Sleeping after a Spinal Cord Injury

Ever wondered how something as simple as sleep can become a challenge? For people with spinal cord injuries, it’s a daily reality. Spinal cord injuries happen when the bundle of nerves in your spine gets hurt, changing how your body moves and feels. 

These injuries don’t just affect your daytime activities – they can turn bedtime into a tricky puzzle too. Sleep, that essential reset button for our minds and bodies, becomes a challenge that goes far beyond simply closing your eyes and counting sheep.

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From breathing difficulties that rival the most persistent snoring to pain that seems to amplify in the quiet of night, sleep with spinal cord injuries is a multifaceted issue that touches every aspect of daily life and long-term health.

But here’s the silver lining: while the path to restful nights may be winding, it’s far from impassable. With the right knowledge, tools, and support, individuals with SCI can transform their sleep from a nightly struggle into a restorative experience.

Whether you’re newly adjusting to life with SCI or have been navigating this journey for years, this article aims to be your roadmap to better sleep. We’ll dive into the unique challenges, backed by scientific insights, and emerge with practical, actionable strategies.

Because at the end of the day (or rather, at the start of each night), everyone deserves the chance to wake up refreshed, ready to face the world with renewed energy and optimism.

Challenges of Sleeping with a Spinal Cord Injury

Sleeping with a spinal cord injury (SCI) can feel like solving a tough puzzle every night. Let’s look at some of the main hurdles people face when trying to get a good night’s rest.

Breathing Problems

Some spinal cord injuries affect the muscles that help you breathe:

• Obstructive sleep apnea (OSA) is very common, with prevalence estimates ranging from Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source 40-91% in chronic SCI patients. This is compared to at least 10% Verified Source Medline Plus Online resource offered by the National Library of Medicine and part of the National Institutes of Health. View source in the general adult population worldwide, with some estimates ranging lower Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source and higher Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source among different sub groups but rarely exceeding 20%.
• Central sleep apnea Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source and sleep-related hypoventilation Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source are also more prevalent in SCI, especially in those with cervical or high thoracic injuries.

Even if a spinal cord injury doesn’t directly affect your breathing, the consequences it can have may increase your risk factors for sleep-disordered breathing.

• Anatomical changes: SCI can lead to increased upper airway collapsibility due to changes in muscle tone and control. Your doctor might suggest mouth and throat exercises to help.
• Reduced lung volumes: Particularly in cervical Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source (neck) and high thoracic Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source (upper back) injuries, respiratory muscle weakness leads to reduced lung volumes, which can contribute to upper airway collapse.
• Obesity: Weight gain Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source is common Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source after Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source SCI due to Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source reduced Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source mobility, Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source which increases OSA risk.
• Medications: Many medications used in SCI management (e.g., muscle relaxants, pain medications) can affect breathing and upper airway muscle tone.

These changes can make it harder to take deep breaths. You might feel short of breath lying down or have trouble coughing, which can disrupt your sleep.

Pain and Discomfort

Pain can make it hard to fall asleep or stay asleep. You might feel aches, tingling, or burning sensations in different parts of your body.

People with SCI often experience different types of pain:

1. Neuropathic pain: This is caused by damage to the nervous system. It can feel like burning, stabbing, or electric shock sensations. This pain can occur below the level of injury and is often chronic.
2. Musculoskeletal pain: This can result from overuse of certain muscles, especially in the arms and shoulders for those who use wheelchairs. It can also come from poor posture or spasticity.
3. Visceral pain: This is pain from internal organs, which can be affected by SCI.
4. Circulatory issues: Poor circulation in paralyzed limbs can lead to uncomfortable sensations when lying down for extended periods.

These feelings can change depending on how you’re lying down, making it tricky to find a comfortable position. Moreover, SCI can limit mobility, making it hard to shift positions during sleep. This can lead to discomfort from pressure points or exacerbate existing pain.

When you’re in pain, it can be hard to relax enough to fall asleep. Your mind might focus on the pain, making it even harder to drift off.

Even if you do fall asleep quickly, the pain can cause you to wake up multiple times during the night. This fragments your sleep, reducing its quality and restorative effects.

Even if you don’t fully wake up, pain can cause micro-arousals that move you into lighter stages of sleep, reducing overall sleep quality. Some people find that their pain is worse in the early morning hours, causing them to wake up earlier than desired.

Difficulty Changing Positions

Turning over in bed can be a big challenge after a spinal cord injury. You might not be able to move parts of your body easily, or at all. This means you could end up stuck in one position all night, which can lead to other problems like bed sores.

