Sleep Hygiene

Injury and pain can impair a person’s sleep. This may be due to the pain itself, or it could be because of anxiety associated with the injury. Conversely, impaired sleep can contribute to pain and delay injury recovery. Therein lies a vicious cycle which can be particularly significant in people with chronic pain. Fortunately, physiotherapy can break this cycle by reducing pain and improving function. Hands-on techniques can achieve this in conjunction with a well-made exercise program. This cycle can also be broken by directly addressing how a person sleeps. Changing your sleeping habits is an effective, evidence-based method for improving quality of sleep. In other words, a person can improve their pain and function by improving their ‘sleep hygiene’.

This blog post will provide you with various tips to improve your sleep hygiene, which will in turn help you to get the most out of physiotherapy. Sleeping is a habit that you can learn! Small changes can have big effects.

You can improve your sleep hygiene by following these rules:

Take care of your body

  • Do not drink caffeine after 4pm: no tea, coffee or cola
  • Do not eat a big or spicy meal late in the evening (a light bedtime snack is okay)
  • Do not go to bed hungry
  • Avoid alcohol and nicotine
  • Exercise regularly

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Physical exercise, such as a brisk walk, in the late afternoon can help to make your body tired and help you to sleep. Try to do some exercise every day.

Sleep only at night-time… do not have day-time naps, no matter how tired you feel. Naps keep the problem going by making it harder for you to get to sleep the next night.

Having a regular bedtime routine, teaching your body when it’s time to go to sleep.sleep-2

  • Have a soothing drink like camomile tea or a milky drink
  • Have a bath, or a routine of washing your face and brushing your teeth
  • Avoid screens and bright lights before bed
  • Go to bed at the same time each night
  • When in bed think of pleasant things (e.g. think of 5 pleasant things that happened that day – they might be big or small, such as a nice conversation, seeing the sunshine, or hearing good music on the radio)
  • Do a relaxed breathing exercise (one hand on your stomach the other on your chest, deliberately slow your breathing, breath deeply in your stomach instead of high in your chest)
  • Try and wake up the same time every day, even if it is tiring to begin with. Furthermore, when you wake up, don’t stay in bed for too long.

Coping with bad dreams can be difficult. Some people don’t like relaxation before going to sleep, or are scared of letting go. If that is you, try these preparation techniques instead:

  • Prepare yourself in case you have bad dreams by thinking of a bad dream then think of a different ending for it. Practice this new ending many times before going to sleep.
  • Before going to sleep prepare to re-orient yourself when you wake from a bad dream.
  • Remind yourself that you are at home, that you are safe. Imagine your street, buses, and local shops.
  • Put a damp towel or a bowl of water by the bed to splash your face, place a special object by the bed, such as a photograph or a small soft toy.
  • Practice imagining yourself waking up from a bad dream and reorienting yourself to the present, by splashing your face, touching a special object, having a bottle of rose or lavender essential oil to sniff, or going to the window to view your surroundings.
  • When you wake up from a bad dream – move your body if you can and reorient yourself immediately (touching an object, wetting your face, going to the window, talking to yourself in a reassuring way)

Make your bedroom a pleasant place to be

  • Get a nightlight
  • Keep it clean and tidy
  • Introduce pleasant smells such as a drop of lavender oil onto the pillow
  • Get extra pillows
  • Make sure that your home is safe e.g. doors locked, windows locked

Remove the following things from your bedroom (if you can)

  • Bedroom clock
  • Phone
  • Computers
  • Eliminate light from the bedroom (Note: some people will sleep better with a nightlight, others will sleep better if it is completely dark… you will need to see what works for you)

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REMEMBER: Bed is for sleeping, so if you cannot sleep after 30 minutes, get up and do another activity elsewhere such as reading or listening to music (try and avoid TV as it can wake you up). After 15 minutes return to bed and try to sleep again. If you still can’t sleep after 30 minutes, get up again. Repeat this routine as many times as necessary and only use your bed for sleeping in.

sleep-4Written by Body Rhythm Physiotherapist Sean O’Brien.

References

Kaku, A., Nishinoue, N., Takano, T., Eto, R., Kato, N., Ono, Y., & Tanaka, K. (2012). Randomized controlled trial on the effects of a combined sleep hygiene education and behavioral approach program on sleep quality in workers with insomnia. Industrial health, 50(1), 52-59.

Sun, J., Kang, J., Wang, P., & Zeng, H. (2013). Self‐relaxation training can improve sleep quality and cognitive functions in the older: a one‐year randomised controlled trial. Journal of Clinical Nursing, 22(9-10), 1270-1280.

Tang, N. K., Lereya, S. T., Boulton, H., Miller, M. A., Wolke, D., & Cappuccio, F. P. (2015). Nonpharmacological treatments of insomnia for long-term painful conditions: a systematic review and meta-analysis of patient-reported outcomes in randomized controlled trials. Sleep, 38(11), 1751-1764.

 

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