Sleep (or lack of)

“O sleep, O gentle sleep, Nature’s soft nurse, how have I frightened thee. That thou no more will weigh my eyelids down, And steep my senses in forgetfulness?”
William Shakespeare, Henry IV, Part 2

I have a love/hate relationship with sleep. I would love some, but it hates me.  I have had trouble sleeping since I was about 14 – well before my neuropathy started. As it happens, the burning and electric shocks have not helped.

Insomnia includes difficulty in falling asleep and difficulty in staying asleep. Insomnia may be thought of as acute (occurring for days/weeks) or chronic (weeks/months/years). The Spielman model of chronic insomnia (published in 1987) proposes three components of insomnia: predisposing factors, precipitating factors and perpetuating factors (now often referred to as the 3Ps).

Predisposing factors include:

  • Genetics – insomnia can run in families
  • Age – more common as we get older (partly related to age-related changes in our sleep/wake cycle)
  • Gender – insomnia is more common in females

Precipitating factors (i.e. the event that leads to the onset of poor sleep):

  • Experiencing a crisis or trauma
  • Caring needs (i.e. for a baby)
  • Illness, hospitalisation or pain (seriously, hospitals are terrible places to try and get sleep)
  • Depression/anxiety
  • Any cause of stress really

Perpetuating factors (keeping the poor sleep pattern going):

  • Poor sleep hygiene
  • Shift work
  • Ongoing stress/illness/pain

Our bodies and our minds function better when well rested – so what can we do about chronic insomnia?

Treat any underlying illness where possible.

Sleep hygiene is often talked about in the management of insomnia, but what actually is it? It’s about creating the most sleep-conducive environment possible – this includes both your physical environment as well as a sleep-conducive mental environment. Most people (myself included) do not have good sleep hygiene.

Elements of sleep hygiene:

  • Going to bed and waking up at the same time every day (the waking up at the same time may be more important)
  • Limiting bedroom activities to sleep and sex only (so no reading or TV in bed)
  • Having a dark and quiet bedroom
  • Limiting caffeine before bedtime – individual cut-offs will vary, but 2pm is a rough guide
  • Limiting screen time in the hour before bed.
    • One aspect of this is allowing our brain to “wind down”
    • Second aspect is the potential “awake” promotion caused by blue light from screens. Do blue-light blocking glasses work? Not sure, I’m still trialling them. If I’m awake in the middle of the night, I do put them on
  • Creating a bed-time ritual. Mine is skin care routine, brush teeth, plait hair, lip balm, hand cream, bed. Repetition of this ritual pre-bed teaches our brain that this is its cue to wind-down and prepare for sleep. This is the one aspect of sleep hygiene that I am all over – my life is ruled by rituals.
  • Seeing some natural light during the day. This helps promote our circadian rhythm – our bodies’ inherent cycle that tells it to sleep when it’s dark and be awake when it’s light. Difficult to achieve if you’re a shift worker (or surgical resident). But apparently you can get light boxes for this purpose.
  • Not staying in bed if you haven’t fallen asleep – it’s recommended you get up if you haven’t fallen asleep within 20 minutes of going to bed (from memory, the majority of people fall asleep within seven minutes) and then try again when you get “sleepy” again (we all have a natural cycle between the times that we feel sleepy – mine is roughly 90 minutes). HOWEVER
  • Don’t watch the clock – i.e. don’t check the time if you can’t fall asleep or you’ve woken up during the night (so how you’re supposed to tell it’s been 20 minutes I have no idea)
  • Try to avoid naps during the day or limit them to 30 minutes
  • Get some exercise (as little as 10 minutes has been shown to benefit sleep)

Strategies outside of sleep hygiene:

  • Meditation/mindfulness
  • Chamomile tea
  • Sleep sprays/oils (lavender is probably the most common – I like lavender as a plant, but personally not a fan of lavender oil. And just be careful with essential oils – they can be irritating to skin)
  • Magnesium
  • Sleep supplements – Valerian is probably most common

And finally, pharmacological management (medications). I have not tried any of these. Please always discuss with your doctor:

  • Benzodiazepines
  • Non-benzodiazepine benzodiazepine receptor agonists (BZRAs)
  • Sedating antidepressants
  • Melatonin

Sleep tight 😊

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