DEAR DOCTOR K: I have chronic pain from arthritis. Lately it's so bad that I can't get a good night's sleep. What can I do?
DEAR READER: Chronic pain and insomnia are, unfortunately, a common combination. What's more, chronic pain puts you in double jeopardy: First the pain robs you of restful sleep, then losing restorative sleep makes you more fatigued, which makes you more sensitive to pain.
Why does pain often seem worse at night? During the day, you pay attention to what's going on around you. However, when you lie down to go to sleep, there are fewer things to distract you -- just the pain.
I can sympathize. I had severe arthritis in my right hip that interfered with my sleep for years. It's a common problem. There are millions of people like us.
Many pain specialists recommend a strategy called "relaxing distraction" to get to sleep. Relaxing distraction can come in the form of widely available audio recordings. Some teach basic rhythmic breathing meditation. Others focus on guided imagery, in which you imagine being in a calm, relaxing location.
Pain relievers, while essential for pain control, can be a double-edged sword. That's because some, including opioid pain relievers like codeine, hydrocodone (Vicodin) and oxycodone (Oxycontin, Percocet), can disturb sleep -- as well as create addiction.
If you do take pain medications, work with your doctor to find one that does not interfere with sleep. If possible, take the pain reliever right before bed, especially if pain wakes you in the middle of the night.
When your pain awakens you at night, what you do next is important. First, try meditation, visualization, or whatever relaxing distraction you favor. If that doesn't work, get up to read a book in a quiet room with low light. Don't watch TV; even dull shows are stimulating enough to make it harder to fall asleep. Do something mind-numbing, like organizing the sock drawer. The next thing you know, you will go back to bed and want to sleep.
It's also important to stay on a regular sleep schedule. Go to bed at the same time every night. No matter how the night goes, rise the next day at the same time and remain awake until your planned sleep time. This helps to set your internal sleep clock and enhances your natural sleep drive.
What about sleeping pills? If it's pain that's making it hard to sleep, sleeping pills won't help. When I was a young doctor, a patient taught me a lesson. She was in her late 80s. She told me that her only problem was "the aches and pains as you get older." She was the only patient in her 80s that I wasn't prescribing a single medicine for.
One day she told me that "the only pill I need, or will ever need, is my sleeping pill." Since I wasn't prescribing anything for her, I was puzzled. Then she explained: Her sleeping pill was one aspirin tablet an hour before bedtime.