These painful sores form when your skin is pressed against a surface for a long time. Pressure sores are not just uncomfortable—they can also lead to serious health problems if not treated. A pressure relief mattress can prevent bed sores but further assistance will likely be needed to mitigate the effects of long-term bed rest.

Circadian Rhythm Sleep-Wake Disorders

Circadian rhythm sleep-wake disorder Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source are a significant yet often overlooked aspect of sleep disturbances in individuals with spinal cord injury. These disorders stem from disruptions to the body’s natural 24-hour cycle, which regulates sleep, hormone production, and various physiological processes.

In SCI, particularly in cases of neck spine injuries, your normal circadian rhythm can be severely compromised.

The main problem is with a hormone called melatonin. Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source Melatonin helps control when we feel sleepy or awake. In people with severe neck injuries, the nerves that control melatonin production are often damaged.

This means their bodies don’t produce melatonin normally, which can really mess up their sleep patterns. Melatonin supplements may help, but that doesn’t necessarily solve the entire problem.

SCI can also affect body temperature cycles. Our body temperature normally changes throughout the day, which helps control our sleep.

In people with SCI, especially those with paralysis in all four limbs (tetraplegia), this temperature cycle can be off. Their body might cool down earlier than normal, making them feel sleepy at odd times.

Another issue is light exposure. Our bodies use sunlight to know when to be awake or asleep. People with SCI, especially those who can’t move much, might not get enough natural light. This can further disrupt their sleep cycle.

These sleep cycle problems can cause several issues:

• Feeling very sleepy during the day
• Feeling tired all the time
• Having trouble thinking clearly
• Difficulty falling asleep at night
• Waking up too early in the morning

These issues don’t just affect sleep. They can also impact other body functions like digestion and heart health. This might be one reason why people with SCI are at higher risk for heart problems.

Muscle Spasms

Sudden, involuntary muscle movements, called spasms, can jolt you awake. Muscle spasms in SCI occur due to changes in how the nervous system controls muscle movement. They can range from mild twitches to strong, painful contractions.

While some spasticity can be beneficial for circulation and muscle tone, excessive spasms can interfere with sleep and daily activities. They might make it hard to relax and fall asleep fast, or they might cause you to shift position, leading to discomfort.

Sleep Positions and Techniques

After a spinal cord injury, getting comfortable at night can be challenging. However, finding the right way to position yourself can make a significant difference in how well you rest.

The best sleeping position for you depends on the level of your spinal cord injury. Here are some general guidelines:

For cervical (neck) injuries:

• Sleep on your back with a small pillow or roll under your neck
• Use pillows to support your arms
• Consider a specialized wedge pillow to elevate your head slightly

For thoracic (upper back) injuries:

• Side-lying position with pillows between your knees and supporting your back
• Back-lying position with pillows under your knees

For lumbar (lower back) injuries:

• Back-lying position with pillows under your knees to reduce pressure on your lower back
• Side-lying position with a pillow between your knees

For sacral (tailbone area) injuries:

• Back-lying position with a small pillow under your hips
• Side-lying position with pillows supporting your back and between your knees

These are general suggestions. Always consult with your healthcare provider or occupational therapist for personalized advice on the best sleeping positions for your specific injury.

“In my clinical experience,” notes Dr. Miller. “I’ve noticed that people with spinal cord injuries report better sleep when they feel confident in bed mobility (moving around the bed).”

“Positioning with pillows as described above is also important but placing the pillows can be challenging at first. We practice positioning, often in circle sitting (upright sitting with feet together to form a circle for improved balance) using compensatory strategies or active muscles to place pillows and then position the person.”

Creating a Comfortable Sleep Environment

Your bedroom can make or break your sleep quality. Let’s explore how to set up your sleep space to help you get the best rest possible after a spinal cord injury.

Choosing the Right Mattress

For individuals with SCI, mattress selection is critical not only for comfort but also for preventing pressure sores. Consider these options:

• Adjustable air mattresses: These allow you to customize firmness and can be adjusted to relieve pressure on specific areas of your body affected by SCI.
• Memory foam mattresses: They can conform to your body shape, potentially reducing pressure points common in SCI.
• Latex foam mattresses: Latex foam contours to the body similarly to memory foam, but with a more responsive feel. This can help distribute weight evenly and reduce pressure points.
• Alternating pressure mattresses: These can be beneficial for individuals with high-risk SCI who are prone to pressure sores.

Consult with your SCI specialist, occupational therapist, or wound care nurse about which type might best suit your specific level of injury and needs.

