"We are living in an age when sleep is more comfortable than ever, and yet more elusive.”
-David K. Randall
We all know the difference a good nights sleep has on our mind and body; we are eager to start the day, our senses are awake, and things that usually stress us out seem to be less problematic. Even though someone who is asleep appears to be seemingly lazy, a shut-eyed-organism is surprisingly filled with trillions of cells working to restore, rejuvenate, detox, and heal the body. Simultaneously, sleep also aids the mind in storing and processing memories, consolidating newly learned information, and helping with focus, creativity and decision making skills when awake. It’s no wonder then that humans, and every single other animal, needs restful sleep.
In his book Dreamland, David K. Randall informs us of how our quantity and quality of sleep underlies all of the decisions we make throughout the day, sleep also significantly impacts our emotional intelligence. Randall emphasizes that if we don’t get enough sleep, our body will keep score of the debt, and feel emotionally and physically fatigued until we get proper rest we need. “Humans need roughly one hour of sleep for every two hours they are awake, and the body innately knows when this ratio becomes out of whack. Each hour of missed sleep one night will result in deeper sleep the next, until the body’s sleep debt is wiped clean.”
Sleep is mandatory for our well being, especially when we are suffering from chronic pain — unfortunately, pain is also one of the leading causes of insomnia. Studies have shown that two-thirds of the people who suffer from back pain have insomnia; studies have additionally shown that disrupted sleep also worsened back pain. Insomnia and pain clearly influence each other, when one is impacted it seems that the other is as well. Another finding from the NSF 1996 survey, showed that people who experience pain AND sleep problems scored significantly lower in general mood, physical health, ability to handle stress, ability to get up and go, and their ability to concentrate compared to people who didn’t experience pain and sleep problems. The good news is that we have some control over our sleep habits, but first we need to learn which habits promote sleep and which ones obstruct it.
Here is a list of bad habits that you may need to get rid in order to get a better nights rest:
- Do not consume any caffeine in the late afternoon or evening. Caffeine is found in coffee, certain teas, soft drinks, chocolate and cocoa. Furthermore, here is some medicine that may also include caffeine:
- allergy, anxiety, depression, epilepsy, nausea, thyroid medicine
- cold, cough and decongestants
- Do not consume any tobacco products which contain nicotine not only stimulate the body and promote wakefulness, but they are also bad for your health.
- Do not drink Alcohol before going to sleep because it interferes with feeling rest due to blocking your REM sleep.
- Do not eat before going to sleep, it can cause indigestion, acid reflux and overall decrease the quality of your rest because your digestive system will be hard at work.
- Do not exercise during the 3-4 hours before going to bed. Try exercising in the morning, afternoon or during the early evening.
Creating an optimal sleep environment will also help you fall asleep and stay asleep. Here are some tips for doing so:
- The temperature of your bedroom should be on cooler side, not cold and not hot.
- Your bedroom should be quiet. If you have noisy pets or a partner who snores, try using earplugs, downloading a noise app (I like using a free app called Rain, Rain), or getting a white-noise machine to help mask other sounds.
- Your bedroom should also be dark, try covering your bedroom windows with dark curtains. You could also try wearing a sleeping mask.
- One of the most important things to consider is the comfort of your mattress. If you
are experiencing pain, it is really important to buy a mattress that suits your needs.
Create soothing bedtime rituals to ease your mind and body at the end of every day. Here are some rituals and activities you can experiment with before you go to sleep:
- Try to meditate, journal, or read something that helps you unwind.
- Listen to soothing music or a podcast.
- Do not watch TV, eat, pay your bills, send emails etc. in your bed. Create an intention to use your bed as a sleep sanctuary. (Having sex in bed is also ok).
- Try to go to sleep at the same time every single night, make sure your schedule is consistently the same 7 days a week!
- Try using an essential oil diffuser, a few oils that are known to promote calming and soothing effects on the mind and body are lavender, cedar wood, chamomile and bergamot.
- Drink teas that promote sleepiness, such as chamomile, lemon balm, lavender or Sleepy-Time tea blends.
- Take a hot shower or a nice bath before going to bed. Add episome bath salts to help relax any muscle soreness.
Whatever you decide to do for your last bedtime activity, try to keep in mind that it should promote calmness. Invest your time in figuring out what activities your body responds well too— and stick to those habits, your body will thank you!
There is a lot of debate in the medical literature about which came first, anxiety or chronic pain? It's one of those chicken and egg situations. To me all that matters is that I can tell you, if you have been living with pain for more than 6 months you probably have some anxiety. It is not as important to me to know which came first because you are now living with both. And anxiety increases pain and pain increases anxiety, creating what I can a "death spiral" where without help the person just gets sucked farther and farther down into misery.
So let's assess the problem:
Anxiety is defined as 'A negative reaction of a person to stress, often leading to over arousal'
'An emotional state, similar to fear, associated with arousal an accompanied by feelings of nervousness and apprehension'
What is an anxiety disorder?
Anxiety disorders are a unique group of illnesses that fill people’s lives with persistent, excessive, and unreasonable anxiety, worry, and fear. They include generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder (SAD), and specific phobias. Although anxiety disorders are serious conditions, they are treatable.
What chronic pain conditions and diseases commonly occur with anxiety disorders?
Arthritis —The amount of anxiety and mood disorders (such as depression) is higher in individuals with arthritis than in the general population. Some studies have found anxiety disorders are even more strongly associated with arthritis than is depression.
Fibromyalgia —In a recent study of 336 adults, published in the Journal of Clinical Psychiatry, those with fibromyalgia were almost 7 times more likely to have suffered from an anxiety disorder than those without the disorder.
Migraine —Migraines (and chronic daily headaches) happen a lot in people with anxiety disorders, as well as in those with mood- and substance-abuse disorders. Many studies have found that generalized anxiety disorder and panic disorder are particularly associated with migraines or other types of headaches. As with fibromyalgia, researchers have suggested that there may be a common tendency to develop anxiety disorders, depression, and migraine headaches.
Back Pain —Anxiety disorders and back pain often co-occur; back pain is more common in people with anxiety and mood disorders than in those without them.
Does chronic pain complicate the condition of a person who also has anxiety disorder?
An anxiety disorder and a co-occurring chronic pain disease can make a person’s health more difficult to treat. But a variety of treatments and lifestyle changes can offer relief. Possible health complications are noted below:
Chronic pain sufferers who also have an anxiety disorder may have lower pain tolerance or a lower pain threshold. People with an anxiety disorder may be more sensitive to medication side effects or more fearful of harmful side effects of medication than chronic pain suffers who aren’t anxious, and they may also be more fearful of pain than someone who experiences pain without anxiety.
What treatment considerations are made when someone has co-occurring conditions?
Many treatments for anxiety disorders may also improve chronic pain symptoms. Usually a comprehensive plan with a number of treatment types is necessary. Below is more information about some treatment options for anxiety disorders and chronic pain.
So don't be surprised if you find yourself worrying more, or even feeing symptoms of panic if you have been in pain persistently for six months or more. That is pretty common. But DO take anxiety seriously as it can have detrimental effects to your health (lower immunity, poor quality sleep, increased pain and crabby mood to name a few!). There is treatment for anxiety available so make it a priority. You will be surprised by how much lowering your anxiety level can also lower your pain.
Yours in health,
Adapted from: “Anxiety Disorders and Chronic Pain,” by Anxiety Disorders Association of America. http://www.adaa.org/gettinghelp/MFarchives/MonthlyFeatures(july07).asp
Krista Jordan, Ph.D., ABPP