Toolkit - Sleep Hygiene — Small Steps To Freedom

I understand that for many people living with chronic pain, night can be one of the worst times of the day – there’s nothing to distract from any pain or discomfort and any medications you’re on can have an effect on how, when and even if you’re able to fall asleep. I have all too vivid memories of how long the nights felt after my last major operation in 2015 when my pain would often increase from the sheer effort of getting ready for bed and all that entails. Thank heavens Netflix had Spooks at the time – I don’t know what I’d have done without it quite frankly! But I think that is a trap we can fall into far too easily when trying to cope with managing sleep alongside chronic pain – we look for distraction to help us fall asleep rather than actively creating the most ideal conditions within which to do so.

My intention with creating this Toolkit is to support people in making small changes that can make a huge difference to their quality of life. Sleep is so essential to our overall wellbeing and that’s why I’m choosing to include it here.

One of the things I very quickly got on top of during my pain management programme was what they termed ‘sleep hygiene’. It felt like something easy and manageable to tackle, unlike (whisper it … ) pacing. As with all good habits and intentions it inevitably slipped somewhat, so when I was experiencing a bad flare up this summer my physio recommended I take another look and see if I could get back on top of it. I did and this time took proper notice of the difference it made and I have to say, it’s something I’m now working really hard to ensure stays on track. It’s still a work in progress but I know that it makes a massive difference to my quality of life so I would urge anyone reading this to please give it a try for a few weeks and see how it works for you. Ideally I would recommend keeping a sleep journal for a couple of weeks leading up to making changes and continuing to do so throughout the first few weeks of change and just see what differences and patterns you begin to notice.

So, it’s time to …

BUILD A BED-TIME ROUTINE

Ultimately the aim should be to establish a regular wind-down routine that you repeat every day. This doesn’t need to take long– anything from 15 minutes to an hour is ideal but having a regular routine will condition both your body and mind to recognise that it is nearing the time to go to sleep. It is therefore also really important that your bed-time is the same every night – going to bed at 8pm on a Monday, 11pm on a Tuesday, 9pm on a Wednesday, midnight on a Thursday etc isn’t going to support your body in establishing a recognisable pattern. Consistency really is key! If you want a bit of a lie-in at the weekend try to keep it to no more than an hours difference from weekdays.

Whatever you spend your routine doing is entirely up to you – key is that it should be a quiet, relaxing and enjoyable period of time for you. Below I’ve included the biggest tips I have for creating those ideal sleep conditions that will ultimately help you function and feel a whole lot better.

THE SCIENCE

A key thing to understand about the human body and sleep is that we all have a cycle known as the circadian rhythm (more often referred to as the ‘body clock’) that actually tells our bodies when to sleep and wake over a 24-hour period, and this rhythm is managed internally by the production of melatonin and can be affected by external environmental cues such as light. 2-3 hours before bedtime the brain begins to produce melatonin, which starts to make you sleepy and alerts your body that it’s night-time. When daylight, which is blue light, is recognised by receptors in the backs of our eyes in the morning the brain stops producing melatonin and the waking part of the cycle begins. When sunlight fades and we are in darkness or the yellow glow of artificial lights/candles, melatonin production begins again in readiness for sleep.

BLUE LIGHT

Many of you will already know this but what produces blue light? Screens. Phones, laptops, tablets, television. All blue. So when you’re happily sat in bed having that last 5 minute/1 hour scroll through Instagram for the day you are confusing the heck out of your brain! It will have already begun melatonin production, possibly hours before, and now it’s being told it’s time to be switched off again, way earlier than expected. Then the blue light gets turned off and you might be lying there wondering why your mind is racing (over stimulation of content as well as light will be at play here) and sleep is eluding you as the brain has to change tack again. The recommendation is to switch off all blue light for at least one hour before bed. This has definitely been the hardest one for me!

