By Penney Cowan, Founder and CEO American Chronic Pain Association

Sleep is the golden chain that ties health and our bodies together.” — Thomas Dekker

Sleep restores our body, allows us to function during the day, think clearly, and enjoy the moments.That sounds wonderful, but as many of us know, sleep and pain are strange bed fellows.It is just not easy getting a good night sleep when pain seems to interfere many of your nighttime hours---those hours where you lie alone hoping that sleep will come quickly, that your body will be able to finally let go of some of the pain and stress so thatyou can escape even if just for a few hours.But as hard as you may try, you just cannot seem to get a good night's sleep.For many sleep is next to impossible.

Sleep disturbance is a common problem for many people.Why is it that after a long day, exhausted as you might be, you can still not get a good night sleep.You even struggle with just falling asleep.When sleep does come, it seems short lived, with far too many moments where you wake up and struggle to get back to sleep.

When Sleep Isn't Sleep

Some people complain that they almost never sleep. When they are studied in sleep laboratories with all-night brain wave recordings, it is found that they actually sleep most of the night.However, their deep, slow-wave sleep is "contaminated" with brain waves characteristic of wakefulness.Thus, their sleep isn't restful, and they are often aware of being awake during the night.

Closed for Maintenance

Sleep isn’t merely a time when your body shuts off. While you rest, your brain stays busy, overseeing biological maintenance that keeps your body running in top condition, preparing you for the day ahead. Without enough hours of restorative sleep, you won’t be able to work, learn, create, and communicate at a level even close to your true potential.[1]

While many people struggle with sleep because of stress, such as the night before a trip, an exam, family issues, or a major event at work, the problem is usually short lived. But living with chronic pain or an ongoing stress like COVID-19 can contribute to a chronic sleep problem. So how much sleep do you really need?

How Much Is Enough?

According to the National Sleep Foundation, a young adult between 18 and 25 and adults up to the age of 64 need about the same amount of sleep: seven to nine hours on the average.But they could be well rested with between six to ten hours of sleep.Older adults need about seven to nine hours a sleep each night.However, it is important to be aware that there is no amount of sleep that is correct for everyone.Some may feel good after five hours while other need as much ten hours of sleep each night.

Melinda Smith, M.A., Lawrence Robinson, and Robert Segal, M.A., Sleep Needs, If you aren't getting the amount of sleep you need, the first thing to do is talk to your health care professional to see if there is a physical reason for poor sleep, such as sleep apnea.

What Can Help?

If everything checks out,there are some things that you can do to help improve your sleep.Below are some helpful hints to improve your sleep.

Exercise: Vigorous physical exercise in the afternoon or early evening (NOT close to bedtime) has been shown to increase the portion of time spent in the deepest stages of sleep. So, you may not sleep more, but you will probably sleep better if you exercise.

Schedule: It is important to set the same time for bed every night and stick to it rigidly. It may help to prepare yourself for bed with a bedtime ritual, such as a bath, a glass of milk, etc. at the same time each night. Then you should set a wake-up time and stick to this, no matter how little you have slept the night before. It's very tempting to sleep in when you've been awake half the night before, but this only increase the chances that you won't sleep well the following night.

Naps: Usually naps increase the problem of insomnia. They should generally be avoided by those with insomnia until their sleep has become regulated. On the other hand, a 20-minute period of napping, meditation, relaxation exercises, etc. can help to reduce the tensions of the day for many and can enable them to resume tasks with renewed energy.

Stimulants: No coffee or tea after dinner. Also, until you're sure you are not affected by them, avoid chocolate (caffeine), decongestants, etc., in the evening.

Don't Fight It: Many people drive themselves into a near frenzy rolling and tossing all night in a futile effort to force themselves to sleep. Make a rule for yourself that if you aren't asleep after 15 minutes, you'll leave the room and do something restful. Knitting is good, as are such things as jigsaw puzzles, or quiet radio shows, but they should not be done in the bedroom. Mystery shows, true crime stories, and action movies are off limits. Not only do they cause adrenal in to flow, but they're hard to leave. Stay off your electronic devices, as well. When you begin to feel drowsy (no human is capable of staying awake forever) then return to bed. If you're still awake in 15 minutes, leave the room again.

Bedrooms Are for Sleeping: And loving. Nothing else. Using the room for paying bills, doing homework, arguing, etc., can prevent the room from being a comfortable refuge in which you can automatically relax.

Avoid Habituation Drugs:Avoid drugs such as tranquilizers and sleeping pills.Most people who have used these drugs for a period of time and in substantial amounts find that it takes as long as six months for their sleep to fully normalize.

1. If you have back trouble, lie on your back and place a small pillow under your knees to take the pressure off your back.

2. If you sleep on your side, allow the leg touching the mattress to extend up and slightly bend the other leg up toward your chest.

3. If you have neck problems, place a small pillow roll under your neck instead of using large bed pillows. This will keep your neck well positioned in relation to the rest of your spine.

4. Try to avoid sleeping on your stomach: it puts strain on your spine.

Of course, pain and pain flairs may always interfere with your sleep no matter what you do to improve it. If that is the case, you need to discuss with your health care professional what they might do to help you obtain a better night’s sleep.


