Pain Management Sleep Problems

Patient Information Leaflet produced by the Physiotherapy Service Specialist Services Unit (Cambridgeshire)

Providing a lifetime of care

Cambridgeshire Community Services NHS Trust: providing services across Cambridgeshire, Peterborough, Luton and Suffolk

Important facts about sleep

Normal amounts of sleep vary from one person to another but is usually between 4 and 10 hours per night. How much sleep you need may vary according to your age, sex, lifestyle, work, social demands and physical and emotional health. Sleep patterns change throughout our lives. For example we usually sleep less and have more wakeful periods as we get older.

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Reasons for poor sleep

Too much rest with insufficient activity and exercise Increased pain due to overdoing an activity Daytime naps Medication use and withdrawal Caffeine Cigarettes Alcohol Worries and anxieties Irregular hours Clock-watching

Effects of lack of sleep

Less able to enjoy things Pain is harder to live with Less resistance to infection More irritability with others Depression and feelings of hopelessness Slower mentally and physically

What can I do to help? There is no quick and easy solution to sleep problems. You may have had some temporary success using sleeping tablets, alcohol or herbal remedies but they will eventually lose their effectiveness and may have significant side effects or harmful effects. It is important to think about your own personal sleep problems and develop some strategies to deal with them. One way of getting a clearer idea of what your sleep problems are is to keep a sleep diary for a few nights.
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Strategies to improve your sleep 1. Develop a regular routine to allow you to wind down and relax in the hour or two before bed. This will help you prepare mentally and physically for bed and feel more settled. Eg lock up, bath, clean teeth, undress etc. Go to bed at the same time each night do not try to get more sleep by going to bed earlier. Get up at the same time every morning no matter how you slept the night before. This will help to keep your body clock in a routine. Avoid stimulants such as coffee, tea, chocolate or cigarettes four to six hours before going to bed. Keep evening alcohol low. For many people more than a glass of wine or beer can affect their sleep pattern, even if they initially promote sleep. Make sure you have a range of different ways of getting comfortable eg using different pillows, lumbar rolls or a comfortable chair if necessary. Try not to think about getting to sleep. Lying in bed relaxed is refreshing even if you are not asleep. Try not to nap or sleep during the day even if tired. Gradually increase your daytime activity and exercise. Aerobic exercise during the day really helps sleep at night, but do not do a lot of strenuous exercise just before going to bed.

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10. Associate your bed and bedroom with sleep rather than with worry or work. Try not to use your bedroom during the day except for relaxing. Go to bed and turn the lights off only when you are sleepy and within a limited time period (eg 9.00 to midnight). Do relaxation exercises to try to wind down. If after 15 to 20 minutes you have not fallen asleep do something to occupy your mind like reading a chapter in a book. 11. If you do wake up during the night and have trouble getting back to sleep try not to clock-watch, it will only irritate you. Try not to lie in bed tossing and turning. You could get up and sit in another room and do a restful activity until you feel sleepy again. Then you can return to bed. 12. If you are kept awake by worry, it can be worth trying a problem-solving approach. At least an hour before winding down for bed write down the worries or problems that are on your mind. Then write down all the possible solutions you can think of. Try to complete this at least an hour before winding down for bed. You can evaluate the pros and cons of these solutions the next day. If you wake or do not fall asleep because of these worries, remind yourself that you have the matter in hand and that going over it now will not help. If a new worry crops up in the night, write it down and deal with it the next day.

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13. If you are coming off tablets you should check if this could cause temporary sleep problems. You can then be prepared for such problems and be reassured that they will settle as your body is cleared of the tablets. This may take some time with certain tablets. 14. When you have a bad night (and they will happen) try to think about why it happened rather than jump to conclusions (eg it shows that I do need my tablets) it may be because you have overlooked one of the above points. 15. Remember that bad nights happen to everyone sometimes and may be just one of those things. 16. Keeping a sleep diary each night can show you that your sleep is improving even if you do not feel that it is. After a week or two you can look back and usually see that your sleep is improving gradually. If this is not the case then you need to review your routine.

REMEMBER IT WILL TAKE TIME FOR THESE METHODS TO HELP YOU IMPROVE YOUR SLEEP SO YOU NEED TO STICK TO THESE METHODS FOR SOME TIME EVEN IF PROGRESS IS SLOW.

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For further information about this service contact: For Huntingdon and Cambridge City and South areas If you are unsure about any of the advice in this leaflet or if you require further advice from a Chartered Physiotherapist, please contact your local self referral service on: Huntingdon - 8.15am - 12.15pm

01480 434980
Cambridge City and South Cambridgeshire - 1pm - 5pm

01223 446999
For East Cambs and Fenland area Self referral is not currently available, please contact your local Physiotherapy Department if you are unsure about any of the advice: Physiotherapy Department, Princess of Wales Hospital, Lynn Road, Ely, Cambs, CB6 1DN - Tel: 01353 652046 Physiotherapy Department, Doddington Hospital, Benwick Road, Doddington, Cambs, PE15 0UG - Tel: 01354 644213 Physiotherapy Department, North Cambs Hospital, The Park, Wisbech, Cambs, PE13 3AB - Tel: 01945 488062 For Peterborough area Self referral is not currently available, please contact your local MSK Physiotherapy Department if you are unsure about any of the advice: City Health Clinic, Wellington Street, Peterborough, PE1 5DU Tel: 01733 466671
Cambridgeshire Community Services NHS Trust Tel: 01480 388184 / 308216 Email: ccscommunications@ccs.nhs.uk Website: www.cambscommunityservices.nhs.uk Code: AS/PD/LFT/0279 - V1.4 (Oct 2012) Date of Production: November 2010 Date of Review: November 2013

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If you have any concerns about this service or suggestions for improvements, contact our Patient Advice and Liaison Service on Freephone 0800 013 2511 or email: ccs-tr.pals@ccs.nhs.uk For free, confidential health advice and information 24 hours a day, 365 days a year contact NHS Direct on 0845 46 47 or via www.nhsdirect.nhs.uk If you need this information in a different format such as in large print or on audio tape, or in a different language please contact Cambridgeshire Community Services NHS Trust Communications Team on 01480 308216 or via email at: ccscommunications@ccs.nhs.uk Polish: Jeeli potrzebujesz tych informacji w innym formacie, jak na przykad w duej czcionce, w formacie audio lub w innym jzyku, prosimy o kontakt z Cambridgeshire Community Services NHS Trust (Publiczny Zesp Opieki Zdrowotnej i rodowiskowej) pod numerem telefonu: 01480 308216 lub email na adres: ccscommunications@ccs.nhs.uk Portuguese: Se precisar desta informao em formato diferente, tal como impresso em letra grande, cassete udio ou noutra lngua, por favor contacte o Cambridgeshire Community Services NHS Trust (Trust NHS dos Servios Comunitrios de Cambridgeshire), atravs do telefone 01480 308216, ou envie um e-mail para: ccscommunications@ccs.nhs.uk Russian: , , , 01480 308216 no ccscommunications@ccs.nhs.uk Cantonese: Cambridgeshire Community Services NHS Trust01480 308216 ccscommunications@ccs.nhs.uk Bengali

Turkish: Eer bu bilgininin kendi dilinizde evirisini (ya da daha byk harflerle basksn veya kasete kaytl halini) isterseniz, ltfen Cambridge Blgesi Kamu Hizmetleri Ulusal Salk Hizmeti Birimini (Cambridgeshire Community Services NHS Trust) 01480 308216 nolu telefon numarasndan arayn veya ccscommunications@ccs.nhs.uk adresine e-mail gnderin.