Alex B. Waking up with pain

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Question

I wake up in the middle of the night with back pain. What technique can be used to overcome the trigger of going to bed at night? I can lay in bed and twist and squirm or get out of bed and sit up until the pain goes away or I doze off and on with the pain.

 

[Alex Bloom LCSW]

Answer

Hi, thanks for the question. It's actually very common for people to have pain and tension arise at night or when they're sleeping. I will often remind people that TMS springs from the unconscious parts of the mind, and it is during sleep that the unconscious comes up and is closest to the surface. The normal defenses blocking it out are much less and so it can often be a trigger for increased symptoms.

People hold a lot of tension at night while they sleep. This why things like mouthguards are so common, people will often be tense to the point of grinding their teeth as they sleep. What you can then do is take on whatever you can to help release and ease some of this tension. If you find that getting up and sitting quietly, reading or watching TV helps, then go ahead and do it. The important thing is to try and avoid getting hard on yourself and putting on the pressure of "I need to go to sleep or else...". This just reinforces the tension and fear, making it both harder to sleep and reinforcing the symptoms themselves (purpose of TMS -> keep you anxious/fearful). Progressive muscle relaxation, mindful breathing and so forth can be very helpful for this. Remember to tell yourself that the pain can't hurt you, that you know what it is and that just getting out of bed and taking the pressure of yourself to fall asleep can actually be more restful than tossing and turning, worrying about your symptoms.

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[Walt Oleksy (RIP 2021)]

I like Alex Broom's suggestions for relaxing when you can't sleep.
I am amazingly better recently for sleeping more soundly and not waking up in the middle of the night.
If I do, I am getting much better at falling back to sleep by deep breathing. Within a few minutes, I'm asleep again.

If deep breathing alone doesn't get me to sleep or back to sleep, I do deep breathing while counting from 100 to 1
backwards, or even just from 50 to 1 backwards. It keeps my mind focused on counting and not worrying,
and worrying is a main cause of sleeplessness.

I also avoid watching television or being on the computer at least an hour before bedtime.
The bright light of a TV screen or monitor is enough to keep us awake before bedtime.

I often watch one of the Youtube videos on sleep and relaxation about an hour before bedtime.
It puts me in a calming mood.

A relaxing mantra also can be helpful... "I feel sleepy now. I am going to sleep now."