Past Posts Pulldown Menu

Saturday, January 01, 2000

Improving Sleep Guide

Sleep is the Holy Grail for many of us, not just those with CFS/FMS.. and so here I have compiled a list of things to do, and not to do, to improve your sleep. This isn't sleep 101 - but more an article on getting you on the right track to better sleep. Be patient with these methods, and as always - I'm not a doctor, so consult your doctor before you try anything! (this article focuses on Behavioral Sleep Therapy, a proven method when dealing with fibro and CFS)

I will add to this post whenever I find something of use for you!

The Ellusive Delta Wave Sleep
For people with chronic fatigue and fibromyalgia, as well as other disorders, the level of restorative sleep - aka Delta Wave sleep, Stage Four sleep, Slow Wave Sleep - elludes us. This means less restorative growth hormones to our damaged tissues, which in turn causes pain, weakness, poor muscle tone, aches, etc. This is a viscious cycle that leads us to hallucinations, irritability, perpetual grogginess, bla bla bla, I don't want to depress you with the details - let's just say it's bad and we all need to focus on getting it better. Keep it simple, and it's less daunting! Let's call this mountain a mole-hill, and start climbing it!

Behavioral Conditioning: Good Dog, Bad Dog
Sleep conditioning can be likened to training a dog or a child how to do something - you have to have plenty of patience, you have to repeat until understood, you have to correct at everytiny step, and you have to reward, affirm, and add plenty of love. If you're not going to put love into this, then you have to work on that first, as frustration will build a bad foundation for this sleep therapy.
So let's go through some tried and tested laws of getting better sleep first. These may be very difficult at first, but after a month or so - you will get the hang of it, and will notice your sleep improving. I have gone through the training and can tell you that it does work, however with every case of FMS/CFS things can be different. The first few days or even weeks, you may fall asleep all the time, or be very grumpy, irritable, depressed, paranoid, forgetful, etc etc (if you have CFS/FMS, chances are you know what I'm talking about)... so make sure it's not during an extra-stressful time that you start this. You should start seeing improvements in your energy level after about 2 weeks to a month. Whenever you want to fall asleep, it's important that you not, as naps for fibro can make night time sleeping more fragmented than it already is - as well as more shallow than it already is. Tips on how not to fall asleep will come later on in this post!!

Remember: trying this method will not only help you be in control of your situation (in fibro and other illnesses, feeling in control is a great thing), but you can also know you tried and know you did you best. And in this kind of battle, that can create more self-confidence, bravery, and optimism. So give it your best, my friends, and try-try-try!

