One of the (many) problems of living with a chronic illness, and particularly chronic pain, is that deep, restorative sleep is hard to come by. In fact, it's estimated that 95% of folks with Fibromyalgia experience chronic sleep disturbances (1). Ninety. Five. Percent. And that doesn't mean that we just need an extra cup of coffee in the morning to get started. It actually contributes to the vicious cycle of chronic pain in many ways, including:
Disrupting our brain's ability to properly process pain (leading to an increase in pain symptoms) (2),
Lowers our pain threshold (3),
Increases spontaneous pain symptoms (4), and
Increases levels of inflammation, leading to an increase in pain symptoms (5).
Additionally, poor sleep often leads to brain fog (6), low mood, and depression (7), which many of us already experience, and all of which feed into poor quality of sleep and - you guessed it - an increase in pain. It also means less energy to do things we know can improve pain symptoms, such as movement, preparing nutritious meals, participating in self-care, or even making time for positive social interactions.
When we sleep, there are 4 different stages that we cycle through: stage 1, stage 2, stage 3, and REM sleep (8). Sometimes, people refer to these stages as Non-REM sleep (stages 1-3) and REM sleep. They are classified by differences in eye movements and brain activity. I made this little chart (9,10) to use a reference.
Occurs during the first few minutes of sleep, body begins to relax, brain activity begins to slow
Body relaxes more, breathing and heart rates slow, eye movement stops, brain activity changes
Muscles relax even more, brain waves are the slowest, body restores and repairs itself, and immune system is strengthened. Contributes to insightful thinking, creativity, and memory.
Brain activity is similar to an awake brain. Eye movement becomes rapid, breathing rate becomes irregular, pulse increases, most muscles experience temporary paralysis. Most dreams occur here (research shows that they can also occur in non-REM sleep), and it is vital to cognitive functions such as memory and learning.
Now, based on this information, it might make sense to think that I'm going to tell you that you should just get more sleep. I'm not going to do that. I've been on the receiving end of that comment, and it is not in any way helpful. But, if sleep is an issue for you, here are a few things to try:
Take a Nap (Preferably Earlier in the Day)
A lot of sleep experts don't recommend napping, arguing that they can make you feel groggy and mess up your sleep cycle, making it harder to sleep at night. I get the impression that these sleep experts haven't experienced chronic pain (or chronic sleeplessness). Chronic pain is exhausting at the best of times. In my opinion, sleeping during the day is better than trying to function on zero sleep, with amplified symptoms. That said, I do have some naptime recommendations:
For chronic sleeplessness, nap in 90-minute increments. Otherwise, keep your naps to 20 to 30 minutes. A 90-minute nap is the approximate length of a complete sleep cycle (moving through stages 1, 2, 3 and REM sleep) (11). Since cycling through these different stages is integral to our health, this could be very helpful, especially when we're chronically sleep deprived. However, if you aren't in a position to be able to dedicate 90-minutes to a nap, stick with a shorter one, capping it at 20 to 30 minutes. This will be long enough to get some light sleep and help you to (hopefully) feel more refreshed, but too short to move into deep sleep, which (when interrupted) can lead to grogginess.
Try to schedule your naps earlier in the day. If you find that napping during the day makes it harder to fall asleep at night, consider keeping 8 hours (or more) between your nap and your regular bedtime (12). So, if you normally go to bed around 10pm, aim to take your nap before 2pm whenever possible.
Try Restorative Yoga
Restorative yoga is a very specific style of yoga that emphasizes intentional rest and relaxation. This practice uses an abundance of props such as blankets, pillows, blocks, and chairs to fully support you within a posture. Intentional relaxation can induce what's known as the "relaxation response" (13), where marked physiological changes occur in the body, including slower breathing and heart rates, lower blood pressure, and slower brain activity. Sound familiar? These are responses we also see in stage 2 and stage 3 of our sleep cycle.
I find this practice to be one of the most accessible, as postures can be done from a bed or on the floor, there is very little movement, most props can be found around the house, and it requires no previous experience.
If you haven't tried this style of yoga before, I'm teaching a virtual 90-minute class on Sunday April 16 at 11am. Replays will be available for all who sign up. (The link for more information, and to sign up, is available at the bottom of this article).
