Management of Insomnia and Pain

Nonpharmacologic Management of Insomnia and Pain

Basic principles of sleep hygiene

Maintain regular sleep-wake patterns and consistent pre-sleep routine (wind down)

  • Arise at the same time each day (7 days a week), regardless of sleep quantity or quality the night before.
  • Avoid extended naps to compensate for the poor nighttime sleep (limit naps to 30 minutes)
  • Eat regular meals and avoid heavy, spicy foods for 2 hours prior to bed.
  • Establish a relaxing bedtime ritual (discontinue stress-provoking activities well before bedtime).
  • Put down portable electronic devices (cell phone, ipad). The blue light suppresses melatonin
  • When unable to sleep, do not spend more than 15 to 20 minutes lying awake in bed. Get up and relax in a separate room. Return to bed only when sleepy. Repeat this routine as often as necessary. This avoids establishing your room as a cue for alertness and distress.

Control environmental factors

  • Ensure adequate light exposure in the morning and into the late evening.
  • Take a 30minute hot bath, 60-90 minutes before bedtime (not closer to bedtime.)
  • Keep the sleeping environment dark, quiet, comfortable, and slightly on the cool side. Use a white noise machine to screen out background noise and decrease arousal threshold.
  • Set a wake-up alarm and keep the clock face turned away. Do not focus on how much time is spent awake in the middle of the night.


  • Take regular exercise each day
  • Avoid vigorous exercise right before bed.

Limit stimulating substances and know drug effects

  • Take smoking or nicotine several hours before bedtime, and never smoke in the middle of the night.
  • Limit the use of alcohol at night because if fragments sleep as it is metabolized.
  • Reduce caffeine use, and discontinue all caffeine 8 hours before bedtime (coffee, tea, soft drinks, chocolate, etc).
  • Avoid over-the-counter sleep medication.
  • Review the timing of all medications with your doctor because they may negatively impact sleep and might be substituted or rescheduled differently.
  • Endure adequate pain medication at night if need.

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