The Bed
  • Your bed is only for sleeping! No talking on the phone, no yoga on the bed, no working on your laptop or whatever - the bed is for sleeping. Some books say you can use it for sex too.
  • The bed must be comfortable. If you have extra money to save, buy the sweetest bed you can, you know - a pocket coil bed or that super NASA foam-bed. Try out lots of beds at the store and then start saving, or if you're lucky enough: purchase it right away!
  • The pillow must be comfortable. I have one of those NASA foam form-fitting pillows, very comfy. They range from 30$ - 150$, and are well worth it. Try them out at the store first.
  • Mattresses and Pillows have a limited lifetime, so you'll have to replace them once in a long while. Mattresses should be rotated and flipped (ask the store clerk or consult the maker for rotation and flip suggested time periods).
  • Bedding shouldn't make you too hot, overheating has been proven to cheat humans of sleep - however, a chilled room will not interfere with sleep. As long as it's not cold enough to freeze you! Hehe. The bedding also shouldn't cause you any discomfort.
  • Make sure your bed is clean. I know that cleaning can be difficult for us, so if you're disabled enough - you can buy more than two sets of sheets and when one is dirty - ask a friend or family member to wash them for you when they have time. Otherwise, rotate the sheets and wash the dirty pile when you are more able.
The Bedroom
  • A calm, peaceful atmosphere should describe your bedroom. If possible, remove any computers, tvs, and other sources of stimulus from your bedroom.
  • Make sure you are able to make the room completely dark for your bedtime hours.
  • Make sure you are able to make the room quiet for your bedtime hours, use ear plugs, or if you have the resources - find a way to deaden the sound in the room itself (applying certain materials to the walls can cut down drastically on sounds, etc).
The Schedule Issues
  • Wake up at the same time every day (as close to it as possible)
  • Go to sleep at the same time every day (as close to it as possible)
  • Exercise each day (as much as is possible without endangering yourself a flare up or worse, even if it's just 5 minutes a day of exercise, do what you can!) at the same time each day, if possible. The body loves a schedule.
  • No napping, if possible. Napping can be very dangerous to your sleep cycle and can make your night time sleeping fragmented and shallow.
  • Try to get some light in the day time, and try to keep things darker in the night time.
  • Do not exercise after supper.
  • Do not eat supper too late.
  • Try to eat meals at the same time (roughly, if possible) each day.
  • Set a cut-off time for exciting activities in the evening. I cut my exciting activities at 8:00pm.. After this time, nothing exciting or overstimulating. It's hard to get the hang of, but a lot less insomnia happens. This gives your body time to wind down.
  • Try not to get too hot before bed time.
  • Try to write out a to-do list and any thoughts that you have that seem to be cycling.. allot a certain time for this. I do it every night an hour before I go to sleep, and I allot 20 minutes. Anything I forget, I make a rule to say: if it's meant to be, it'll come automatically. In other words, instead of sitting in bed thinking of all the things you have to do, write it down so you can get to sleep much more easily. Journalling at this time is also suggested.
The Big No-No List for Better Sleep
  • No alcohol
  • No stimulants: coffee, cigarets, etc.
  • No eating late, if you are hungry (hunger can make it harder to sleep), you should eat a light complex carbohydrate-rich snack.
  • No drinking tall glasses of water before you go to sleep.
  • No arguments before bed - concede defeat if it means a better night's sleep. Set a cut-off time.
  • No computer late, try to be de-computerized at least four hours before you go to bed. The bright screen and activity can make your internal clock go haywire. Set a cut-off time.
  • No exciting books or movies before bed. Set a cut-off time.
  • No worrying about insomnia!! That actually causes insomnia. Just follow the steps and let your body assume everything will work out fine.
Tips on Following Through with the Sleep Behavioral Therapy:

How not to Fall Asleep:
  • When you feel yourself about to doze off:
    • Stand up and reach for the ceiling, then let both arms slowly and gracefully fall to your sides. Repeat this three or four times (or more), depending on how bad your arm pain/fatigue is.
    • Here are some Yoga poses that release energy but don't require too much energy to do - click on the name to see pictures of the pose:
      • The Cobra
      • The Cat
      • The Cow Faced Post
      • The Fish (be careful to put a soft pillow under your neck if you have a weak neck. Some people with fibro find this really good for relieving pressure on the tender points of the neck and shoulders)
      • The Half Spinal Twist (or if you're a student of Yoga, try a variety of twists)
      • The Lion (very good for relieving tension for those with TMJ, but with anything on this blog, please consult your doctor)
    • Learn Tai Chi or QiGong, as both of them are gentle, but release trapped physical energy. Sounds silly? Well it works, whether it sounds silly or not! And neither of them require that much exertion, and you can stop whenever you get too tired, too much pain, or any other wrong discomfort. For those of us with Fibro, everything can be uncomfortable, but some things are less painful/uncomfortable than others.
      • Tai Chi is a "soft" martial art that uses slow and gentle movements of the body in a long pattern. It usually takes about a year to learn properly, and there are many good teachers and books out there. This increases circulation, releasing energy and also helping you get fitter.
      • QiGong is a very gentle body-posture exercise that uses the principal of Chi - just like Tai Chi, but is even less physically demanding for some. The static postures can sometimes tax muscles that have little or no stamina - but do only as much as you can. Just like Tai Chi, this helps circulation and this releases energy.
    • Drink water - as water can release energy by halting dehydration, which by itself can cause fatigue. Keeping well hydrated during the training phase (and every day of your life) is very important, and will keep you awake more.
    • Smell peppermint! This smell sharpens the mind and can keep you awake a bit more.
    • Get up and do something else: talk on the phone, read a book (but not a boring one, make it as exciting as possible), etc.
    • Turn on the lights! To keep awake, get into a bright room, as dark rooms are conducive to sleep!
During your sleep therapy, after a few days, it's important to start tweaking. What this means is to adjust your schedule to fit your individual needs. That is, add 15-30 minutes to your sleep schedule. Try to add this in the morning, not going to sleep earlier - as that can cause more problems. Waking up in the morning 15-30 minutes later is safer tweaking, and can leave you feeling more refreshed. If you need a bit more time, then do it! Keep working within reasonable confines (try not to sleep 22 hours a day, you're not a Koala!!) of common sense. Give each alteration (tweak) at least a few days to set in before you make up your mind if it's better or not. You can do this with other parts of your schedule, like cut-off times for certain activities (like computer time).