Sleep Foundation:

How to Sleep Better:

Sleep Tips:

Sleep: What you need to know:

American Chronic Pain Association : From Patient To Person: First Step, pp. 166-169, © 1987-2016 , ISBN # 0-9673878-3-3

Updated: Jun 20

The way that the Pakistan government have collaborated with patient and community

organisations during this pandemic sets a great example for other countries,

says Hussain Jafri

The covid-19 pandemic has affected billions of people around the globe and exposed limitations and

deficiencies in all health systems. The impact has been particularly devastating in low and middle income

countries due to relatively weak health infrastructures and fragile economies. Pakistan, falls into this


In 2019, the country was ranked 152 out of 189 on the Human Development Index. Health inequalities are high compared to the average in South Asian countries. The covid-19 pandemic has devastated the economy and the country’s health system is being hugely challenged. In response to the crisis, patient advocates and community organisations have come forward to help the government in a variety of ways including the following:

Telephone helplines: patient organisations have collaborated with different universities and other professional organisations to establish telephone helplines for patients and families during the ongoing lockdown. The objective of establishing these helplines is for patients and community members to call and seek psychological counselling and any other help they need during this time of stress and isolation. One example, is Alzheimer’s Pakistan, who together with with Government College University, has launched a nationwide helpline for people with Dementia and their family caregivers.

Social media campaigns and support groups: patient organisations have been very active on social media during the current pandemic and have set up campaigns to provide their communities with advice and guidance on how to cope with the current situation. Facebook and WhatsApp are actively being used to create awareness and provide ongoing updates on covid-19. Some patient organisations have formed WhatsApp support groups for patients and caregivers through which they are able to provide ongoing support.

Support for non-covid patients: as health systems focus almost exclusively on the prevention of covid-19 and the management of those affected, this is having a negative effect on other patients with non-covid related health problems. These people are facing great challenges for getting the care they need. An example of this is patients with beta thalassemia, an inherited anemia, who are facing serious obstacles to obtain the one or two monthly blood transfusions they usually require due to a decline in voluntary blood donations. The Thalassaemia Federation of Pakistan, the national umbrella organisation of thalassaemia charities, has set up an awareness and advocacy campaign through social, electronic and print media highlighting the shortage of blood for this group of patients. This campaign was extremely successful. The President of Pakistan and the Health Minister participated, and following meetings with the Thalassemia organisations, have taken steps to ensure the supply of fresh blood at public sector hospitals through a donation campaign run by the health department’s blood transfusion authority.

Development and dissemination of information: access to comprehensive, appropriate, and simplified information about the diagnosis, prevention, treatment and other services related to covid-19 is vital. But information developed by health professionals tends to be difficult for patients and the community to fully understand. Patient organisations in Pakistan have been actively involvedin the voluntary coproduction and dissemination of information. Their involvement has supported government and healthcare systems to convey accurate and understandable information to communities.

Support for patients with special needs: patients with disabilities and special needs are often ignored in times of humanitarian crisis like the current pandemic. Previous experience of dealing with emergency situations in Pakistan and elsewhere show that the health services tend to overlook their essential requirements. To counter this, the Pakistan Patient Safety Network has advocated for patients with special needs such as mental illness, disabilities, and other chronic conditions. As a result of this campaign, the health minister ordered that all patients with covid-19 disease should be fully assessed and their special needs recorded and responded to.

Distribution of food: the economic cost of covid-19 is huge and for a developing country like Pakistan this presents daunting problems. The country has been under lockdown for many weeks and most people are experiencing severe financial hardship. Those who are in informal employment and are paid on daily basis such as labourers, construction workers, carpenters, waiters, small vendors, shopkeepers, rikshaw and taxi drivers are the worst hit. Many have been unable to afford food. The Jahandad Society for Community Development is currently working with the City Government Lahore to establish a network of charity organisations to distribute food ration packs to daily wage earners. To date, this network has already distributed food rations to more than 90,000 families comprising of over 550,000 people. Some patient organisations, such as Alzheimer’s Pakistan, are providing food rations packs to needy patients in their own communities. Similar public and private networks, comprising of patients and community organisations and local governments, are established all over the country.

Free medicine: the economic downturn has also affected patients with chronic conditions as they are no longer able to pay for their medicines. Providing people with the medicines they need for free is a huge task, but patient organisations are playing their part again. For example, the Thalassaemia Society of Pakistan is providing free medicines and treatment to all the 3000 patients with Thalassaemics registered with their organization.

Corona relief tiger force: the Prime Minister, Imran Khan, has established a voluntary task force to assist the Pakistan government in providing food and essential commodities to the areas under strict lockdown. So far around one million people from all walks of life, including patient advocates, have joined this task force and are working alongside armed forces and civil administration to deliver people the food and other essential supplies they need.

Despite being a low resourced country, Pakistan has so far been able to meet the challenge of the covid-19 pandemic. Reported death rates are low compared to many other countries. One reason for this may be due to the way that patient and community organisations have joined hands with the government during this crisis, and provides a great example of collaborative action which other countries can learn from.

Hussain Jafri is the founding Director and chair elect of World Patients’ Alliance. He is also the vice chair of the Advisory Group of the WHO PFPS program.

Reference: This blog has been taken from British Medical Journal (BMJ)

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