Neuropathy affects sleep patterns of over 50 % of the neuropathy patients. How to cope with this menace?

1. s Neuropathy Affecting Your Sleep?
By Leslie MacGregor Levine
Insomnia (or sleep disturbances) affects up to 50 percent
of the general population.¹ It may take several forms:
difficulty falling asleep at night, waking up too early in the
morning, waking up frequently throughout the night; and
generally poor sleep. In addition, people with insomnia
can also develop ‘daytime’ symptoms—such as daytime
sleepiness, fatigue, depressed mood, lack of energy,
impaired cognition, memory problems, irritability, and
decreased alertness and concentration—that, over time,
takes a toll on relationships, productivity at work, and
overall health and wellbeing.
The Link Between Neuropathy and Sleep
Neuropathy can impact sleep in a number of ways. For
some, the neuropathy symptoms may cause the sleep
disturbances (e.g., neuropathic pain makes it difficult to
fall asleep or stay asleep; abnormal sensations or
hypersensitivity to touch, particularly in the feet and legs
makes it difficult to fall asleep). With daytime distractions
(e.g., work, friends, family, hobbies, etc.) at a minimum
during the evening hours leading to bedtime, many
patients will find themselves focusing more on the pain;
and, so many report that their perception of the pain
actually increases when attempting to fall asleep and this
delays falling asleep. For others, the neuropathy
symptoms may be made worse by sleep disturbances
(e.g., sleep deprivation can lower your pain threshold and
pain tolerance and make the existing neuropathic pain feel
worse).
Managing Sleep Disturbances and Neuropathy
People who sleep poorly are also susceptible to
depression and other mood disorders, changes in eating,
decrease in physical activity, and an overall decline in

2. health. Compounded with neuropathy, this becomes a
vicious cycle.
 Improving Daytime Habits and Bedtime Routines
to Improve Sleep
When dealing with neuropathy, you may find yourself
thinking your insomnia is the least of your problems.
But, the compounding effects of neuropathy and
sleep disturbances require that you address both
head on. Start by tracking your symptoms and sleep
patterns, and then making healthy changes to your
daytime habits and bedtime routine:
- Keep a regular sleep/wake schedule;
- Develop a bedtime ritual (e.g., taking a warm bath,
reading light material);
- Limit or eliminate caffeine four to six hours before
bed and minimize daytime use;
- Avoid smoking, especially near bedtime or if you
awake in the middle of the night;
- Avoid alcohol and heavy meals before you go to
bed;
- Turn off your TV, smartphone, iPad, and computer
a few hours before your bedtime;
- Adopt relaxation techniques to help induce sleep
(e.g., give yourself an extra hour before bed to relax
and unwind and time to write down worries and plans
for the following day; meditation ; deep breathing
exercises); and
- Create a comfortable sleeping environment (e.g.,
make sure your bedroom is dark, quiet, and well-

3. ventilated; use bed and pillows that are comfortable;
elevate the bed sheets so that it is not in direct
contact with your legs and feet).
 Seeking Your Doctor’s Help to Address Sleep
Disturbances
If sleep problems persist and interfere with your
ability to function, it may be time to consult your
doctor. You will want to describe your sleep
symptoms; effects of sleep symptoms on your daily
activities and neuropathy; medication history
(because many prescription medications can also
affect the quality of your sleep, including some herbal
remedies).
Upon evaluation of your neuropathy and sleep problems
(as well as ruling out other causes of sleep disturbances),
your doctor will review:
 Self-help techniques—These are techniques you
can adopt (as described above) if you are not already
incorporating them to address your insomnia;
 Non-pharmacological treatments—These include
cognitive behavioral therapy, relaxation techniques,
stress management, and acupuncture that can help
improve sleep disturbances. They are preferred to
prescription sleep medications which can lead to
sleepiness during the day, can cause dependency,
and come with side effects;
 Pharmacological treatments—These are used as a
last resort and should only be used for short periods
of time especially when the insomnia is
chronic. Sometimes, medicines used to reduce pain
or aid sleep can affect your sleep.
- Over-the-counter pain medications—For mild

4. pain, over-the-counter pain medications (e.g.,
Tylenol, Advil) may suffice. Some over-the-counter
pain medications also have an antihistamine to help
with sleep (e.g., Advil PM or Tylenol PM).²
- Prescription medications—For more severe or
chronic pain, your doctor may recommend
prescription pain medications (e.g., ultram, opioids
such as oxycodone, hydrocodone bitartrate and
acetaminophen, codeine, and morphine). Other
drugs can also help with pain, such as some
antidepressants and anticonvulsants. To help with
sleep, your doctor might recommend drugs typically
prescribed for anxiety, called benzodiazepines (e.g.,
lorazepam, clonazepam, triazolam). Your doctor may
also consider nonbenzodiazepine hypnotics that are
particularly helpful for sleep and appear to be better
for longer-term use than benzodiazepines (e.g.,
zolpidem, eszopiclone, zaleplon).³
Poor sleep, depressed mood, and anxiety can complicate
your (and your doctor’s) efforts to manage neuropathic
pain. The key is to recognize this triad and partner with
your doctor to find the right treatments and approaches
that work best for you.