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CRPS and sleep are unhappy bedfellows. Here, To look at somebody with CRPS is to stare exhaustion in the face. Allodynia and bed linen are not happy bedfellows. And even when extreme fatigue makes sleep inescapable, pain triggered by subconscious movement means slumber is far from restful and refreshing. Let’s take a closer look at CRPS and sleep.
REM
We alternate between rapid eye movement (REM) sleep and non-REM sleep. During a ‘good night’s sleep’, roughly 25% is REM, 75% non-REM. During REM sleep, our eyes move around rapidly, and our brain activity is similar to when awake. Typically, we dream during REM sleep. During non-REM sleep, our brain settles down and is less active. In the deeper stages of non-REM sleep, our breathing slows, and our blood pressure falls. After falling asleep, non-REM sleep comes first, followed by a shorter period of REM sleep, before the cycle starts over again.
During REM sleep, the body is in full-on healing mode, physically and mentally. Deprivation of REM sleep serves to deepen and entrench the pain cycle, worsening and perpetuating pain.
CRPS and sleep
I have lost count of the number of people with CRPS who have told me that they believe they could adapt to living better with their pain if only they could guarantee a good night’s sleep. Despite that, medication to aid sleep seems generally unpopular among sufferers. As one told me recently, “On top of everything else I have to take and with all of the other side effects, feeling groggy the whole time because of the sleeping tablets is just as bad as being tired through lack of sleep.”
Their disrupted night is brought home to me daily when I check my email inbox first thing every morning. Inevitably, emails arrive from clients throughout the night.
Many people with CRPS feel they are losing their minds as their short-term memory evaporates, and they lose their ability to concentrate. One client told me she has such difficulty remembering when (or whether) she last took her medication that she places her tablets in clusters on a laminated sheet marked with times of the day.
Lack of sleep also leads to impatience and irritability. Not only does that have an increasingly negative effect on your own mental health, but on those closest to you. A common regret people with CRPS express is the negative effect the condition has on their children.
Sleep hygiene
Originally developed in the late 1970s for insomnia, the ‘tools’ of sleep hygiene are now recognised as being of benefit to people suffering chronic pain.
Sleep hygiene is simply following practices and routines to maximise the prospect of having a good (or at least a better) night’s sleep. The following are not exhaustive and can be adapted to suit your own life and situation:
- Avoid napping, no matter how tired you feel during the day. If you’re dozing off, get some fresh air – even just opening the window. Try to engage in some activity to stimulate the brain: watch a TV drama, read an engrossing book, work on a jigsaw, or even play a computer game.
- Only use your bedroom for sleeping so that your mind begins associating that room exclusively with sleep. Your bedroom should also be a good environment for sleep. Ensure it’s dark enough, the right temperature, and, as far as possible, do anything you can to reduce noise. Even an ‘old fashioned’ ticking clock can provide an unwelcome focus for your mind as you lay in the dark.
- Avoid caffeine for at least 8 hours and nicotine for at least 3 hours before bed. Both are stimulants. Also, whilst alcohol may help you fall sleep initially, it disrupts your sleep cycle, meaning you wake more during the night.
- Develop a routine for going to bed aimed at slowing down your mind and getting into sleep mode. The routine may begin an hour or two before bedtime by engaging only in more relaxing activities to help slow down your mind. Avoid those stimulating activities mentioned earlier – TV dramas, computer games, the book in which you are engrossed. Also, doing things in the same order each night helps to develop that routine.
CRPS and sleep: Bedtime
Once in bed, sleep hygiene techniques continue:
- If you can’t sleep, get up and do something quietly until you feel sleepy; practice a relaxation technique or read something factual. Return to bed, but if you still can’t sleep, get up again and return to the quiet activity. In the short term, this may reduce the overall sleep you achieve. But it’s all about developing good sleeping habits. Research shows that you should eventually fall asleep sooner as time goes by.
- A good sleeping routine means getting up at the same time every morning, no matter how tired you feel. Again, this will initially prove incredibly difficult but should eventually help you to sleep at night.
- As we all know, exercise is good for us for many reasons. If you have mobility issues, exercise is more challenging. However, a physical therapist can work with you to develop a regime tailored to your ability. That might even involve exercises you can perform from your chair. Exercise both tyres you and reduces anxiety, both of which aid sleep. However, avoid exercise immediately before bedtime.