Getting a good night’s sleep is very important for health. Sometimes, pain can make it difficult to get a good night’s sleep. Here is some information regarding pain and sleep courtesy of Stephanie Linder at The Sleep Health Institute (edited).
Pain and Sleep
When thinking about the most prevalent and significant health problems, chronic pain is rarely the first thing that comes to mind. But the consequences of pain should not be underestimated: it burdens more people in the U.S. than heart disease, cancer, and diabetes combined.
Much of this pain is not simply a short-term or minor issue. Over 100 million people with pain in the U.S. find that it lasts for weeks or months, and more than 14.4 million people have the highest level of pain. Studies have estimated the total economic cost of pain in the U.S. to be at least $560 billion per year.
One way that pain can impact quality of life is by affecting sleep. Pain and sleep also have an even deeper connection: sleep disturbances can contribute to the onset and severity of pain. In fact, the impact of sleep on pain may be greater than that of pain on sleep.
How Pain Affects Sleep
Doctors and researchers have long recognized a relationship between pain and sleep. Initially, this relationship was primarily understood based on the negative effect that pain can have on sleep.
Patient experience supported the presence of this connection. Sleeping problems are “perhaps one of the most prevalent complaints” of patients with chronic pain, and studies have found that 67-88% of these patients report sleep complaints.
Both acute and chronic pain can complicate the ability to get good sleep. When suffering from pain, especially acute pain, a person may not be able to settle into their normal sleeping position. In some cases, including with chronic pain, it can be difficult to find any comfortable position in which to relax and fall asleep. Falling asleep is only part of the problem. The predominant complaint of pain sufferers is interrupted sleep from repeated nighttime awakenings. With each awakening, the challenge of falling asleep with pain rears its ugly head again.
Anxiety can compound pain-related sleep problems. Anticipating pain or dwelling on pain, both of which can occur with pain catastrophizing, can burden the mind in a way that makes it harder to get a good night’s sleep. People with an anxiety disorder often struggle with sleep disturbances, and those may be exacerbated by the presence of acute or chronic pain.
That pain can disrupt sleep is only part of the story. Further research into the association between sleep and pain identified clear indications that sleeping problems can contribute to pain. In fact, the impact of sleep on pain may be greater than the impact of pain on sleep. As one review of existing research summarized, “assessed in broad strokes, sleep and pain may appear to be reciprocally related, whereas finer-grained analyses suggest that poor sleep may exert a stronger and perhaps more durable toll on the experience of chronic pain.”
This review found that the impact of sleeping problems on pain were multifaceted. People with sleeping problems were more likely to develop new cases of pain. They were also more likely to experience increases in daily pain levels and to have a worse long-term outlook for resolving pain. The reverse was also found — that good sleep can help resolve pain — which enhances the strength of the causal connection between sleep disturbances and pain.
Better sleep may also play a role in managing the psychological aspects of how pain is experienced. As lack of sleep can contribute to anxiety, increasing quality and quantity of sleep may help combat worries about pain including the preoccupations that are part of pain catastrophizing.
Further research is needed to continue to clarify the connections between sleep and pain. For example, there is a need to expand this analysis to include more types of pain. The research to date has focused primarily on chronic pain, specifically from headaches and musculoskeletal causes. Nevertheless, there is strong evidence that indicates that an emphasis on improving sleep can deliver meaningful benefits for preventing and managing pain.
How to Get Sleep When You Have Pain
Improving your sleep can play a useful role in a treatment plan for pain. Because pain can make it harder to get good sleep, though, it takes some planning and effort to get the most and best sleep that you can. This section reviews some steps to help you optimize your sleep and pain management.
Consult a Health Professional
If you have acute or chronic pain that is affecting your ability to undertake normal daily activities, it is important to see a health professional. A doctor or nurse can try to identify the underlying cause and recommend appropriate treatment, and this can be an essential component of achieving lasting reduction or elimination of pain.
A doctor may make referrals to other health professionals that can offer further help. For example, specialists in pain management or in specific kinds of pain, such as headaches or fibromyalgia, can give tailored suggestions to fit your situation. Referrals to physical or occupational therapists can help create a home program for exercises or stretches to do before bed or when you wake up.
A referral can be provided for a psychiatrist as well. Psychotherapy assists many patients in controlling their response to pain. Some psychiatrists have a background in cognitive behavioral therapy for insomnia (CBT-I), which has proven results in combating many types of sleep disturbances.
Sleep hygiene is an umbrella term that refers to creating the right context for sleep. That context is composed of your environment and your habits. Focusing on both can provide an avenue for addressing problems with both sleep and pain.
A good starting point for improving sleep hygiene is with your sleep environment. In this section, we’ll walk through some of the core elements of your sleep setting and how to improve it.
Mattress and Pillow
Where you sleep is central to how well you sleep. If you’ve ever had to sleep on a clunky pull-out sofa bed, you’ve likely experienced how a bad mattress can interfere with sleep and can cause you to wake up with aches and pains.
Choosing a great mattress and pillow helps achieve two key goals: increasing comfort and giving your body the support it needs. Comfort is subjective and relates to the firmness of a bed. Firmness is often described on a scale of 1-10 with 1 being the softest. For most people, medium firm, between 4-7, is the most comfortable; however, some people prefer a much softer or firmer bed.
Support refers to how well a mattress promotes the alignment of your body. Proper spinal alignment can help to prevent and resolve issues around waking up with pain. Typically, responsive mattresses promote alignment because they can provide extra cushioning at your main pressure points.
As an example, people wondering how to sleep with lower back pain and sciatica frequently find that a responsive mattress gives bolstered support in the lumbar area. People who have arm pain and numbness while sleeping are also likely to find that a responsive material, which has extra give at the shoulder, offers relief.
Extra pillows can add additional comfort and cushioning as well. A body pillow or a pillow between the knees can help take pressure off the lower back in side sleepers. Stomach sleepers often find that small, thin pillows can give needed cushion to the neck or abdomen. Extra pillows can be used to elevate part of the body to fight inflammation as well.
The characteristics of your mattress and pillows should be in concordance with your body weight and sleeping position. Most experts say that side sleeping is the best position, but the fact is that many people find it hard to elect a sleeping position. For that reason, it can be hard to say that there’s any best sleeping position for neck pain, headaches, joint pain, or other conditions. Instead, a well-selected mattress and pillow can give your body the support in needs in the position that you usually sleep in.
Once you have your mattress and pillow selected, the next step is to find bedding that is a match with your needs. Different types of bedding and sheets can be better for staying cool or staying warm. A quality comforter with the characteristics that you prefer can make your bed cozy and comfortable when you head to bed.
Setting Up Your Bedroom
It’s important to think about not just your bed but your entire bedroom. Making it comfortable, welcoming, and free of distractions plays an important part in sleep hygiene.TemperatureSoundLight
Choosing your routines wisely can make it easier to get great sleep. There are several sleep-related habits that can boost your sleep hygiene.Go to bed and wake up on a scheduleHave a pre-bed routineCut down on non-sleep activities in bedLimit alcohol intake
Learn More About Pain and Sleep
- The American Chronic Pain Association (ACPA). ACPA is a nonprofit organization that delivers information about chronic pain and tools for self-care and pain management. Resources about support groups are also available.
- The U.S. Pain Foundation. This organization advocates on behalf of people who suffer from chronic pain and provides information to better understand and cope with pain. The Pain Connection program organizes a network of support groups.
Government Research Initiatives
- The National Institutes of Health (NIH) Pain Consortium. The NIH Pain Consortium is an initiative to encourage research and collaboration in the field of pain across different disease-focused agencies within the NIH.
- The National Center for Complementary and Integrative Health (NCCIH). This government research agency focuses on non-traditional medical therapies. Their website is useful for people interested in mind-body medicine and the use of natural products, providing details of the known benefits and risks.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). NIAMS is the lead agency of the U.S. government on arthritis and many other conditions that cause pain. Their website provides useful background and insight into new directions in research.
- The Arthritis Foundation. This nonprofit group works to educate and support people with all types of arthritis while promoting research and advocacy directed toward government, insurers, and employers.
- The American Migraine Foundation (AMF). This organization, a patient-focused offshoot of the American Headache Society, helps people who suffer from migraines to better understand how to cope with these headaches. A registry is available for patients who want to contribute to migraine research.
- The National Headache Foundation (NHF). The NHF website provides a physician-finder tool to help patients find specialists, describes ongoing research in the field, and offers educational materials, including webinars.
- American College of Obstetricians and Gynecologists (ACOG): Endometriosis. ACOG is the leading national organization of women’s health professionals, and this page offers information about the causes and treatments for endometriosis.
- The Endometriosis Foundation of America. The Endometriosis Foundation is a nonprofit group that strives to raise awareness about endometriosis and empower women affected by this condition through information and advocacy.
- American Diabetes Association. The American Diabetes Association promotes research, advocates for patients, and disseminates useful information for preventing and living with different types of diabetes.
Gastrointestinal Problems & IBS
- International Foundation for Gastrointestinal Disorders (IFFGD). IFFGD is a nonprofit group that works to bring awareness to GI disorders like IBS. They offer various programs for patient knowledge and support.
- University of Washington Medicine: Finding Solutions for Chronic Low Back Pain. This video featuring Dr. Mark Jensen explores some of the key issues in treating chronic lower back pain and directions for future research.
- Mayo Clinic: Tools to Manage Chronic Pain. This video describes different components of the Mayo Clinic’s approach to addressing chronic pain.
- ACPA: Consumer Guide to Pain Medications and Treatments. This series of videos from the ACPA delves into available medications to treat pain and the benefits and risks that accompany the use of them.
- Swedish Hospital: What is Fibromyalgia and How is it Treated? This video from Dr. Gordon Irving with the Swedish Medical System in Seattle gives an overview of fibromyalgia symptoms, treatments, and research.
- Harvard University: Sleep Health and Education. The Sleep Medicine program at Harvard operates a website with evidence-based information about an array of sleep-related issues.
- The National Sleep Foundation (NSF). This sleep-focused organization shares articles about sleep and has links to numerous resources for learning more about optimizing your nightly rest.
- Psychology Today: Cognitive Behavioral Treatment for Insomnia (CBT-I) Defined. This article by Allison Siebern Ph.D., a board-certified sleep psychologist and Assistant Professor at Stanford University, gives an introduction to CBT-I.