Sleep Strategies for Chronic Pain
Sleep problems and chronic pain seem to go hand in hand. Frequently people with RA who have uncontrolled pain, find it difficult to fall asleep, or if they do fall asleep, it is often disrupted(1). In this blog post, we will discuss sleep strategies you can implement to improve your sleep as you struggle with chronic pain.
Pain and sleep are closely linked and impact each other(2). There is a reciprocal relationship where pain during the day affects the quality of that night’s sleep and poor quality sleep increases pain levels the next day(1). In fact the latest findings point to sleep effecting pain levels greater than the other way round. So it is important to try and give yourself the best chance of having as good sleep as possible.
Having a bad night’s sleep can make you feel more pain sensitive (2). The lack of sleep fuels inflammation and toxicity, causing increased pain during the day. Lack of sleep is a huge stressor on the body and is the quickest way to HPA-axis disruption and adrenal dysfunction, which can initiate and perpetuate autoimmune disease. 
It can be challenging to break this Pain-Sleep Cycle. Many people with chronic pain, particularly pain linked to autoimmune disorders, turn to powerful sleep medications to help ease the pain and to help them sleep. While these medications maybe useful in some circumstances, long-term use can exacerbate health issues and even beco
me a physical or emotional addiction. Many sleep medications are indicated for short term use only as your body builds up tolerance to them.
What are some strategies you can use to improve sleep and reduce your pain?
Set up a routine
Get up at the same time each morning regardless of the sleep you had the night before.
Go to bed roughly around the same time each night
Do the same things in the same order each night, e.g. get things ready for the next day, have a shower, brush teeth, clean your face and moisturize, get into pyjamas, then read a book etc. This helps the body learn to expect sleep and prepare for it. It is important that the last thing that you do in the routine is quiet and relaxing. This is winding down time.
Shut down all electronic devices including smart phones, TVs, computers (laptops) a couple hours before bedtime.
Stop watching TV and looking at your phone or computer two hours before bedtime. The blue light that emanates from these electronic devices causes melatonin to shut down, right when it needs to be ramping up just before bedtime. You can also use a blue-blocking app, the “night mode” setting on your phone, or opt for blue blocker glasses, to minimize the effect of bright screens on melatonin.
Turn the lights down. For at least a half-hour to two hours before going to bed, try to avoid bright lights.
Limit caffeine or move it earlier in the day.
Caffeine intake can certainly impact sleep, especially for those who are particularly sensitive to its stimulating effects. Limiting caffeine to the morning only, preferably before 2 pm, or at least eight hours before bedtime, can be helpful. If giving up caffeine sounds daunting, there are actually a bunch of great coffee alternatives to try:
Get adequate sunlight in the morning and throughout the day.
The amount, type, and timing of light we get throughout the day can have a profound effect on our circadian rhythm.  It is recommend to get outside and be in the morning sun for at least 20 minutes within the first hour of waking up (ideally before 8 am, but even if you are waking up later, getting outside ASAP will help to shift your circadian rhythm), and avoid wearing sunglasses if possible. Sunlight on our retinas helps activate morning cortisol production and helps set our circadian rhythm for the day.
In the winter, you can use a blue light lamp in the morning to help mimic morning light.
Consider changing your mattress.
Having a mattress that properly supports your body and is free of toxins and allergens can help you sleep better!
Sleep in a dark and cool room.
Use blackout curtains to make your room darker.
Turn off all lights (including nightlights).
Try wearing a sleep mask.
Cover any blinking or tiny blue lights in your home.
Keep the temperature of your room around 65-68 F as a cool environment promotes sleep. You can use blankets if you feel cold but keep your bedroom at a cool temperature.
Other Solutions for reducing pain and improving sleep
Magnesium cream is a wonderful way to address muscle and joint pain, as is arnica cream.
I also love peppermint essential oil. Mixing a few drops with a carrier oil (coconut oil is great for this!)
Magnesium combined with Melatonin works very well to help with sleep. There is a product I love from “Ancient Minerals” Goodnight . It’s a beautiful blend that helps to address both pain and sleep.
Herbal teas - Chamomile tea and Passionflower tea might help relieve insomnia and anxiety, as it appears to boost the level of gamma-aminobutyric acid (GABA) in the brain, which lowers brain activity and can lead to relaxation and better sleep (3).
Holy Basil or Tulsi tea has also been used for thousands of years to support a healthy stress response and promote more restful sleep
Practice Mindfulness and Meditation
In this modern day world, our minds are constantly churning thoughts one after the other. Most of these are related to some kind of tasks or chores (personal or work related) that we need to do that cause us anxiety. If your mind is in a troubled state, it will be difficult for you to fall asleep. Practicing mindfulness or doing regular meditation can help ease that anxiety and calm your mind. Doing a 15 minute guided medication can do wonders to help you relax and sleep better. I highly recommend this book 'Healing Mindset' handbook by Eileen Laird that gives you simple practical tips to relax and establish a mind body connection. Keeping a gratitude journal and writing thankful notes at night can help you get in a good frame of mind to help you sleep better.
Do not miss the sleep bus
Most of us naturally get tired in the late evening anywhere between 8 pm and 11 pm. If however, you decide to stay up past that window, the body may get a “second burst” of energy, and that will make your body so alert that you will have trouble sleeping for a while after that. You may have experienced that when you are at a social event where you stay past your regular bedtime. That is why I always tell my clients - "Don't miss the sleep bus when it comes as you will have to wait for a long time to fall asleep if you miss it!"
Get your female hormone levels checked
If none of the above strategies help you in improving your sleep, your hormone levels could be the culprit. Most women experience insomnia and trouble sleeping throughout the night when their hormone levels drop in perimenopause or menopause. If you are in that stage, I recommend that you see a OB GYN or a functional medicine practitioner who can prescribe some botanicals/herbs or Hormone Replacement Therapy (HRT) to help with your hormone levels.
Finally, as I mentioned in the beginning, chronic pain can also make it difficult to sleep and hence taking different steps to reduce inflammation and pain in your body can go a long way to improve sleep. I will discuss strategies to reduce pain and inflammation in future blog posts. You can also check out the Rheumatoid Strong and the Rheumatoid Strong Plus programs that provide you with holistic strategies to help reduce inflammation and pain.
Kelly GA, Blake C, Power CK, O’Keeffe D, Fullen BM. The association between chronic low back pain and sleep: a systematic review. Clin J Pain. 2011; 27(2):169-81. DOI:10.1097/AJP.0b013e3181f3bdd5. [PubMed]
Sivertsen B, Lallukka T, Petrie KJ, Steingrimsdottir OA, Stubhaug A, Nielsen CS. Sleep and pain sensitivity in adults. Pain. 2015; 156(8):1433-9. DOI:10.1097/j.pain.0000000000000131.[PubMed]