At some point, everybody has trouble sleeping.
Sleep problems aren’t unique to those with spinal cord injuries. However, some unique challenges make it harder to get a good night’s sleep, causing ongoing sleep problems for those with a spinal cord injury.
Image credit: Mpho Mojapelo
A study of sleep complaints with people with a spinal cord injury found that almost 40% of the participants described their quality of sleep as “fairly bad” to “very bad”.
Dealing with spinal cord injury sleep problems effectively starts with understanding why they can occur. Below are some of the challenges unique to people with a spinal cord injury and three main sleep problems you may be experiencing.
Why can spinal cord injuries cause sleep problems?
After a spinal cord injury, sleep quality can be degraded, and a sleep cycle is consistently interrupted due to several issues:
Pain and spasticity
Any pain you’re experiencing will prevent you from falling asleep and staying asleep throughout the night. The sudden, sometimes violent contraction and spasms of muscles below your level of injury, known as spasticity, can also ruin a good night’s sleep and cause pain. Understanding how to manage and control spasticity after an SCI will help ensure that you’re minimising the impact of symptoms on your sleep.
Frequent interruptions
Having to perform intermittent catheterisation will likely reduce your overall quality of sleep. Also, frequently changing body positions in bed to avoid pressure ulcers can contribute to a poor sleep cycle.
Hormone changes
After a spinal cord injury, certain hormones may be reduced, including melatonin, which helps to regulate the sleep-wake cycle. Antidiuretic hormone (ADH), which usually increases at night to minimise urinary output, is also decreased. The result may be even more intermittent catheterisation interruptions.
Body temperature disruptions
The body’s temperature regulation system helps with the proper timing of sleep, making sure that you feel sleepy when it’s your usual bedtime. This internal thermostat is compromised when you have a spinal cord injury, causing your sleep cycle to become disturbed.
Depression
While depression is a common mental disorder that hinders sleep, many people with a spinal cord injury struggle to cope with the many challenges. This can often trigger occasional, sometimes chronic, depression that significantly impacts sleep.
Understanding how to combat depression due to a spinal cord injury can be invaluable in not only avoiding sleep problems but can also help to improve your overall quality of life.
Understanding 3 common sleep problems
There are many types of sleep problems anybody can experience, but these are the three most common issues:
Circadian rhythm sleep disorder
We all have an internal body clock that governs our sleep and wake cycle. When the cycle gets out of alignment with the normal 24-hour day, circadian rhythm sleep disorder will cause sleep problems. Not only will you experience poor sleep quality, but this disorder can also cause an extreme lack of energy throughout your day.
Chronic Insomnia
This sleep disorder impacts 36% of the UK adult population. Among those with a spinal cord injury, 54% of participants in a USA study cited chronic insomnia as an issue to getting a good night’s sleep. Of course, many factors can cause insomnia, but, in general, having a spinal cord injury presents a host of distinct challenges that can hinder or detract from good quality sleep.
Sleep apnoea
Out of these three main categories of sleep disorders, sleep apnoea is by far the one that is most associated with serious medical consequences.
Sleep apnoea occurs when there are numerous episodes during sleep when breathing stops for at least ten seconds, causing a dangerous drop in oxygen levels. Severe consequences of this disorder are a decline in mental abilities, the onset of cardiac and pulmonary diseases, and the potential for major accidents due to extreme daytime sleepiness.
Sleep apnoea tends to be relatively common in people with a spinal cord injury; understanding how to prevent sleep apnoea is essential to improve one’s overall health and wellbeing.
How to manage spinal cord injury sleep problems
The following tips will help ensure that you’re working towards resolving any sleep problems you may be experiencing due to a spinal cord injury.
Plan to avoid pressure ulcers
To prevent skin breakdown that can develop into a serious pressure ulcer, your therapist probably directed you to change positions every two hours as you lie in bed. Naturally, waking up so many times a night doesn’t lend itself to restful sleep.
Work with your healthcare team and caregiver to develop a sensible plan that balances the need to change positions with the vital need for rejuvenating sleep. You may need to use pillows in strategic positions to keep the weight off your back or other potential areas where pressure ulcers could develop.
Use a night bag for your intermittent catheter
Consult with your medical team to see if a larger catheter bag can be worn when you sleep to avoid getting up and draining the collected urine during the night.
Typically, these products attach to your leg bag or catheter valve and are placed on a nightstand or the floor bedside to collect urine as you sleep. A single-use night bag may be a good option to reduce the risk of infection.
Address chronic pain
Unfortunately, chronic pain is all too common for people with a spinal cord injury. Pain can bring on insomnia or significantly impact sleep quality.
Many with a spinal cord injury experience what’s known as neuropathic pain below the level of injury, often described as a burning sensation or uncomfortable prickly discomfort. Consult with your doctor about potential treatment and spinal cord injury pain management.
Start an exercise program or try a new sport
It can feel like a struggle to regain strength and stay fit with a spinal cord injury and maintain a healthy weight. However, you may be motivated to exercise/stay aerobically fit if it aids in a restful night’s sleep.
There are numerous other benefits of exercise after a spinal cord injury, so you’ll not only be avoiding spinal cord injury sleep problems but also enhancing your overall quality of life.
Explore wheelchair sports, wheelchair yoga, swimming, or other adaptive water sports. If you’d prefer something a little more adventurous, consider adaptive adventure activities, which will help you boost both your mood and fitness.
Be sure to schedule your exercise early in the day — any remaining adrenaline in your system may keep you awake. Always check with your doctor or physical therapist before starting a new exercise program.
Stay away from these three sleep busters
You should look to avoid the following to minimise sleep problems due to a spinal cord injury:
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Excessive alcohol
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Caffeine
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Smoking
Limit caffeine to the morning or early afternoon. Although alcohol may help you fall asleep, it can disrupt your sleep cycle and hinder restful sleep. Besides the many documented risks of nicotine — whether smoked or chewed — it is a stimulant that can cause sleep problems.
If you’re experiencing spinal cord injury sleep problems, work with your healthcare team for possible remedies, including medication, caregiver help, lifestyle changes, or even changes to your catheterisation process or products. If you’ve been diagnosed with sleep apnoea, it’s essential to address this issue to avoid serious medical consequences.
Together, you can make a plan to get you the valuable rest you need every night.
Do you have further questions? Get your SCI questions answered by the Navigator Team by sending us a message or contacting us on 0800 373 858.
References:
- Sleep Complaints and Sleep Quality in Spinal Cord Injury: A Web-Based Survey - PubMed (nih.gov)
- sci.washington.edu/info/newsletters/SCIU_Spring_2013-.pdf
- Spinal Cord Injury Sleep Problems: Causes and Management | Flint Rehab
- Sleep Disorders in Patients With Spinal Cord Injury - Neurology Advisor
- https://www.formulatehealth.com/blog/insomnia-statistics-uk-how-many-people-have-sleep-problems