How to Keep Motivated:
It is important during this time to know why you are trying to improve your sleep. Get a journal, online weblog, or just grab a piece of paper - or use your mind if you have a good memory: and write down what sleep means to you! Write down what it means to you physically, emotionally, intellectually, and spiritually. For example:
  • Physically, better sleep to me means healing. It would mean that I would have more energy and feel less sluggish. Even if I don't feel like a million bucks, feeling even a little better would mean that I could do more - and that include do more to get even better!
  • Emotionally, better sleep would mean that I wouldn't be as grumpy, angry, frustrated, or moody!
  • Intellectually, better sleep would mean my memory and mind in general would be sharper. I could be more confident by having people correct me less often for mistakes in grammar and turning whole sentences around. I would be able to think more clearly and devise more ways to get better!
  • Spiritually, better sleep would mean that I could be more motivated on my path to better health, I could be more compassionate and become more of an enlightened person without so many days of utter fatigue.
Write your list and really put your thoughts into it. If you don't want to use the categories I have chosen, choose your own: family life, work life, social life.. what does better sleep mean to you if you're a parent? More time playing with the kids? More patience, more mental clarity to better pay attention and do what you want to do - and not just what you can do? Write this list and you'll be much more motivated to stick to the program.

* * I t ' s o k a y ! ! ! * *
Don't you dare be hard on yourself during this time! It's okay if you have a bad day and you need to nap! We aren't robots. The whole point of behavioral training is to get yourself into the groove of the thing you're trying to learn. The more you follow your new rules, the more your body will tame itself, but with fibro, it'll always be somewhat unruly. You will, in all probability, have to start this therapy over and over again, because of flare-ups. During flare-ups, your body can fall asleep on its own, and fall into shallow sleep and leave you even more tired when you wake up - so this treatment won't be for you during your worst possible days. Don't stress out over it! Just know it's normal for fibro, it's a cycle, and you have to learn, like most people with fibro, perfectionism is bad! Get back up gently after a flare-up and start all over again, and each time you will make more progress.

This isn't a competition, so you're not losing a game... you're winning each time you have the guts to dust yourself off and start again.
Kudos to you! You are a real hero!

How to Document Progress:
Just like the previous section, get a notebook, blog, paper, etc - and every day, write down what time you went asleep (which should be the same every day) and what time you went to sleep (which should be roughly the same time every day) - whether or not you were forced into a nap, whether or not you lost emotional composure.. write down your feelings about the program. More importantly, write down how much energy you had that day. The journal entry can look something like this (ignore the times tho, since everyone has their own schedule:

Wake time: 7:00 am
Energy level: Okay in the morning, poor at night
Emotions: Mostly happy, but felt very frustrated by my fatigue again.
Physical symptoms of sleep deprivation: Loss of concentration was the main symptom today.
Went to sleep at: 10:00pm (it's good to write this right before you go to bed, or first thing the next morning if that's not an option)

Links for Your Further Study and
Sources of Information for this Article:

The Fibromyalgia Handbook, by Harris H McIlwain, M.d. and Debra Fulghum Bruce, Owl Books/Henry Holt & Company, (3 Editions, 1996, 1999, 2003).

Fibromyalgia for Dummies by Roland Staud, M.d., Christine Adamec.

Article online at Fibromyalgia Symptoms

5-HTP and L-Tryptophan is an article about the usefulness of this Serotonin Precursor (by increasing your intake of the amino acid Tryptophan (most popularly known to be found in Turkey, but is found in a a large variety of foods in different amounts). I highly recommend you look into this substance.

LifeTips.Com: Sleeping Disorders Tips is a neat place to get tips, make sure to check the related categories on the lefthand menu bar.

Talk About Sleep is a great site where you can find more information about sleep disorders, sleep tests, sleep doctors, you can chat with others about sleep disorders - find out about sleep meds, treatments, etc. Definitely check this out.

About.Com's Chronic Fatigue Insomnia Tips

SleepNet's Tips for Better Sleep

National Pain Foundation: Dealing with Insomnia and Other Sleep Disorders

Mother Insomnia has useful information natural medicines to combat insomnia, you can also purchase the herbs etc from here.

No comments: