We are delighted to have teamed up with the London Sleep Company to bring you expert advice on the importance of sleep and how you can sleep more effectively. As musculoskeletal (MSK) practitioners, who work in the health and wellbeing sector, we commonly see that sleep can aggravate MSK ailments and MSK ailments can affect sleep! Below is a fantastic article by Amy, a leading sleep expert at the London Sleep Company.
Before we start, it's worth remembering:
- Sleep is essential to your health and wellbeing
- Pain can affect your ability to get good quality sleep
- Being tired can impact your levels of pain
- There are things you can do to improve sleep, even if you experience pain
While we sleep, our bodies are busy doing overnight maintenance. Our brains process waste and consolidate memories, while our muscles, bones and organs repair themselves. Sleep also protects our immune systems.
In short, it’s important you get good sleep, both in terms of quality and quantity. When you have a musculoskeletal condition (e.g. back pain, arthritis) that causes pain, it can be challenging to get the sleep you need.
But don’t fear, there are things you can do to manage your pain and sleep better in turn.
How much sleep do we need?
For adults aged 18-64, the recommended amount of nightly sleep is 7-9 hours. But it’s also important to remember that some people require more or less – so as long as you’re waking up feeling refreshed and rested, don’t become anxious that you’re not hitting that ‘magic number’.
National Sleep Foundation, How Much Sleep do we Really Need? [ONLINE] available at https://www.sleepfoundation.org/ excessive-sleepiness/support/how-much-sleep-do-we-really-need)
Those suffering from chronic pain often find their symptoms are made worse by insomnia and other sleeping disorders. Of those experiencing chronic pain, an estimated 50-80% have ongoing sleep difficulties.
Cheatle, MD, Foster S, Pinkett A, Lesneski M, Qu D, et al. Assessing and Managing Sleep Disturbance in Patients with Chronic Pain. Sleep Medicine Clinics, Volume 11, Issue 4 , 531–541. dx.doi.org/10.1016/j.jsmc.2016.08.004)
Research has demonstrated that disrupted sleep can exacerbate chronic pain (Schrimpf M, Liegl G, Boeckle M, Leitner A, Geisler P, Pieh C. The effect of sleep deprivation on pain perception in healthy subjects: a meta-analysis. Sleep Med. 2015;16(11):1313-20.). Unfortunately, there is a vicious cycle at play; pain can disrupt sleep.
Difficulty sleeping makes the pain worse, which in turn makes sleeping more difficult. Not getting enough good quality sleep lowers your pain threshold, and that can greatly impacts on the quality of your sleep.
Pain can also reduce your ability to be active, and that too can further impact sleep quality and pain levels. Together these things can increase stress and anxiety, which again, impact sleep and pain levels. The diagram below visualises the pain-sleep relationship.
Breaking the pain/sleep cycle
On a positive note, there are many things you can do to manage pain and improve your sleep:
Better your bedding
Your choice of bedding can have a huge impact on your sleep quality, MSK condition and comfort. Try exploring which mattress and pillow suits you and your body best. Both offer varying levels of support for your body, so it’s really important to get it right.
You should also ensure your linen is comfortable and keeping you at the right temperature. That may mean changing it up depending on the season.
If you find yourself either particularly hot or cold during the night, linen is an excellent choice of bedding fabric. It’s breathable, meaning it stays cool during the summer and warm during the winter. It also helps regulate your temperature as you sleep. Twice as durable as cotton, pure linen is also bacteria resistant meaning it has anti-allergenic properties.
It’s also important to consider your choice of duvet; a duvet's tog rating relates to its warmth (not its weight – that depends on filling). The higher the tog rating, the warmer the duvet, with 2.5 – 7 tog, an ideal choice for spring and summer and 10.5 – 13.5 being better for the for autumnal and winter nights.
|Summer lightweight duvet||Spring/Autumn weight duvet||Winter weight duvet|
|1.0 – 4.5 tog||7.0 – 10.5 tog||12.0 – 13.5 tog|
Everybody’s sleep cycle is unique, which is why it’s important to find what works for you. All-season duvets (consisting of two separate duvets, which can be used separately for a lightweight option, or connected for a warmer winter option) offer flexibility and versatility. There are also bespoke options available, e.g. duvets with a higher tog value at the bottom of the duvet (for those with cold feet!), or a duvet with different tog ratings on either side (perfect for couples).
