• Carly Adams, DPT, OCS

Pain Management and Sleep


One area of physical therapy I focus my energy is in management of persistent, or chronic pain. We all know someone who seems to ALWAYS be in pain… or maybe that someone is you. Chronic pain management has received even more press lately as the “opioid epidemic” as it has been called, is being addressed by the media.

Pain can be modulated, managed, and even reduced through many means in addition and instead of the use of medication. I want to focus on one area that consistently is brought to my attention: sleep. We all love sleep, and if we don’t admit to loving it, we at least admit we need good quality sleep to function. In my experience, every person I’ve talked to that deals with chronic or persistent pain has sleeping issues. When I ask patients with persistent pain how they sleep, responses usually are to the effect of “Sleep? What’s that?!” or a long stare followed by an eye roll and sigh. Suffice it to say, there is a notable correlation between pain and sleep.

I follow several physical therapists on social media, and I found a great list of sleep recommendations that all of us, especially those who 1) struggle to get adequate sleep or 2) battle with chronic pain will benefit from reading AND applying. They are adapted from one of my favorite chronic pain “gurus”, Adriaan Louw. This was adapted from Dr. Dan Pope’s website:

1) The Bedroom Should be for 2 Things Only

You know what they are, so get everything else out e.g. phones, ipads, computers and televisions.

2) Keep Your Bedroom Dark and Cool

Consider heavy black out blinds. Make the room a bit cooler at night with air conditioning. No lights or electronics should be showing at night. The amount of light your body is exposed to can effect cortisol and melatonin levels, 2 hormones vital for sleep and alertness.

3) Set the Same Sleep Time Every Night

Going to sleep closer to when the sun goes down and waking when the sun rises can also be beneficial for cortisol / melatonin cycles. Louw recommends getting to bed before 12 (Obviously the sun usually sets before then in most areas). A steady bed time and rise time will help regulate your sleep/wake cycle.

4) Slowly Calm Down Before Bed

The idea is to slow down a bit before it’s time to sleep. This means several hours before bed to stop using electronics. Dim the lights; do things that help you relax, potentially try meditation.

5) Sleep 7-9 hours per night

Getting enough sleep has a myriad of benefits including improving efficiency and productivity. The amount of sleep needed probably differs from person to person but I doubt some people operate best on just 4 hours. Sleep can be trained. Get in bed at the same time each night. Stay in bed until your chosen wake time regardless of whether or not you’re actually asleep. Eventually you’ll be sleeping the prescribed times.

6) Keep a Notebook by the Bed

Many people have difficulty sleeping because they can’t control their thoughts at night. Write them down (to do list) and make an effort to complete them the next day.

7) Snorer Leaves the Room

Having a sleeper next to you who can’t stop snoring does not help sleeping at all. Adriaan’s recommendation was to have the snorer leave the room and sleep elsewhere.

8) Taper Water Before Bed

For obvious reasons. Peeing 7 times per night because you drank a gallon of water before bed time isn’t good.

9) Limit Alcohol Consumption

Alcohol can help relax your body and prepare your body for rest. However, too much alcohol can disrupt sleep as your body is processing the alcohol.

10) Take Naps of 20 Minute or Less (Stay in Phase 1)

Our sleep occurs in cycles. We slip into deeper sleep cycles as we sleep for longer durations. When we first fall asleep this stage is closest to our normal brain activities and as we sleep further the brain activity changes. This is why you may feel groggy after a several hour nap but feel ready to go after a shorter nap. Keep your naps between 10-20 minutes to minimize this effect. Also keep in mind that if you take long naps during the day you may disrupt your sleep cycle at night. Again, you may have to find what works best for you.

I hope these tips lead to better and more restful sleep!


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