Chronic Pain and Sleep -
Is There Hope?
by Katie Harris
Nothing on this website is intended to be a substitute for professional medical advice, diagnosis, or treatment. You should always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The contents of this website are for informational purposes only.
It’s 11 pm, you’re home after a long day and all you want to do is jump into a big pile of pillows and fall asleep. However, you know you’re probably going to wake up in a few hours with your whole body stiff from laying in one place, or not be able to fall asleep at all. So, you might be wondering what’s the point.
If this sounds familiar, you probably think a lot about chronic pain and sleep, and may have asked yourself: Is there hope? Whatever the cause of your discomfort, there may be a few ways we can help.
01
What is Pain Anyway?
There’s a reason why many doctor’s appointments require you to describe your discomfort on a scale. They usually ask about the level and quality of your pain using a one to ten scale to describe the sensation. Throbbing, burning, stabbing, no one’s experience is the same. While none of those are fun words to describe how we may be feeling, they often give doctors indicators of what you’re experiencing and where it could come from.
For example, burning could be muscle or disc-related, while numbness and tingling could come from nerve damage or pinching. If these sensations are so unpleasant, you aren’t alone in wondering why our bodies are so good at letting us feel them.
According to Johns Hopkins Medicine, pain comes from the brain, and in most cases, it’s a warning to us that there is something wrong and we should stop what we are doing to aggravate the problem.
The warning type of pain, such as burning your hand on a hot pan or banging your head on a low ceiling, is called acute. This type of pain can also bring about a slew of other physical and mental effects like anger, nausea, and dizziness. Just think about how a dog acts when you need to remove a thorn from their paw.
There is a difference, however, between acute and chronic pain. Chronic pain is characterized by ongoing issues that last for weeks, months, or even years according to the National Institute of Health. The cause could be an old injury from a car accident, a disease affecting the nerve tissues like fibromyalgia, or even the effects of surgery. Unfortunately, the causes aren’t always as simple, making treatment more difficult.
02
Common Causes of Pain
Chronic pain probably has the most varied causes of any condition, because it’s just that, pain that won’t go away. In some cases, you may not even be aware that your condition is classified as chronic because you’ve become so accustomed to it. We’ll list a few of these issues below and then get to the ways you can improve your rest with them.
Cancer Pain
Not that it’s a contest, but cancer is at the top of the US News’ list for the most painful medical conditions because not only is the disease itself extremely uncomfortable, the treatments are often even worse. According to the American Cancer Society, depending on the type of cancer, symptoms can include headaches, muscle aches, joint stiffness, and bone tenderness.
One European study showed that sleep quality in stage VI cancer patients suffers as pain increases and quality of life decreases. This means the worse you feel, the worse you sleep, which in turn can worsen your pain once again. If you’re experiencing these symptoms with cancer, the ACS stresses that any type of pain is treatable, and you should talk to your doctor about your options.
Fibromyalgia
Caused by damage to the nerve tissues throughout the body, fibromyalgia has no known cure according to the Mayo Clinic, and when it flares, it can cause bouts of extreme pain that can last for hours, days, or months. When it comes to rest, this can be a major interruption, but these flares do end eventually. Sleep problems are even a factor in diagnosing patients with fibromyalgia because the disease causes such notable disturbances, according to Psychology Today.
Arthritis
Arthritis is a particularly painful condition that doesn’t just affect the elderly. Juvenile Rheumatoid Arthritis or JRA is an auto-immune condition that can also flare up throughout your life causing painful joints and stiff muscles. Because this condition is often accompanied by restless leg syndrome, sleep can be even more elusive.
Arthritis can appear in many forms, and while none of them are a good time, there are many ways of treating and coping with the condition, but we’ll get to more of that in a moment.
Temporomandibular Joint Dysfunction (TMJ)
This is a long name for the sensation of tightness, or a locking sensation in the jaw. This pain can come out of nowhere and lead to difficulty chewing, talking, and many other important activities that affect your quality of life. In some cases, TMJ can come from grinding your teeth at night, or tightly clenching your jaw. This discomfort can disrupt sleep and cause increased pain when you wake up in some cases.
Endometriosis
Once dismissed as regular menstrual discomfort (which is still nothing to scoff at) endometriosis is caused by endometrial cells growing into the back, pelvis, bowel, and other tissues. With the monthly hormonal changes to these cells, they become inflamed and cause widespread pain throughout the body.
There are a variety of treatments for endometriosis ranging from medication to surgery to remove the misplaced cells. When untreated, however, this pain can disrupt waking life and your rest as many tasks become unmanageable. One study conducted in Brazil unsurprisingly showed that having endometriosis caused sleep quality to deteriorate significantly.
03
Why Is It So Difficult To Sleep?
These are only a few of the many diseases that can cause chronic pain, but there is one thing they all have in common: messing with your sleep. From struggling to find a good position to painful skin contact with the bed, any number of factors could be making it difficult to get the rest you need, but there are some not so obvious triggers that you may want to consider. In other words, we’re going to put on our nerd goggles and delve into some of the underlying problems that are messing with your rest.
Anxiety
While pain is distracting enough, sometimes the fear of pain or the worry that it will interrupt your sleep can interfere with your schedule or desire to wind down. In other cases, pain and anxiety naturally occur together, according to Harvard Medical School. This is especially common with nerve-related disorders such as fibromyalgia because of the biological similarities between brain function during anxiety and pain.
