Improving your sleep

Problems with sleep are very common for children and young people with chronic health conditions. Sleep is essential for your health and wellbeing, and it improves your energy.

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

Research suggests that it is 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.

Common sleep difficulties include:

• having difficulty getting to sleep at night
• frequently waking up during the night
• waking early
• sleeping too much

Factors which can contribute to poor sleep

Factors which can contribute to poor sleep include:

• irregular bed and wake times
• sleeping in the day
• worry or stress
• high pain levels
• 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 (tea, coffee, cola)
• watching screens before trying to get to sleep
• doing a demanding activity later in the evening
• being too hot or too cold
• bright lights or lots of noise
• using your bed for lots of different activities such as playing and doing homework
• spending waking hours in bed

Ways to improve sleep

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 to work on, as well as practical changes.

Setting up a sleeping pattern

Sleep times

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. Fix times close to what you do already and aim to be consistent.

Winding down

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. 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.

Getting up

Set your own alarm and aim to get up within 15 minutes of it going off. Sitting up and getting your feet on the floor will help stimulate your body to wake up and be active. Do not make decisions about how you feel whilst you are laying in bed!

Preparing for sleep

A set routine will help you to prepare mentally and physically for sleep.

Try to wind down in the hour or so before you go to bed.

Include relaxing activities in your schedule such as watching television, having a warm bath, listening to music. Avoid stimulating activities which will keep you alert, for example, studying, decision-making, computer games. Turn off mobile phones, tablets, laptops at least 30 to 60 minutes before you go to bed.

Develop a regular order of doing things, for example, turning out the lights, brushing your teeth and so on. This will act as a signal to your body that it is preparing for sleep.

Get into a good routine

Go to bed when you begin to feel sleepy. Try to go to bed at a regular time, so your body knows when to expect to go to sleep. Do not change things too much to start with. Fix a time close to what you do already and aim to be consistent. You can always bring the time earlier or later gradually.

If you are not asleep within 20 minutes, do not just keep waiting to go to sleep. Try relaxation and breathing techniques. You may need to get up and have a drink or read for a while. Repeat this step as often as is required, and also if you wake for long periods in the night.

Get up and out of bed at the same time each day. It may be helpful to set your alarm clock. Aim to get up within 15 minutes of your alarm going off.

Other tips

• try not to nap during the day, as this can lead you to sleep less well at night
• avoid exercising close to bedtime as it can make sleeping more difficult. However, exercise in the day can help you sleep better at night
• eating a large meal before bedtime, fizzy drinks, or drinks with caffeine in them, can make sleeping more difficult
• 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
• try to make your bedroom a comfortable temperature and has the lighting you prefer to help you sleep
• if you have pain try other strategies to help such as hot water bottles or wheat bags
• 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. Your bed will become a signal only for sleep

Try to stick to this plan. Remember it can take several weeks to get into a good routine

I cannot stop worrying at night

Lying in bed at night worrying about problems can make you feel tense and prevent you from going to sleep. This is because your body produces a stimulating hormone called adrenaline, which keeps us awake.

The following problem-solving strategy may help you to reduce worries at night.

Reassure yourself that sleep will come when it is ready.

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

Other ideas include:

• Keeping a diary or journal to help you express and process your thoughts and worries.
• Planning 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.

How do I deal with frustrations?

If you become frustrated about not being able to fall asleep, and worry about the possible consequences the next day, it is likely that sleeping will become more difficult the harder you try to fall asleep.

• do not try too hard to fall asleep
• tell yourself that ‘sleep will come when it is ‘ready’ and that ‘relaxing in bed is almost as good’
• try to keep your eyes open in the darkened room and as they (naturally) try to close tell yourself to ‘resist closing them for another few seconds’. This will “tempt” sleep to take over. Or tell yourself to try and stay awake as long as possible
• imagine a pleasing scene or try repeating a word (such as “calm” or “relax”) every few seconds, and practice relaxation and breathing techniques

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. You could try flicking through a magazine or book to help you re-direct your focus away from not sleeping.

If you cannot go to sleep or wake up worrying about a problem, remind yourself that you have the matter in hand, and that worrying about it now will not help.

If new worries occur at night, ‘postpone’ them to the next day.

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.

Use 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. Visualising a restful or happy place can also be a good way of adjusting your thoughts and focus. Calming the nervous system in this way helps it shift from the alert state to the ‘rest and digest’ state and puts you in a better place to fall asleep.

What if I sleep too much at night?

If you sleep for more than 10 hours a night, you may waken feeling unrefreshed, and feel that you may need to go back to sleep. You are probably sleeping for too long, and would benefit from cutting down your sleep.

• cut down your sleep time gradually, either by going to bed 30 minutes later, or getting up 30 minutes earlier
• set a set waking time and going to bed time
• be consistent in either getting up earlier or going to bed later
• do not try to catch up on sleep by getting up later or going to bed earlier if you feel more tired. Stick to the same waking time and going to bed time
• check on your sleep pattern weekly, and continue to reduce your sleep time gradually until you are sleeping for the amount of time with which you are happy

After changing your sleep pattern, you may feel more tired for the first few weeks, but in the long run you can expect to feel more energetic.

The quality of your sleep should increase, as the quantity of your sleep decreases.

What if I sleep during the day?

Some people fall asleep in the day time, because of exhaustion or needing to rest with high pain levels. 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.

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.

Once you have regulated your day time sleeps (after 1 to 2 weeks) you can start to reduce their length by around 5 to 10 minutes a week.

Reducing your day time sleep works best when you are also following a night time sleep plan, and resting 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 your body needs. Sticking to the plan will help your body clock to readjust and your sleep will improve.

Our bodies adapt to what we do by giving us more energy if we are active, and less energy if we rest more.

As you start to do more activity, with pain management techniques, your sleep will also continue to get better.

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 pain management.