People with pain often report disrupted sleep, and we usually think of pain making sleep difficult. This is often true, but could the reverse also be true? Could poor sleep lead to chronic pain? It turns out that research supports this idea. It has been known for many years that poor sleep quality makes the pain worse and can predict the development of chronic pain. You have probably experienced increased pain and achiness the day after a night of poor sleep.
A study of over 10,000 people published in the journal Pain in 2015 reported that people with chronic pain and chronic sleep problems were almost twice as likely to have increased pain perception as people with either chronic pain or insomnia, or neither condition. We don’t know WHY or HOW sleep and chronic pain are related, although there are a few ideas.
Sometimes it’s pretty clear that pain causes sleep disruption. Many people use distraction to manage chronic pain very effectively, but the process of falling asleep involves reducing distractions, so the brain starts to focus on the pain. When the brain focuses on pain, perception of pain increases, and … there goes sleep. This is also a reason why pain is perceived as being much worse overnight. But quite often, even when pain is controlled by medications or other therapies, sleep is still disrupted, setting you up for more pain.
Sometimes other physical or mental health problems, or the medications to treat those problems, cause disrupted sleep. Some pain medications can disrupt sleep, although most cause increased sleepiness. One type of pain medication that can cause disrupted sleep is opioids, although that seems counter-intuitive – we usually think of opioids as causing sleepiness, which also happens. But opioids can cause hormone changes that affect sleep patterns, withdrawal from short-acting opioids overnight can cause sleep disturbance, and opioids can worsen depression, sleep apnea, and restless leg syndrome, which affect sleep.
It is clear that sleep and pain are interrelated, and that addressing sleep problems is part of managing pain. If you have trouble sleeping, there are a few things you can do. A place to start is with “sleep hygiene,” which are behaviors that promote healthy restful sleep. A few essential points are to go to bed at the same time every evening and get up at the same time every morning, do something restful and relaxing before bed (not watching the evening news or the last game of the World Series), avoid “screens” in bed (TV, smartphone, e-books, etc). An internet search for “sleep hygiene” will quickly provide you with a full list.
Aromatherapy can be useful. Lavender has been well known for centuries to promote sleep. You can also try essential oils of lemon or yuzu citrus, bergamot, ylang ylang, clary sage, or jasmine. Herbal teas are helpful for many people, including chamomile, valerian, vetiver, passionflower, and lemon balm –but you should check for interactions with any medications you take.
If none of that helps, talk to your health care providers (including mental health) about medications that may be disrupting your sleep, and see if those can be changed, either the medication itself or the timing of doses. Quitting smoking can lead to improved sleep. Nicotine withdrawal overnight can lead to disruption of sleep and early awakening. Your health care provider can help with smoking cessation. Diphenhydramine (the active ingredient in Benadryl) is an effective sleep aid for many people, as is melatonin, which is a pill form of the substance the brain uses to put itself to sleep. Both are available without a prescription, but you should check with your providers before taking them, to avoid possible medication interactions.
If you snore or have “restless legs,” a sleep study may be useful in determining what therapies might be beneficial. Prescription sleep medications may be indicated, but these should be used very sparingly because tolerance to the effects can develop quickly.
What DOESN’T work: Alcohol does make people fall asleep faster and sleep more deeply – early in the night. Later in the sleep period, alcohol before bed causes increased wakefulness as it is cleared from the body. Alcohol can also make sleep apnea and restless leg syndrome worse, further disrupting sleep.
Sleep is important, but everybody has a “bad” night here and there. It is also very normal and very common to wake briefly during the night, sometimes two or three times. This is not something to worry about, but if you have significant difficulty getting to sleep, getting back to sleep, or staying asleep more than 3 times a week for more than 3 months in a row, it’s worth making some changes, as part of your pain management strategy.
At North Shore Pain Management we provide advanced, evidence-based, multidisciplinary and cost-effective pain management. Our goal is to improve your ability to return to the activities you have been missing as well as provide a meaningful reduction in pain.