Tips for Sleeping Better

My most recent Chronic Illness/Chronic Pain Support Group meeting was on sleep.  It is an area that many people struggle with, especially those of us with illness and/or pain. I am sharing with you my list of tips to help you sleep better. 

Tips for sleeping better

1. Reduce caffeine, especially late in the day.
2. Limit alcohol- it may help you fall asleep, but the quality of the sleep will be poor.
3. Eliminate smoking- nicotine is a stimulant.
4. Don't eat a large meal right before bedtime. Eat a small nutritious bedtime snack of protein and complex carbs, such as fruit and yogurt.
5. Exercise early in the day.
6. Take rest breaks during the day if you need to, but don't nap. Naps can reduce the quantity and quality of sleep at night.
7. Go to bed and get up at the same time every day, whether you are working or not.
8. Treat any medical condition that may be affecting your sleep.
9. Make sure your bed and pillow are comfortable. Use extra pillows as needed to support knees or arms.
10. Eliminate noise or mask it with a white noise sound machine.
11. Keep your bedroom dark or wear a mask over your eyes.
12. Keep your bedroom at a comfortable temperature- some people sleep better if the room is cool.
13. Reserve the bedroom for sleep and sex only, so you associate the bed with relaxation, not with work.
14. Reduce stress during the day. Don't take problems to bed. If your mind is thinking about a problem, tell yourself that you will have time enough to work on it the next day, and turn your mind to relaxation.
15. Do what you need to do to make your body comfortable- moisten eyes and mouth, etc.
16. Give yourself time to wind down.
17. Establish a bedtime ritual that will signal to your body that it is time to relax. Some ideas include a warm bath and relaxing music.
18. Don't force yourself to sleep, or get anxious if you aren't falling asleep.
19. If you can't sleep, get up and do something relaxing such as reading until you are tired and can sleep.
20. Use relaxation techniques, such as progressive muscle relaxation, and deep breathing.
21. Imagine yourself floating on a cloud, or on a raft on the sea. Visualize yourself going down an escalator, or floating down on a leaf. The lower you go, the more relaxed you become.
22. If sleeping difficulties persist, consult your doctor.
23. If you have nightmares, try this: Write down your nightmare. Write a new, more pleasant ending. Repeat the new ending over and over in your mind for 3 minutes before going to bed.
    
    
    Pleasant dreams! 

Better Choices, Better Health

For the past five weeks, I have been participating in an online workshop called 'Better Choices, Better Health'. I don't remember how I found it, but I am glad I did. On their home page, their tag line is 'A Stanford University Workshop to help you manage your health: a service of the National Council on Aging'. It is a six week workshop for people living with chronic conditions that teaches/encourages you to make lifestyle choices that will maximize your health.

When you enroll in the workshop, you are put into a group of about 20 people who will be your classmates for the six weeks. Each week there is a lesson to read online, and opportunities to post problems and action plans. An action plan is like a goal, only more specific. After reading the lesson and writing your own action plan, you are invited to read what others have posted, and post your replies. Classmates and volunteer group leaders give each other suggestions, validation and encouragement. Topics covered include ways to deal with pain, fatigue, and stress, healthy nutrition and exercise choices, and communication with family and doctors. You are instructed to 'log on at your convenience 2-3 times per week for a total of about 2 hours per week.' I have found that I am spending closer to 4 hours on the website each week, and some of the others in the group have also commented that it takes more than 2 hours to get through all the site has to offer. I like to be thorough, and want to read everything, though there is no requirement to do that.

In addition to the discussion center, where the posts are located, there is a section of the website titled 'My Tools'. In it, there are many tools such as the Fitness Zone, where you can post a fitness goal and log your progress; a Health Profile, where you can track your weight and blood pressure, among other things; a Nutrition Zone; Relaxation Zone; Web Resources and an Online Journal.

And that's not all. They also send you a book titled Living a Healthy Live with Chronic Conditions, by Lorig, Holman, Sobel, Laurent, Gonzales and Minor. This book is itself a wonderful resource, with chapters on self management, symptoms, exercise, communication, sex, advance directives, nutrition, medication and planning for the future. There are separate chapters on living with chronic lung disease, heart disease, arthritis and diabetes. Chapter 20, the last chapter, is titled: 200+ Helpful Hints. Each week there are optional readings in the book to go along with the lesson.

Setting goals is easy. The hard part is following through. This workshop not only shows you how to divide your goals into very specific steps, or action plans, but also provides the social support and camaraderie needed to encourage you to stick with it. One of the main changes I have made is to keep a food journal. It is making me more aware of what I eat, and reminding me to make better choices. I have started to jot down pain levels as well as highlights of the day's activities, to see if there are correlations.

So what does this whole program cost? Nothing. It is totally free, except for the time and effort you put into it. I highly recommend it. To get started, go to the Better Choices, Better Health home page and click on the button that says: Not Enrolled? Learn More.

Stigma

I read an article recently titled 'Neutralizing Stigma', by Jackson Rainer, PhD, In the magazine Arthritis Self-Management. Dr. Rainer defines stigma as “an unfavorable assessment of a person that is based on a particular attribute, usually one that marks the person as different from others”. In other words, it stereotypes people who are different as not 'normal'. It can take the form of rejection or discrimination, based on fears and prejudice arising from that sense of difference.

I usually think of stigma as related to metal health. Many people still think of mental illness as voluntarily being lazy (depression), or crazy (schizophrenia). Mental illness is as real as physical illness, caused by imbalance of chemicals in the brain. I often tell my patients at the hospital that they have the opportunity to educate people, if they choose. People with mental illness are not 'those crazies out there', they are us, people like any other people, who happen to have an illness.

This article is about the stigma against people with arthritis. My first reaction was 'What stigma?” The first anecdote was about a woman with hands deformed by rheumatoid arthritis being called 'lobster lady'. That is one form of stigma, being called names because of one's differentness. The second anecdote in the article tells of a woman being assisted from the car to her wheelchair by her home health aide. A passerby talked about her with the aide as if she were invisible. This depersonalization is another form stigma can take. Those of us with invisible illness may be subject to a variant of stigma. People may assume we are lazy, or are faking our illness to get out of work or social obligations.

Stigma hurts by making the person feel inferior or inadequate. Chronic illness or pain can make us less able and independent, and this can make us feel inferior or inadequate in our own mind. When we hear others say or imply it, it only confirms it to us. It can be a challenge to maintain high self esteem when living with illness. With lower self esteem, one is more likely to listen to and believe what others say about them.

Stigma needs to be dealt with on two levels. The first is learning to cope well with illness and with your own feelings of being stigmatized. This can include educating yourself and those close to you, finding support groups and community resources, and counseling if needed. Develop your self esteem based on who you are and what you can do, rather than what you can't do. Remember that just because someone says something to you or about you, you don't have to believe it.

This leads me to the second level of dealing with stigma. Stigma comes from ignorance, prejudice and fear of 'other'. The key to eliminating stigma is education. People are less afraid and more accepting of things they understand. Think out how you can explain your illness/disability briefly, in easy to understand terms. Humor can help to diffuse discomfort on both sides. Be aware that not everyone wants to be educated, and there are people who will be hostile to your efforts. When confronted with this, accept it for what it is. Don't take it personally, it is them, not you.

People with handicapped parking stickers who don't have obvious disabilities often get rude looks or remarks from people who see them getting in or out of their cars. This article quotes a man who knows 'the look' all too well. When he sees it, he just laughs and says “Arthritis. Can't walk as far as you. I can see you're jealous because I have a closer parking space to the door, but don't be. It's really not worth it.”