sleep and pain

As a physical therapy clinic, we couldn’t count the number of times we hear patients say they can’t sleep very well because of their pain. The fact that pain can cause difficulty sleeping is extremely common and well-known. However, what many don’t realize is that the relationship between sleep and pain goes both ways. In fact, research has shown that the effect of sleep on pain may actually be stronger than the effect of pain on sleep.

Shortened sleep duration, fragmented sleep (i.e. frequent waking during the night), and poor sleep quality have all been found to increase pain sensitivity and are risk factors for developing chronic pain. Several studies have found that even one night of limited sleep is associated with an increase in pain intensity and decrease in pain thresholds the following day. This means that poor quality sleep can exacerbate pain you’re already experiencing or increase the chance that you will experience pain from something that normally wouldn’t bother you.

This relationship is true in people who are having surgery as well. As a matter of fact, a recent research review showed that pre-surgery sleep problems were the strongest predictor of poor control of post-operative pain. Even poor sleep just the night before surgery has been found to influence the severity of post-op pain. It’s not shocking that good sleep after surgery is also very important for your recovery. In one study looking at patients who received total knee replacements, good quality sleep was found to correlate with better pain relief in the acute phase and better functioning 3 months later.

Researchers report that sleep difficulties increase pain due to a few reasons. First, there is a direct relationship between sleep and pain. Sleep impacts the chemical responses in your body, including inflammation and your immune system, which has corresponding effects on your body’s resilience. Studies have found that sleep deprivation can impair your brain’s ability to reduce pain signals and can increase the sensitivity of your nerves and spine. Then smaller triggers can begin the cascade of events in your body that lead to the sensation of pain. Secondly, there seems to be an indirect psychological cause for the relationship between pain and sleep as well. Those who have difficulty sleeping tend to get excessively worried about their sleep, which can then trigger an emotional response and arousal of your nervous system. Worry and anxiety about your pain can also keep your brain going at night making it difficult to fall asleep. In short, this means you can end up in a cycle where stress about your pain or difficulty sleeping causes further sleep disturbance and then more pain and disability as a result.

The good news is that there is plenty you can do to avoid this self-perpetuating cycle.

Here are some tips for improving your sleep both in the short term and long term:

1.       If you have a rough night’s sleep, you can reduce pain sensitivity by taking a short (i.e. 30 minutes) nap in the morning or afternoon. Just don’t sleep too long or nap too late and interfere with the following night’s sleep.

2.       Deep breathing, listening to music, or mediation can help you relax and not focus on your pain or stress about getting to sleep at night.

3.       Take advantage of “feel good” modalities, such as ice or heat before bed to reduce the chance of pain interfering with your ability to fall asleep.

4.       Follow basic sleep hygiene habits: get enough sunlight during the day, get enough exercise, maintain a healthy diet, and avoid stimulants including digital screens, caffeine, and alcohol close to bed.

5.       Make your bedroom a place for only sleep. Don’t watch TV in bed. Try not to bring life’s stresses into the bedroom. If you find you cannot turn your brain off or are in too much pain to sleep, don’t stay in bed. Get up and go to another room to distract yourself for a while until you feel sleepy enough to try going to bed again.

6.       Keep your bedroom cool, dark and quiet.

7.       Maintain a regular sleep schedule. Go to bed and get up at the same time every day and night.

8.       When reducing medication use, consider maintaining your normal night-time dose as the last dose you wean from to allow for a good night’s sleep and improve pain the following day. For further information regarding types of medication, dosage and frequency as it relates to your individual condition, reach out to your physician.

9.       Talk with your physician about which pain medication may be best. For example, though opioids help reduce pain, they can often interfere with your sleep.

10.   If you have difficulty sleeping, consider working to improve your sleep quality before having surgery.

11.   After any surgery, try your best to keep a regular sleep-wake rhythm while in the hospital and back at home, even if you aren’t working or in school. An eye mask and ear plugs can help reduce noise and light to improve sleep while in the hospital as well. And work with your doctor to manage your pain at night so you can sleep well to improve your pain levels the following day. Return to normal activity and daily rhythm as soon as possible.

12.   If you have a history of difficulty sleeping, consider discussing it with your physician or a mental health professional, as treating insomnia has been shown to reduce pain as well.

To sum it all up, sleep and pain management go hand in hand. If you’re having trouble with either one, or likely both, don’t hesitate to ask your physical therapist at Spine and Sports Rehabilitation Center for strategies to help you get some restful sleep and get out of pain. Contact us to begin to address you pain and improve your sleep.

Sources:

1.       Faraut B, Léger D, Medkour T, et al. Napping reverses increased pain sensitivity due to sleep restriction. PLoS One. 2015;10(2):e0117425. Published 2015 Feb 27. doi:10.1371/journal.pone.0117425

2.       Krause AJ, Prather AA, Wager TD, Lindquist MA, Walker MP. The Pain of Sleep Loss: A Brain Characterization in Humans. J Neurosci. 2019;39(12):2291-2300. doi:10.1523/JNEUROSCI.2408-18.2018

3.       Pacheco D. Pain and sleep: Common sleep disturbances & tips. https://www.sleepfoundation.org/physical-health/pain-and-sleep. Published December 4, 2020. Accessed February 9, 2022.

4.       Salwen JK, Smith MT, Finan PH. Mid-Treatment Sleep Duration Predicts Clinically Significant Knee Osteoarthritis Pain reduction at 6 months: Effects From a Behavioral Sleep Medicine Clinical Trial. Sleep. 2017;40(2):zsw064. doi:10.1093/sleep/zsw064

5.       Sipilä RM, Kalso EA. Sleep Well and Recover Faster with Less Pain-A Narrative Review on Sleep in the Perioperative Period. J Clin Med. 2021;10(9):2000. Published 2021 May 7. doi:10.3390/jcm10092000

6.       Staffe AT, Bech MW, Clemmensen SLK, Nielsen HT, Larsen DB, Petersen KK. Total sleep deprivation increases pain sensitivity, impairs conditioned pain modulation and facilitates temporal summation of pain in healthy participants. PLoS One. 2019;14(12):e0225849. Published 2019 Dec 4. doi:10.1371/journal.pone.0225849