Pain and Sleep Guide
If you are losing sleep due to a painful condition, you could be making your condition worse with each night that passes.
The Centers for Disease Control and Prevention (CDC) recommends adults get at least 7 hours of restful sleep each night for optimal health, yet less than two thirds are getting adequate sleep. The problem is getting worse. According to a study published in the journal Sleep, the percentage of adults sleeping 6 hours or less has increased a whopping 31 percent since 2004. In fact, sleep problems have become such a problem among Americans that the CDC describes sleep deprivation a “public health epidemic.”
“Sleep deficiency can cause cognitive difficulties including making it tough to learn new things; form new memories and recall old ones; make positive, helpful choices; pay attention to the task at hand; and to regulate our emotions, among other factors,” says Katherine Hall, a sleep psychologist and one of the sleep coaches at Somnus Therapy, an online sleep therapy program for people suffering from sleep problems.
“Since lack of sleep causes us to struggle with emotional regulation, this can contribute to mental illness,” she adds. “Many people who have chronic insomnia struggle with mood swings, acting out of character, being impulsive, feeling hopeless, or lacking motivation. Lack of sleep can also lower libido in both men and women, causing reduced sex drive, impacting relationships and confidence levels.”
Furthermore, insufficient sleep can wreak havoc on our physical health as well, leading to an increased risk of heart disease, kidney disease, high blood pressure, obesity, diabetes, and stroke. It also leaves our bodies somewhat defenseless. “When we aren’t sleeping well, how our immune system reacts is affected,” Hall says. “This can make it harder for our body to fight off illnesses, and make us more susceptible to getting sick.”
How can you reverse the effects of sleep deprivation? By getting a good night’s sleep, of course. We asked a team of experts to offer some tips for getting a good night’s sleep. Here’s what they had to say.
You probably have heard of the circadian rhythm, the body’s internal 24-hour clock that triggers sleepiness at night and wakefulness in the morning. There are a lot of factors at play in keeping it wound and working properly. Numerous studies have shown that “getting outside in the natural light” is one of the strongest components in regulating the circadian rhythm, Hall says.
Natural daylight helps you wake in the morning and stay alert during the day. When evening falls and dusk gathers, sensors in the eyes alert the brain that it’s time to start winding down for the day.
The circadian clock is most sensitive to light beginning about two hours before your usual bedtime and throughout the night until about an hour after your usual waking time. Exposure to light during this sensitive time can throw your circadian rhythm off kilter and make it difficult for you to feel sleepy when it’s time to go to bed.
And it’s not just daylight. Artificial lighting can also disrupt your circadian rhythm and interfere with sleep. There are ways to counter these effects. If you have difficulty falling asleep at night, keep the light levels in your home dim during the two hours before you plan to go to bed.
Caffeine has a host of benefits from decreasing fatigue and improving memory to sharpening your mental functioning. But consuming caffeine in the evening can derail your sleep. Cutting out caffeine before bedtime should be a no-brainer. But even a cup of joe or a caffeinated soda late in the afternoon can leave you wide-eyed at bedtime.
“Caffeine has a half-life of about 5 hours. So if your go-to pick-me-up is a 4 o’clock java, approximately half of that caffeine would still be in your system at 9 p.m.,” Zhang says. “Some people metabolize caffeine quicker than others and aren’t as affected by the jitters or energy boost that it provides. However, it’s more likely that you don’t fully realize how much your afternoon coffee fix impacts your ability to wind down at night.”
According to a study published in the Journal of Sleep Medicine, consuming coffee even 6 hours before bedtime can disrupt sleep.
Even if you don’t physically feel the effects of caffeine at bedtime, it may still be in your system, Zhang says. “This week, try giving yourself a caffeine ‘cut-off’ time of at least 6 hours before bedtime. The earlier, the better.”
It’s tempting to wind down at night time by watching TV, browsing your laptop or tablet, or scrolling through your smartphone. But those electronic devices give off blue light, which stimulates the brain and tricks it into thinking it’s time to be awake and alert.
Harvard University researchers conducted an experiment comparing the effects of 6.5 hours of exposure to blue light to the same numbers of hours of exposure to green light. They found that blue light suppressed the secretion of melatonin — the sleep hormone — for about twice as long as green light. It also shifted circadian rhythms by 3 hours as opposed to 1.5 hours with green light.
Blue light “tells your body to wake up,” says Mark Zhang, CEO and founder of Manta Sleep Mask. That’s helpful in the morning, but not so much when you’re trying to sleep. If you can, try turning off the screens 1-2 hours before bedtime and pull out a book instead. And if ditching your laptop and phone for a couple of hours before bed isn’t an option, try blue light-blocking glasses.”
