Improving Sleep

Improving Sleep by Linda Horncastle

I (Linda) have suffered from Fibromyalgia since 1989. I managed to improve enough from being on the point of buying an electric wheelchair in 2004 and being unable to work for 20 years because of pain and fatigue to re-register as a therapist. I retired from running a private clinic specialising in helping people with chronic pain and fatigue in 2021. I have gained experience by attending lectures and helping to run the Chiltern Fibromyalgia and Chronic Fatigue Group since 2001.

We had a discussion in our support group on the importance of sleep. Please note we are all different and respond differently to different treatments and therapies. We all have different perpetuating factors that increase our symptoms. I believe when we want to reduce symptoms of Fibromyalgia or other chronic conditions such as CFS or chronic pain that is affecting our sleep we can think of our bodies to be like a diamond. Each facet of the diamond needs to be polished to improve our symptoms. Sleep is one of these facets.

According to Dr Ernest Choy sleep should be the first symptom we should try to improve.

A sleep study in the 1970’s with students showed that those who missed deep restorative sleep developed fibromyalgia type symptoms.

Some of us have too much sleep, others not enough. Both these can be a cause of fatigue. Some of the following suggestions may help you improve your quality of sleep.

What is a Circadian cycle?

According to Paul Chek’s book ‘How to Eat, Move and be Healthy!’ he say this is a natural physiological cycle of about 24 hours.

Following these natural rhymes should help improve your health. Going to bed when it’s dark and awake when it’s light. If you are not following the natural rhyme of light and dark you could be increasing your stress hormones?

If you feel your sleep pattern is sleeping during the day and awake at night it might be good to do an adrenal stress profile salvia 24 hour test to see whether your cortisol and DHEA are following the correct pattern? It could be that you need some supplements to help or perhaps move to a country that matches your pattern of sleep, a bit drastic!!

What is sleep?

When you are asleep there are different names for the stages of sleep. Starting with REM.

This is the time you dream and then the stages of light sleep 1-2 and deep sleep 3-4.

The first natural cycle is usually about 90 minutes and these generally get less during the night. Deep sleep, the pink area below the red line, is the time your body repairs. You’ll know if you’ve missed it if you don’t feel refreshed after you’ve slept. Those of us with fatigue are usually missing this deep sleep. This is because we are often disturbed when our brain try’s to move to deep sleep. This can be caused by pain or worries. This causes spiky alpha-waves in the brain to intrude on what should be the time of slow gentle delta waves. An interesting point is those of us only having a few hours’ sleep may still be getting the deep sleep needed as this is usually at the start of sleep.

Try a sleep diary: To help see if you are following a good pattern. The OT Sue Pemberton in her book ‘Fighting Fatigue’ suggests keeping a sleep diary:

What is sleeping too much?

• Sleeping for 12 hours + and still feeling unrefreshed?

• ‘Catching up’ can be normal e.g. after an infection.

The consequences of sleeping too much are:

• It increases the need for more sleep.

• The body gets used to the habit of excessive sleep and late waking.

• Inability to concentrate properly.

• Loss of motivation and energy whilst awake.

• Reduced enjoyment and satisfaction with life.

What do you do if you are sleeping too much?

• Gradually reducing the hours you sleep.

• Getting up earlier e.g. 8.30 am each day.

• Go to bed when you feel tired. Gradually reducing the hours slept e.g. by 15 minutes.

• Avoid ‘catnapping’. Or do this at a regular time and reduce gradually over a few weeks, try to replace this with quality rest instead of sleep.

• You may feel worse to begin with….

Quality not quantity applies to sleep

Are you not sleeping enough?

Do you feel tired and wired? Worried you are not getting to sleep?

• Aim to wake up at a regular time. Regulate your sleep pattern.

• Wind down before going to bed, e.g. a warm bath. Try avoid watching tense dramas or the News on the TV just before bedtime.

• Use bed for sleep and sex only……..!

• Some suggest avoiding reading, eating, watching TV or using computers or iPad/Kindles in bed. Associate bed with sleep and rest rather than activity. We are all unique and what helps one person may not help another. I have reactive hyperglycaemia which means I need to eat (protein plus slow acting carbohydrates) little and often to stop my blood sugar levels from dropping and causing an increase in my symptoms. I find a small snack before bedtimes helps stop the drop in blood sugar levels during the night waking me up.

What can you do if you are not falling asleep or wake up in the night?

• Try to sleep for approx. 20 minutes then Get up!

• Leave the room do something relaxing. But this must be un-stimulating and boring.

• Try to associate bed with sleep rather than stress or activity.

Do you catnap?

• Try to avoid sleeping during the day

• If you sleep during the day it’s harder to get to sleep at night.

• Same as before re avoiding ‘catnapping’- set an alarm if you do, start with an hour and try to gradually reduce the time you sleep.

