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​Sleep Health and Chronic Pain

Sleep loss can make chronic pain more of a challenge to cope with, and chronic pain can contribute to loss of sleep. Sleep disorders can also contribute to depression, and some sleep disorders increase the risk for other health conditions including cardiovascular disease. Fortunately, many people can improve their sleep quality through self-management and/or the use of various appliances to address sleep apnea. See our sleep tips, followed by our tools and resources that may help with your sleep challenges.

Ten Sleep Tips – In Sickness and in Health

  1. Keep a regular sleep schedule
    The sleep-wake cycle is regulated by two factors – i) a "circadian clock" in the brain and ii) the body's need to obtain sleep after a period of wakefulness. Particularly as we age, it is beneficial to go to bed and get up at the same time each and every day - improves both sleep performance and sleep quality throughout the week. Keep track of your sleep times with a sleep diary.
  2. Avoid caffeine
    Caffeine is a stimulant and is commonly used for its alerting effect. Caffeine products, such as coffee, tea, colas and chocolate, remain in the body on average from 3 to 5 hours, but the stimulant effect may affect some people for as long as 12 hours. Even if you do not think the caffeine affects you, it may be disrupting your sleep. Avoiding caffeine within 6 hours of going to bed improves sleep quality.
  3. Avoid nicotine
    Nicotine is also a stimulant. Smoking before bed makes it more difficult to fall asleep. Nicotine can cause difficulty falling asleep. Then, when smokers go to sleep, they experience withdrawal symptoms from nicotine, which cause arousals (lighter sleep) and awakenings.
  4. Avoid alcohol
    Although many people think of alcohol as a sleep aid because of its sedating effect, it actually disrupts sleep causing nighttime awakenings. Consuming alcohol leads to a night of less restful sleep both due to the withdrawal effects and because its diuretic effects require more bathroom visits.
  5. Don't eat or drink too much close to bedtime
    Over-eating or drinking may make you less comfortable when settling down for bed. Spicy foods may cause heartburn, which leads to difficulty falling asleep and discomfort during the night. Restrict fluids close to bedtime to prevent mid-night bathroom visits.
  6. Exercise at the right time promotes sleep
    Aerobic exercise at the right time can make it easier to fall asleep and contribute to sounder sleep. But be careful! Exercising right before going to bed can make falling asleep more difficult by making you more alert and raising your body temperature. For these reasons, try and finish your exercise at least 3 hours before bedtime. Late afternoon exercise is the perfect way to help you fall asleep at night. CIRPD provides tips on exercising and staying physically active.
  7. Use relaxing bedtime rituals
    A relaxing, routine right before bedtime sends a signal to your body that it is almost time to go to sleep. Avoid arousal activities like working and exercise that can make it more difficult to fall asleep. Try an activity that is relaxing, such as soaking in a hot tub, reading, listening to music or having a massage. If you are unable to avoid tension and stress, it may be helpful to learn relaxation therapy from a trained professional.
  8. Create a sleep-promoting environment
    Most people sleep best in an environment that is cool, quiet and dark. Check your room for noise or other distractions, including a bed partner's sleep disruptions, light and a dry or hot environment. Make sure your mattress is comfortable and supportive for you and your bed partner.
  9. Associate your bed with sleep and sex only
    Use your bed only for sleep and sex to strengthen the association between bed and sleep. If you associate a particular activity or item with anxiety about sleeping, omit it from your bedtime routine. For example, if looking at a bedroom clock makes you anxious about how much time you have before you must get up, move the clock out of sight. Do not engage in activities that cause you anxiety and prevent you from sleeping.
  10. Limit non-sleep time in bed and reduce naps
    Get into bed only when you are tired. If you do not fall asleep within 15-20 minutes, it is best to get out of bed and do another relaxing activity until you are feeling sleepy again. Generally, if you have difficulty sleeping through the night it is best to avoid naps and horizontal rests as this weakens “sleep pressure” the following night and may start a cycle of poor sleep at night caused by catching unrestorative sleep in the day.

(Adapted from the National Sleep Foundation, 2004)

There are resources that provide practical tools that may improve sleep for those with chronic pain.

Evidence-based Overviews

Sponsor Organization
Chronic Pain and Sleep
National Sleep Foundation
Healthy Sleep
Harvard Medical School
Pain and Sleep
Sleepdex – Consumer Website
Sleep Disorders
Medline Plus
Sleeping Well
Royal College of Psychiatrists

​Research Articles 

Decision Aids and Toolkits

Sponsor Organization
Help Yourself to a Good Night's Sleep
Vancouver Coastal Health
Insomnia: Should I take Sleeping Pills Decision Aid
Pain Resource Centre
Canadian Pain Coalition
Patient Decision Aids
Ottawa Hospital Research Institute
Reduce Stress to Sleep Better
Here to Help BC
Sleep and Arthritis
Arthritis Research UK
Sleep Apnea: Should I have a Sleep Study
Sleep Apnea: Should I have Surgery
Sleepiness Assessment Quiz
National Sleep Foundation
Two Week Sleep Diary
American Academy of Sleep Medicine
Two Week Sleep Diary
Human Performance Resource Center - USA
Wellness Module: Getting a Good Night’s Sleep
Here to Help BC

Last Modified: 12/17/2015 4:45 PM