You can help prevent blue light from disrupting your sleep by turning off your electronics at least an hour before bedtime. If you simply can’t, try investing in a pair of blue light-blocking glasses, or install an app on your phone that blocks blue light.
A nightcap may seem ideal to help you sleep at night. Alcohol does, indeed, make you sleepy and calm your stress level, which can help you to fall asleep. But one too many drinks too late at night can also interfere with your sleep.
“Sipping on a nightcap or having a couple of glasses of wine after dinner may seem like it’s helping you sleep. However, alcohol actually disrupts your sleep cycles.” Zhang says.
A review published in the journal Alcoholism: Clinical & Experimental Research, confirmed that alcohol acts as a depressant and sedative and shortens the time it takes to fall asleep. But it also decreases deep sleep and reduces REM sleep. In other words, too much alcohol before bedtime puts you to sleep but also limits restorative REMS sleep. Then it forces you awake in the middle of the night and prevents you from falling back to sleep. When you do wake up for the day, you will likely feel groggy.
Alcohol also fills up your bladder and dehydrates you, which means drinking too much before bedtime can wake you through the night so you can use the bathroom as well as rousing you to guzzle water.
“Instead of having alcohol before bed,” Zhang suggests, “try having a warm and calming drink, like herbal tea or a turmeric latte.”
When your nighttime sleep suffers, you can become excessively sleepy during the day and be tempted to settle in for a nap. You’re not alone. According to a 2009 Pew Research Center report, about a third of adults take an occasional nap. Zhang is a leader in the “pro-napping movement,” and educates others on why an afternoon nap is crucial for unlocking one’s full potential.
A 2003 study by Sara Mednick, PhD, a psychologist at the University of California, Riverside, found that a 60- to 90-minute nap was just as effective as a full night’s sleep. In another study she found that an afternoon nap was as effective as an afternoon dose of caffeine at enhancing alertness and attention. But naps also boost some forms of memory consolidation.
However, a nap longer than 90 minutes can leave you the rest of the day suffering with sleep inertia — that groggy state when you first wake up during which your cognition and sensory-motor performance are impaired. And, like caffeine, a nap too close to bedtime can make it difficult for you to fall asleep at night.
The secret is to plan your nap so that you wake before entering the third stage of sleep, or after you’ve passed through REM sleep and re-entered lighter Stage 1 or 2 sleep.
Other nap strategies include taking your nap before 3 p.m. or, better yet, consider a quick catnap. According to a study published in Sleep, individuals who took a 10-minute nap experienced more improvement in short-term performance and less sleep inertia than those who took a 30-minute nap.
Speaking of lavender and chamomile, they’re both natural sleep aids, along with melatonin, valerian root, and magnesium, to name a few. Sure, you can pop a few over-the-counter or prescription sleeping pills to help you fall asleep at night. But those can leave you with unwanted side effects, including next-morning drowsiness. You may also become dependent on them.
Natural sleep aids are a much healthier alternative. They also come in a variety of forms, such as teas, pills, essential oils, and incense. Some studies have backed up the sleep improvement of various natural sleep aids, including a one that found older people with dementia experienced fewer sleep disturbances after lavender aromatherapy, and another that found menopausal and postmenopausal women slept better after taking a valerian root supplement.
“It’s hard to get a good night’s sleep without enough of the mineral magnesium because magnesium facilitates sleep-regulating melatonin (sleep hormone) production,” says Dr. Carolyn Dean, who has spent more than 30 years studying sleep. “Studies have shown that magnesium helps you get a deep and restful sleep.”
“Your bedroom should be your ultimate place of peace,” says Jeff Brown, mattress industry expert and president of Big Fig Mattress. Take a look around your bedroom and take notice of things that may hinder sleep and what can be done to improve them.
“Step one is investing in a quality mattress that fits your body so that you can reap the mental and physical benefits of amazing sleep,” Brown suggests. “The quickest way to ruin a relaxing evening in bed is to end up tossing and turning, sweating like a marathon running, or feeling like your mattress has swallowed you. There is no ‘one size fits all’ when it comes to mattresses, so do your research and find what works for your body type.” You’d be surprised how much comfort and support a new mattress made with memory foam, latex foam, or a combination of foam and innerspring, can add to your sleep quality.
“After that, it’s about setting the mood and killing distractions,” Brown adds. “Keep your room cool and pick sheets that breathe and wick moisture away from your body, like cotton or bamboo.”
Use black out curtains or an eye mask to block out unwanted light, and lower the thermostat so that it’s a few degrees lower than it is during the day. “The sleep room temperature should be cool and comfortable, which will vary for each individual and will be around 67F or 19C,” says Marvin Nixon, a health and sleep coach and owner of Nixon Health Coaching Ltd. And if you have noisy neighbors, “a white noise machine can help to drown out the noises of the night — especially if you live in a noisy building or in the city — while creating the perfect atmosphere for good sleep,” Zhang adds.
Another way to bolster the rhythm of your internal clock is to create a nighttime routine. This signals to your body and brain that it’s time to sleep. Nighttime routines should begin about 30 minutes to 90 before bedtime and include personal hygiene practices, such as brushing your teeth and washing your face, as well as listening to soothing music or reading a book.
One great way to unwind is by taking a bath. According to Science Daily, biomedical engineers have found that people who take a warm bath about 90 minutes before bedtime are able to fall asleep faster.
“Our bodies have a natural temperature cycle that correlates with our circadian rhythms — and we like to have a slightly cooler body temperature right before sleeping. Baths help because increasing your body temperature as you bathe actually results in your body cooling down to the perfect sleep temperature after your bath, right as you’re falling asleep,” ,” Zhang says. “Try sudsing up tonight and see how it affects your sleep. Extra points if you use a calming scent in your bath, like lavender or chamomile.”
What and when you eat at night can impact the quality of your sleep. Generally speaking, it takes about 2 to 4 hours for food to move from your stomach into your small intestines. During that time, your body is actively working to digest the food you’ve eaten. Lying down can worsen bloating and flare acid reflux attacks, both of which interfere with sleep.
Waiting at least an hour, and ideally longer, after dinner to go to bed also helps reduce your risk of stroke by about two thirds, according to a University of Ioannina (Greece) Medical School study.
On the flip side, if you wait too long after a meal to go to bed, a rumbling stomach could cause enough discomfort to interfere with sleep. Try snacking on foods that promote sleep, such as bananas, oatmeal, or almonds.
“Eating the wrong foods at night can also make it hard to sleep, especially foods that are high in refined sugars and carbs. This will likely cause you to wake up due to blood sugar fluctuations, which can occur when you eat highly processed foods,” says Heather Hanks, a nutritionist with Instapot Life.
“You can get a better night’s sleep by eating foods that are easy to digest, such as low-carb veggies and lean protein,” she says. “You can also help promote sleep by drinking tart cherry juice, which helps increase melatonin levels. Just be sure to find a brand that does not contain added sugars as this will work against your sleep intentions.”
However, be sure not to load up on too many fluids before bedtime or you’ll be running to the bathroom during the night to relieve your bladder.
Regular exercise improves physical and mental health. But it can also improve your sleep, according to researchers at Johns Hopkins Center for Sleep at Howard County General Hospital. They found that people who engaged in moderate aerobic exercise experienced an increase in restorative slow wave sleep, also referred to as deep sleep.
“It’s always the first thing I think of whenever I have a night or two of bad sleep: ‘Am I getting enough exercise?’” says David McHugh, CEO and founder of My Mixify, a business blog focused on fitness, health and wellness. “It seems like it’s too good to be true, but just moving your body and getting your heart rate up can really have a profound effect on how well you fall asleep — and stay asleep — at night.”
“There is a caveat, though. Make sure you don’t workout right before you go to bed,” he adds. Exercise also causes the release of endorphins — hormones secreted within the brain and nervous system that cause a feeling of euphoria. “If you’re doing it correctly, [exercise] will also … increase your heart rate, your adrenaline, and the temperature of your body, at least to a certain extent.”
“It’s okay to work out in the evening, but make sure you wait at least a few hours to give your body a chance to cool down,” he adds. The Johns Hopkins researchers recommend waiting at least 1 to 2 hours to allow the endorphins to wash out of the system, and provide ample time for the adrenaline levels and body temperature to return to normal.
Your bedroom should only be used for sleep and sex. If you use the space for other activities such as lounging, working or studying, watching TV, or eating, you’re less likely to associate your bedroom with sleep and intimacy and instead associate it with other, possibly stressful, activities. And believe it or not, this can impede your sleep.
Instead, “create a sleep sanctuary,” says Lisa Young, a nationally recognized nutritionist and author of · Finally Full, Finally Thin. She is also an adjunct professor of nutrition at New York University. When creating your sleep sanctuary, remove the things that interfere with relaxation and sleep — like work or study materials and food — and focus on creating a relaxing sleep environment.
