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Sleep and pain

睡眠和痛苦

Learn how you can encourage sleep to form part of your musculoskeletal pain co-management plan

（学习如何让睡眠成为肌肉骨骼疼痛共同治疗计划的一部分）

Sleep problems and chronic pain seem to go hand in hand. Frequently people with chronic pain find it difficult to fall asleep, or sleep is often disrupted with long night awakenings1. Even if you get a good amount of sleep, you can still feel very tired in the morning as the quality of sleep is often poor. Because of this, it is common for people to want to address sleep as part of pain management

.(睡眠问题和慢性疼痛似乎是密切相关的。患有慢性疼痛的人常常难以入睡，或者由于长时间的失眠而睡眠中断。即使你睡得很好，早上还是会觉得很累，因为睡眠质量通常很差。正因为如此，人们通常想把睡眠作为疼痛治疗的一部分。)

Having a bad night’s sleep can make you feel more pain sensitive2. Pain and sleep are closely linked and impact each other2. There is a reciprocal relationship where pain during the day affects the quality of that night’s sleep and poor quality sleep increases pain levels the next day1. In fact the latest findings point to sleep effecting pain levels greater than the other way round. So it is important to try and give yourself the best chance of having as good sleep as possible

.(晚上睡不好会让你对疼痛更加敏感。疼痛和睡眠紧密相连，相互影响。这是一种相互关系，即白天的疼痛会影响当晚的睡眠质量，而睡眠质量差则会增加第二天的疼痛程度。事实上，最新的研究结果表明，睡眠对疼痛程度的影响要大于睡眠对疼痛程度的影响。所以，努力让自己有最好的机会睡个好觉是很重要的。)

Some sleep facts(一些睡眠的事实)

It is helpful to understand some basic concepts about sleep before we look at what we can do to improve it.

To drop off to sleep our nervous system has to calm down. If you have chronic pain, you have a much more active nervous system. This can interfere with how quickly you fall asleep and how deep a sleep you get.

Know what good sleep looks like. Most people assume that a good night’s sleep involves a steady drop into deep sleep, staying in that deep sleep for most of the night and then gradually moving up into a lighter sleep before you wake. Healthy sleep actually looks quite different from that and instead comes in waves during the night – see the image below.在我们了解如何改善睡眠之前，了解一些关于睡眠的基本概念是很有帮助的。

?为了入睡，我们的神经系统必须平静下来。如果你有慢性疼痛，你的神经系统会更加活跃。这会影响你入睡的速度和睡眠的深度。

?知道好的睡眠是什么样的。大多数人认为好的睡眠包括一个稳定的进入深度睡眠，大部分晚上保持这种深度睡眠，然后逐渐进入较浅的睡眠，直到你醒来。健康的睡眠实际上看起来与那完全不同，相反，在晚上是一波一波的——见下图。

There are a number of stages of sleep we cycle through:

We start with stages 1 and 2 which are lighter stages of sleep.

Then we go down into deeper sleep in stages 3 and 4 sometimes called slow wave sleep.

We move back up to lighter sleep and then into rapid eye movement or REM sleep. This is where we dream.

This cycle gets repeated a number of times throughout the night, with more time spent in deep sleep at the beginning of the night and more time spent in lighter stages and dreaming towards the morning.

Notice that after most of the REM stages, we wake up. It is normal to wake multiple times a night. Most people will roll over and go straight back to sleep without even realising it.? When you are in pain, you can wake and notice your pain. This results in an increase in the activity in your nervous system that then has to calm down all over again to fall back to sleep. If we can help you to fall asleep more quickly initially, many of these same strategies will also help you to fall back to sleep once you wake during the night.

Pain affects sleep, but a lot of other factors can either improve or impair sleep too1. These are things that you may have more control over and if addressed, can help your sleep3.

