Pain + Insomnia = Painsomnia

Whether it is because of medication side effects, pain itself, or just life, a lot of us with migraine also deal with occasional insomnia.

For me, it happens most frequently when I'm having a couple of days in a row with fewer migraine symptoms. Because I haven't had to take the medications for pain and nausea that tend to cause drowsiness, even if I feel fatigued I can find myself lying awake at night with my eyes wide open. My iPhone switches at 7 pm to the new “Night Shift” setting to diminish sleep issues, but I still force myself to put it down, out of reach, and try to breathe deeply, calm my brain, and just lie there until sleep comes.

But, so very often, it doesn't.

One of the important lifestyle adjustments doctors suggest those of us with migraine disease make is to go to bed and rise in the morning at regular intervals, the same times every day. Lack of proper sleep, or too much sleep, can trigger a migraine. Unfortunately, knowing exactly what the results to my illness will be from too much wakefulness causes me to feel extra anxious about it, which obviously doesn't help the situation. After a reasonable amount of time trying to relax in bed, I'll scroll through Facebook again, or read part of a novel, and get more and more frustrated and agitated each time I try again to close my eyes and let the drift happen.  This is when I begin to toss and turn, possibly develop restless leg syndrome, and invariably, the allodynia I often experience in my arms and legs will make its appearance and the sheets will begin to feel like sandpaper against my skin.

For me, this is what “painsomnia” truly is. In online support groups for migraine and other illnesses, you will see much discussion of painsomnia, a term coined by "spoonies" (those in the chronic community). I have seen many creative memes and graphics depicting this unpleasant combination of pain and sleeplessness, which is loosely defined as chronic pain being too severe to allow for normal sleep. However, I find that for me, the insomnia tends to come first. The frustration and agitation lead to restlessness, allodynia, and eventually headache. On these nights, I may finally drift off into a light, unsatisfying sleep between 4 and 6 a.m. When I wake up from that at around 8 or 9, I will have a full-blown migraine with increased fatigue, significant pain, balance issues, and nausea.

What a fantastic way to start the day.

It happened to me this past weekend, which at least is slightly easier in that I don't have to prepare the girls for school and drive them there at predetermined (early) times. But last night was Sunday, so I prepared in advance for possible painsomnia so that Monday morning would go as smoothly as possible. Fortunately, I entered a fairly solid sleep before midnight, which could have been coincidence, or maybe because I followed these steps throughout the afternoon:

  • No caffeine after 1:00pm. I love Cherry Coke, but yesterday I made sure I was drinking water or Gatorade in the afternoon and evening. I also made sure to not take any medications which contain caffeine, or those which can cause sleeplessness as a side effect, such as Sudafed.
  • Slowing down before lying down. Now and then throughout the evening, I made sure to pause and sit quietly, breathing deeply. Practicing meditation or yoga before bedtime can help calm the brain, heart rate, and blood pressure so that when you do lie down to sleep, your body is ready.
  • No snacking before bed. Going to bed hungry doesn't help, obviously, but I find if I eat right before I try to sleep, I have a harder time drifting off.
  • Putting screens away. I do keep my phone near my bed at night, but I last night I plugged it in and silenced it before the girls' bedtime and didn't pick it up again. Even with settings that reduce melatonin-affecting blue light exposure, seeing your uncle's angry political Facebook post or reading a news alert about a disturbing world event will not exactly invite relaxation. (If you haven't yet discovered “Night Shift,” it can be activated on iPhone through Settings > Display & Brightness. For Android devices, there is a free app called “Twilight.”)
  • Preparing completely for morning. One way or another, morning will certainly arrive. If the girls' clothes are laid out, lunches at least partially made and backpacks ready to go, it is much easier to shuffle through my morning routine even if sleep has been evasive.
  • Listening to quiet music. I find if I have something to listen to, my mind doesn't become caught in repeating anxious thought patterns as I try to go to sleep. I love Radiohead for this. I also sometimes use an app called “Relax” which plays white noise, nature sounds, or soothing music.

In addition to the above steps, I also always take 5 mg of Melatonin with my night meds, which helps regulate sleep naturally and can be beneficial for migraine prevention too. If you feel lack of sleep is adversely affecting your health or state of mind, do make sure to talk to your doctor; and certainly do so before adding even over the counter supplements or sleep medications to your regimen. Feel free to share any of your own methods for sleeping more successfully in the comments!

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