To Sleep, Perchance to Dream – But What if You Have Painsomnia?

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By Wendy Burnett

Okay, you don’t know what “painsomnia” is, or if you have it, but you definitely have trouble sleeping on a regular basis, right? After all, that’s a common issue for anyone with chronic illnesses. Painsomnia is a term I came across on Twitter; I don’t know who came up with it, but it is absolutely perfect for what it’s intended to describe. (If you invented it, or know who did, please leave me a note in the comments so I can give credit where credit is due.)

painsomnia – combined word made up of the words pain and insomnia, used to describe an inability to sleep because of high pain levels.

There are tons of posts and articles out there with tips for going to sleep more easily and getting better quality sleep. There are also a lot of articles about ways to reduce your pain levels. There are, however, only a few posts or articles available that suggest ways to do both at the same time. (Most of them are found on blogs that focus on living with chronic illness in general, or a specific illness.)

Doctors aren’t much help with this one, since they usually want to throw another pill at the problem. More pills can be problematic for anyone with a chronic pain disorder like fibromyalgia, since sleeping pills and pain medications may not work well together. Even if you have medications for both pain and sleep, sometimes even the maximum safe dose isn’t enough and you need extra help.

There are lots of safe options you can try that won’t interact with the medication you take, but first I’m going to give you a short list of things NOT to do.

• NEVER, ever use alcohol with pain medications. This is one of the most dangerous things you can do, since alcohol and pain meds are both depressants, and the combination can (and often does) kill. This is even more dangerous if you’re also taking muscle relaxers, sleep medications, or anxiety medications in any combination with your pain-killers.
• Don’t add over-the-counter medications that haven’t been approved by your doctor. OTC pain and sleep medications can also have serious, even deadly, effects when combined with prescription medications. Even cough and/or cold medications and antihistamines can be dangerous if they contain alcohol or an ingredient that causes sleepiness.
• Finally, (and this one is going to sound a bit odd from me, since anyone who has read much of this blog knows I’m a great proponent of herbs and supplements,) don’t use herbs with prescription medications unless you’ve thoroughly researched the possible interactions or discussed it with an expert herbalist you trust. (I am not an expert, I’m a knowledgeable amateur. Without knowing exactly what you take, and what the dose is, even an expert can’t make definite recommendations, only suggestions of things for you to research.)

Now for the good stuff, things you can do to make it easier to sleep, in spite of the pain:

Heat:

Heat is great for easing the aches and pains of many chronic illnesses, and most of us have electric heating pads, but going to sleep with one turned on can be dangerous. It can cause burns if left in one spot for too long, and if you roll over on it and get it folded over, you can end up breaking the wires inside and getting a bad electric shock or shorting it out and causing a fire. For bedtime, a much safer option is TheraBeads Microwaveable Moist Heat Packs. It may take a bit of experimentation to determine how long to nuke them for, but I have one of the neck wraps and a rectangular one that I love. I zap them right before I go to bed, and they stay warm more than long enough for me to fall asleep. There’s no chance of burns after you fall asleep, because they gradually cool down, the hottest they ever are is when you first pull them out of the microwave. (If the Therabeads hot packs are too expensive, you can get a similar result with a sock filled with cheap white rice heated in the microwave. This doesn’t provide the moist heat that seems to help the best; and it’s difficult to shape in a way that is comfortable to lay on; but it is an affordable, workable solution for areas where you can put it on top of  or beside the painful area.)

Another option, if you have extra pillows and more sore spots than heat sources, is to lay a goose down pillow over the area that needs heat. This one takes longer while you wait for the insulating properties of the goose down to build up the heat, but it works well. (I don’t know if other types of pillows will work or not, since I only have goose down, but it’s worth a try. If you try another kind of pillow, please let me know  how they work.)

A final note: I sometimes have so many heat sources on different areas that I get overheated. If I’m going to be awake, I’ll place a well-wrapped ice pack on my stomach to help cool me down. (Don’t do this right after a meal, since the cold will slow down digestion and can cause some discomfort from that.) After 20 minutes (which is the longest you should ever leave an icepack in one spot,) I move it to the top of my head or the back of my neck for about 10 minutes. That helps to reduce my body temperature, without making any of my joints hurt. At bedtime, I put it close to, but not touching, the top of my head, since I (hopefully) won’t be awake to move it every 20 minutes. The cool air coming off the icepack encourages my body to send more blood to the area to keep it warm, and helps to cool the blood before it returns to the areas that are receiving heat. (This also works with the icepack near your feet if the cold doesn’t make them hurt.)

Pillows:

Pillows are another important “tool” for helping you get to sleep. Many of my chronic friends use multiple pillows to help them get comfortable, and the wrong pillow under your head can make sleep impossible and cause you even more pain.

If you wake up every morning with a stiff neck, tense shoulders, or a headache; you’re almost certainly sleeping on a pillow that is wrong for you. Pillows are very individual, since the “right” pillow for you depends on a lot of different things. The first is whether you sleep on your side or your back, but that’s not all that needs to factor into your decision.

Your pillow needs to keep your head and neck in a “neutral” position, so that your spine is straight, and your head isn’t tilted forward or backward. Imagine a perfectly straight, level line running from the top of your spine through the top of your head. If your pillow allows your head to droop, or pushes your head up; so that the line meets the top of your head anywhere other than directly over the top of your spine; it will put a strain on all the muscles of your neck, shoulders, and upper back. This can cause you to have trouble falling asleep or staying asleep; as well as causing headaches and/or pain in the neck, shoulders, and back.

