I realize that you didn’t open this book to only learn about the problems associated with being overweight. You need answers—and you need them today! Millions of pain sufferers have disordered sleep, especially insomnia (difficulty falling asleep or maintaining sleep, or an inability to feel rested despite adequate time spent in bed). With age, the prevalence of insomnia increases as sleep time decreases, even though the time spent in bed might increase. There is a better way.

Here are some easy strategies that I recommend to my patients when they are “tired of feeling tired” and want to make changes to increase quality sleep.

Lose Weight

I’ve said it repeatedly throughout this book—weight loss is the best way to guarantee pain-free living. Not only does carrying around extra baggage increase pressure on your joints, weighing as little as 10 or 15 pounds over your desired weight can increase pro-inflammatory markers which worsen problems like obstructive sleep apnea. Following the Pain-Free Diet will help you lose pounds and reduce the risk.

Find a Comfortable Sleep Position

Trying to find a comfortable sleep position with pain is not easy—but it can be done. Here are some suggestions:

Make sure your mattress is firm for good support during sleep. If you are sleeping on a soft mattress, this puts extra stress on your back, neck, and hips. In addition, if your mattress is more than three years old, consider replacing it with a new, firm mattress. Some of my patients who suffer with arthritis, disk disease, fibromyalgia, and other problems with pain prefer sleeping on a waterbed, and find that it gives maximum support and comfort.

Try a pillow. If your neck, shoulders or upper back causes you pain problems, try one of the specially made pillows that fit the contour of your neck and ease stress on that part of the body. You can find these online or at any medical supply store.

If you have back pain, including arthritis of the spine, try to sleep on your stomach for at least a brief period each night This can help to prevent posture problems, particularly a “stooped over” appearance, which is a common problem in many types of spinal arthritis, especially ankylosing spondylitis (see glossary).

Take a Warm Bath before Bedtime

Sleep characteristically occurs when the body temperature is declining, whereas wakefulness occurs when the temperature is rising. In findings published in the journal Clinical and Sports Medicine, researchers concluded that skin temperature of hands and feet (particularly warm feet) seems to be the crucial variable for the association between internal body temperatures, sleepiness, and sleep. You can safely take advantage of skin warming/core cooling by taking a luxurious warm bath before bedtime to enhance sleepiness and deeper sleep and keeping your bedroom temperature cool (about 68 degrees Fahrenheit).

Keep Your Bedroom Dark and Quiet

Wear earplugs if you are bothered by noises while sleeping. Some people find that “white noise”—from a machine that produces a humming sound or a radio tuned to a station that has gone off the air—helps. Also, get blackout shades for your room to make sure it is fully dark. Light is a cue for the body to awaken; darkness signals relaxation and sleep. Wear a sleep mask if you are ultrasensitive to light and find it disrupts your sleep time. Turn your clock with the face toward the wall so you are not tempted to check the time all night long.

Watch What You Eat and Drink

Eating foods high in complex carbohydrates can raise levels of serotonin, a brain chemical essential for sound sleep. Also, try eating foods rich in B vitamins, such as whole grains, peanuts, bananas, and sunflower seeds, which help to counteract the effects of stress. Lastly, avoid alcohol and caffeine. Alcohol can cause you to fall asleep quickly, but many people wake up in the middle of the night and have trouble getting back to sleep. Even one cup of coffee (150 mg of caffeine) can disturb the quality of sleep, increasing wakefulness and making it difficult to feel rested the next day.

Consider Taking Melatonin

The natural hormone melatonin may be helpful for many who have difficulty falling asleep. Melatonin is thought to regulate sleep cycles and help to set the brain’s biological clock. But the amount of melatonin produced by the body lessens as we age, with adults experiencing about a 37 percent decline in daily melatonin output between the ages of twenty and seventy. We know that melatonin is a potent free radical scavenger, and melatonin deficiency is related to suppressed immunocompetence.

Melatonin supplements are sold over-the-counter at most pharmacies; talk to your doctor and see if this might help your sleep problem. Some people who take melatonin find it helps them fall asleep easily; others wake up after several hours of deep sleep and are unable to get back to sleep.

Maximize Sleep with Yoga

The Child’s Pose, shown below, can be done several times a day. This is a great yoga posture to practice as you prepare for sleep, or if you need a calming moment in a stressful day.

Kneel on the floor on your hands and knees with your hands under the shoulders and your knees under your hips, with your toes touching. Stretch your neck forward and lengthen your spine through the tailbone. Gently rock the weight of your body back toward your feet, letting your hips stretch further back as you continue to lengthen and stretch your spine. Stretch your arms forward and walk your fingertips as far forward as they will go on the floor or rug, lengthening your arms fully. Stretch from your shoulders.

As your hips stretch backward, focus on the stretch from your armpits to your hips, lengthening the sides of your torso and back. If you are flexible, continue stretching and relax your neck as your forehead touches the floor. Pressing the forehead against the floor or pillows helps to calm your mind as the forehead and eye muscles completely relax. If this is hard, put one or two pillows under your forehead. Rest a few seconds and allow your forehead and eye muscles to relax.


Figure 1—The Child’s Pose

Avoid Naps

If you are exhausted, a short nap might help you to become more alert. But for most people, napping only makes it more difficult to get quality sleep at night. If you do nap, keep it to around 20 minutes so you will sleepy again at bedtime.

Avoid Nighttime Exercise

It is known that people who exercise close to bedtime have more problems relaxing and sleeping. This may be because exercise is stimulating, causing you to feel alert and raising your body temperature. The raised temperature will only begin to fall as long as 5 or 6 hours after exercise, and this fall signals to the body that it is time to sleep. Try to exercise early in the day while you have energy or in the afternoon, so your body has time to calm down before you climb in bed.

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