiene can make a significant difference. Healthy sleep hygiene habits include the following:
Do not go to bed unless sleepy. Instead, engage in a relaxing activity until becoming sleepy. This might include listening to music, reading a book or magazine, knitting, or practicing relaxation exercises. Stimulating activities should be avoided.
If one is not asleep after 20 or 30 minutes, get out of bed. Lying in bed for hours, trying to sleep, adds stress, making it less likely an individual will fall asleep. It is often helpful to do something relaxing for a time, then return to bed. In this way, people gradually train their bodies that the bed is a place to relax with the goal of falling asleep.
Develop rituals that help with relaxation. Helpful rituals might include taking a warm bath, having a light snack, listening to a few minutes of music, or reading. Engaging in the same ritual each evening before bed can train the body that it is time to fall asleep.
Avoid use of electronic devices just before bedtime. Smartphones, laptop computers, tablets, and smartphones all emit light that mimics daylight. The glow from these devices can confuse the body about the time of day. Turning off electronics at least half an hour before going to bed is advised.1
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. Having a darkened room is also likely to be helpful. Any distracting sounds that might make it difficult to fall asleep or disrupt sleep later should be eliminated, if possible.
Keeping track of sleep in a daily log may be helpful when the individual meets with the doctor about sleep issues.
Develop a Healthy Sleep/Wake Cycle
Keep a consistent bedtime/waking routine. Going to bed at the same time each night and getting up the same time in the morning—seven days a week—helps the body develop a healthy 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." In this situation, an individual who did not fall sleep until 2 a.m. might compensate by "sleeping in" until noon. If this counterproductive pattern gets established, the routine sleep-wake cycle becomes more and more disrupted.
Avoid 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.
Maintain a regular schedule. 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 who is on disability should attempt to maintain as much of a daytime routine as possible. This might include eating meals at the same time, engaging in other distractive or volunteer activities at regular times, and sticking to a pre-bedtime routine.
Avoid vigorous exercises within four to six hours of bedtime. Regular exercise is usually helpful for back pain, and promotes good sleep, but vigorous exercise just before bedtime can be disruptive. Any vigorous or cardiovascular exercise should be completed at least six hours before bedtime. Relaxing exercises such as yoga can be done before bedtime in order to help initiate a restful night's sleep.
Avoid Caffeine, Alcohol, and Nicotine Products
Limit caffeine late in the day. Caffeine is widely known for its stimulating effect, which can interfere with deep sleep, and also may worsen symptoms of restless legs syndrome. The impact is likely to be even more significant for those with chronic pain. Caffeine consumption should be eliminated, or at least restricted. Caffeine remains in the body for several hours, and should not be consumed after noon.
Avoid or limit alcohol use. Alcohol is often used as a sleep aid, but can be counterproductive. While alcohol may help a person fall asleep, it often causes sleep disruptions the rest of the night.2
Limit smoking—or avoid it completely. People who smoke are more likely to have sleep problems, including trouble getting to sleep and waking earlier than desired in the morning. Smoking is also a risk factor for sleep apnea, a condition that includes waking multiple times in the night.3-5
Patience is advised when beginning to follow healthy sleep hygiene guidelines. It may take some time to see the full effects of changing one’s habits.