Adjusting Room Temperature

Keeping your room at the right temperature can help you sleep better. Furthermore, many individuals with SCI, especially those with higher-level injuries, have difficulty regulating body temperature. To accommodate this:

• Keep your room cool, typically between 60-67°F (15-19°C).
• Use breathable, moisture-wicking bedding to manage the sweating often associated with SCI.
• Consider a programmable thermostat to adjust temperatures throughout the night, accommodating for SCI-related temperature regulation changes.

Using Supportive Pillows

Pillows aren’t just for your head—they can help position your whole body comfortably when you have SCI.  Use pillows strategically:

• Body pillows: Can help maintain proper alignment for those with limited mobility due to SCI.
• Wedge pillows: Useful for elevating legs or upper body, which can be beneficial for circulation and respiratory function in SCI.
• Specialized SCI pillows: Some pillows are designed specifically for cervical SCI to provide proper neck support.

Experiment with different pillow arrangements to find what feels most comfortable and supportive for you.

“While pillows are helpful to provide pressure relief, it’s important for the person to be able to re-adjust the pillow as needed,” says Dr. Miller. “Once a person finds suitable pillows, I make sure the patient practices moving the pillow prior to them attempting to sleep to ensure safety.”

“People with limited or no hand movement due to spinal cord injuries sometimes use a tenodesis grip Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source to perform tasks. Tenodesis grip relies on wrist extension and finger flexion to accomplish a task when the person no longer has the ability to grip with their hands.”

Managing Noise and Light Levels

A quiet, dark room can help you fall asleep faster and sleep more soundly, especially as SCI can often lead to heightened sensitivity and sleep disturbances.

• Use blackout curtains to block light, which is especially important if SCI medications affect your sleep-wake cycle.
• Try earplugs or a white noise machine to mask any disturbing sounds, including those from medical equipment often used in SCI care.
• Set up a voice-activated system to control lights and devices if SCI limits your mobility. This can be part of a greater smart home setup for sleep.

Essentially, set up your room to be as peaceful as possible for better sleep.

Managing Sleep-Related Health Issues

Many people with SCI face a unique set of sleep-related health issues that require careful management and attention.

These challenges can include an increased risk of pressure sores due to prolonged immobility, difficulties with bladder and bowel control, muscle spasms that can jolt one awake, and persistent pain that makes falling asleep an arduous task.

Each of these issues not only affects sleep quality but can also lead to serious health complications if not properly addressed.

One of those serious conditions is Autonomic Dysreflexia (AD). AD is Verified Source Medline Plus Online resource offered by the National Library of Medicine and part of the National Institutes of Health. View source a potentially life-threatening medical condition that can Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source occur in individuals with SCI, particularly those with injuries at or above the T6 level (the upper thoracic spine). The automatic nervous system Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source overreacts due to noxious stimuli such as a full bladder, skin irritation or pain.

Effective management of these sleep-related health issues is crucial not just for improving sleep, but for enhancing overall quality of life, preventing secondary health problems, and maintaining optimal physical and mental well-being.

It often requires a multifaceted approach, combining medical interventions, lifestyle adjustments, and specialized equipment or techniques.

Preventing Pressure Sores

Pressure sores develop when prolonged pressure on the skin reduces blood flow to an area, causing tissue damage. People with SCI are particularly vulnerable to pressure sores due to:

• Reduced sensation, which means they may not feel discomfort from prolonged pressure
• Limited mobility, making it difficult to change positions frequently
• Potential circulatory issues that can slow healing

Common sites for pressure sores include the tailbone, hips, heels, and elbows.

Now, since bed sores can develop quickly when you stay in one position for too long, you want to move when you can to prevent this. If you’re unable to move independently, then caregivers should assist in changing position every 2-4 hours, even during sleep.

You also need to look for specialized pressure-relieving mattresses to help distribute body weight more evenly. Then accessorize with pillows designed to relieve pressure on vulnerable areas. Wedges, cushions, and bolsters can act as positional aids.

If you can, invest in an adjustable bed. It allows for easy position changes and elevation of specific body parts.

When you’re awake, you want to do what you can to keep your skin clean, supple, and dry. Here’s where a nighttime skin care routine comes in handy, with mild, pH-balanced cleansers and hypoallergenic moisturizers. Consider also using barrier creams in areas prone to moisture.

Check daily for any signs of skin breakdown like red or sore spots, especially in high-risk areas. Use a mirror or camera for hard-to-see areas. Seek medical attention immediately if signs of skin breakdown are observed.

