We move through 5 stages of sleep in each sleep 'cycle' and each 'cycle' lasts about 90 minutes. The lengths of these cycles vary throughout the night. See diagram below:
Pain affects our ability to sleep, and poor sleep makes pain worse. It's a vicious cycle. It is sometimes hard to know what is the culprit. Is the pain causing your poor sleep, or is the poor sleep making the pain seem worse? Sleep deprivation certainly magnifies pain, makes us less tolerant of it. Getting a good nights sleep may be all it takes to reduce your pain, or at least be able to cope with your pain better.
I have noticed my pain worse on days that I have slept badly. As I often sleep badly I am usually in pain throughout each and every day! My tolerance of this pain, and indeed people around me is tested daily; my patience is tested, and I often feel like crying, shouting or just losing my temper with those near me. Yesterday I was not too bad pain wise, today I am suffering again. Last night I only slept for about 5 hours, and it was poor quality sleep with lots of waking. On bad days I do a pretty good job of hiding how I feel, I think I do anyway! I keep myself busy, distract myself.
This is where the Nortriptyline comes in that the Consultant has prescribed. I am to take one 10mg tablet 1-2 hours before bed. (The dose for depression is apparently 25-150mg). Nortriptyline is an anti depressant where sedation is a side effect. It is thought that low dosage Nortriptyline helps improve sleep patterns. It works by changing the chemicals around the nerve cells of the brain. This in turn changes how the brain will process pain signals it is receiving. It is hopefully not a long term thing. I am using it to help promote a healthier sleep pattern long term- thereby stopping this cycle of pain-sleep deprivation- pain.
This is supported by many studies that have shown that lack of sleep produces a heightened sensitivity to pain. Studies also claim that poor sleep can stop analgesia working as effectively as it would in someone who sleeps well.
Examples of some studies -taken from Painscience.com
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