Extra pillows can also be very helpful. A body pillow can help to keep side-sleepers from twisting their back into an unnatural position and support their top arm and leg. A  pillow or rolled blanket under the knees for those who sleep on their backs can prevent strain on the lower back and hips and help with sciatica pain. Finally, a foam wedge (in addition to the pillow) will raise the head and upper body several inches, and can help those who have heartburn problems or difficulty breathing when laying flat.

For more pillow ideas, check out this blog post: ‘Twas the Night before Christmas (A Tale of Four Pillows). Not only does it have lots of useful info, it’s really cute, too. (There are lots of other great posts on there, too.)

Breathing Exercises and Guided Meditations:

Another thing that helps me is breathing exercises. When I lay down, I focus on my breathing, taking long, slow, deep breaths in, then slowly releasing them. If it’s a really bad night, I’ll repeat “go to sleep” in my head on each inhale and exhale, with “go to” on the inhale and “sleep” on the exhale. That helps me relax, and keeping my attention on my breathing helps me to NOT pay attention to the pain.

I also have multiple guided meditations and relaxation exercises on CDs and as mp3s. I use them on a regular basis, with a set of earbuds or headphones. Focusing on the exercise ALWAYS sends me to sleep. (I don’t think I’ve ever heard the end of most of them, unless I’ve listened to them while I was sitting at the computer or something.) If earbuds or headphones make it too difficult for you to get comfortable, listening to the meditations or exercises until you’ve learned them by heart, then practicing them when you go to bed will also help.

Miscellaneous Bits and Pieces:

Taking a bath with 2 cups of epsom salt before bed helps to relax tense muscles and ease pain. (Use a water temperature that is comfortable for you, and if you need a temperature that’s too cool to easily dissolve the salt, pre-dissolve it in a little bit of hot water, then adjust the temp in the tub.) Adding a few drops of lavender essential oil to the bathwater will enhance the effect of the epsom salt. (Before using any essential oil other than lavender for the first time, please see my article Using Essential Oils Safely.)

Adding a drop or two of lavender essential oil to your pillow or a diffuser can also help you relax and sleep.

If light and noise are an issue, a good sleep mask and set of earplugs are essential. I use a Bucky Eye Shade because it’s very lightweight and comfortable, as well as being easily adjustable. It does a good job of blocking the light, even when I sleep on my side, and has a small pocket on the front for storing my earplugs so I don’t misplace them.

Herbs:

Disclaimer: I am not a doctor or certified herbalist, and do not recommend using herbs without consulting an expert. Herbs can be useful, but many of them can and do interact with prescription and over-the-counter medications. NEVER use any herbal product without making sure it’s safe with your own particular combination of meds and physical issues.

I use herbal teas to help me go to sleep, too, but that requires a good bit of research and experimentation to determine which ones would be safe with your particular medications, any allergies you may have, etc. Chamomile is a decent one for bedtime, and is easily found at almost any grocery store on the coffee and tea aisle, but if you’re allergic to ragweed or any other member of the daisy family you could be allergic to it, too, and need to be EXTREMELY careful if you decide to try it.

Catnip is another option, if there are possible allergy issues with the chamomile, but you have to either get it from an herb store or order it on line (unless you happen to grow it) because it’s not available in a regular grocery (the stuff they sell for you to give your cat isn’t safe for human consumption, it’s almost always too old and is frequently contaminated with other stuff.)

Your Mattress:

I’ve left this one for last because most of us can’t afford to buy a new mattress anyway, but if you can afford to, this might be the best thing you’ve ever done for your painsomnia.

The vast majority of us own innerspring mattresses, which is fine for most people, but for those of us with chronic pain, they can be the worst possible kind of mattress there is. The springs can put pressure on sensitive areas, and the older the mattress is, the more likely it is that some springs will have different pressures from others. In addition, innerspring mattresses don’t conform to your body very well, so you may not be getting the support you need in some areas, while other areas are receiving too much support.

The reading I’ve done suggests that the “memory foam” type mattresses and the “Sleep Number” mattresses tend to be the best for those of us with chronic pain. Both are conformable, and neither has anything in them that will cause pressure points or uneven support. They each have advantages and disadvantages, and the choice between them is very individual.

I use a “Sleep Number Bed,” and my reasons for choosing it over the foam may give you some hints about which type would work best for you. I like being able to change the firmness of the bed to suit my needs. I can make it firmer if I’m having more problems with low back pain, and soften it if I need less pressure on my joints.

I also have problems with overheating on the foam. I purchased a pillow made out of the memory foam when I was trying to decide which type of mattress to get, and I’m really glad I did. I couldn’t spend more than a couple of hours on that pillow without getting soaked with sweat anywhere my body touched it. I can’t imagine trying to sleep with my entire body resting on it, since just the pillow made me miserably hot, and that was actually the determining factor for me.

The foam does have a major advantage though. If you can’t afford a new mattress, you can get a foam topper for your old mattress. This solves most of the issues caused by an innerspring mattress (unless the mattress is so old that it has deep, permanent depressions in it) while costing much less than a new mattress.

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Related articles

• Find the Right Pillow for You Based on Your Sleep Style [Sleep] (lifehacker.com)
• Sleep Help to Sleep Better (leggotunglei808.wordpress.com)
• What Bed is Best with Fibromyalgia?

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