Approximately 65% of adults with chronic pain have insomnia or a diagnosed sleep disorder. So in this article, we’ll be exploring the link between chronic pain and sleep, and ways to break the continuous cycle of pain and sleeplessness.
Did you know that approximately 65% of adults with chronic pain have insomnia or a diagnosed sleep disorder? It’s true. And, guess what? Older adults are especially prone to chronic pain and insomnia.
The truth is chronic pain and insomnia make for a bad mix. In fact, chronic pain disrupts sleep in approximately 20% of Americans three or more nights a week. Regardless of the origin of the distress (back or hip pain, headaches, gastrointestinal, or even emotional pain), chronic pain not only robs you of your energy and happiness but also prevents you from properly resting your mind and body. Rest is crucial for repairing your body and easing your pain. And, guess what? When you are fatigued from a lack of sleep, you feel pain more intensely.
And, when you are in constant pain, oftentimes, the best way to get relief is to go to sleep.
Unfortunately, however, people who struggle with chronic pain often have a hard time relaxing long enough to fall asleep. This can lead to pain and even more sleepless nights. The result? Crankiness, mood swings, extreme fatigue, disorientation and confusion, cognitive delays, poor short-term memory, high blood pressure, weight gain, low productivity, aches and pains, depression, anxiety, etc. Sleep helps your body refill its energy reserves and heal from daily stresses.
But, if you suffer from chronic pain and happen to fall asleep, the pain may worsen throughout the night, causing you to wake up periodically in agony. And, if you are able to get back to sleep once you prematurely awaken, you may be extremely tired the next morning. These “mini-arousals” can prevent you from drifting into a sound sleep, leading to daytime fatigue upon awakening. When you’re unable to get the sleep, you need to function properly, you become hypersensitive to pain. In other words, your pain worsens.
The good news is you can break this continuous cycle of pain and “sleeplessness”. There are ways you can get a sound sleep – even if you are struggling with chronic pain. How? Well, by developing positive sleep habits that you can stick with indefinitely and by relying on your body’s natural instinct to “shut down” when its energy reserves are depleted. Addressing your pain and insomnia simultaneously can help you get the relief you need to be your “best self!”
Is There a Link Between Sleep, Chronic Pain, and Mental Health?
Studies suggest that people with chronic pain may experience an endless cycle of pain, insomnia, depression, or anxiety. For instance, a person with chronic pain may experience anxiety if he or she is unable to fall or stay asleep.
Once this person finally falls asleep and awakens the next morning, he or she may feel groggy, depressed, moody, extremely tired – and even achier than before. If this individual is unable to get proper rest the next night, he or she will experience a repeat cycle of chronic pain, poor sleep (insomnia), and mental health issues (depression or anxiety).
In fact, researchers found that approximately 33% of people who have chronic pain also struggle with anxiety or depression. Thus, study results suggest that people, who suffer from chronic pain and depression, not only have elevated levels of pain and poor sleep habits but also have a hard time “shutting down” when it is time to relax and go to sleep.
What Prevents Some People with Chronic Pain from Falling and Staying Asleep?
The truth is chronic pain impacts sleep patterns differently, depending on the individual and the severity of the symptoms. For instance, some people experience nighttime flares (increased pain) that are triggered by their sleep positions. While others may experience constant pain that doesn’t ease up once bedtime hits. Sometimes, the bed (too soft or too hard pillows, heavy covers, a lumpy or too hard mattress, etc.) itself is uncomfortable or the environment is too chilly, hot, quiet, or noisy, preventing sleep.
However, stress is a major culprit in the never-ending chronic pain/insomnia saga. Stress worsens everything, so it just makes sense that it could ramp up your pain and prevents you from falling and staying asleep. Add in frequent “wake-ups” and you end up with an individual, who is functioning on little-to-no fuel. In fact, a 2013 study found that frequent “nighttime wake-ups” were the most common sleep concern in people struggling with chronic pain.
To fully grasp the cycle of chronic pain and insomnia, you must first understand the sleep cycle process. Once you fall asleep, you go through several stages – light sleep, deep sleep (slow-wave sleep), and REM (rapid eye movement) sleep. To feel fully refreshed and ready for the next day, you have to successfully move through all three stages (light sleep, deep sleep (slow-wave sleep), and REM sleep). If your chronic pain disrupts one or more of these stages, it can cause you to awaken the next morning feeling worse than you did the night before – “pained” and tired, unmotivated, and irritable.
