The Magic of Sleep Hygiene and Where it Fails for People With RA
About ten years ago, I had had it. My sleep patterns had become so awful that I spent three weeks sleeping about two hours a night. My body had become an overtired infant that screamed all night, but my screams were silent screams of frustration, anxiety, and pain that got worse every night. I’ve had difficulties with falling asleep for as long as I can remember- as a child I would spend hours lying in bed looking out the window at my favorite tree, dreaming about ways I would climb it someday and seeing shapes in the silently moving leaves. Once I fell asleep I was golden; often I’d wake up to the off-key tunes my Dad liked to sing while marching up the stairs in the late morning, “Good Morning To You, My Children!” he would happily wail as I covered my ears and groan. Over the years, though, bedtime became a time filled with fear as I wondered what the night would bring. I tried every herb I heard of and some of them really helped for awhile, and took medication for many years but even with all of these helpers, at times my body would just completely refuse to sleep. The first step to changing anything is understanding it, and the day I’d had it, I booked an appointment with a sleep specialist to finally figure out how to fix my problem.
I wish I could say that the appointment solved my problem; it didn’t. What it did do is make me more aware of my sleep habits, what sleep experts call sleep hygiene. Much of sleep is learned behavior; in order to help your body to sleep you need to create the right environment, both internally and externally. Sleep hygiene teaches you how to give it the right cues. As I learned and began to try these tips I also became very aware of where these guidelines fail people with RA, as our sleeplessness usually begins with the same causes- inflammation and pain, two things that can’t be trained away.
So, what are the guidelines that encompass Sleep Hygiene and how can you tweak them to help you sleep, even with pain and swelling? First I’ll list the guideline and then I’ll talk about the “hacks” I’ve created for myself.
- Have a regular schedule: As much as you can, go to sleep and get up at the same time every day, even on days off.
- Sleep when sleepy
- Get up if you can’t sleep in 20 minutes and do something that doesn’t stimulate your senses like reading the phone book.
- Avoid caffeine,alcohol and nicotine.
- Use your bed for sleeping and sex only. No reading, watching TV, or looking at your computer or phone in bed.
- No napping allowed.
- Use sleep rituals that encourage sleep.
- Use a warm bath or shower to relax, one or two hours before bed.
- Don’t watch the clock.
- Use a sleep diary.
- Exercise regularly.
- Eat right- don’t go to bed hungry but also don’t have a heavy meal close to bedtime.
- Keep your bedroom cool, and dark.
This works in theory, but for people in pain, any minute of wasted sleep matters so I don’t bother with waking myself up unless I absolutely have to; if my body will sleep in it means my pain and fatigue will be lower so I’ll have a better chance sleeping the next night.
Meaning don’t go to sleep unless you are really sleepy, so you don’t lie in bed too long.
This is a good suggestion, although I amend it a bit, I go to sleep as I’m getting sleepy not when I’m exhausted because the act of getting into bed takes time and energy, and my bedtime ritual involves lying with a hot pack on my back for a few minutes. If I wait until I’m exhausted often I can’t sleep, which is a paradox I’ve found many people with chronic pain face.
This one I never follow with one exception- if my pain is so bad I need to stretch or do something to alleviate it a bit. I can’t remember the last time I fell asleep that fast, and I’m not convinced that it ever happened after the age of two for me. So, getting up every twenty minutes is simply a way to stay up all night, not get me to sleep.
This is a good suggestion. We all know caffeine and nicotine are stimulants, obviously bad choices for sleep, and alcohol makes you drowsy, but interrupts sleep quality, so even if you are asleep you aren’t; getting the rest you need.
This is another one I don’t pay attention to fully. I always read in bed, this is part of my nighttime ritual and has been since I was a kid. I understand the rationale for the guideline, but I know that for me, reading is essential to relax my mind, and that relaxes my body. The blue lights coming off your phone and computer are known to interrupt your circadian rhythm, so I avoid them, and I avoid reading from tablets at night for the same reason.
This one made me laugh- I ignore it completely. Again, for someone without pain or inflammation I understand the reason, but naps have saved my sleep. And by naps, I mean taking time to lie down in the afternoon, to listen to meditation music and rest my body/mind, and feeling like I won the lottery if I actually drift off. If I lie down and relax during the afternoon, I don’t end up overtired as much at night and as I said, over-fatigue is a sleep killer for me.
Some ideas would be deep breathing before sleep, having a lavender sleep pillow, or a cup of herbal tea.
This idea I love. I have a ritual that involves a heating pad, sleep herbs, reading, and brainwave music that I listen to. I highly encourage everyone with sleep issues to start a ritual, keeping in mind things that help you to relax, and definite no-nos. Anything that interrupts your circadian rhythm, your bodies internal clock, is a bad idea, and basically that means you need to keep the lights down after sunset.
Love this idea, and as someone with JRA, I move the timeline up a bit. If I do a shower or bathe too early my muscles my tighten back up before bed. But you need your core body temperature to be lower when you got to sleep so getting too hot is counter-producitve.
I follow this religiously. I don’t have a clock in my room and keep my phone turned off by the bed. Just last night I had to turn on my phone to check a reminder after I tried to get to sleep, and saw the time. It did nothing but stress me out more.
I did this once and it didn’t help. But I do recommend this idea, because it makes you pay attention to what you are doing and how it may be impeding your sleep.
A good idea, but there are obvious issues with this. I move my body every day in some way, but try to avoid over-doing it because this will increase my pain and make it harder to sleep.
A good idea all around. Focus on foods that you are confident don’t upset your digestion.
Again, a great idea, and I follow this one to the tee. These two thing help you circadian rhythm to encourage sleep.
I hope these guidelines, with tweaks, can help you to sleep soundly in the upcoming days and weeks- let me know if you have tweaks of your own!