Sleep When Pain Won’t Quit: Stimulus Control & Wind-Downs

I’ve done a couple of posts on sleep, I think it’s that important, and today I bring you a blog post about another aspect of “sleeping” with chronic pain. Living with chronic pain is a relentless battle, and often, one of the most significant casualties is a good night's sleep. It's a cruel cycle: pain disrupts sleep, and poor sleep amplifies pain. This blog post is a detailed guide to understanding this relationship and, more importantly, a practical handbook for reclaiming your nights. I’m excited to delve into the science of sleep, explore the concept of stimulus control, and provide a wealth of strategies and ideas for crafting a personalized wind-down routine that can make all the difference.

The Vicious Cycle: Why Sleep is Hard with Chronic Pain

Pain and sleep are deeply intertwined, and the relationship is a two-way street. When you live with chronic pain, your body is in an almost constant state of heightened stress. Pain signals bombard your nervous system, making it difficult to relax and drift off. It can take me hours to fall asleep, or, I can go to sleep ok because of utter exhaustion, but don’t stay asleep and am awake for hours in the night. The constant discomfort, whether it's a dull ache, a sharp jolt, or a throbbing sensation, can wake you up multiple times throughout the night. I’m up at least 4 times in the night, some nights it’s more. I usually am only able to sleep an hour or two at a time. This fragmented, poor-quality sleep leads to fatigue and exhaustion during the day, which in turn can lower your pain tolerance, making the pain feel even more intense. This is the vicious cycle we need to break. You may be thinking that getting consistent night’s sleep won’t make that much difference, but once you start focusing on your sleep, and doing things that improve it, you will notice a difference in your pain level and intensity. 

The Impact of Pain on Your Sleep

Chronic pain doesn't just make it harder to fall asleep; it also disrupts the natural architecture of your sleep. A healthy sleep cycle consists of several stages, including deep sleep (non-REM) and REM sleep (when dreaming occurs). These stages are crucial for physical repair, cognitive function, and emotional regulation. Pain can cause you to spend less time in deep sleep, which is essential for tissue repair and pain modulation. As a result, you wake up feeling unrested and your body is less equipped to handle the pain of the day ahead. It’s interesting, because my sleep app with my watch monitors heart rate and blood pressure during the night, as well as what sleep cycle you are in, and my results have me not getting much deep or REM sleep, some nights I don’t get any at all. Not getting much deep sleep and REM sleep does impact me, not just with my pain, but also my brain fog. I’m so exhausted, I struggle with thinking clearly and full body fatigue makes me feel like I’m dragging myself around all day, heavy, tired and not able to fully pay attention.

The Power of Working with Your Circadian Rhythm and Natural Energy Cycles

I use Rise, a sleep app, and using that app, it’s the first time I learned about sleep cycles and working with your Circadian Rhythm, and natural energy peaks and dips. Our bodies are governed by an internal clock, the circadian rhythm, which regulates our sleep-wake cycle. When you're in pain, this rhythm can be thrown off, but by working with it, you can significantly improve your sleep. The sleep app I use sets this all out for you and calculates the times of day when these things will occur, based on your sleep data. Some things to help you improve your sleep are: 

• Exposure to Natural Light: Getting sunlight, especially in the morning, signals to your body that it's time to be awake and alert. This helps to set your internal clock. Try to get at least 15-30 minutes of natural light exposure each morning. 
• Consistent Sleep Schedule: Even on weekends, try to go to bed and wake up at roughly the same time. This consistency reinforces your circadian rhythm.
• Listen to Your Body: Pay attention to your natural energy dips and peaks. If you feel a wave of fatigue in the afternoon, a short power nap (20-30 minutes) can be helpful, but avoid long naps, as they can interfere with nighttime sleep. I also learned that doing some exercise in the afternoon during an energy dip can have a positive impact on energy and sleep. Personally I don’t nap well due to some of the medication I’m on, but I do do some exercises most afternoons, which help me to get as good of a night’s sleep as possible. 

