Before I got sick I battled with insomnia for many years. It started with living with several extremely noisy housemates at uni that meant what little sleep I did get had to be managed around what quiet time they’d let me have.
Over time this led to such anxiety with getting to sleep that my mind whirred as I tried to rest, so although I’d regularly be exhausted I couldn’t get any rest at all.
I felt powerless about something that should be effortless, and when I became ill with endometriosis (and started full time work) it was one of the first things I had to sort out to get some quality of life back.
Happily I’ve lived with near perfect sleep since becoming ill, it’s one of the few areas that I don’t have much difficulty with anymore. Although much of my sleep can still be unrestful (and I have wider chronic fatigue problems).
That said, I didn’t quite appreciate how restorative my sleep was until I got a new set of neighbours that caused me several days of restless nights and I got flashbacks to a time that I’d all but forgotten about.
I know some of you must still be in the worst throws of insomnia, and I know how utterly miserable it can be so I’ll do my best to share what has helped me get over that particularly horrible hurdle.
Fixing sleep isn’t easy
These are the things that helped me, but like living with chronic illness there’s no silver bullet to solving sleep problems and it will take a while. The good news is, it is possible. I average 7/8 hours sleep a night and I always fall asleep within five minutes (or less).
It is however important to remember that lots of sleep problems may be compounded by problems with chronic fatigue. Fatigue is different issue entirely from a lack of sleep and you might find my advice for chronic fatigue more useful if so.
Also my advice on self managing pain will be useful too, pain management kinda goes hand in hand with getting a good nights sleep.
Figure out if you’re a lark or a night owl
This is the first thing to do. We often joke about being more of a night person or morning person, but there’s actually some logic to this. Some people (as they move into adulthood) will settle into one of these two roles, and it changes over time as you get older. You’ll probably have a preference one way or the other, and trying to fight against this in-built preference may make fixing sleep issues more difficult.
I’m a lark by nature. I’m at my best in the mid morning, and I usually prefer getting up early and going to bed earlier, some people are the complete opposite. Figure out which broad type you are, and tailor your guidance for a good nights sleep accordingly.
If you’re really not sure about your sleep type, try one of the many sleep quizzes online for some advice.
Choose your intended bedtime and make baby steps towards it
Fixing sleep problems is a long and difficult process. You stand a better chance of succeeding if you set yourself a series of small goals rather than jump straight to your intended bedtime. For example if you can’t get to sleep until 1am normally, making yourself go to bed at 10pm is probably going to mean that you lie in bed completely unable to nod off.
Start by aiming for 15 minutes earlier than normal, and start the routine of a normal bedtime (that I’ll come to shortly), then amend this over time.
Sleep patterns are hard grained into our daily routines, so like treatment for chronic illness it can take a long time until you see an improvement. It will mean a great deal of planning and preparation. Think of it as being kind to your future self (later that day) and the hard graft of fixing sleep will become easier.
Most importantly, don’t lose hope if you don’t manage what you want to accomplish straight away, this is perfectly normal.
When you can’t sleep, do something else
The hardest thought to overcome in those long nights unable to sleep was the wasted time, both in not being able to rest but also not having the energy to do a lot else.
I remember that I used to cook a lot during those long nights, either to solve the immediate need of my stomach eating itself with tiredness, but I also used to bake and cook myself nice things for what was going to be the next rubbish day.
If you’re starting to associate your bed with not being able to sleep then maybe somewhere else to sleep might be a good idea. If you’ve not got the space for this, a trick I use is to sleep the other way around in bed to normal for a bit, happily it has the same effect. 🙂
If you’re looking for more ideas the expert patient programme has it’s own part of the (free) course on getting a good nights sleep too.
Lighting is important too
You might prefer sleeping with a little ambient light in the room at night, but I’d really recommend trying to sleep in darkness or near darkness. This will encourage your body to slip into sleep more naturally, because that’s actually what’s normal for it.
How you wake up in the morning is important too. I really rate using a daylight alarm clock that takes you at your intended time by increasing the light in the room. I actually wake up in the winter purely using this method and you feel more rested and less “shaken up” by waking up compared to loud sounds. I had my doubts about this method but it does work wonders.
Keep busy, and keep moving
This is easier said than done and I realise that, but you’re unlikely to sleep well at night if you don’t move very much. I started sleeping better the day I started cycling to work every day. Strangely with chronic illness you have to spend some energy to get some energy back and once that boost wears off you’ll naturally exhaust yourself for bed later on.
If the idea of something like cycling is too much, think about what you can personally manage in your day to move around more. If you’re tossing and turning at night it’s possible that you need to increase your activity in the day to improve your chances of a good nights sleep.
You’ll have more success with this idea if you make it part of your routine. I found time to exercise by making cycling my only way to travel to work. When I’m on my lunch break I make sure that I have to pick up my prescriptions at the pharmacy that’s the furthest away from my office so I have to walk more to go get my tablets.
