Sleep and spinal cord injury

Good sleep makes all the difference to how you cope during the day, especially if you face unique challenges because of your spinal cord injury.

The amount of sleep, and the quality of that sleep, is one of the most important factors contributing to your mental and physical health. Living with a spinal injury can be stressful, both physically and emotionally. This stress may disrupt your sleep, or your sleep may be disrupted by physical factors resulting from your injury.

Improving the quality of your sleep will improve your health and resilience, and there are a few easy steps you can take to do this.

How much sleep do I need?

There is a wide range of sleep time that is considered 'normal'. Most people need around 7.5 hours per night. However, some people are fine on 5 hours, and others need as much as 9 hours per night. You need to work out the right amount for you. The best way to do this is to see how you function during the day. If you feel refreshed in the morning after 7 hours of sleep, and are able to stay awake during the day, then you don't need more than that. If you still feel tired, then you might be someone who requires an hour or two more.

What are some factors that can disrupt my sleep?

When you have a spinal cord injury, you may have medical problems that disrupt your sleep. You might have pain, spasm or breathing problems (e.g. sleep apnoea). Treating these problems are important first steps in getting a good night's sleep.

There are a number of things you can do immediately to improve your sleep:

Limit caffeine

Many people drink coffee for its stimulating effects, but stimulation is not good when we are trying to sleep. Avoid caffeine, or limit it to the morning if you are having problems sleeping. Caffeine is present in coffee and black tea, but also many soft drinks, so check labels.

Limit alcohol

People who don't drink alcohol generally get better sleep. Alcohol is a sedative, but while it may help you fall asleep, it may disrupt your sleep cycle and quality of sleep. Try to avoid alcohol altogether if you have sleep problems, or limit drinking to early in the evening.

Limit sleeping pills

Many prescription drugs used for sleep can help you fall asleep, but they disrupt your sleeping cycle, so you aren't as rested. Many of these medications are also addictive, especially the benzodiazepines such as Valium. Sedatives usually should not be taken for longer than two weeks and are not recommended as a long-term solution for sleeping problems. If you are taking a sedative for sleep, talk to your doctor about eliminating it. Getting off these medications must be done gradually and with medical supervision. Stopping abruptly can be dangerous.

Stop smoking

Nicotine is a stimulant and can contribute to sleep problems. (One more reason to quit!)

What if I am not getting enough sleep?

If you are not getting the amount of sleep you require, it can be useful to look at your 'sleep hygiene' (good sleeping habits). If you are having trouble sleeping and feeling fatigued during the day, attention to some of these simple things may help.

Dos

• Go to bed and get up at the same times each day. You can train your internal body clock by maintaining consistent sleep and wake times.

• Get some sun. Sunlight activates receptors in the eye that are involved in regulating our sleep cycle. Sun exposure in the morning will bring forward your sleep cycle; sunlight in the afternoon will delay your cycle so that you feel sleepy later than usual.

• Make your bedroom comfortable. Have it at a suitable temperature and keep noises and outside light to a minimum.

• Get into a 'going to bed' routine. If you follow the same routine each night, you can train your body to prepare for sleep. By following the same routine your mind comes to associate these behaviours with bedtime and begin to drift into 'sleepy' mode.

• Have a warm shower or bath about an hour before bed; raising or lowering body temperature readies your body for sleep.

• Learn a relaxation technique to help quieten your mind.

Don'ts

• Don't go to bed too hungry or full. A glass of warm milk or a banana contains natural sedatives (tryptophan).

• Don't have long naps (more than 30 minutes) later in the day.

• Don't watch television in your bedroom before sleep. Television requires active attention. You can listen to the radio, as this is a more passive activity.

• Don't smoke right before bed and avoid alcohol, as your mind 'wakes up' as alcohol wears off. Avoid caffeine for 4-6 hours before bedtime.

Many sleeping problems are due to bad habits built over a long period, so you won't fix problems overnight. Different things work for different people, so find what works for you and stick with it.

• It is important that you try not to obsess about your sleep problems. One poor night's sleep is not a problem; just return to good sleep habits the next night. However, if you still have difficulty despite good sleep hygiene, then see your doctor, as something else may be disturbing your sleep.