• To avoid waking in a groggy state, such as the middle of deep sleep you might find an App helpful. The one I was recommended is called ‘Sleep cycle’ available via iTunes or this web site www.sleepcycle.com . There are others available which can be used on phones or IPads.

Sleep environment – What works for you?

Here are some possible ideas to consider:

• Reduce noise? Use ear-plugs or listen to music.

• Try reading, listening to relaxing music, bird song, listening to the radio though you need a timer to stop it working as it could wake you up or use the Audibile app. for listening to books as it has a sleep button.

• Bedroom too light? Blackout curtains or blinds.

• Dim lights 2 hours before bedtime to reduce light on the skin which will help your natural sleep hormone, melatonin to work. Or use 'Blue and Green light blocking wrap round glasses in the evening. Light stops melatonin working.

• Reduce light in the bedroom when asleep, turn off all electrical lights, even the tiniest light (particularly blue lights such as on clocks, phones, TV, iPad / Kindle)

• Try not to turn on a light when you e.g. go to the toilet in the middle of the night or use only a dim light.

• Some might find it helpful not to have any electrical devices near your head when sleeping.

• On waking try to get into daylight within 30 minutes of walking to stop melatonin working. I stand at my window first thing in the morning and find this helps. If it's dark in the morning consider a SAD lamp.

Temperature – which is better hot or cold?

• Most people suggest a cooler bedroom to aid sleep.

• Make your bed as comfortable as possible – some like memory foam mattresses or a duvet on top of the mattress, silk pillow cases, grain bags Goldlocks pillow ( I can measure you for these).

• Take pain killers before bedtime.

• Some in our group found light boxes used during the day helped them. One lady sent me details of the light box she has recently purchased. I suggest trying it out in case your eyes might be sensitive to some the light boxes. The LitePod Company (based near Stokenchurch) www.sad.uk.com On the home page there are some good videos explaining about light boxes. Our member visited the company and saw what they were like before deciding which one to purchase. The size of it means it fits into a carry case when she is away from home.

Foods that can aid sleep.

• A light supper? Those who find they feel better after eating carbohydrates should eat slow release complex carbohydrates e.g. oatcakes or cereal, but avoid eating 3-4 hours before bedtime but those who feel better after protein meals should eat a protein rich snack 1-2 hours before bedtime. Helpful drinks: Milky drinks, CherryActive, see their website www.cherryactive.co.uk The drink is like an unsweetened Ribena that is diluted with water. It is available at health shops and cheaper on some websites e.g. www.dolphinfitness.co.uk Tel 01273 921 222 (10-4 Mon-Fri)

• Tryptophan converts to serotonin, some good choices are: yogurt, oats, poultry, eggs, nuts and tuna or 5 HTP supplement

• Avoid stimulants: Coffee, tea, chocolate and sugar. Smoking tobacco results in a release of adrenaline. Alcohol can reduce the time it takes to fall asleep. However, this is offset by having a more disrupted sleep in the second half of the night. We are often more sensitive to alcohol.

• Try narrowing the time you eat from 9am to 7pm, having a time with no food research says helps your mitochondria work better. Mitochondria produce energy in the cells. This won't work if you suffer from severe hypo-glycaemia and need to graze throughout the day and some people benefit from a snack just before sleeping to stop the blood sugar level drop waking you up during the night.

Reducing stress. How do you stop worrying?

• Do you worry that you can’t sleep! Become more knowledgeable about sleep, you’re probably getting more sleep than you realise. You don’t have to get 8 consecutive hours of sleep. The first few hours can be when you get the best quality of sleep.

• Unresolved worries – what do you do? Try Relaxation techniques, have a notebook on your bedside table to writing a note of things you want to remember the next day,

Medication

Can work in the short term but you can build up a tolerance or an addiction. Did you know the side-effects of some medication can be insomnia and anxiety? Look at the information leaflet that comes with your medication. If you think this might be a problem ask your doctor if you can reduce the dosage.

Medication e.g. amitriptyline can make you feel ‘groggy’ in the morning you could try taking amitriptyline at 7pm in the evening rather than just before bedtime.

Try the Alpha-Stim instead. Gentle microcurrent therapy that has research that proves it can prolongs the time in deep sleep. Very few medication can help with this. Most sleeping pills only help you reach level 2 sleep.

If the above doesn’t help: I suggest:

• Ask your doctor for a sleep study

• Or investigations for Sleep Apnoea.

DISCLAIMER:

This article is for informational purposes only and should not be used as a substitute for the medical advice or services of your health care providers. Every effort has been made to make this publication as accurate as possible. This information is not intended for self-diagnosis, treatment, or the justification for accepting or declining any medical treatment for any health problems or diseases. Any application of the information presented in these pages is at the reader’s own discretion.