SLEEP AND SEX ONLY

Again, I understand that for some people this may be difficult but if you are able to spend time outside of your bedroom – do it. Get up in the morning, make your bed (it will make walking back into the bedroom to go to sleep much more pleasant than walking in to a crumpled pile of duvet) and leave the room. Your bed and bedroom should be used for two things only – sleeping and sex (though for heavens sake, if you’re lucky enough to be having sex, take that out of the bedroom too!). This is beyond simple but leaving our bed/-rooms during waking hours means that heading back into that space at night becomes automatically associated with sleep.

CLIMATE CONTROL

I am the most nesh person going and in the dead of winter I am often to be found with my heat pad and a hot water bottle to keep the chill at bay in bed. However, there is nothing I hate more than a hot bedroom – it’s stifling, oppressive and makes me fidget more as I slowly burn like a thousand suns (my medication has buggered up my internal thermometer so if I get overheated I’m doomed). Heat pads and hot water bottles on the other hand are removable and once chucked out of bed allow me to cool down quickly. Studies show that a mild temperature of between 18C and 24C is ideal in bedrooms.

HERBAL TEAS AND SUPPLEMENTS

There are a variety of amazing teas out there that make use of the right combination of ingredients to help us along to the land of nod. Some of the key ingredients to look out for include:

Chamomile – a common ingredient in sleep teas, it contains an antioxidant called apigenin, which binds to specific receptors in the brain, decreasing anxiety and supporting sleep
Valerian – a flowering plant that has been used to ease insomnia, anxiety and restlessness for hundreds of years
Lavender – thought to have relaxing and anti-stress properties, studies have shown it improves sleep quality

The big guns in my arsenal are a rock steady, good quality Chamomile, Pukka’s gorgeous Night-Time blend and Snore & Peace by Clipper.

I also take a Magnesium supplement 1-2 hours before bedtime. Magnesium helps maintain healthy levels of GABA, a neurotransmitter that promotes sleep and relaxation. It is one of seven essential minerals that the human body needs in large quantities but it is not naturally produced by the body – it is really important therefore that our diets include plenty of magnesium rich foods, such as dark leafy greens, seeds and nuts, whole grains and more besides. Magnesium deficiency is really common among adults though which is where taking a good quality supplement can help ensure healthy levels are maintained. Research indicates that it supports deep, restorative sleep, as well as regulating the body’s stress-response system, which will also impact on sleep quality.

NOTE: Please be sure to check any teas, herbs or supplements are safe to use alongside any medication you are taking.

ACTIVE RELAXATION

Once in bed and settled comfortably (or as close as) an active relaxation can be a great way to a) check in with your body; b) act as a mindfulness exercise and; c) fully relax your body ready for sleep. There are some slight variations but in essence an active relaxation will take you through the process of focusing on and/or tensing a body part and then relaxing the muscles. Usually you’ll start with your feet or legs and work your way up the body towards the head. I’ll be completely honest – I rarely make it past my midriff before I am dead to the world! There are lots of videos available on YouTube.

SLEEP SOUNDS & STORIES

It’s not for everyone but I love falling asleep to sound. Once settled comfortably in bed I’ll turn on a sleep sound or story from either the Headspace or Calm apps on my phone. There’s everything from fairy tales, myths re-told, glorious travelogue descriptions of places to the sound of rainfall or wind rustling through leaves. As we’re now into autumn I’m particularly fond of rainfall as it’s a sound I love anyway but it feels particularly delicious when tucked up warmly in bed.

SUMMARY

Other things you may wish to consider include: limiting nicotine, caffeine and alcohol intake, as these all interrupt sleep in various ways; reading for relaxation; taking a warm bath etc. A bedtime routine does not have to be long or complicated. As long as what you’re doing makes you feel good and relaxed at the end of your day, go with it. I hope the tips here are useful to you, contributing to better sleep and allowing your body to properly relax and repair as it should be doing through the night. If there are other tips you find really help please do comment below and share, I’d love to hear them!