Managing Long Term Chronic Pain - Course Notes Week 4

Week 4 of The Pain Management course saw a few returners and a couple of absences, but I'm getting used to who everyone is, so it's much easier and more relaxed now. I was late, because the stupid bus didn't turn up, so I missed goal setting and recap from last week, which wasn't ideal, but everyone was welcoming and forgiving. I had previously warned them that the bus is hourly and not exactly reliable. Stagecoach, sort yourselves out! Anyway, this weeks theme was Sleep and, since I have a sleep disorder and already have a reputation for falling asleep in class, this should be interesting. 

When I arrived, the conversation was about if we have problems with sleep or not. Most said yes, and we talked about how that affects us. The leader made a huge list of all the different problems associated with sleep and it was quite an eye opener (pun, sorry!). It was really interesting to see how differently people experience sleep deprivation and how it effects us. Some of the top symptoms were cognitive problems, irritability and forgetting things. My personal favourite is falling asleep on public transport. It's astounding how well you can sleep when you don't actually want to! We then had a lesson on the natural sleep cycle of the human body, which was really interesting, but a bit complicated to go over, without the accompanying whiteboard graphic, however I have found this explanation of How the Sleep Cycle Works, from Dreams, which explains it really well, using a similar graph. What I learned was that you are meant to drift in and out of sleep throughout the night, you don't stay in a deep sleep for a long period of time, the problems only start when you fully wake up and can't get back to sleep again.

My sleep disorder often means that I wake up in the middle of dream sleep, which is really disruptive, and leaves me feeling exhausted. It's not really how your body is meant to wake up, you should wake up during the 'wake' part of your natural sleep cycle, and it takes much longer to wake up when you are, effectively, 'interrupted (in this case, by your own brain) in the deep part of sleep. There doesn't seem to be an obvious solution to this, but it was suggested that going to sleep and waking up at the same time every night might help retrain my brain and I thought maybe I should try my Lumie Bodyclock again. I have had it for a couple of years, but I lost interest in it, as I didn't have enough plug sockets to keep it plugged in all the time and it was a pain having to reset it everyday. 

In groups, we talked about what we could do to try to improve our sleep and we also discussed two of the main sleep issues; not being able to get to sleep and waking in the night then not being able to get  back to sleep. The second is slightly different to the first, but some of the solutions work for both. It was really useful, because we all came up with different ideas, and by the end of the individual group section, we had quite a long list of different ideas. Such as: 

• Controlling caffeine intake
• Switching screens off an hour before sleep
• Not eating anything late in the evening that takes a lot of digesting
• Writing down any worries or things we need to remember for the next day
• Establishing a good sleep routine

A good evening routine is very important to improve length and quality of sleep. It's a good idea to try and keep to the same routine, so that your body gets used to knowing when it's sleep time, particularly when it comes to bedtime. Going to sleep and waking up at the same time every day is a big help for your sleep routine, as it ensures your body clock is maintained and you can wind down at the same time each day. It also avoids getting too much sleep and feeling drowsy because of it. 

After that, we took part in a relaxation exercise that is designed to help you sleep. There are various types of relaxation methods and this one was a physical one, where you tense and relax different parts of your body, gradually lulling yourself into a sense of extreme relaxation and sleepiness. It's really good for taking your mind of things, if you are a worrier, and gives you something to focus on, instead of just thinking about the fact that you are still not asleep! The NHS offers various audio guides for common mental wellbeing issues and you can find the Overcoming Sleep Problems Audio Guide by clicking the link. 

At the end, we set goals for the following week. Mine was to improve the way I talk about my condition. I have always been quite embarrassed to talk about my illness and the way it affects me and I go out of my way to hide it from people. I think it is going to take some time to achieve this goal, so I'm going to begin with Part 1: What do I mean when I say 'Ok'? Which is my standard response if anyone asks me how I am. It can mean anything from 'I am fed up with talking about it' to 'I don't think you really want to know', so I knew it would be a challenge to get to the bottom of it. After this, it was time to go home and I realised that, ironically, this was the first session that I hadn't struggled to stay awake for!