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Pahavit's Universe

pahavit
Date: 6-10-2009 5:20 PM
Subject: Pain Management Class #4
Security: Public
Tags:disability/medical, pain management class, stanford pain management center
Pain Management Class #4


In today's pain management class we learned about the importance of good quality sleep in controlling pain.

There are so many things that can interfere with getting proper sleep at night -- stress, worry, emotional issues, and pain, to name a few.  Some people have trouble falling asleep, others have trouble staying asleep, while others sleep all night but have poor quality sleep.  In most cases there is more than one factor that contributes to sleep problems, so it can be complicated to resolve.  Today we learned 10 things we can do to help us get the best possible sleep at night.

These strategies are based on classical conditioning, or associative learning (a.k.a the Pavlovian response), where a stimulus and a response that are not naturally related come to be associated with one another, such as Pavlov's dogs salivating when they heard the bell.  If we follow as many of these good sleep hygiene behaviors as possible we will create actual physiological changes in the body that will lead to establishing restorative sleep, because of the association of doing them in relation to bedtime and sleep.

We learned the importance of maintaining a regular schedule; not tossing and turning but getting up out of bed if we are not relaxed enough to fall asleep after 30 minutes; minimizing non-sleep activity in bed (no reading, web surfing or eating); using a bed that is comfortable for us; leaving worrying for the daytime; developing a pre-sleep ritual; getting regular physical activity; not eating large meals immediately before bedtime (also, not using caffeine, nicotine or alcohol then either); not focusing on how long we've slept (because it's the quality of sleep we get, not the quantity, that's important); and not napping during the daytime.

Most of these are habits I've developed on my own over the years, with the exception of using the bed for reading and using my laptop.  I may or may not try to give that up.  (OK, I'm not perfect.  If that's my one vice, though, I'm doing pretty good.)  The most useful strategy for me has been not obsessing over how long I've slept or over what time it was during a night of wakefulness.  As soon as I decided to ignore the clock after going to bed I lost a lot of anxiety and negative emotions about how little sleep I was going to get, and it made coping the next day on less than optimal sleep more bearable.  There have been times when I've felt better and functioned better after 3 hours of sleep than I have after 9, so the actual numbers really don't mean much to me.

An important aspect of these strategies is that they are not something passive that happens to us but are behaviors that we must actively engage in in order for them to succeed.  A lot of people resist active participation in their own pain management program, preferring the passive approach of being given a shot or a pill by their doctor and not making any kind of lifestyle changes.  But personally I prefer things I can do for myself, at home, in my private life, independent of any doctor or pharmacist.  I have more control that way and I'm not dependent upon someone who is not realistically always available at any given moment to drop what they're doing in order to treat me if I'm having a flare.

We ended the class today with a relaxation exercise of deep breathing and a mental body scan.  It was enjoyable to have a little island of peace and tranquility in the middle of the day.  When I got home I was soooooooooooooooooooooo relaxed . . .

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