“A clean, clutter-free bedroom, fresh linens, black-out shades, keep temperatures somewhere in the upper sixties (I know this seems cold, but people sleep better in cooler environments), and a pink noise or white noise machine creates a calm, sleep-friendly environment,” Young says. “Also, keep TVs and computers out of the bedroom.”
Just as natural daylight helps sync the circadian rhythm to help you sleep better, so does keeping a consistent sleep and wake schedule — even on weekends.
“Getting out of bed by the same time every day strengthens the sleep/wake cycle and ensures that adequate sleep pressure builds during the day,” says Martin Reed, a certified sleep health education and founder of Insomnia Coach. “Over time, this can make it easier to fall asleep at night and improve sleep quality.”
A study published in the journal BMC Public Health, backed up these findings, showing that people with irregular bedtime schedules had poorer sleep quality. Establishing a regular one vastly improves sleep.
Not sure the best time to go to bed? First, plan out what time you need to wake in the morning, suggests Paul Green, director of the Manhattan Center for Cognitive-Behavioral Therapy in New York, and psychologist with expertise in the behavioral treatment of insomnia.
“A lot of difficulty falling asleep happens because your body just isn’t ready to sleep yet,” he says. “Remember, if you sleep 8 hours a night, that means your body will tend toward being awake for 16 hours after you wake up. Take that into account when deciding when to get in bed.”
Taking time before bedtime to focus on relaxing and de-stressing can do wonders for your sleep, whether you choose to do breathing exercises, meditate, or yoga. In fact, a national survey found that 55 percent of people who did yoga found it helped them sleep better and more than 85 percent said it helped reduce stress.
“You may already be a pro meditator, or you may be one who thinks it’s just for the yoga crowd. But whether you realize it or not, meditating (or even just deep breathing) can help you to fall asleep,” Zhang says. “We’re all prone to racing thoughts that won’t calm down — so if you’re affected by this, know that you’re not alone. Counting to ten and focusing on your inhalation and exhalation as you breathe can help your body relax almost immediately. Repeat until you’re fast asleep.”
One way to incorporate relaxation exercises into your schedule is to reserve the time. “Create a daily one hour ‘buffer zone’ before bed to allow enough time to relax and unwind,” Reed says. “During this time, you shouldn’t work or do anything stressful. The daily buffer zone should be used only for pleasurable activities (such as reading, meditation, yoga, etc) in order to set the stage for sleep.”
As Dr. M. Safwan Badr, president of the American Academy of Sleep Medicine once said, “I say the bed is for two things that begin with the letter ‘S,’ and struggling and suffering are not among them.” Yet, being unable to fall asleep at night, or waking during the night and being unable to fall back to sleep, can be frustrating and stressful, especially if you are facing a lot of work or must be alert the next day.
“If you are already struggling with sleep then spending more time in bed will simply lead to more time awake in bed rather than more time asleep,” Reed says. “This leads to more tossing and turning during the night, and more worry, stress, and anxiety related to being awake in bed. Over time, this creates an association between the bed, worry, and wakefulness — rather than sleep, and relaxation. This makes sleep more difficult.”
Lying in bed tossing and turning, hoping for sleep to return can be fruitless. Then, how can you get back into the zone to fall asleep again? For starters, stop looking at the clock.
“It’s common to keep looking at the clock if you’re not sleeping. You might find yourself thinking, ‘If I can fall back asleep now, I’d get four hours of sleep.’ We’ve all been there,” Hall says. “However, this only increases anxiety and fuels the cycle of being unable to sleep. It’s a good idea to stop yourself looking at the clock: turn clocks away from you so you can’t see them from your bed, or even remove them from the bedroom.”
After about 20 minutes, try getting out of bed. You can go into another room and sit in a comfortable chair and read, listen to music, play a repetitive game like Sudoku, or do relaxation exercises. Avoid turning in the TV or staring at your phone screen as these can give off brain-stimulating blue light. And avoid eating or drinking anything besides water. When you begin to feel drowsy, head back to bed and try again.
Nearly 70 million Americans have insomnia — difficulty falling asleep at bedtime, or waking during the night unable to fall asleep. Sleep deprivation can also have long-term medical and mental repercussions. But you don’t have to be a slave to sleeplessness.
“There’s so much you can do to sleep better at night and it all starts with analyzing it, taking a deeper look at the trends, and thinking about the things you do that can help you and are hurting your sleep,” says Dr. Pietro Luca Ratti, a sleep expert and neurologist for WhatASleep.
If you’ve made some of the changes mentioned above and are still struggling to get a good night’s sleep, it may be time to consult with a medical doctor, psychotherapist, or a sleep specialist.
If you are losing sleep due to a painful condition, you could be making your condition worse with each night that passes.
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