Train your brain
Our minds are tricky creatures, and often try to do the opposite of what we want them to. This theory applies to sleep in that if you try to fall asleep, chances are your brain will put a swift stop to that. On the other hand, if you try to stay awake without distractions, it’s likely your brain will fight it and send you to sleep.
Don’t put pressure on yourself to fall asleep; anxiety and stress levels will increase which will make it even harder to drift off. Try to reframe your thoughts – ‘how lovely it is to be lying down and resting’. Below is a table with some easy ways to try and challenge negative thoughts:
|Self-defeating, negative thought||Positive, realistic way to challenge that thought|
|Unrealistic expectations: I should be able to sleep well every night. Nobody else has a problem.||Many people struggle with sleep now and then. I can improve my sleep with practice.|
|Exaggerating: Every night is the same – I never get any sleep!||Some nights I sleep better than others. Every night is not identical.|
|Catastrophizing: If I don’t get some sleep tonight, I’ll mess up at work and they will fire me!||I can get through a day at work even if I am tired. I can still rest and relax in bed tonight, even if I can’t sleep.|
|Hopelessness: I’m always going to have a sleep issue and I can’t do anything about it.||Insomnia can be overcome. If I can manage my worry and focus on positive solutions, I can beat it.|
|Fortune telling: It’s going to take me hours to fall asleep tonight.||I can’t know what will happen tonight. Using the strategies I’ve learned, maybe I will fall asleep quickly.|
Create a sleep schedule (and stick to it!)
Help your body’s natural sleep rhythms by going to bed at the same time each night and waking up at the same time each morning, even on weekends. This helps your body regulate the production of the hormones needed to sleep (melatonin) or stay awake (serotonin). Limit the time you spend in bed to the amount of sleep you feel you need each night. This will help to reduce overnight waking. The optimum amount of sleep will differ from person to person, but trial and error can help you find out what works for you.
NB: Once in bed, don’t look at the clock, especially if you’re having trouble sleeping! This can create anxiety, which in turn will make it harder to sleep. Try moving your clock to somewhere less visible.
If you can’t sleep, get up
This may seem counterintuitive (and really hard!) but if you are struggling to fall asleep after 20 minutes (https://www.sleepfoundation.org/insomnia/treatment/what-do-when-you-cant-sleep) then get out of bed and do something relaxing in a different room. You don’t want your bedroom to become a place you associate with trouble sleeping or anxiety.
Try something that requires the use of your hands and your head, like a jigsaw or some colouring.
Or you could try making a warm drink (e.g. hot milk, no caffeine), doing some stretching or slow breathing exercises and go back to bed when you feel more comfortable or sleepy. If you’re waking due to pain, it may be that you need to do this a few times throughout the night if you’re having a difficult night.
However, make sure you avoid devices that emit blue light (e.g. laptops, TVs, phone and tablets) as they suppress melatonin, a sleep inducing hormone.
Relax Into Rest
A breathing exercise championed by holistic health and wellbeing guru Dr. Andrew Weil, is said to relax you by boosting the amount of oxygen in your blood stream, slowing your heart rate, and releasing more carbon dioxide from the lungs.
We often take breathing for granted, passing it off as something insignificant that our bodies do all the time. But used correctly, it's actually a highly powerful way to control our minds and bodies.
According to Dr Weil, here’s how you do it:
Place the tip of your tongue against the ridge of tissue just behind your upper front teeth, and keep it there through the entire exercise.
- Exhale completely through your mouth, making a whoosh sound.
- Close your mouth and inhale quietly through your nose to a mental count of four.
- Hold your breath for a count of seven.
- Exhale completely through your mouth, making a whoosh sound to a count of eight.
- Repeat the cycle three more times for a total of four breaths.
Another trick recommended by the National Sleep Foundation as a way of falling asleep fast, is ‘Progressive Muscle Relaxation’. This practice involves slowly tensing and then relaxing each muscle in your body to help your body unwind.
