Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Restorative Sleep

Regarding sleep disorder among chronic back pain patients:

Sleep studies are not always needed. However, is the patient napping during the day, or, at least attempting to do so, and complaining of lack of sleep.

Recent research has shown that the most common form of pain management is an attempt to avoid the pain by going to sleep.

Patients with migraine headaches, for example, will try to nap during the day, often repeatedly, to avoid their pain.

However, not only is this not effective as a pain management tool, its impact is that it creates a subsequent pattern of insomnia. This insomnia not only becomes a source of subsequent poor pain management, but a patient who is sleep deprived does not have the physical and emotional resources to fully participate in other activities such as physical therapies or, often, even showing for medical appointments.

Thus, patients are referred to me and are described as having been non-compliant in other offices. One of the first measures in my office is to obtain from the patient a sleep history (unfortunately, a sleep history may not have been obtained yet, and many patients feel that their surgeon will not address non-surgical issues.)

a. Did they sleep well the night before seeing me
b. Are sleeping problems a recurrent concern for them
c. Are they napping during the day
d. Are they having trouble falling asleep and/or is their problem having continuous sleep
e. When they are sleep deprived do they feel that their pain is worse on the day following these difficult nights

There is also the matter of sleep hygiene: 1. Do the patients take their narcotic pain medication just before bedtime, 2. If prescribed sleep aids, are they taking them appropriately, 3. When unable to sleep, do they remain in bed entertaining their worries and concerns, 4. Do they read in bed and/or watch television, 5. Do they have any daily agenda for which they feel the need to arise, 6. Are there any family consequences to their using large time segments during the day for napping, 7. What is their pattern of caffeine use, 8. Are they using alcohol in an attempt to induce sleep, 9. Are they doing their home exercises in the evening, 10. Are they eating late at night or during the night and 11. Do they feel their sleep disorder is disruptive to other family members.

Often insurers are reluctant to authorize sleep medication (i.e. “hypnotics”). Yet quite often, addressing sleep problems can be the most direct route to mobilization and pain management.”

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