Sleeping With Pain 
Recently a nice lady came to see me about pain in her shoulder and neck which was radiating into her hand. She was not sure what happened she just woke up with pain and it slowly got worse. She said mostly in her shoulder. I asked her what she wanted out of therapy, what was her goal. She said, as many people do, “I just want a decent night’s sleep, it’s driving me crazy.” About 80% of the patients who see me either with injuries, fractures, foot pain, hand numbness, you name it, all say they have trouble sleeping. It’s no joke if it is you, believe me. Many people like to sleep on their side which is natural. In fact, it is recommended you sleep on your side or your back and not your stomach, as it can be bad for your back. One fellow admitted that he had shoulder pain but could only sleep on that one side. “I can’t change the way I sleep, I just can’t,” he said. So our goal for him was to get rid of his shoulder pain so he could sleep. Another interesting fact is that sometimes people take pain medicine to block the pain so they can sleep. Many are class three narcotics which contain opioid base medicine to reduce pain. Unfortunately, studies show these types of narcotics are not only habit forming, but they also suppress REM (rapid eye movement) sleep. REM sleep is a deep sleep which you need to feel more refreshed in the morning. So, while people think they are getting sleep, the quality of the sleep is very shallow and not refreshing. They start to get dark circles under their eyes and are quite tired. Studies also show lack of sleep increases pain sensitivity. So, pain which may ordinarily be minor, feels more intense or achy due to lack of sleep. This creates a vicious cycle of pain=no rest=worse pain=no rest=pain cycle. Once you are on this pain and lack of sleep merry-go-round, it is hard to get off! Clinically we need to ask our patients if they are sleeping properly. Patients may or may not tell us about numbness, tingling, or pain, however if we ask them about sleeping often you will find that pain is at the root of the problem. What can be done to solve this problem? Well, it is very important to identify the source of the problem, get a good diagnosis, and develop an effective treatment plan to reduce pain as soon as possible. Sometimes this takes time. During the time our patients are in therapy, it may take a few weeks before they begin feeling better. We teach a few tips to help our patients sleep better with pain. We also work with the physician. Perhaps a sleep lab consult is in order. This can often be very helpful. A comfortable mattress is key as well. The old rule of a very hard mattress is an old wives tale. Modern bedding has developed a decently firm underlayment, but has a cushioned layer on top that can cradle the body and prevent pressure points you can get with a too firm mattress. Visit a local furniture store and check it out for yourself. We also like gentle stretching before bedtime but no vigorous exercise for 3 hours prior to going to bed. You also should go to bed and get up at the same time each day. Try not to run a sleep deficit and then “catch-up” on the weekend. Avoid napping in the day. Also avoid excessive alcohol. Many people drink alcohol as a sleep aid because it slows you down and can be relaxing. However, it actually disrupts sleep, causing nighttime awakenings. A few drinks with dinner is okay, but avoid overdoing it. Consuming alcohol leads to a night of less restful sleep due to restlessness, dehydration, and its diuretic effects which requires more bathroom visits. Avoid caffeine after lunchtime. Relaxing routines can be helpful. This sends a signal to your body that it’s almost time to go to sleep. This makes it easier to fall asleep. Try a relaxing activity such as soaking in a warm tub, reading or listening to relaxing music, or having a massage. If you are unable to avoid tension or stress we can teach you stretching to help you relax. Try creating a sleep promoting environment. Most people sleep best in an environment that is cool, quiet, and dark. Use room darkening shades to keep it dark at sleep time. Use bright lights when you awaken, this sets your circadian rhythm (your body’s natural clock). Keep noise and distractions, including a noisy sleep partner, to a minimum. Use a night light in the bathroom. The most important thing you can do for yourself and your family and friends is to take care of yourself. Healthcare is not a luxury and you should not feel guilty for getting help. If you have pain, numbness, or aching in any part of your body, give us a call at TriState Hand and Occupational Therapy at 301-759-4263. We will get to the root of your problem and get you feeling better. Try therapy first at Tri-State Hand and Occupational Therapy, you will be glad you did. See you soon! |
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