Painsomnia and insomnia


Two triggers are very well known to me because I have fibromyalgia. Sleep deprivation and oversleeping. Both are horrible triggers. Both are predictable triggers. The main issue with fibromyalgia is that it comes with full blown insomnia and sleep dysfunction as part of the game plan, so getting sleep and restorative sleep is, well, near impossible. This is a migraine trigger. Then, well, if you are like me years of chronic migraines and FM leads to depression which causes over-sleeping and This is a migraine trigger. It seems lose one way and lose the other way. Lose and then also lose.

One thing I know is the pain cycle that occurs. Lose sleep because of pain, have lack of sleep which triggers a migraine, migraine gives you painsomnia so you cannot sleep, sleep deprivation triggers a migraine… and on and on till madness. Painsomnia is technically insomnia due to pain. For me it is insomnia and insomnia due to pain. As in the insomnia is already there, but I take medication for it, but the Pain trumps the medication, therefore I simply do not sleep. Ergo painsomnia.

I am not one to talk about how to resolve these issues because I am told I have the worst insomnia my doctor has even seen. This is simply because it is ingrained since childhood. I have hypermobility syndrome, a form of EDS, which can cause insomnia which it did as a child. So I had insomnia of delayed onset and frequent waking when I was young. Then I developed FM symptoms as a teen and it got substantially worse. Delayed onset insomnia to the point of taking  4 hours to fall sleep and then when I did it was frequent wakings. I was running on 2-4 hours of sleep most of the time. Skipping school to sleep. Complaining of pain and fatigue. Then in my 20’s migraines and so after chronic migraines and then came in the severe painsomnia, which with FM already had a role but now it was a predominate role. So what ended up happening was severe sleep deprivation. I wasn’t actually getting enough sleep to function. Thus the medication I am on. However due to the severity medication doesn’t actually affect me very much at all. I am on trazadone 100mg, which by itself does nothing and zopiclone, together I get about 5 hours of disrupted sleep. Unless, well, bad pain day and then it is less or none at all. So when I say I can help someone with insomnia… I have such a severe ingrained case of it nothing much helps with it. It has been too long you see. My brain had the problem and now it developed a real pattern for it. Not that I wasn’t doing all the things I was supposed to to help it from a rather early age. And all the herbals. And Melatonin  And everything you can possibly think of. I did it. And then did it again. And again. And together. Hell, I’m taking melatonin now even, yet Again.

But I do know a thing or two about sleep. And sleep hygiene is the First step.

Good sleep hygiene
The first step to address sleeping issues is to look at your sleep hygiene. While most sleep dysfunction can be complex and difficult to manage, if you maintain good sleep hygiene it will help with the treatment along the road.
• Avoid stimulants such as caffeine up to four hours prior to bedtime. Caffeine builds up in the body through the day so it is best to avoid after lunch.
• Maintain a consistent sleep pattern of waking up and going to bed at the same time.
• Avoid late night snacks. If you do snack stick to small snacks that have a lot of carbohydrates in them as these tend to aid in making you feel drowsy.
• Never exercise before bedtime but try to exercise regularly even if that exercise is going for short walks, yoga or doing some stretches.
• Have no distractions in the bedroom. No TV, video games, iPhone or laptops. Do not do your work in the bedroom. Or snack. The bedroom should be reserved for sleeping or sex and we don’t want our brain to be associating the space with other waking activities.
• Make the room as comfortable as possible for sleep. Use blackout curtains to reduce light or a sleep mask. Use some method to reduce background noise whether that is earplugs, meditation music or a white noise machine. Ensure the room is not too hot or too cold. I have tinnitus, so I play the radio constantly on a soft radio station… likely not a great idea but tinnitus in the quiet drives me Mad.
• Do not take frequent naps but if you feel that you need to keep them under an hour.
• Do not watch TV at least an hour before bed because it is stimulating for the brain and makes it difficult to relax. The same can likely be said for being on the computer. But before that if you use the computer use Flux on it which has a rose coloring to it, not blue light. Same with your iPhone, have a rose light filter, which comes with the new ones… blue light keeps the brain all awake like and interferes with sleep.
Nonprescription sleep aids
There are many nonprescription herbal remedies in pill form, teas or drops. One thing you must always remember is that all of these, just like prescription medications, can have side effects and interactions. They can interact with you existing medications; for example, valerian is suggested to have the potential to increase the effectiveness of antiseizure medications, so if you take antiseizure medications this would not be the sleep remedy for you. Therefore, it is vital we consider these alternative herbal treatments just like we would any other medication and ensure we mention to our doctor and pharmacist that we are taking them.
  • Hops
  • L-theanine
  • Passionflower
  • Valerian root
  • Melatonin
  • Wild Lettuce leaf
  • Kava kava

I have always recommended Valerian and Hops but do remember to talk to your doctor first before adding it. And melatonin is Always a good first one to go for starting a 3mg and working up to 10mg if it doesn’t work.

Then there is medications all of which mean a discussion with your doctor.

And after All that Painsomnia, is still a different entity than Insomnia, due to the Pain factor. What do we do when pain prevents sleep? It is a very difficult question to answer. I have often been told things that seem contrary for insomnia that actually work. One of them is to get up. Get up do something boring, walk about the house and stretch your legs, whatever, and then go back to bed. Sometimes the adjustment can help you out of the mental place of ‘not sleeping’ and ‘in pain’ to ‘getting comfortable’ again. It is a mental trick and sometimes it does it. I have even done a trick I use for sleep paralysis. If you get sleep paralysis over and over again due to sleep deprivation you get up and you put your face under freezing water… and go back to bed. Sometimes I do that for pain. Hands and face. Sort of startling and try to go back to sleep then. Sometimes I just get up and put on some Japanese mint oil on my forehead, temples, jaw and neck and the sensation and scent of it help.

And sometimes, I  don’t sleep. And I get up for hours until the pain dulls enough that I can sleep. This happens more than I would like. And then I go to bed around 10AM or 11AM. Or not at all and have a wicked migraine from it.



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