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.