Managing Bladder and Bowel Difficulties

Proper management helps prevent serious health complications such as urinary tract infections, kidney problems, and skin breakdown. It’s also essential for maintaining personal hygiene and dignity.

Effective bladder and bowel routines can significantly improve quality of life by reducing accidents, discomfort, and embarrassment. For sleep specifically, good management reduces nighttime disturbances, allowing for more restful and uninterrupted sleep.

Bladder

Plan your fluid intake to minimize nighttime bathroom needs. Empty your bladder before bed, and consider using absorbent products for nighttime protection.

If you use intermittent catheterization, perform a catheterization right before bed, ensuring thorough emptying of the bladder to minimize the risk of nighttime accidents.

For those with indwelling catheters, it’s important to check that the catheter is functioning properly before bed. Ensure the drainage bag is empty and positioned correctly for nighttime drainage.

Positioning in bed is also important. If you use an indwelling catheter, position yourself to allow for proper drainage. You might need to use body pillows or wedge pillows to maintain a comfortable position that doesn’t put pressure on the bladder.

If you’ve been prescribed any bladder relaxants or anticholinergics, take them as directed by your healthcare provider. These can help reduce bladder spasms and nighttime voiding.

Bowels

Try to complete your bowel program earlier in the day, not right before bed. A consistent schedule helps train your body and reduces the likelihood of nighttime bowel movements. If needed, perform a quick check or mini-bowel program before bed to ensure emptying

Be mindful of your diet close to bedtime, avoiding foods that may stimulate bowel movements or that typically cause gas or discomfort.

Regarding medications, take any prescribed stool softeners or laxatives at the appropriate time. If you use suppositories, time them so they’re effective well before bedtime.

Controlling Muscle Spasms

Muscle spasms can jolt you awake and disrupt your sleep. Discuss with your doctor about medications that can help control spasms, especially at night. Possible ones they might prescribe include:

• Baclofen or Tizanidine: Common muscle relaxants that can reduce spasms.
• Diazepam: Can help relax muscles but may cause drowsiness.
• Gabapentin or Pregabalin: May help with both spasms and nerve pain.

For a simpler approach, doing gentle stretches and relaxation exercises before bed can help release muscle tension. Try moving joints through their full range and lightly massaging specific points. As you settle in before the night, find comfortable positions that minimize triggers for spasms.

Use warm compresses on spasm-prone areas to soothe them. You can also try a warm bath or shower before bed. Some also find cold compresses provide more relief from muscle spasms, so you might have to experiment a little.

You should also seek additional help if:

• Spasms suddenly increase in frequency or intensity.
• Current management strategies stop being effective.
• Spasms are causing significant sleep disruption or daytime fatigue.

Managing Pain Before Bedtime

Pain can make falling asleep difficult.  Meanwhile, effective pain management can improve sleep, overall quality of life, and participation in daily activities.

Now, it’s common to treat SCI pain with medicine. However, taking medicine for pain at the right time is very important. This helps make sure the medicine works best when you’re trying to sleep.

It’s important to talk to your doctor about which medicines to take and when to take them. Your doctor will help you find the best mix of medicines for your pain.

Relaxation techniques can be powerful tools in your arsenal. Practicing deep breathing exercises, progressive muscle relaxation, or guided imagery can alleviate anxiety about pain. Many apps and recordings are available to guide individuals through these relaxation exercises.

To go a step beyond standard relaxation techniques, you could try psychological approaches such as Cognitive Behavioral Therapy (CBT) to change pain-related thoughts and behaviors. Certain types of CBT focus on Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source managing insomnia and chronic pain together, as the two tend to go hand in hand.

Technology can also assist in pain management. Many smartphone apps are designed for pain tracking and management, and some studies suggest that virtual reality can help with sleep by distracting from pain.

Keeping a pain diary to track pain levels and factors that influence pain can help identify patterns and inform treatment strategies. You also concurrently keep a sleep diary, to help you track disrupting pain and other factors that affect your sleep.

Developing a Healthy Sleep Routine

A good sleep routine can make a big difference in your sleep quality. And the first step is to set a regular sleep schedule.

Yes, this means you go to bed and wake up at the same time every day, even on weekends. This helps your body’s internal clock stay on track. Stick to your schedule as much as possible, even if you didn’t sleep well the night before.

Your body will gradually adjust to the routine, making it easier to fall asleep and wake up.

Then, you can create a calming bedtime routine to help you wind down. Try these ideas:

• Take a warm bath or shower
• Read a book
• Journal before bed
• Practice relaxation techniques like deep breathing exercises
• Dim the lights and avoid bright screens an hour before bed

Your daily and evening routine can also impact your bedtime routine. For example, stimulants can interfere with your ability to fall asleep.