Try Following a Short, Guided Meditation
A few years ago, I was regularly hearing that a 10 minute meditation was the same as sleeping for 4 hours. I can't comment on the validity of that statement, and I haven't been able to find any scientific research suggesting that. But, similar to what we see with restorative yoga, participating in meditation can also induce the relaxation response (14). If napping makes you groggy or affects your sleep, meditation may be a helpful alternative. And, when done before bed, it may actually help improve sleep quality (15).
If meditation on your own feels intimidating, consider trying out a guided meditation. There are many free ones available through phone apps, on podcasts, and on YouTube.
Audit Your Sleep Hygiene
While chronic sleeplessness is often out of our control, there are some things we can try in order to promote better quality sleep. Consider comparing what your habits and behaviours look like on a daily basis against the list below (16):
Go to bed and wake up at the same time each day. This will help your body get into a more consistent rhythm. For best results, make gradual changes to your sleep routine, rather than trying to force yourself to bed 2 hours earlier than what you're used to.
Include some relaxation time as part of your bedtime routine. This could be reading (nothing too intense!), gentle stretching, or even some meditation - anything that helps you feel more calm.
Darken your room and avoid screens before bed. A darker space will help promote melatonin production (the hormone that helps us fall asleep). Conversely, electronics that emit blue light may actually discourage the production of melatonin. Plus, most screen-based electronics will increase mental stimulation.
Don't try to force yourself to sleep. Instead of focusing on trying to sleep, try progressive relaxation techniques where you systematically relax every part of your body. Also, if you aren't feeling tired within 20 minutes or so, you may be better off getting out of bed and trying some different relaxation techniques (look at point 2).
Limit alcohol consumption and consider limiting caffeine intake in the afternoon and evenings.
Restrict activities in bed to sleeping and sex.
Make yourself more comfortable. Research shows we sleep better when the room is cooler and darker, so consider turning down the heat at night and using black out curtains. If possible, replace old pillows and mattresses (and making sure they are designed for the way you sleep). I also found my sleep improved when I started using a weighted blanket.
I know that getting good sleep is near impossible with chronic pain, especially during a flare. But I hope you are able to find some supportive techniques to help you feel more rested. For me, my weighted blanket and restorative yoga made the biggest difference.
Cheering you on,
(1) Whale, K., & Gooberman-Hill, R. (2022). The Importance of Sleep for People With Chronic Pain:
Current Insights and Evidence. JBMR plus, 6(7), e10658. https://doi.org/10.1002/jbm4.10658
(2, 4) Haack, M., Simpson, N., Sethna, N., Kaur, S., & Mullington, J. (2020). Sleep deficiency and chronic
pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology :
official publication of the American College of Neuropsychopharmacology, 45(1), 205–216.
(3, 6) Pacheco, D., & Rehman, A. (2022, April 29). Pain and sleep: Common sleep disturbances & tips.
Sleep Foundation. Retrieved March 16, 2023, from https://www.sleepfoundation.org/physical-
(5, 7) Choy E. H. (2015). The role of sleep in pain and fibromyalgia. Nature reviews. Rheumatology, 11(9),
(8-9, 11-12) U.S. Department of Health and Human Services. (n.d.). Sleep phases and stages. National
Heart Lung and Blood Institute. Retrieved March 16, 2023, from
(10) Summer, J., & Singh, A. (2023, March 2). REM sleep: What it is and why it matters. Sleep Foundation.
Retrieved March 16, 2023, from https://www.sleepfoundation.org/stages-of-sleep/rem-sleep
(13-14) Lasater, J. H. (2016). Relax and renew restful yoga for stressful times. Shambhala.
(15) Summer, J., & Rehman, A. (2022, December 16). Meditation and sleep. Sleep Foundation. Retrieved
March 16, 2023, from https://www.sleepfoundation.org/meditation-for-sleep
(16) Suni, E., & Vyas, N. (2023, February 23). What is sleep hygiene? Sleep Foundation. Retrieved March
24, 2023, from https://www.sleepfoundation.org/sleep-hygiene