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Is there a link between poor sleep and chronic pain?

Yes! Pain might be sleep’s biggest enemy.

The link between the two resembles a vicious cycle. Pain causes people to struggle to fall or stay asleep; meanwhile, poor sleep can contribute to a lower pain threshold, which means you may become for sensitive or intolerant to pain. 

How pain impacts sleep

Pain can cause someone to arouse hundreds of times a night for even just a few microseconds at a time. This is called alpha intrusion or microarousal and it can then interrupt their sleep patterns enough to make it harder for them to achieve deep sleep.

Deep sleep (stage 3) and REM sleep provides two critical components of sleep architecture:

  • Stage 3 sleep allows the body to repair itself at the cellular level and release human growth hormone into the body
  • Stage REM sleep allows the brain to clean itself and consolidate memories, emotions, new learning, and experiences.

Without these two stages of sleep, the brain and body will, over time, start to function less efficiently. This can lead to the potential for future chronic illness, higher risk for accidents, impaired cognitive performance, and the likelihood of mood disturbance.

Pain can lead to some restrictions in sleep positioning, which can keep you up at night. If you have reflux, for example, but you can’t sleep on either side due to arthritis in the hips, this could spell disaster because you will not be able to find a comfortable position no matter what you try.

How sleep impacts pain

A 2009 study showed that people who are sleep deprived tend to have lower pain thresholds, even in normal healthy individuals. Lack of sleep potentially increases inflammatory responses in the body, which can disturb the body’s ability to cope with pain responses.

For some, multiple health conditions that include chronic pain make it hard to exercise regularly, even when exercise is prescribed as a helpful pain management tool.

When healing from injuries or surgery, part of the rest requirement for healing demands adequate sleep even after you think you feel better. The body used a lot of energy in the process of cellular repair even if you are sedentary. Sleeping and rest will shorten your recovery if you make them a priority.

Can treating chronic pain lead to disrupted sleep?

The bad news

Some pain medications can cause insomnia or worsen conditions like sleep apnea. If you suffer from insomnia or suspect you might have a sleep breathing disorder, and you are taking drugs for chronic pain, you should have a conversation with your doctor and pharmacist about your options.

The good news

More non-drug options for pain management, including neurostimulation, have been developed to target pain points for certain kinds of health conditions. Also, alternative practices like chiropractic adjustment, massage, acupressure, and acupuncture have been shown to relieve pain for many.

What can patients with chronic pain do to improve their sleep?

The obvious, yet difficult to apply, solution is to treat the root cause of the pain. No pain means better sleep. But pain management is a challenge for some people who have multiple health problems and additional medications to consider, as well as drug allergies and concerns about interactions. In addition, doctors are less likely to prescribe certain pain medications due to increasing problems with opioid addiction, so pharmaceutical approaches may be less available to you.

Some nonpharmaceutical steps you can take to offset sleep problems related to pain include:

  • Avoiding caffeine 5 hours before bedtime. Caffeine may be usefully administered to treat migraines and other headaches during the day, but it will lead to insomnia at night.
  • Avoiding alcohol. Alcohol is a drug that can have numerous negative impacts on the body, especially when mixed with other medications. The biggest problem with alcohol is that it can rob the body of deep sleep, where repair of both mind and body takes place. It may help you fall asleep, but it will lead to more harm than good over the course of the night.
  • Avoiding exercise right before bed. Exercise changes the chemical composition of the body and can lead to higher level of wakefulness hormones—like adrenaline—which can make sleeping harder.
  • Taking cat naps in the afternoon to offset lost sleep from the night before. Don’t oversleep! Ten to twenty minutes can be refreshing.
  • “Banking” sleep. If you expect to undergo surgery in the near future, try to get extra sleep before you go in for the procedure. This added “bank” of sleep can help speed up recovery, sometimes significantly.
  • Trying different kinds of therapeutic pillows and mattresses. Some people with chronic pain sleep best in a reclining chair. Others prefer a wedge pillow for sleeping upright. Still others will put a pillow between or beneath their knees, use a special side sleeper pillow, or raise the head of their bed a few inches to find added comfort.
  • Keeping your room cool and use multiple layers of light bedding that you can replace and remove at will. A too-warm room can make sleeping uncomfortable because it can alter the body’s thermal regulation. Feeling too hot or too cold may make pain unbearable.