Sleep problems (back pain management programme)

Important facts about sleep

Normal amounts of sleep vary from one person to another: it is usually between four and 10 hours per night.

How much sleep you need may vary according to your age, sex, lifestyle, work, social demands and physical and emotional health.

Sleep patterns change throughout our lives. For example, we usually sleep less and have more wakeful periods as we get older.

Reasons for poor sleep

• too much rest with insufficient activity and exercise
• increased pain due to overdoing an activity
• daytime naps
• medication use and withdrawal
• caffeine
• cigarettes
• alcohol
• worries and anxieties
• irregular hours
• clock-watching

Effects of lack of sleep

• less able to enjoy things
• pain is harder to live with
• less resistance to infection
• more irritability with others
• depression and feelings of hopelessness
• slower mentally and physically

What can I do to help?

There is no quick and easy solution to sleep problems. You may have had some temporary success using sleeping tablets, alcohol or herbal remedies. However they will eventually lose their effectiveness and may have significant side effects or harmful effects.

It is important to think about your own personal sleep problems and develop some strategies to deal with them. One way of getting a clearer idea of your sleep problems is to keep a sleep diary for a few nights.

Strategies to improve your sleep

1. Develop a regular routine to allow you to wind down and relax in the hour or two before bed. This will help you prepare mentally and physically for bed and feel more settled. For example, lock-up, bath, clean teeth, undress etc.
2. Go to bed at the same time each night: Do not try to get more sleep by going to bed earlier.
3. Get up at the same time every morning no matter how you slept the night before. This will help to keep your body clock in a routine.
4. Avoid stimulants such as coffee, tea, chocolate or cigarettes four to six hours before going to bed.
5. Keep evening alcohol low. For many people more than a glass of wine or beer can affect their sleep pattern, even if they initially promote sleep.
6. Make sure you have a range of different ways of getting comfortable, for example using different pillows, lumbar rolls or a comfortable chair if necessary.
7. Try not to think about getting to sleep. Lying in bed relaxed is refreshing even if you are not asleep.
8. Try not to nap or sleep during the day even if you are tired.
9. Gradually increase your daytime activity and exercise. Aerobic exercise during the day really helps sleep at night, but do not do a lot of strenuous exercise just before going to bed.
10. Associate your bed and bedroom with sleep rather than with worry or work. Try not to use your bedroom during the day except for relaxing. Go to bed and turn the lights off only when you are sleepy and within a limited time period (for example 21:00 to midnight). Do relaxation exercises to try to wind down. If after 15 to 20 minutes you have not fallen asleep do something to occupy your mind like reading a chapter in a book.
11. If you do wake up during the night and have trouble getting back to sleep try not to clock watch, it will only irritate you. Try not to lie in bed tossing and turning. You can get up, sit in another room and do a restful activity until you feel sleepy again. Then you can return to bed.
12. If you are kept awake by worry, it can be worth trying a problem-solving approach. At least an hour before winding down for bed, write down the worries or problems that are on your mind. Then write down all the possible solutions. Try to complete this at least an hour before winding down for bed. You can evaluate the pros and cons of these solutions the next day. If you wake or do not fall asleep because of these worries, remind yourself that you have the matter in hand and that going over it now will not help. If a new worry crops up in the night, write it down and deal with it the next day.
13. If you are coming off tablets you should check if this could cause temporary sleep problems. You can then be prepared for such problems and be reassured that they will settle as your body is cleared of the tablets. This may take some time with certain tablets.
14. When you have a bad night try to think why rather than jump to conclusions (for example, it shows that I do need my tablets). It may be because you have overlooked one of the above points. Remember that bad nights happen to everyone and may be ‘just one of those things’.
15. Keeping a sleep diary each night can show you that your sleep is improving even if you do not feel that it is. After a week or two you can look back and usually see that your sleep is improving gradually. If this is not the case, review your routine.

Remember it will take time for these methods to help you improve your sleep so you need to stick to them for some time even if progress is slow.