SLEEP PREPARATION

• Sunlight first thing in the morning may help to set your body’s clock.

• Sunlight exposure at noon, exercise at noon, or exercise five hours before bedtime may also promote sleep (serotonin or dropping body temperature).

• Avoid napping more than one hour during the day or in the evening hours.

• Avoid chemical stimulants at night, such as nicotine, caffeine, dietary protein, citrus, fat, and  >3oz. alcohol.

• Avoid emotional stimulation at night, such as certain types of television or literature, phone calls, or intense discussion/arguments.

• Create a time during the day called “worry time” to process the events of the day, to avoid rumination at night.

• Use the bedroom for sleep only (no TV, reading, phone calls, work).  This associates the bedroom with sleep only.

• Use pain management or relaxation strategies, such as a warm shower or bath, stretches, pain meds, to decrease any pain or anxiety before bedtime.

• Use imagery to separate yourself away from the stressors of the day (tail pulling off).

• Create a pre-sleep ritual which, when used nightly, will signal your body that it is time for sleep.

• Have a light snack before bedtime; being too hungry or full can inhibit sleep.

• Keep the same bedtime and awakening hours.

• Go to sleep when your body feels ready, not when you feel you “should”.

• Cover up or turn away clocks in the evening to avoid anxiety about when to go to sleep   or if you awaken during the night.

• Morning Routine: create a gentle transition from sleep to awakening.  Awaken earlier to avoid rushing in the morning.

 

ENVIRONMENTAL CONSIDERATIONS

• Provide optimal lighting with window shades,  heavy drapes, eye mask, night light.

• Decrease annoying sounds with earplugs, white noise, unplugged phones, family and neighbor cooperation.

• Create an optimal temperature and ventilation (fans, A/C, dual controlled electric blanket, socks and gloves).

• Cushion painful areas (shoulders, hips) with eggcrate mattress, featherbed, body pillow.

• Use pillows between the knees (or kneepads) for sidelying or under the knees for backlying.  Use only enough pillow under the head to keep the ear and shoulder aligned.

 

SLEEP AIDES AND MEDICATIONS

• Vitamins: Calcium/Magnesium/ Zinc at bedtime.

• Restless Legs:  Quinine or Parkinson’s disease meds.

• OTC:  Valerian, Melatonin, Chamomile, Calms Forte , Silent Night, Lavendar

• (Caution: many are not FDA approved or may interact with prescription medications adversely)

• Meds:  Tricyclics (elavil, trazadone at low doses), Restoril, Ambien, Sonata.

• Avoid: Valium, Benadryl, alcohol which do not promote normal sleep.

 

SLEEP INTERRUPTIONS/ INSOMNIA

• Prepare ahead of time for sleep interruptions by having enjoyable activities (reading, crafts) ready to do if you awaken and cannot return to sleep.

• If awake for longer than fifteen minutes, get out of bed.  Research shows you will probably stay awake for one hour or more.  Repeat your pre-sleep routine.

• If you can’t get something off your mind, write it down and discard it. Train yourself to deal with problems in the morning.

 

COMBATTING JET LAG

• Adjust your watch to the time of your destination at eat and sleep in that schedule.

• Remove your shoes and drink extra fluids, avoiding alcohol or caffeine.

• Get sunlight (back of knees, preferably) whenever possible during and after your trip to re-set your biological clock.

 

GOAL:  Stage IV sleep 30% of the night and a good sleep 5/7 nights of the week.

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References:

Wegener, S.  Fatigue and Sleep Disturbance in Arthritis
Lacks, P.  Behavioral Treatment for Persistent Insomnia
Hauri, P.  Sleep Disorders: Current Concepts
Waterhouse, D.  Sleep, Diet, and the Brain (Seminar, 1994)
Melvin, J.  Treatment of Chronic Pain (Seminar, 1993)