我们的睡眠周期有几个阶段:?我们从第一阶段和第二阶段开始，这是较轻的睡眠阶段。

然后我们进入深度睡眠在第三和第四阶段有时被称为慢波睡眠。?我们回到较浅的睡眠状态，然后进入快速眼动睡眠(REM)。这是我们梦想的地方。

?这个循环在整个晚上会重复很多次，在刚开始的时候更多的时间处于深度睡眠，更多的时间处于较浅的阶段，直到早上开始做梦。

请注意，大多数REM阶段过后，我们都会醒来。晚上醒多次是正常的。大多数人翻了个身，然后在不知不觉中又睡着了。当你感到痛苦时，你可以醒来并注意到你的痛苦。这会导致你的神经系统活动增加，然后不得不再次平静下来，重新进入睡眠。如果我们能在一开始帮助你更快入睡，那么很多相同的策略也能帮助你在夜间醒来后再次入睡。

疼痛影响睡眠，但还有很多其他因素也能改善或损害睡眠。这些事情你可能有更多的控制权，如果解决了，就能帮助你入睡。

How can I improve my sleep?我如何改善我的睡眠?

To help improve your sleeping experience with pain try utilise some of?sleeping with pain recommendations.

Routine

Get up at the same time each morning regardless of the sleep you had the night before.

Go to bed roughly around the same time each night

Spend half an hour (a very active person may need longer than this) before bed, doing the?same things?in the?same order?each night, e.g. get things ready for the next day, have a shower, brush teeth, get into pyjamas then read a book. This helps the body learn to expect sleep and prepare for it. It is important that the last thing that you do in the routine is quiet and relaxing. This is a wind down time.

Only go to bed when you're sleepy

Your sleep goes in waves throughout the night. Your energy levels also go in waves throughout the day. It is important to go to bed when the energy level is in a dip.

Look for signs of sleepiness

Make the association between “bed” and “sleep” really strong

Your body learns to make associations all the time. We notice that our mouths salivate when we smell our favourite food cooking. We have learnt that soon after smelling food, we will get to eat it. We want to build up the association between bed and sleep, NOT bed and other activities, or bed and stressing about not sleeping, or bed and pain.

Only use the bed for sleeping (and sex)?e. no reading books, watching tv, resting (Find somewhere other than the bedroom to rest during the day)

That also means no tossing and turning in bed feeling frustrated about being awake.

If it has been more than 20 mins (roughly) and you have not fallen asleep, get out of bed and do a quiet (non-stimulating) activity, until you feel sleepy and try again.

Relaxation

For the body to drop off to sleep, the nervous system needs to calm down. This can be achieved through involvement in calm non-stimulating activities, or through relaxation. You can find some relaxation techniques in our?mindfulness and pain management module.

Relaxation techniques are particularly helpful when you are worried about not being able to sleep or about your pain. However, for it to work well when it is needed it needs to be practiced regularly.

Practiced regularly to bring down back ground level of nervous system activation

Use when dropping off to sleep

Sleep hygiene

This simply means, managing those things that you do during the day that can affect sleep.

Diet

avoid heavy, fatty or sugary foods before bed

avoid caffeine, coffee, coke and chocolate 4 hrs before bed

have some milk – it is sleep promoting

Exercise

Even low levels of exercise are beneficial to sleep

Don’t exercise within 2-3 hours before going to bed, as it will increase the heart rate and body temperature making it harder to sleep

Light

The greater the difference between day time light and evening darkness the more “melatonin” the body produces, This is a hormone that promotes sleep

Reduce light in the bedroom

Increase sun light exposure during the day

Noise

Ensure a quiet environment

Temperature

The core body temperature falls as we drop off to sleep

A warm shower in the evening is helpful as it will increase the body surface temperature initially, followed by cooling of the core body temperature

为了改善你的疼痛睡眠体验，试着使用一些疼痛睡眠建议。

例程

?每天早上都在同一时间起床，不管你前一晚睡得怎么样。

?每晚大约在同一时间上床睡觉

?每晚睡前花半小时(一个非常活跃的人可能需要更长的时间)，按照同样的顺序做同样的事情，例如:为第二天做准备，洗澡，刷牙，穿上睡衣，然后读一本书。这有助于身体学会期待睡眠并为之做好准备。重要的是，你在日常生活中做的最后一件事是安静和放松。这是一个放松的时间。

只有当你困的时候才去睡觉

你的睡眠整晚都是一波一波的。你的能量水平也会在一天中波动。当你精力不充沛的时候上床睡觉是很重要的。

?寻找困倦的迹象

让“床”和“睡眠”之间的联系更加紧密

你的身体一直在学习联想。我们注意到，当闻到我们最喜欢的食物烹饪时，我们的嘴巴会分泌唾液。我们已经知道，闻到食物的味道后，我们很快就会吃掉它。我们想要建立床和睡眠之间的联系，而不是床和其他活动，或者床和失眠带来的压力，或者床和疼痛。

?床只用于睡觉(和做爱)e。不要看书、看电视、休息(白天找个卧室以外的地方休息)

?这也意味着不再因醒来而在床上辗转反侧。

?如果已经超过20分钟(大致)，你还没有入睡，下床做一个安静的(非刺激性的)活动，直到你感到困倦，再试一次。

放松

为了让身体进入睡眠状态，神经系统需要平静下来。这可以通过参与平静的非刺激性活动或通过放松来实现。你可以在我们的正念和疼痛管理模块中找到一些放松技巧。

当你担心无法入睡或担心疼痛时，放松技巧尤其有用。然而，要想让它在需要的时候发挥作用，就需要经常练习。

?经常练习以降低神经系统的激活水平

?入睡时使用

睡眠卫生

简单地说，就是管理好你白天做的那些会影响睡眠的事情。

?饮食

?睡前不要吃高脂肪或含糖的食物

?睡前4小时避免摄入咖啡因、咖啡、可乐和巧克力

?喝点牛奶吧，它能促进睡眠

?锻炼

?即使是低水平的运动也有利于睡眠

?睡前2-3小时内不要运动，因为这会增加心率和体温，让你更难入睡

?光

白天的光照和夜晚的黑暗差异越大，身体产生的褪黑激素就越多，这是一种促进睡眠的激素

?减少卧室的光线

?增加白天的阳光照射

?噪音

?确保一个安静的环境

?温度

当我们入睡时，核心体温会下降

?晚上洗个热水澡是很有帮助 内容过长，仅展示头部和尾部部分文字预览，全文请查看图片预览。 以帮助解决潜在的情绪和焦虑问题。

如果你有呼吸相关的睡眠问题，如阻塞性或中枢性睡眠呼吸暂停，请去看你的全科医生、睡眠诊所和查尔斯·嘉丁纳爵士医院或目前许多私人睡眠诊所之一。

那药物和睡眠呢?

药物可以帮助你改善睡眠，但不建议单独使用。许多睡眠药物只有在你的身体对它们产生耐受性时才可以短期使用。

与疼痛相关的睡眠问题通常不是短期问题。他们中的许多人并没有给你一个反映自然睡眠“结构”的睡眠，这可能意味着你仍然感到疲劳。此外，它们还会与一些止痛药(如阿片类药物)产生无益的相互作用。

然而，一些药物可以短期使用，以重置你的睡眠习惯，打破有问题的循环，如午睡。当有慢性疼痛时，有些药物对睡眠更有帮助。与你的家庭医生讨论可能的药物或看一看药物和程序疼痛管理模块。

进一步的信息

想要了解更多关于睡眠的临床信息，我们建议去睡眠健康基金会。要了解如何在疼痛时管理情绪和焦虑，请尝试我们的疼痛管理模块。你也可以在Beyond Blue或ThisWayUp找到情绪帮助。

你可以通过Cochrane摘要找到消费者摘要。另外，如果您需要与您的家庭医生或医疗保健专业人员交谈，请寻求进一步的帮助。

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