Daytime Strategies for Better Sleep at Night

What you do during the day has a huge impact on how you sleep at night. Here are some key strategies to incorporate into your daily routine:

• Gentle Movement: Regular, low-impact exercise can improve sleep quality, reduce stress, and even decrease pain perception. This could be a gentle walk, stretching, swimming, or tai chi. The key is to avoid strenuous exercise close to bedtime. Every morning, I do a 10 minute Mindful Cooldown on Apple Fitness+, which is essentially stretching and meditation. I try to do this every morning. I also do an exercise video, in the “Workouts For Older Adults” section of Apple Fitness+, most afternoons. I’m currently working my way up to doing a 10 minute exercise video 2 times a day. 
• Mindful Hydration and Nutrition: Limit caffeine and alcohol, especially in the afternoon and evening. Both can disrupt sleep. Instead, opt for herbal teas or water. A light, pain-friendly snack before bed can also help, but avoid heavy or spicy meals. Caffeine is something I struggle with, as I’m so bagged all the time, that I have something caffeinated. Over the summer I cut way back and I’m aiming to cut it out all together and just not have caffeine. I’m hoping my body will adjust. 
• Managing Stress: Stress and anxiety are major sleep stealers. Incorporate stress-reducing activities like meditation, deep breathing exercises, or journaling into your day. All three things are a big part of my day. Living with chronic pain is stressful, and it’s not always easy to manage it, so I do what I can to minimize that. I have a good evening routine and a big part of that is meditation and daily reflection, my gratitude practice and setting a daily intention. These things help me manage my stress. 

Stimulus Control: Retraining Your Brain to Associate Bed with Sleep

One of the most powerful tools for a chronic pain sufferer is "stimulus control." This is a behavioral therapy technique that helps you break the negative association between your bed and wakefulness. When you lie in bed unable to sleep, your brain starts to associate the bed not with rest, but with frustration, pain, and anxiety. Stimulus control aims to reverse this. 

The core principles of stimulus control are:

1. Only Use the Bed for Sleep and Intimacy: This is the golden rule. Do not read, watch TV, eat, or work in bed. Your brain needs to learn that the bed's sole purpose is sleep.
2. Get Out of Bed if You Can't Sleep: If you've been lying in bed for 20 minutes and can't fall asleep, get up. Go to another room and engage in a quiet, low-stimulus activity. Don't check your phone or a clock.
3. Return to Bed When You Feel Sleepy: Only go back to bed when you feel a strong urge to sleep. If you don't fall asleep within 20 minutes, repeat the process. This might feel disruptive at first, but it's a powerful way to retrain your brain.
4. No Naps (If Your Schedule Is Off): If you're struggling with nighttime sleep, avoid napping during the day until your sleep schedule is back on track.

The Benefits of a Good Night's Sleep

A good night's sleep is not a luxury; it's a fundamental pillar of health, especially when managing chronic pain. The benefits are profound:

• Pain Modulation: Sleep helps regulate pain pathways and can increase your pain threshold. I did not believe that working on my sleep was going to help that, but boy was I wrong. It really does make a difference. 
• Reduced Inflammation: Sleep is crucial for the body's repair processes and helps to reduce systemic inflammation. I also have arthritis in my hands and my knees, and not getting a good sleep impacts that too. 
• Improved Mood and Cognitive Function: Better sleep leads to reduced irritability, improved focus, and a greater sense of well-being. I am definitely slower mentally if I get a really bad night’s sleep, and also clumsy, which could be bad if I fall. 
• Enhanced Energy and Stamina: With a full night's rest, you'll have more energy to engage in daily activities and self-care. This is a really great benefit, as when I’m able to get out and engage in life, my pain and my mental health is so much better. It is rare for me to feel rested, but by paying attention to my sleep, as I do using the Rise App, has helped me improve it. I am constantly working on my sleep, because it impacts me so much, and each time I reach a milestone, I celebrate it. 

