Nothing can really happen in the context of the DOC Project until you are regularly getting a full night’s sleep. Exhaustion makes it impossible for anyone to concentrate long enough to engage in the program. For anyone with chronic pain, this probably sounds impossible. You may think, how can I sleep with the intensity of the pain I am experiencing? Getting good sleep with chronic pain often requires medication.
If you are having sleeping problems, work carefully with your doctor to figure out which sleep medication is the best for you. Once you’ve started taking it, check with him or her every five to seven days—either at follow-up appointments or via phone–to report back on how things are going. If the first treatment plan isn’t working, adjustments should be made promptly so that you’re sleeping well within three to four weeks. This is the kind of aggressive, solution-oriented approach that I’ve found is most effective.
Insist on getting adequate sleep
If your doctor resists this kind of follow up, do not back down. Calmly explain that getting sleep is a central part of your recovery program, one that you are taking seriously. Of course, if he/she still resists, don’t be afraid to find another physician.
Note: in dealing with sleep problems, some physicians opt for treating your depression, which does improve sleep. However, it takes far too long.
Categories of sleep medications
There are several categories of sleep medications and two basic strategies in terms of how they work. I am including them here to give you an idea of the wealth of options available. One group has a direct effect–they will simply induce sleep. The other group includes medications that are intended for other problems but have drowsiness as a side effect. Sleep can be obtained by taking advantage of this side effect.
In addition to sleep medication, it can be helpful to take a slow-release narcotic, which will last for eight to twelve hours, to help with pain. I don’t like narcotics solely as a means to get a patient to sleep, but they lessen the pain enough to allow the sleep medications to work. Narcotics are covered later in this chapter.
Here are the different types of sleep medications:
- Sedative-hypnotics
- With anti-anxiety properties: Valium, Klonopin, Xanax, Halcion, Ativan, etc.
- Without anti-anxiety properties: Ambien, Lunesta, Sonata
- Antidepressants with drowsiness as a side effect
- Non-SSRI: Remeron, Trazodone
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- Tricyclics: Amitryptiline (Elavil), Nortriptyline (Pamelor)
- Anti-psychotics with drowsiness as a side effect
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- Seroquel, Risperdol
- Melatonin agonists
- Melatonin, Rozeram
- Antihistamines
- Benadryl
- Over the counter sleep aids
I won’t go into the pros and cons of each medication–that is something to discuss with your doctor. But know that one of the above will work for you if used correctly. Pain is not a reason to lose a night’s sleep.
BF