Avoid caffeine for at least 6 hours before bedtime, as it can stay in your system for a long time. Also, try to finish eating at least 2-3 hours before bed to avoid indigestion.

For SCI, it’s especially helpful to set aside some time to do some gentle exercises:

• Range-of-motion exercises for your joints
• Stretches to relieve muscle tension
• Deep breathing exercises
• Guided relaxation or visualization

Remember, such regular movement can improve your sleep quality by limiting uncontrolled muscle spasms. But always check with your healthcare provider before starting any new exercise routine.

When to Seek Help

Sometimes, you might need extra help to improve your sleep after a spinal cord injury. It’s important to know when to reach out to your healthcare team.

Signs of Sleep Disorders

Watch out for these signs that might indicate a sleep disorder:

• Trouble falling asleep or staying asleep most nights
• Feeling tired during the day, even after a full night’s sleep
• Loud snoring or gasping for air during sleep
• Restless legs or frequent muscle spasms at night
• Morning headaches or dry mouth

If you’re consistently having trouble falling asleep, staying asleep, or feeling well rested it’s time to seek help.

Treatments and Therapies

There are many options to help improve your sleep:

• Sleep medication (always under doctor’s guidance)
• Cognitive Behavioral Therapy for Insomnia (CBT-I)
• Sleep studies to diagnose conditions like sleep apnea
• Adjustments to your current medications
• Specialized equipment like CPAP machines or adjustable beds
• Referral to a sleep specialist for more targeted treatment

Your healthcare provider can help determine which treatments might work best for your specific situation.

Trust Healthcare Providers

You want to speak to a trusted doctor if your sleep difficulties occur at least three nights a week and have persisted for three months or more.

Your healthcare team plays a crucial role in managing your sleep health. They can:

• Identify the root cause of your sleep problems
• Check if your medications are affecting your sleep
• Rule out any underlying health issues
• Recommend treatments specific to your needs
• Adjust your care plan to improve your overall quality of life

Don’t hesitate to bring up sleep concerns during your appointments. Good sleep is vital for your recovery and well-being.

FAQs

Can I sleep on my stomach after a spinal cord injury?

Sleeping on your stomach isn’t usually recommended after a spinal cord injury. It can put strain on your neck and back, and make breathing harder. Talk to your doctor or occupational therapist about the best sleeping positions for your specific injury.

How can I manage muscle spasms that wake me up at night?

Try doing gentle stretches before bed to relax your muscles. You can also use warm compresses on spasm-prone areas. Talk to your doctor about medications that might help control nighttime spasms.

Is it normal to feel more tired after my spinal cord injury?

Yes, it’s common to feel more fatigued after a spinal cord injury. Your body is working harder to do everyday tasks, and you might not be getting quality sleep.

Focus on improving your sleep habits and talk to your doctor if extreme tiredness persists.

How often should I change my position during sleep?

Try to change your position every 2-3 hours to prevent pressure sores. You might need help from a caregiver or use special equipment like an alternating pressure mattress.

If you can’t move on your own, set an alarm to remind your caregiver to help you shift positions.

What’s the best type of mattress for someone with a spinal cord injury?

The best mattress depends on your specific needs, but many people find success with pressure-relieving mattresses. These include memory foam, latex, or adjustable air mattresses.

Consult with your healthcare provider to find the right balance of support and pressure relief for your body.

Conclusion

Living with a spinal cord injury presents unique challenges when it comes to getting a good night’s sleep. From breathing difficulties and pain management to positioning issues and circadian rhythm disruptions, individuals with SCI face a complex set of obstacles in their quest for restful sleep. However, with the right approach, many of these challenges can be effectively managed.

It’s important to remember that improving sleep with SCI is often a process of trial and error. What works for one person may not work for another, so patience and persistence are key. Don’t hesitate to seek help from healthcare professionals if sleep problems persist, as good sleep is crucial for overall health, rehabilitation, and quality of life.

As research in this area continues to evolve, new treatments and strategies may become available. Stay informed and open to adjusting your sleep management plan over time. With the right combination of medical care, lifestyle adjustments, and personal dedication, individuals with SCI can achieve better sleep and, in turn, enhance their overall well-being and daily functioning.

Remember, quality sleep is not a luxury—it’s a fundamental aspect of health and recovery for those living with spinal cord injuries. By prioritizing sleep and actively working to address sleep-related challenges, individuals with SCI can significantly improve their quality of life and support their ongoing rehabilitation efforts.