A 2018 study confirmed that people with chronic pain are at risk for sleep disorders, such as insomnia, restless legs syndrome (RLS), sleep apnea, and/or narcolepsy. Although prescription pain meds are available to help with chronic pain, these medications typically come with side effects and serious risks like addiction and overdoses. So, most experts recommend seeking help for the pain and trying natural means to help you fall and stay asleep at night.
Can Lying in a Certain Position Worsen Chronic Pain and Disturb Sleep?
Your sleeping position can influence how much sound sleep you get each night, especially when grappling with chronic pain. For instance, if you have an arthritic condition like lupus or rheumatoid arthritis, you may find some relief by lying on your back. Why? Because this takes most of the pressure off of your joints.
When you lie on your side, the pressure falls directly on those joints, increasing your risk of discomfort and pain – and preventing you from getting sound sleep. On the flip side, however, if you suffer from lower back pain, you probably want to avoid sleeping on your back or stomach, because this can put pressure on your back muscles, nerves, and spine, triggering or worsening your back pain.
So, you may want to consider sleeping on your side if you suffer from lower back pain. You may also want to invest in pillows or a mattress that can relieve pressure from your joints and support your spine.
Some health conditions, like multiple sclerosis (MS) and fibromyalgia can trigger “diffuse pain” or “widespread pain” that can be felt all over your body or in several different areas. This type of chronic pain typically occurs when a condition irritates your nerves, causing tingling, pain, or numbness. Thus, a person who has chronic “diffuse pain” may need to change positions multiple times throughout the night to reduce or stop his or her discomfort. He or she may also want to opt for pillows and an adjustable mattress or memory foam mattress that supports the movement.
Note: If you are unable to change positions on your own, ask a loved one or caregiver to help you adjust your sleeping position.
Can a Lack of Sleep Trigger or Exacerbate Chronic Pain?
Yes, it can.
There appears to be a positive correlation between sleep and pain, however, current research suggests that inadequate sleep may actually be worse for chronic pain than the impact chronic pain has on sleep quality.
A 2012 study found that shorter sleep times, broken sleep, and poor sleep quality can cause a next-day hypersensitivity to pain, especially in chronic conditions like rheumatoid arthritis or lupus. Researchers also found that people with sleep problems have an elevated risk of one-day developing chronic conditions (i.e. fibromyalgia, chronic fatigue syndrome, or migraines). Thus, study results suggest that adequate sleep may actually reduce chronic pain over time.
How are chronic pain and sleep connected? Well, pain and sleep share similar neural pathways and neurotransmitters (brain chemical messengers). In fact, a recent study found that melatonin, a hormone responsible for regulating a person’s circadian rhythms, can influence how we perceive or “see” our pain.
Researchers suggest that a lack or loss of sleep can lead to or exacerbate inflammation and autoimmune conditions. However, adequate levels of dopamine and vitamin D appear to help some people with chronic pain sleep better at night.
Overall, however, studies have garnered varying results on the effects of a lack of sleep on a person’s pain threshold and the brain’s ability to reduce or stop the sensation of pain. Thus, some researchers have concluded that addressing certain neural pathways may impact sleep by reducing or stopping pain, but more studies are needed to definitively determine if this theory is valid.
Still, when trying to determine the link between sleep and chronic pain, it is also important to examine the role sociodemographic factors play in this relationship. A 2006 study found that women are more sensitive to sleep-impacted chronic pain than men, and older adults are more sensitive than younger ones.
Researchers suggest that people with chronic pain are more likely to experience daytime fatigue (due to a lack of sound sleep), but less likely to exercise and consume healthy foods, which are necessary for pain reduction and proper sleep. As a result, pain and insomnia typically rotate in a continuous cycle until the pain and “sleeplessness” are properly addressed. Keep in mind, however, that a person’s “sleeplessness” (due to chronic pain) can also negatively affect a partner or spouse who shares the bed, causing health issues for that individual, as well.
Studies indicate that both children and adults with chronic pain may have a hard time falling and staying asleep at night, and as a result, experience more intense pain than those, who experience restful sleep on a regular basis. Researchers also assert that psychological factors (i.e. depression or anxiety), can, in part, lead to “sleeplessness.”
Precision Pain Care and Rehabilitation has four convenient locations in Richmond Hill – Queens and New Hyde Park, Lindenhurst, and Valley Stream – Long Island. Call the Queens office at (718) 215-1888, or (516) 419-4480 for the Long Island offices, to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko.