I want to get a good night’s sleep. I occasionally do but not regularly and not tonight. It is 4:30 AM, Pink Floyd, and Lou Reed are playing on my radio, and like most nights I have slept about 3 hours. I will be exhausted later and will need a mid-morning nap to sustain myself. This is my usual sleeping pattern, and it is so frustrating for both Sheryl and me.
The question is why I cannot get sustained sleep?
I suggest two factors, and neither is likely to change anytime soon. The first is a built-in alarm clock that rings around 4:00 AM. I call it the blood sugar clock. It seems that my mind is programmed to get up around this time to check my blood sugar. Even with modern technology to detect low blood sugar episodes; I still feel the need (mainly habit) to get up and test my blood sugar. It is a long-standing practice that I have done for years to make sure I did not have dangerous low or high blood sugar during the night. Tonight, when I got up my blood sugar, was 228, or about 100 points higher than normal, so a correction was called for, and now I am waiting to be sure my correction worked.
Once awake, RA seems to take over and drive the whole sleep process. The effort to get out of bed after 3 hours of sleep is extraordinary. The stretching, morning stiffness and the energy it takes to get out of bed, leads to a small ritual of sitting on the side of the bed for a few minutes before standing. I usually do this with my head down to equalize my blood pressure. I have always known this was a good idea, but when my cardiologist diagnosed orthostatic hypotension, it became a necessity.
Just as I must get up, I also know that a lack of sleep can make everything in my body angry. It is like the fatigue of RA is magnified and amplified several times over. Yet this nightly ritual of wakefulness (listening to music, reading, having a sugar free popsicle and wishing I was back in bed) continues.
According to the American Academy of Sleep Science, there are 14 things that can be done to improve sleep hygiene:
- Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
- Set a bedtime that is early enough for you to get at least 7 hours of sleep.
- Don’t go to bed unless you are sleepy.
- If you don’t fall asleep after 20 minutes, get out of bed.
- Establish a relaxing bedtime routine.
- Use your bed only for sleep and sex.
- Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
- Limit exposure to bright light in the evenings.
- Turn off electronic devices at least 30 minutes before bedtime.
- Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
- Exercise regularly and maintain a healthy diet.
- Avoid consuming caffeine in the late afternoon or evening.
- Avoid consuming alcohol before bedtime.
- Reduce your fluid intake before bedtime.1
I believe I practice about half of these useful suggestions. My biggest issue is clearly the electronic devices. I am not ready to give that part of my life up yet. But I believe this list helps me identify the biggest issues, and that is at least a good start.
If you find sleep difficult, I suggest looking over the list. Perhaps there are changes you can make to help things along. If these suggestions do not work and you find yourself awake around 4:30 AM, first try Pink Floyd then give me a call, chances are good I will be awake, and we can listen to Pink Floyd together.
When was your last flare?