Improving your sleep with chronic fatigue

Problems with sleep are common for children and young people with chronic fatigue. This resource will give you some useful information and tips on how to manage your sleep as part of your energy management programme.

Sleep is essential for your health and wellbeing. Sleep improves your energy, helps with healing and allows your mind and body to relax. Not having enough sleep can make all symptoms feel worse, affect your moods and reduce concentration and memory.

Research suggests that it is actually possible to have too much sleep. Most children and teenagers need around 9 hours sleep. More than this can cause lethargy, muscle stiffness and pain, headaches and reduce motivation to be active. The more you sleep the less refreshing it is, and the more you feel you need. This goes against our natural instinct which tells us if we are tired we need more sleep.

Sleep difficulties

Sleep difficulties are caused by:

• Irregular bed and wake times
• Sleeping in the day
• Worry or stress
• Pain
• Emotional upset such as having an argument
• Feeling sick or tummy pains at night
• Eating close to bed time, especially sugary foods and drinks
• Having drinks with caffeine in the evening such as tea, coffee, cola
• Watching screens before trying to get to sleep
• Doing a demanding activity (mental or physical) later in the evening
• Being too hot or too cold
• Bright lights or lots of noise
• Using your bed for lots activities other than sleeping, such as eating, playing, watching TV or playing games
• Spending waking hours in bed

There are many ways to improve your sleep pattern and the quality of your sleep.

It may be useful to keep a diary of your sleep. This is a good starting point to understanding what is actually happening, and can help you monitor changes.

It is useful to start with practical strategies to help you establish a regular sleep pattern.

Looking at other factors that may be affecting your sleep, such as low mood, worries or pain will also be important alongside the practical changes.

Setting up your sleep pattern

Decide on a regular time that you will go to bed and get up.

This will help your body and brain to set its ‘body clock’. The waking and getting up times are particularly important in setting your sleep pattern, so aim to get up at the same time no matter what time you fell asleep the night before.

Do not change things too much to start with. Set times close to what you do already and aim to be as consistent as you can.

Settling down to sleep

Allow time to wind down at night, perhaps with a book, music on headphones, writing a diary or colouring. Breathing exercises and relaxation can also be helpful. Aim to do the same thing in the same order each night. These will become signals to your brain and body that you are getting ready to sleep.

Tips for good sleeping

Avoid food and drinks that contain stimulants such as tea, coffee or fizzy drinks before you go to bed.

Switch off all screens at least 30 minutes before you want to sleep. The light from screens slows down the production of a chemical called melatonin in our brains which helps us switch off ready for sleep.

Make sure your bedroom is a comfortable temperature and has the lighting you prefer to help you sleep.

Aim to use your bed only for sleeping. Do not watch TV or do other activities such as homework on your bed. Try not to use it during the day so your bed will become a signal only for sleep. Clear your bed of clothes, magazines, phones, toys and so on as they can distract you and restrict your movements.

Use strategies that help you to manage any pain you may have. Use hot water bottles, wheat bags or pillows for support. Remember to take regular medication or apply topical creams. Have a go with other techniques suggested by the Chronic Fatigue Team.

Waking up and getting up

Decide on a regular wake time and set your own alarm. Aim to be getting out of bed within 15 minutes of it going off. Sitting up and putting your feet on the floor will help encourage your brain and body to be active. It is best not to make decisions about how you feel until you are out of bed.

Tips to help make getting up a little easier:

Ask other people in your family to help. Parents or siblings can call you, bring you a drink or open the curtains for example.

Set more than one alarm and perhaps put one out of reach so that you have to get out of bed to switch it off.

Create a short routine for getting out of bed. For example taking a deep breath, sitting up and counting to 3.

Put the radio on after the alarm has sounded.

Tell yourself ‘it is good to get up and get moving’ even if you do not feel like it!

Difficulty sleeping

Worrying about not being able to sleep can make it even harder to relax and fall asleep as it stimulates hormones like adrenaline which keep us alert and awake.

Tips for helping you sleep:

Reassure yourself that sleep will come when it is ready.

If you have been lying awake for more than 20 minutes and are not close to falling asleep try getting up or sitting on the edge of the bed to cool off. Keep the lights very low. Remember, your bed is only for sleeping so if you are laying awake for a long time your body will associate bed with this instead of sleeping. You could try flicking through a magazine or book to help you re-direct your focus away from not sleeping.

Stretch or gently move your body if pain or stiffness is a problem for you.

Have a drink or go to the toilet if you need to, but do not get involved in any demanding or stimulating activities such as computer or TV.

Work through your wind down routine again to signal to your brain that you are preparing to go to sleep. You may need to do this several times.

Try a relaxation technique, such as counting breaths in and out, imagining each part of your body from toes to head and let it relax with your breath out. Visualizing a restful and happy place can also be a good way of adjusting your thoughts and focus.

Calming your nervous system in this way helps it shift from being alert. From the fight or flight state, to the ‘rest and digest’ state, and puts you in a better place to fall asleep.

Worrying thoughts and busy minds

If you cannot sleep because your thoughts seem to be going round and around, or you are worrying about things, it may be helpful to talk to your therapist. They have many ideas and techniques to help you create your own sleep strategies, or get the help you need for managing stress or low mood.

Other ideas include:

Keeping a diary or journal to help you express and process your thoughts and worries. It may also be helpful to plan in time each day to talk through your concerns.

Learning how to ‘let go’ of troubling thoughts is a useful way of finding some calm even when things around you are difficult. Mindfulness strategies can help you with this.

Day time sleeping

Some people fall asleep in the day time because of exhaustion or needing to rest with pain or other symptoms. If you have got used to sleeping in the day, it can be hard to stop and you may feel you cannot do without it.

Day time sleeping can affect all aspects of our lives, especially going to school or college, seeing friends or taking part in clubs and sports. Managing night and day time sleep is an important part of energy management.

Tips for reducing day time sleeping:

Start by keeping a record of when you sleep in the day and for how long. Work out an average time that you sleep and plan to do this each day, either by using an alarm or by asking someone to wake you at an agreed time. You will need to stick to these times, even if you feel you could sleep longer on some days.

After 1 to 2 weeks once you have regulated your day time sleeps you can start to reduce the length of them by around 5 to 10 minutes a week.

Reducing your day time sleep works best when you are following a night time sleep plan too, and resting regularly for short periods in the day. Once you start pacing your daily activities you will start to notice that you need less and less day time sleep.

Changing your sleeping habits will feel strange for a while, and may go against what you feel your body needs. Sticking to the plan will help your body clock to readjust and gradually improve your sleep.