Incorporating sleep into my treatment of pain was my first step in starting the DOC Project. I felt I had a whole new weapon that was very effective and simple. I realized that once I was successful in getting my patients to sleep, there was always some improvement in their sense of well being if not also in their pain.
Most patients with chronic pain sleep poorly and are tired during daylight hours.They often feel pain more keenly at night when they have fewer distractions. But without sleep, quality of life is compromised and day-to-day stress and pain are difficult to handle. The perception of the pain increases.
In 1997, I started to incorporate sleep treatment into my practice. If a patient had an acute problem such as a ruptured disc, I would use sleep medications in addition to pain medications. It was much easier for my patients to wait it out until the disc healed if they were able to sleep. Whenever chronic pain was involved, the results were consistent: over the course of two to four weeks, my patient’s mood and coping mechanisms would improve with consistent sleep. If they did not get to sleep, I would aggressively keep switching meds until we found the right treatment. Not sleeping was not an option. I was able to get most of my patients to sleep reasonably well within four to six weeks.
The first step in the DOC program is to get at least a month of adequate sleep. It is an integral part of calming down the nervous system.The program isn’t effective unless you are rested. Many adults think they can get by on less than eight hours of sleep, but consider 7 hours a minimum. Most people, especially with chronic pain, do not get a full night’s sleep.
There was one study done in which female volunteers were measured in terms of the quality of their Stage V sleep, also called REM sleep, for a period of time. This is the stage where the most dreaming takes place. It was discovered that the less amount (and poorer quality) of REM sleep, the higher the sensitivity to pain. (1)
It is my first obligation to simply get my patients to sleep. Patients argue with me that it is impossible to sleep with the pain. However there are very few situations where the right combination of medications cannot be found to yield a consistent good night’s sleep in spite of the pain. If your physician is not addressing your insomnia, insist that he or she does. It is one of the first responsibilities you must take on to pursue your pathway to a better quality of life.
- Karaman S, et al. Prevalence of sleep disturbance in chronic pain. European Review for Medical and Pharmacological Sciences (2014); 18: 2475-2481.