What can I do to reduce wakefulness during sleep to get a good night's rest?

Divya Rakesh, MD
Kedar Angirus, MD
April 19, 2022

Nowadays I have trouble sleeping.  I am awake by 3:00 am and unable to go back to sleep. I don’t feel well rested. My chronic knee pain is getting worse. I’m not able to go for my evening walks because of pain and tiredness.  My doctor says that I should get some exercise and good rest.  How can I get a good night’s sleep and feel rested?

Sleep, the natural painkiller

If you relate with the above statements, you are not alone. A recent CDC publication has revealed that 1 in 3 adults are not getting enough sleep on a regular basis. The average person requires 7 to 8 hours of sleep, a good quality sleep.  Sleep quality is a measure of how well we are sleeping – whether our sleep is restful and restorative.

If you have sleeping difficulties, you may find it either difficult to fall asleep, stay asleep or may wake up too early in the morning and not be able to sleep again.  The next day, you may have tiredness,  low energy, irritability and memory issues.   You may also feel that your chronic pain has worsened and this may contribute to difficulty feeling comfortable and relaxed.

Sleep difficulty may occur occasionally for a day or two or may persist for months.  Poor sleep hygiene perpetuates sleep difficulty which can eventually affect overall health and worsen your chronic pain.  Good sleep hygiene practices, on the contrary, can lessen or reverse sleep difficulties and reduce your pain.

Sleep acts as a natural analgesic that can help manage and lower pain says lead sleep expert at UC Berkeley, Dr. Walker.  Listed below are some evidence-based good sleep practice recommendations that will help you get a good night’s sleep and break the vicious sleep-pain cycle.

Continue reading below to know more about the art of sleeping, the do's and the don'ts that'll guarantee a restorative sleep.

1. Set your internal clock

Have a fixed bedtime and wake up time - and that’s applicable for weekends and vacations!  By following this consistently, your mind and body will eventually learn that this is your sleep schedule and this will make you feel sleepier at bedtime and alert when it is time to wake up. A systematic review published in the Journal of Applied Physiology, Nutrition and Metabolism points towards less favourable health outcomes which includes deterioration of bone health and causing weight gain in individuals with later and variability in their sleep timing. This can in-turn contribute to inflammation and pain which can create a rather vicious sleep-pain cycle.

2. Enhance your sleeping environment

Keep your bedroom dark, quiet and cool.  The ideal temperature for most adults would be 60 to 67 Fahrenheit (15 to 19° C), the cooler it is the better, because it promotes melatonin  secretion which is a sleep-inducing hormone and thereby increases your REM sleep (one in which you dream) and slow-wave sleep stage which is known to have restorative properties. A warmer room temperature on the other hand can have quite the opposite effect. Invest in a good mattress and pillows and understand which sleeping positions help relieve your chronic pain. You can also invest in gel-based mattress toppers which tend to have heat dissipating and cooling effects. You will be surprised that making these small changes can prevent wakefulness in the night over a period of time.

3. Bright light exposure during the day

Increase exposure to bright lights during the day, get as much light in the mornings and afternoons to accelerate your circadian rhythm (the body’s internal clock).  In addition, make sure to incorporate regular exercise preferably in the mornings.  It is important to avoid intense exercises as it can aggravate your aches and pain.

Avoid daytime napping as it can disrupt your sleep cycle.  However, some elderly people may need short napping during the day to function efficiently.

Practice effective coping strategies to relieve your stress – yoga, meditation, social support from loved ones, spending time with nature, spending quality time with people or pets, pursuing hobbies.

Time-limit all your activities even if you are feeling energetic and your pain is less because you might unknowingly overdo and cause a pain flareup. So, try preventing the ensuing boom-bust cycle by being careful.  Also avoid any activities that can possibly flare-up your pain in the evenings.  Evenings are the time to slow things down physically, mentally and emotionally.  

4. Slow-down before going to bed

Slow down your activities.  Dim the lights and practice relaxing routines at bedtime such as having a warm bath, listening to light music, practising relaxing yoga and deep breathing exercises such as diaphragmatic breathing. Learn this breathing technique by watching this short video by Anooka Health Coach Doris Ward.

Also try to refrain from drinking too much fluids late in the evening.  Too much fluids may make you wake up a couple of times in the night to empty the bladder.

At bedtime, think of calming thoughts and do not indulge in thoughts that make you worry or anxious.  If you are having pain, do not go to sleep as it will disrupt your sleep.  Try to plan your medication schedule in such a way that it provides peak pain relief around the time you want to sleep ensuring a good quality sleep.

5. Absolutely no stimulants

Do not use stimulants.  If you drink coffee, have it before noon as caffeine stays in your bloodstream for six to nine hours. It can disrupt your sleep and prevents you from getting deep sleep.  Overeating, heavy meals and smoking late in the night are also known to disrupt sleep.  Have dinner at least three hours before you sleep.  If you feel hungry before going to sleep, do not starve, have a light snack such as yogurt, banana, a glass of warm milk or a low-sugar granola bar before going to bed.  Avoid alcohol before going to bed as it is known to disrupt your sleep patterns.

6. No devices in bed

Avoid the use of electronic devices while in bed.  This is probably the hardest thing to do for most of us but research has consistently linked longer electronic device use before bedtime with poorer sleep quality.  Experts recommend stopping the electronic devices use 30 mins before bedtime in order to reach good sleep quality.  Another recommendation is to avoid checking your messages, emails, news or playing games on your phone that stimulate your brain.

Despite following good sleep routine, sometimes I wake up in the middle of night and am unable to fall asleep quickly.  What can I do?

If you’re unable to sleep within 15 minutes or so, don’t feel anxious or forcefully try to put yourself to sleep, it just won’t work. Instead, go to another room and read a book (not on your tablet device!!) suggests sleep expert Luis F. Buenaver.  Do not use bright lights and preferably read a book that is not too stimulating as stimulating books and activities such as reading mystery novels and solving puzzles can stimulate the brain and keep you awake.  In addition, avoid obsessively checking the clock.  This could make you more anxious and keep you awake. Then, when you feel sleepy, go back to bed and try to fall asleep.

Bedrooms should be used only for sleep, intimacy and sickness.  Practising this technique will retrain your brain and extinguish the association between bed and reading, bed and devices, bed and wakefulness, bed and thinking about not sleeping, bed and worrying and bed and being in pain.

Some of the recommended activities when you cannot sleep include activities requiring low light, low movement and low stress; activities that can be easily stopped when you feel sleepy; activities that are boring or not too rewarding such as reading a book, knitting, playing solitaire, listening to music, mild yoga stretches, etc.

Incorporating these small changes in your daily sleep routine will help you get a good quality sleep and good health in the long run.

If your sleeping difficulties persist, please contact your doctor and check for presence of any sleep disorders or underlying problems that may be the cause of your sleep issues.

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