Sleep is hugely important. Dr. Hansom says the following about it in his book, Back in Control:
Sleep
Incorporating sleep into my treatment of pain was my first step in conceiving the DOCC program. I felt I had a whole new weapon that was very effective and simple. Once I was 39 successful in getting my patients to sleep better, there was always some improvement in their sense of well-being if not also in their pain.
Most patients with chronic pain sleep poorly and are tired during daylight hours. They often feel pain more keenly at night, when they have fewer distractions, and a good night’s sleep is difficult to attain. But without adequate sleep, quality of life is compromised and day-to-day stress and pain are difficult to handle. Perception of pain is altered.
I started to incorporate sleep treatment into my practice around 1997. If a patient had an acute problem such as a ruptured disc, I would use sleep medications in addition to any pain medications. It was much easier for my patients to make it through the healing process if they were able to sleep well. Whenever chronic pain was involved, the results were the same: with consistent sleep, a patient’s mood and coping mechanisms would improve over two to four weeks. If they could not get enough sleep, I would aggressively keep switching meds until we found the right treatment. Not sleeping was not an option.
The first step in the DOCC program is to get at least a month of adequate sleep. It is an integral part of calming down the nervous system. None of the other elements of the program will be effective unless you are rested. Many adults think they can get by on less than eight hours of sleep, but consider it a minimum. Most people, especially if they have chronic pain, do not experience a full night’s sleep consistently.
There was one study done in which female volunteers were measured in terms of the quality of their Stage V sleep, also called REM sleep, for a period of time. This is the stage where the most dreaming takes place. It was discovered that the less amount (and poorer quality) a subject’s REM sleep , the higher her sensitivity to pain.13
I had one fifty-year-old businessman who had experienced chronic neck pain for almost two years. There was no specific injury. He continued to work as an owner of a small accounting firm but was miserable. Extensive physical therapy had been no help. I started a strong sleep medication, which immediately allowed him to sleep a full night. After two weeks, the medication was still working well and the plan was to start him on an aggressive physical therapy program. However, by his eight-week visit I was surprised to find he was completely pain free. The power of sleep had never been so apparent.
Again, my first obligation is to simply get my patients to sleep well. Patients argue with me that it’s impossible to sleep with the pain. There are very few situations, though, where the right combination of medications won’t yield a consistent good night’s sleep in spite of the pain.
Later on he has another section, too:
In treating chronic back pain, sleep is the trump card. All of the other variables affect
sleep and sleep affects the other variables. I will see my patients back frequently
specifically to check on sleep. If you have sleep issues, you should do the same with your
own doctor. Not sleeping well is not an option in the successful treatment of chronic pain.
It’s common to experience more pain at night than during the day since there are
not as many distractions. There are multiple strategies to obtain a good night’s sleep
regardless of whether you are experiencing pain. They include:
• Sleep hygiene
• Medications
• Stress management at bedtime
• Treatment of an underlying sleep disorder
He has a section on each of the four strategies on pages 51-55 of his book, and they all made sense to me. He actually uploaded a draft of the entire book up onto his site where you can download it for free:
http://www.drdavidhanscom.com/wp-content/uploads/2013/04/Final-Manuscript-6-29-12.pdf
I found the book incredibly helpful in my recovery from TMS relapses and would recommend the download for anyone interested in TMS. I figured that if a successful spinal surgeon was telling me that mindbody worked and that I didn't need surgery, then it must be true. I think the only reason he cares so much is that he had TMS, too - just about every symptom. He talks all about it in the book.
