Practitioner resources | Ten Footsteps – a practitioners’ guide | Sleep

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Relaxation and
mindfulness

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Sleep

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Sleep

Sleep is the third most important health impact for those with pain, so it makes sense to focus your efforts on guiding people to sleep well.

This is not about promising a perfect night’s sleep every night. Your role is to:

dispel myths by sharing what we know about normal sleep
share techniques and resources that will help the patient to improve their sleep over a period of weeks

Actions you can take

Get to know all about sleep

Here’s a quick overview of things which can affect the sleep of people living with pain and what might be helpful:

Pain itself

Mindfulness, progressive muscle relaxation and other distraction techniques have been demonstrated to help people get to sleep and improve sleep quality

Pain medicines

Review analgesia – does it need a trial of adjusting the dose or formulation to provide some relief overnight. Long-term analgesic use can worsen sleep (opioids especially) so consider if analgesia may be making sleep worse.
Avoid prescribing sleeping tablets long-term – they can cause rebound insomnia. With these and analgesics, discuss with the person and support them to review their use, how useful the medication is in helping them achieve their goals and plan a slow and steady reduction when they’re ready. As well as improving sleep and pain, reducing unhelpful polypharmacy is known to be beneficial for people’s general health and well-being.

Bedroom comfort

Bedroom is for sleeping only and best kept dark, quiet and cool
Do not use any devices that emit blue light, such as smart phones or tablets, in the bedroom. They affect secretion of melatonin from the pineal gland and make it harder to get off to sleep

Mood changes

Untreated depression or anxiety may contribute to poor sleep. Good treatments are available with both talking therapies and medications.

Lack of routine and daytime inactivity

Build fitness and activity with a range of different movement activities: walking, stretching, swimming, tai chi, watering plants etc. Moving more often is the key
Try to set regular times each day for activity and rest
Set a consistent bed time and rising time (most important)
Have a consistent bedtime routine
Stick with this plan for several weeks to allow the body to adapt – even if there are setbacks

Unhelpful thinking about poor sleep

Lots of worried thinking disrupts sleep. Thinking like about sleep itself, the lack of it, the impact of pain on day to day life and the pain itself. CBT-I is helpful here
Use relaxation skills e.g. breathing exercises
Mindfulness resources that aim to improve health and lessen stress are valuable

Side effects of medicines

Medicines may contribute to day time drowsiness and inactivity and interact with opioids / gabapentinoids so best avoided or only very short term
Avoid excessive day time napping – this will affect the quality of night sleep

Food and drink choices

Reduce or cut out caffeine
If having caffeine, avoid after lunchtime
Avoid drinking late in the evening if you wake needing to urinate
Avoid eating large quantities of food late in the evening before sleep time as leads to more restless sleep
Alcohol and cigarettes can reduce sleep quality

Medical issues

Obstructive sleep apnoea (OSA) or restless leg syndrome (RLS) may be contributing to poor sleep

Explore the value of mindfulness resources such as apps

These aim to cultivate patience and trust that sleep will come. They do not induce sleep like medicines. Mindfulness works best if practised regularly.

Mindfulness can:

help break down the vicious cycle of insomnia by guiding attention away from unhelpful thinking and worrying about not sleeping.
reduce stress and anxiety, which increase our perception of pain; it calms and regulates emotions, decreasing our perception of pain or frustration of not sleeping.
help greater awareness of thoughts, feelings and body sensations so the person can respond better to the body’s need for rest, balalnce of exercise / activity and healthy eating to maintain a healthy lifestyle.

Resources you can use with the person you are supporting

How to Sleep Well with Pain

ALSO AVAILABLE AS A PRINTED BOOKLET

This leaflet draws on recent sleep research and provides simple-to-follow guidance for patients to develop the skills they need to start getting a good night’s sleep.

Download

Online resources for people with pain

The Sleep Council website

The Sleep Foundation

Meditations for sleep: Headspace website

Live Well with Pain Health and Wellbeing Check tool

The Live Well with Pain Health and Well Being Check tool is a self-completion, person-centred tool that can be shared easily with patients and clients.

The data from this completed tool will help identify the actual current impact of chronic pain on the individual and their health.

You can find a more detailed explanation of the Live Well with Pain Health and Well Being Check tool here.