What to do about Painful Sleepless Nights

One particular night I was lying awake and sleepless wondering how those of you living with chronic pain ever manage to get any sleep. I had nothing to keep me awake - like pounding, dull, or excruciating pain.

Unfortunately, sleepless nights are something I'm very good at. However, it provides fertile ground for stories - articles seem to gather in my relaxed brain and if not freed will result in a completely sleepless night.

I began to remember a paper I'd read earlier in the day about temporal jaw pain and facial exercises. Remembering this I thought, nothing else to do – I'll do some jaw exercises. There I was lying in the dark repeating sets of 10, of three different jaw exercises. Much to my surprise they made me yawn - well probably not a surprise really, I was opening and closing my mouth against resistance.

Hoping, I did more. Then as I yawned more I thought “I'll soon get to sleep now”.

But no - here I am writing to you at 3:00am - 5 hours after going to bed and attempting to sleep. Well, the jaw exercises were a failure. But my relaxation (in an attempt to get to sleep) produced questions from another article I was reading earlier about chronic pain.

The article was a collection of interviews about the experiences of 20 New Zealanders with chronic pain.

19 have pain at night.

20 find it difficult to change position.

That shows the level of the problem people have with such a fundamental issue as sleep essential to good health and wellness. Sleep together with exercise and a good diet are the prerequisites of health for all of us.

Why Pain at NIght?

o   Lying in bed, as I can attest, there is nothing to distract you.

o   You're captive in your bed in the dark.

o   All there is to do is focus on you and your body which is unfortunately full of pain.

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Some say my relaxation and meditation audios have helped some of my clients.

I've done that many nights. But for painless me that doesn't always work, perhaps it's me listening to my voice?

Pain when you move would be another reason for pain at night. When we’re unable to sleep it's natural to be tossing and turning. It's a popular activity as one hunts for sleep.

One of the findings from the research was even during the day there can be a variation in pain levels.

“Reasons for fluctuation in pain, all respondents said pain tended to be worse some days than others”.

This is where my training and research can explain how this can happen. Many health care practitioners, specialists and doctors are beginning to acknowledge that chronic pain is now accepted as no longer physical pain. There is no injury or tissue damage - it is the brain creating and sending pain signals.

We need to recognize the neural networks are created within our brain by our life experience or various traumas we have suffered. A key symptom of neural network syndrome is this variability that the respondents mentioned. Their pain varied seemingly for no reason.

Pain can move around the body - impossible if a physical injury - or the level of severity of pain fluctuates - again impossible if there is a physical injury.

In a search for answers, it's easy to ask why is pain worse today or tonight?

Perhaps the brain has little to do therefore it can focus on pain signalling rather than driving to work, cooking dinner, or enjoying a movie.

When Budge (2012) did the research, the focus was on when was pain worse, resulting in almost 100% saying at night. Thus, taking us down a dark alley as there is little we can do while lying in bed, in the dark.

Let’s move from Negativity to Positivity

New ideas in chronic pain treatments are suggesting we could be going in the wrong direction.

Instead of the focus being on: -

“Why pain is worse today let's change it to why is pain less some days?”

o   Make notes.

o   Keep a “I feel good today diary”.

o   Give a feeling good score out of 10 (don't do ‘how much is my pain out of 10 today’).

o   Share with your family and friends how good you feel.

We rarely change bad behaviour by negativity and punishment, rather by positive responses and encouragement.

Challenges with Changing Negative Behaviour

As I've found in my previous career as a teacher to change behaviour can be almost impossible with some errant pupils. Perhaps we can consider these errant, uncontrollable, unreasonable pupils as our pain.

They can change but: -

o   it takes time, and

o   it takes energy,

o   our energy to create change.

Therefore, for these pupils, I had to search for some small change, for a small amount of time or an instant that I could catch them being good. In this same way, don't search for your pain, search for those small intervals of feeling good.

Returning to that good night’s sleep?

I remember a lovely client, a man in his early sixties with chronic anxiety. On his third appointment his first conversation was about his awful sleep he had the previous night. He woke up at 3am and couldn’t get back to sleep before he needed to get up at 6am.

My positive response.

“What time do you go to bed?”

“Usually 9 – 9.30am”

Here’s the positive – “Wow, you got nearly 6 hours sleep – that’s great!”

Now, you may not agree but 6 hours sleep is OK sometimes. My reaction produced a ‘perked up’ response and we moved on with the session with a more positive atmosphere than if I had spent time emphasising about those three sleepless hours.

Conclusion

In much the same manner we need to search for ways to bring the good about our lives into chronic pain, even during treatment sessions.

Care must be taken initially when first meeting a chronic pain client as their journey through numerous tests, treatments, diagnoses, doctors, and pain specialists has likely been arduous and long. Listening and rapport are needed first.

I wouldn't have made the congratulatory comment about my clinet's sleep in our first consultation.

As I began with my sleep problems, sleepless in Christchurch. I need to notice the nights I slept. Stop integrating the negatives of why I didn't sleep like changing that naughty student - I just need a good night's sleep. Keep a record of the nights I got a good sleep.

I'll return to bed now. I'll try to be positive, knowing that I can begin to sleep well - most nights. Somehow, I need to start to develop a good sleep neural network in my brain instead of just hoping and wishing for that good night's sleep?

Reference

Budge C, Carryer J, Boddy J. Learning from people with chronic pain: messages for primary care practitioners. J Prim Health Care. 2012 Dec 1;4(4):306-12. PMID: 23205380.

Jean Jordan – Naturopathic Medicine Practitioner 20 years’ experience in treating ongoing pain issues and anxiety.

Trainer for 2^nd career health practitioner available through Natural Pain Solutions.

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After studying Postgraduate Pain Management & Freedom from Chronic Pain with Howard Schubiner, I want to spread the word about holistic self-help techniques and introduce basic neuroplastic ideas.