I used to sleep great. Even post-SCI I could sleep 9-10 hours a night, no problem. But recently, as I’m pushing into middle age, I find getting a solid night’s sleep a lot harder than it used to be. I know I’m not alone.

Our editor-in-chief, Ian Ruder, has written about his own sleep battlesmultiple times and our previous editor, Tim Gilmer, has done the same. If you’re a wheelchair user, there are a host of complications and secondary conditions that can disrupt your sleep: spasticity, chronic pain, and sleep apnea are just the most common antagonists. Add neurogenic bladder, compromised temperature regulation, overnight repositioning, and autonomic dysreflexia to the mix, and it’s a wonder wheelchair users sleep at all.

But, of course, we do. Sometimes hard, sometimes in spurts — it all depends on what you currently have going on with your body and your life. Figuring out your personal recipe for better sleep isn’t easy, but if successful, it will undoubtedly improve your life.

We’ll first look at the disability-specific tactics many wheelchair users need to manage in order to improve their sleep, and then look at the routines and lifestyle habits that can get you closer to a restful night’s sleep.

Disability Sleep Complications

If you have a disability that affects your upper body as well as your lower, there’s a good chance you experience sleep-related breathing problems. According to sleep medicine researcher Dr. Abdulghani Sankari, “At T6 and above, the prevalence is above 80%. It is higher in the cervical [injuries] up to C4,” he says, “up to 90%.”

Those shocking numbers appear in a new article by John Mohler, “Better Nights, Better Days: CPAP, BiPAP and Disability,” which looks at the problems caused by sleep apnea and the treatments available. Mohler uses a power wheelchair because of multiple sclerosis, and his story provides a few valuable takeaways.

First, many wheelchair users don’t realize they have sleep apnea because the typical symptoms mirror those of other issues we deal with on a regular basis. Second, though treatments like CPAP and BiPAP can be cumbersome and annoying in terms of accessibility, they can provide real relief. “After my first full night with the CPAP, my daily 20-minute nap disappeared, and I haven’t had one since,” says Mohler. “Slowly but surely, I graduated to long, peaceful nights and better, safer sleep.”

Another common sleep disrupter is spasticity. Figuring out how to manage spasticity is often a balancing act — too many oral medications can cause drowsiness during the day, but aggressive spasms when you lie down can wake you up throughout the night, leaving you just as drowsy the next day. For some wheelchair users, baclofen pumps can provide a balance that nothing else can. Even then, creativity might be necessary. Alex Ghenis used to wake up from dysreflexia caused by spasms twisting his hips, until he figured out how to use a snowboard strap and a towel to secure his legs in bed.

Other issues? Tim Gilmer writes about how chronic pain can ruin sleep and how the right mattress and mindset can help you rest even when sleep doesn’t come easily. For some wheelchair users, CBD — and sometimes THC — can help calm the mind and the body enough to improve sleep quality.

For quads, temperature regulation can be a major problem: too hot, too cold, always awake. Throughout the winter, I’ve found that sleeping with a heating pad on my neck and shoulders does wonders — just make sure you have the pad where you can feel it, as burns happen. There are now a variety of fancy mattress temperature-control products available as well, from a $440 heating and cooling fan system for your sheets, to a $2,500 AI-controlled, water-pumped mattress pad that claims to keep you at your preferred temperature no matter what the air temp in your room is.

Change Your Lifestyle, Change Your Sleep

Of course, even if you manage all your disability-related sleep issues, it’s possible that you’ll still have trouble falling asleep or staying asleep. Just ask my wife. She’s severely able-bodied and sleeps worse than I do. Disability aside, some people just have a harder time sleeping than others.

If this is the case for you, it’s likely that you’ll need to adjust some of your daily habits to try and improve your sleep quality. C5-6 quad Brian Swift went through a stretch where he was only sleeping a few hours a night. He first tried using sleeping pills and melatonin to help him sleep, but they had no effect. “It wasn’t until he started to change the way he lived that Swift began to see results,” writes Alex Ghenis. “His doctor suggested avoiding midday naps, keeping off his phone and computer starting a half-hour before bedtime, and tiring out his mind and body so he was exhausted by bedtime.”

Those lifestyle changes helped with Swift’s sleep in a way that medications didn’t, and his adjustments are backed up by modern sleep research, which, unfortunately, is still limited to the experience of nondisabled sleepers. Beyond consistent daily physical activity, here are a few things that experts recommend for improving sleep quality:

• Put down the screen at least 30 minutes before bedtime. Read a book, practice breathing exercises, do some gentle stretching. These activities can help calm your mind and body and help you fall asleep faster.
• Limit alcohol intake. A drink with dinner, no big deal. But a few glasses of wine or a night at the bar is going to affect your sleep. You may fall asleep quickly after drinking, but alcohol intake can lead to more broken sleep in the back half of the night.
• Stop with the afternoon coffee. I drink coffee every day, but as I get older my sleep is more affected by timing. According to a Cleveland Clinic article: “Six hours after caffeine is consumed, half of it is still in your body. It can take up to 10 hours to completely clear caffeine from your bloodstream.” Try and keep the caffeine to the mornings if you want to sleep better at night.

This article first appeared in our Health and Wellness newsletter. For more helpful explainers of disability health and wellness topics, please signup.