Good sleep hygiene

What is it? It's a set of principles worked out by researchers to try and get you the right amount of sleep for your needs. This website has distilled it into twelve principles for you, or you can get your information on what to do from trusty old Wikipedia. Or there's this one  or just google "sleep hygiene" and look for a website that describes it in a way that works well for you. One tip I've picked up along the way, but never tried is that jigsaws make a good thing to do if you've gone to bed, but are failing to fall asleep (providing you don't use too bright a light). Basically, you are looking for something that's absorbing, but not so captivating you want to stay up doing it even after you start feeling sleepy. Another top tip from my own personal experience is that if you go onto or increase your dose of meds that make you tired and/or sleepy, then you should reassess your bedtime and/or getting up time, as meds can change the amount of sleep you need.

Does it work? It's another one that won't get rid of your pain, but, if it succeeds in getting you more sleep (and you were getting too little before), your pain's likely to reduce. There's research that says people are more sensitive to pain when they haven't had enough sleep.

Who does it work for? People whose pain is affected by the amount of sleep they get (probably everyone) and who are able to improve the amount of sleep they get using the principles.
 
Who doesn't it work for? People already getting the perfect amount of sleep every day, people whose pain is completely unaffected by sleep and people who are unable to get any additional sleep despite applying the principles.

Yes, but I'm not sleeping enough because of the pain. Yeah, me too. And even with the sleep hygiene tips and amitriptyline, which increases my ability to go to sleep and stay asleep, my sleep is still disturbed by pain and I still often don't get enough. But as far as I can tell, the sleep hygiene tips do help me get more sleep than I would without them (even if sticking to them is sometimes a real nuisance). It's worth a trial run to see if the benefits outweigh the nuisance of the lifestyle modifications you need to make.

How much does it cost? Nothing. It's free, unless you have a lot of modifications you need to make to your bedroom to make it conducive to sleep, in which case, that's the cost.

Is there any evidence for it? There's evidence such as this that people are more sensitive to pain if they haven't had enough sleep. The same article mentions a study that proved that extending sleep length reduced pain sensitivity, albeit on a small sample size. Interestingly, this review of the literature says that sleep impairments are a stronger and more reliable predictor of pain than pain is of sleep impairment.
Rather less encouragingly, this article says though epidemiologic and experimental research generally supports an association between individual sleep hygiene recommendations and sleep at night, the direct effects of individual recommendations on sleep remains largely untested in the general population. Worse, I found this article that says sleep hygiene is normally not enough by itself to treat severe, chronic insomnia.
I suspect what we've got going on here in sleep hygiene is a mixture of theory-based medicine (as opposed to evidence-based medicine) and a collection of things individuals have told doctors worked for them. Basically, there's certainly not any evidence that these recommendations are bound to work for everyone. But there is evidence that lack of sleep is a problem for pain, and the sleep hygiene principles seem to be the best non-medical ideas currently available for increasing sleep. If they're not enough for you, you might also like to try amitriptyline, as, in addition to being used for chronic pain, it also has a sedating effect.

Are there any downsides? Good sleep hygiene involves lifestyle changes. Some of them are pretty minor (like getting up and doing a jigsaw if you can't sleep), but others are pretty major, like going to bed and getting up at the same time every day (what do you do if you usually need to be up at 7 am for work and need to go to bed at 10 pm to get enough sleep for this, but your usual social life involves drinking alcohol and/or staying up till 11 pm or midnight or later?). It's an extra imposition on a life that already has more difficulties and compromises than other people's because of chronic pain.My compromise is to do it, but make some modifications or not bother on some days because otherwise my social life would be even more limited than it already is. I still haven't worked out whether it's best to get up at 7 am on days after I've stayed out late, so I definitely don't get enough sleep, but don't get out of the routine or whether it's better to sleep in late, get enough sleep and risk changing my sleep pattern  - my body already tends towards a 25 or 26 hour sleep cycle as it is.


Are there any other upsides? It's drug-free and has no side effects.

Was it worth the effort? It's something I constantly debate. I do do it. Or at any rate, my alarm goes off at 7.15am every day and I try not to go back to sleep after that (which is difficult with my amitriptyline) and I try to go to bed at 10 pm or earlier. My current dose of amitriptyline means that I'm usually too tired to stay up longer and actually if anything I need more than the 9 hours of sleep I usually get. Without amitriptyline I probably only need about 8 hours a night, on the other hand, without amitriptyline it takes me much longer between going to bed and going to sleep, so my bedtime might not be quite as different as you'd think. Definitely my pain is worse when I have less sleep or am more tired and sleepy, but I find the bedtime and getting up time part of good sleep hygiene a real burden, as it is hard to juggle work, socialising and the 9 hours of sleep amitriptyline makes me need. Overall, my current judgement is still that it's worth the impositions.
 
Which principles of good sleep hygiene do you use? Does it work for you? Do you have any tips or workarounds?