When you find ways to move around more that become second nature rather than chores that’s when you’ll have the most success.
As ever it’s a careful balance between solving your sleep problems and keeping your pain at bay, so the sweet spot to help both is something you’ll have to experiment with.
A lot of issues with sleep can be worked out by sorting out bad habits in the day that could be making your sleep time in the evening harder.
Regular meal times will help too. Your stomach has a big grounding in your internal body clock.
Try not to nap in the day
I realise this is is a big ask, but napping will generally break you out of your schedule of good sleep by making it harder to sleep through the night. This is the least understood aspect of getting a good nights sleep.
When you go without sleep many people will encourage you to take a nap in the day. If you can, try as hard as possible to save naps until you reach that “absolutely have to cannot keep your eyes open” level of sleep. You’ll find getting proper, restorative sleep later on at night much, much easier, and your future self will thank you.
If you absolutely have to nap, try to do this before 3pm and for no longer than 20-30 minutes, to improve your chances of sleeping later that evening. Sleeping longer than 30 mins will mean that you’ll enter deep sleep and get that horrible groggy sick feeling when you wake up rather than feeling the benefit of the nap.
Eating good meals throughout the day will help settle your stomach and hopefully keep you going until your chosen bedtime. If you can get lots of natural sunlight as well which will encourage your body to stay awake. (This is the key to surviving jet lag too). If this isn’t an option (say in the winter) think about getting a sunlight lamp to help you stay awake until about an hour before you want to get to bed.
Stop watching TV or playing games in bed
The type of light that phones, tablets, TVs and computers emit is the same sort of light used in sunlight or daylight lamps that keep you awake. Get yourself into the habit of using your bed for sleep and make it a device-free zone.
If you don’t like sleeping in a completely quiet, or dark room try listening to spoken radio as you go to sleep (on a timer). Most clock radios have dimmed screens and don’t emit a lot a light. Some TVs have this feature too (where the screen will turn off entirely but the sound still works and will turn itself off after a set amount of time).
Have a routine to settle you into bedtime
If you’ve got a preferred bedtime in mind, start a winding down schedule an hour before that. Do all the things you’d normally do to get ready for bed, change, brush your teeth, take your medicine, check the doors locked, everything you have in your head that you need to do before you could fall asleep. Then carry in with your evening routine until you’re ready to sleep (hopefully by your intended bedtime).
Too many people are unable to asleep at bedtime because when they want to go to bed they start running around doing a lot of bits that that should have done earlier in the evening, this can wake you up and make it harder to nod off.
Some people will say not to play video games or watch TV right before bed, but if you’re doing it once you’ve done your bedtime routine (and you find it a relaxing activity) I don’t see the harm, do what works for you, as long as you don’t try to do these things from bed 🙂
Ideally you want to do your wind down routine, then go back to relaxing, then realise you’re getting sleepy, climb the stairs and go straight to sleep. This is how my evening goes nearly without fail now. I’m asleep within five minutes (or less).
Make your bed really comfortable too, invest in a good mattress and I personally love having a heated under blanket. Having sleep as a respite from pain makes is something I really look forward to rather than dread.
You know this already so I won’t dwell on it. Just remember that there’s a lot of caffeine in things you don’t expect like soft drinks, tea and sweet foods. It’s common to use coffee to help you stay awake in the day but again it’ll make things harder for your later self. If you absolutely have to drink a cup, try not to drink anything any later than 6/7pm.
Consider a medication review
I’ve got no experience of using sleeping tablets so I can’t comment on that, but be aware some of your existing pain medication may make it easier or harder to sleep, speak to you doctor or pharmacist to find out if there’s anything in your normal medication that could be causing you sleeping problems as there may be a better alternative for you.
Stick to your good sleep routine (even on weekends)
It’s all too tempting to try and “catch up on sleep” on the weekends but you should aim for even sleep throughout the week. For example for work I get up at 7am and I go to bed around 10/11pm. I make sure I do this on weekends too, and resist the temptation to stay up too late or wake up too late. This helps your body get into a more regular rhythm and if you start doing this on weekends too you’ll find it slightly easier to get up in the mornings and go to bed at night. This is because you’re not forcing your body to do two different things, one in the week and another on the weekend.
If you’re not doing this already, this is why your body will try to wake up at your work time on the weekends even when you don’t want it to, it’s only natural. I rarely lie in anymore and I actually feel better for it.
If you do have to lie in, try to keep it within an hour or two or your regular wakeup time, otherwise when it comes to work on Monday you’ll struggle to get out of bed and that’s exactly what you want to avoid.
Keep up these good habits of sleep and eventually you’ll find it easier. Perseverance is the key, especially in the starting days and weeks. It’s not something simple and it’s not going to be solved overnight but eventually you’ll see an improvement until you hardly have to think about it.