Start by tensing and relaxing the muscles in either your toes or your neck and head, and progressively work upwards or downwards. Tense your muscles for at least five seconds, then relax for 30 seconds and repeat.
Soak away stress
Including a warm bath (or shower) in your evening routine raises and then cools your body to the perfect sleep temperature. So sink in and let the warm water and oils soak away your stress. Both the timing and temperature are important here – research shows that bathing one to two hours (ideally, 90 minutes) before bed in water at 40 to 43°C delivered the best results. A bath at that time and temperature can help you fall asleep around 10 minutes quicker, which over the course of a week adds up to over an hour of extra sleep! (https://www.sciencedirect.com/science/article/abs/pii/S1087079218301552?via%3Dihub)
Many people also find that the warm water helps temporarily relieve pain.
Our Sleep Signatures Bath and Shower Elixir is a complex blend of pure essential oils, expertly formulated with deep, restorative sleep in mind… The perfect addition to your evening routine.
Exercise is important for overall health and mental wellbeing. It can also improve sleep. Some people may find that exercising too close to bedtime keeps them awake, so find out what works for you.
Exercise can also help with weight management, bone health and muscle strengthening, which may in turn improve your MSK symptoms.
Watch your caffeine, nicotine, alcohol and food intake
If you can, avoid caffeine altogether, but definitely after lunch. Watch out for hidden sources of caffeine, such as chocolate and painkillers.
Nicotine acts as a stimulant and can cause difficulty falling asleep, light sleep and early waking.
Alcohol before bed should also be avoided, as it too can interfere with sleep.
Some people find that eating a large meal close to bedtime can impact their sleep, particularly if it causes indigestion.
Our bodies function best when we eat a wide variety of healthy, nutritious foods. A balanced diet with adequate fluid intake can help provide better energy levels, help with weight maintenance and give you an increased sense of wellbeing which can help improve your symptoms.
Sleep like a [Sleep] Log
A log of your sleep (and the things that impact sleep) can help you and your doctor figure out what may be causing your problems.
For 2 weeks, record the following and see if you notice any patterns.
- What time you go to bed and what time you wake up
- How long, roughly, it takes you to fall asleep
- How often you wake during the night
- How you feel
- The things you eat and drink during the day
- Your daily activities, e.g. exercise, naps etc
- Levels of pain
Our Sleep Journal is the perfect tool to help track and improve your sleep.
Thoughts, worries and anxiety can prevent good sleep, so aim to keep them out of the bedroom. Constructive worry is an exercise that can help improve sleep. This is a process designed to reduce worrying at bedtime, by moving that worry to an earlier time and focusing on problem solving steps with the aim of identifying solutions. Ideally done earlier in the evening as opposed to just before sleep, you would write down anything you are worrying about and begin to identify steps towards a solution. If worry creeps up again at bedtime, you can remind yourself that you have already devoted time to these worries and possible solutions and can come back to them tomorrow if necessary.
Our Sleep Journal contains the perfect combination of nightly activities. Comprised of exercises in habit tracking and forming, reflection, gratitude and journaling which are proven to promote sleep, relaxation and positive habits. The Journal will help improve sleep and maximise tomorrow’s potential.
Some people report experiencing reduced levels of pain when they are less worried and stress. It can therefore be extremely useful in terms of pain symptoms to bring the worry and stress levels under control.
The sound of sleep
Noise can seriously impact sleep, and some people report feeling more pain when they are annoyed and stressed. If you cannot put a stop to distracting noises (e.g. a neighbour’s dog or your partner’s snoring), you could try using earplugs.
Generic background noise - like a diffuser or a white noise machine - can really help our minds switch off. Youtube has lots of white and pink noise videos, particularly useful if repetitive external noises are keeping you awake!
To fall asleep, your body’s core temperature needs to drop a few degrees. Aim to keep your bedroom at a cool 17 to 21 degrees. That's the optimum sleep temperature. Being both too hot or too cold can interfere with sleep.
If you are still struggling with sleep or are concerned about any of your symptoms check in with your doctor or health practitioner. You need to ensure that your condition is being adequately managed; managing your condition and any associated pain, as best possible will help you get better sleep.