Creating a Powerful Bedtime Routine: Wind-Down Activities

A consistent bedtime routine signals to your body that it's time to prepare for sleep. This wind-down period should last at least 30-60 minutes and be a time of true relaxation. My evening routine is vital to getting a better night's sleep. 

• Gentle Movement & Stretching: Gentle stretches or a few minutes of yoga can release muscle tension and promote relaxation. Focus on areas where you hold pain. 
• Warm Bath or Shower: A warm bath with Epsom salts (magnesium can help with muscle relaxation) or a shower can be incredibly soothing. The drop in body temperature after you get out of the tub also helps trigger sleepiness. I love getting into the hot tub and just relaxing amongst the trees. 
• Mindful Meditation or Deep Breathing: There are many guided meditations and apps designed for sleep. Focusing on your breath can quiet a racing mind and ease anxiety. I have a couple apps I use for meditation and incorporating meditation into my evening routine increases my chances of getting a better night’s sleep. 
• Journaling: Writing down your thoughts and worries can help you release them and prevent them from keeping you awake. You can also use this time to reflect on positive moments from the day. This is also part of my evening routine. I journal every evening and it’s a great way to release any stress you may be holding onto. 
• Reading (a physical book!): Reading a non-stimulating book can be a great way to disconnect from screens. Avoid anything too thrilling or stressful. I also read each evening. I especially like graphic novels, business and self help books. 
• Listen to Calming Music or a Podcast: Choose a peaceful playlist or a podcast with a gentle, calming tone. Right now I’m into the Mel Robbins Podcast, I find her voice to be calming and what she has to say resonates with me so well. I’ve learned so much from her. 
• Aromatherapy: Using essential oils like lavender or chamomile in a diffuser or on your pillow can create a relaxing atmosphere. I usually use incense sticks and have quite the collection of them. I find it adds a layer to my relaxation. 
• Prepare for the Morning: Lay out your clothes for the next day, pack your lunch, and make a to-do list. This simple act of organization can reduce morning stress. This is something that I struggle with, but on the days I have done this the night before, it cut down on a lot of time I was wasting trying to make decisions and thus cut down on how stressful my morning usually is. 

When Your Sleep Schedule is Off: The Reboot

If you've been consistently struggling with sleep and your schedule is off, it can feel impossible to get back on track. Here's a plan of action:

• Be Patient: It took time for your sleep schedule to get off track; it will take time to fix it. Be kind to yourself. Just keep at it. With consistency you will start to see a positive shift in your sleep schedule. 
• Start Fresh: Choose a night to "reboot." Commit to going to bed at a reasonable time, even if you don't feel tired. This is so important. Also if you pick a date you’d like to start, you are helping solidify that intention, and are more likely to follow through it. 
• Strict Stimulus Control: This is where stimulus control is most critical. Do not stay in bed for more than 20 minutes if you are awake. I do this quite often when I can’t sleep. I get up, write in one of my journals or colour while listening to a restful meditation. I use Apple Fitness+ for meditation, as well as Balance. They work a little differently and each one has a purpose for me. 
• Avoid Screens: For at least an hour before bed, avoid all screens. The blue light from phones, tablets, and computers suppresses melatonin production, the hormone that makes you sleepy. This is a hard one for a lot of people to stop doing. I cheat at this. I have a blue light filter coating on my glasses, and I have to wear my glasses to see what I’m doing, so I’m not as strict about my screen time before bed. 
• Consult a Professional: If you have tried these strategies and are still struggling, consider seeking help from a healthcare professional, a sleep specialist, or a pain psychologist. They can offer personalized advice and explore underlying issues.

Reclaiming your sleep is one of the most powerful steps you can take in managing chronic pain. It requires patience, consistency, and a commitment to self-care. By understanding the link between pain and sleep, implementing strategies like stimulus control, and creating a nurturing bedtime routine, you can begin to break the vicious cycle and find the rest your body and mind desperately need."

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