Sleep and persistent pelvic pain (PPP)

How to improve sleep when you have PPP

Cognitive behaviour therapy for insomnia (CBT-I)

This can be effective in managing sleep problems. Before starting this therapy the doctor might check for other sleep disorders such as sleep apnoea or restless leg syndrome. Sometimes medications are added to therapy for a short time to assist with sleep, but this is not always helpful as some pain medications can cause side effects including poor sleep.

CBT-I focuses on the connections between how you think, what you do and how you feel about sleep. CBT with a CBT specialist can also help manage your PPP and insomnia. There are some parts of CBT-I that will need to be provided by a trained CBT-I provider – eg, GP, psychologist, sleep physician – but there are changes you can make right now that may improve your sleep. The most effective is stimulus control.

Stimulus control

This is about learning to associate being in bed with feeling sleepy and ready for sleep. Here are some tips to aid this:

• Reclaim the bedroom as a restful place, using the bed only for sleep and sex.
• Set an alarm for the same time every morning. This will help to set your internal body clock (circadian rhythm). Getting up at the same time is more important than the time you go to sleep.
• Go to sleep when you are tired and try not to take daytime naps. Most people need between 7-9 hours’ sleep a night.
• If you cannot sleep, don’t force it – get up and do something calming and enjoyable. Most people wake at least once per night and our sleep pattern
  changes as we age.
• Try not to use electronics in the bedroom. Screens emit a blue light that stimulates the brain. If you do use screens in the bedroom, use a blue light filter or night shift function. Stop using any devices an hour before bed.
• If you use an alarm clock in your bedroom, turn it away from you to avoid ‘clock watching’.

Relaxation strategies

These are useful for women with PPP, as pain can increase tension and anxiety, which will affect sleep. These techniques are commonly taught in CBT-I.

• Breathing exercises – deep and slow focused breathing can slow your heart rate and reduce feelings of anxiety and depression.
• Progressive muscle relaxation (PMR) – this involves tensing and relaxing muscles groups. It can be combined with breathing exercises and focusing on visual images.
• Autogenic training – this is a relaxation technique focusing on promoting feelings of calm and relaxation in your body.
• Biofeedback – a technique you can use to learn to control some of your body’s functions, such as your heart rate. During biofeedback, you’re connected to electrical sensors that help you receive information about your body, which can teach you to have more control over these processes.
• Hypnosis – guided or self-hypnosis for insomnia involves learning to relax when given a verbal or non-verbal cue.
• Meditation – this helps to focus attention and can reduce stress and anxiety. Meditation is also part of activities like yoga and tai chi.
• Mindfulness – a type of meditation that aims to help you stay calm and focus on the present moment and not worry about the past or future. Research suggests mindfulness skills can improve how you feel physically and mentally, and these benefits can continue over time.

Positive sleep habits (sleep hygiene)

These tips can help you to have a good night’s sleep:

• A good sleep environment – dark room, comfortable temperature at 16-20C°.
• Limit caffeine (coffee, tea, chocolate, cola) close to bedtime. Try drinking herbal tea or warm milk (milk contains tryptophan, which can aid sleep).
• Limit alcohol and cigarettes. Both disturb sleep patterns.
• Limit drinks before bedtime if you regularly need to get up to go to the toilet overnight.
• Exercise regularly, but try to do it early in the day, as exercise late can interfere with sleep.
• Eat regularly. Don’t go to bed hungry or overfull, as both will affect sleep.
• Try not to watch things like news or social media close to bedtime.
• Use your favourite relaxation technique to wind down in the evening.

If you feel your sleep is not improving, ask your doctor for information about resources including online programs, apps or referral to a psychologist or specialist.