When anxiety becomes intense, it can interfere with rest by causing increased muscle tension, aches, racing thoughts, and an elevated heartbeat.
Interruptions
Intense pain can wake you up from simple movements like rolling over, and from a lack of movement causing stiffness in the joints. Both effects are extremely common with arthritis. When pain wakes you up and causes you to reposition, it can throw off your sleep schedule, lowering your quality of rest.
One study from the University of Utah found that those with chronic pain experience many more sleep disturbances than those without the condition.
Prolonged Sleep Latency
If you have insomnia, you’re probably familiar with the long nights of staring at the ceiling, your phone screen, or the wall for hours before you fall asleep. No matter what you do, you just don’t feel tired. This is because sleep latency, or the time it takes to fall asleep, is longer in those with insomnia.
According to a study at the University of Rochester, this is probably due to a state of hyperarousal before bedtime. According to the study, this is particularly true when it comes to pain. Think about it: discomfort creates arousal, and generally not the good kind. Have you ever been lost in your thoughts when you stubbed your toe, caught your hair in a car window, or banged your head? When we feel unpleasant, we’re instantly alert. Maybe that’s why pinching yourself helps to keep you awake.
However, when this discomfort is constant, it can get in the way of sleepy hormones by placing you in a semi-permanent state of arousal, inducing insomnia.
04
Poor Sleep May Make Pain Worse
If you find yourself in a downward spiral after a few nights of poor rest, you’re probably not imagining it. According to an article in Sleep Medicine Reviews, sleep deprivation increases sensitivity and causes more discomfort. Furthermore, this increased discomfort is likely to further sleep deprivation by creating more arousal, disruptions, and increasing psychological and physical stress on the body.
This research is supported by an article in The Clinical Journal of Pain, which shows those with higher pain intensity report more disturbances in their rest, longer sleep latency, and lower sleep satisfaction. While this may not be the information you wanted to hear, there is a bright side. This pattern also means the reverse is true, so while poor rest means more discomfort in an exhausting cycle, better rest means less discomfort, and more sleep in the future as well.
05
Better Sleep May Improve Pain
According to research from a study in Norway, better sleep could be the missing piece in rehabilitation for lower back pain. The study showed that the likelihood of recovery from lower back pain was directly associated with how well the patients slept. So reducing sleep problems could be key in improving pain.
According to the Cleveland Clinic, in some cases, patients who experience chronic pain are diagnosed with sleep disorders such as sleep apnea, and when the sleep problems are addressed, the pain goes away as well. We aren’t saying that this is the only solution for every type of pain, but there is certainly a relationship between the two.
Depending on why you experience pain, there may be other important factors to consider, but sleep is probably part of the answer.
The key is to break the cycle of poor sleep and worsened pain, and we have a few tips on how you can do just that, but first, there are a few things you may want to discuss with your doctor.
06
Questions for Your Doctor
We want you to sleep better, which is why we did the research for you to try to break down the sciencey terms into language everyone can understand, especially if they’re researching this article at four in the morning in a desperate attempt for better rest. However, we don’t pretend to be experts, so here are a few questions your doctor should be able to answer to lead you on the path to better rest.
Are sleeping pills right for me?
Sleeping pills often sound like a quick fix for insomnia, and after weeks, months, or years of unsatisfactory rest, we don’t blame anyone who decides to give them a try. Before you begin taking them, however, there are a few risks to consider that your doctor should be able to help you navigate.
Aside from the fact that many can become addictive, some pills mainly increase the amount of REM or non-restorative rest you get, though they may reduce interruptions and shorten the time it takes to fall asleep. The main question to ask yourself is if you feel more rested after taking them. If you find your rest is better and you awake feeling refreshed, they might be the right option for you.
Is physical therapy an option?
While physical therapy can be effective for rehabilitation and recovery after surgery or traumatic events, it doesn’t always relieve pain in the short term, and in some cases, it can be more painful before it gets better. However, in an article from PT in Motion, Dr. Keith Poorbaugh, a physical therapist, discusses how physical therapy and sleep can work together for patient improvement.
“Sleep is a necessary element of the healing process,” he says. “Once we have emerged alive and awake from the tissue trauma, the long journey ahead is far less difficult if we develop good sleep behaviors.”
If you’re looking to find ways to relieve your discomfort, talk to your doctor about what physical therapy can offer you, but keep in mind that real change often takes time and effort, and probably won’t be a quick fix. In any case, the better your sleeping habits and behaviors, the more you should be able to accomplish with PT.
Can I take pain medicine at night?
This is a great question to bring to your doctor because there is such a great variety of pain meds. However, when it comes to opioids, it’s probably best to not get in the habit of taking them for sleep. Chronic conditions and opioids have a complicated relationship of their own, but when it comes to rest, it’s pretty clear that opioids aren’t the best option.
A study at the University of California in San Diego found that opioid usage associated with pain reduces the time spent in slow-wave or deep rest, or in other words, the restful and restorative sleep. For those with chronic pain, this could also mean you may wake more easily. It could also mean depriving your body of restorative sleep that could help heal the body and reduce discomfort in some cases.
If you’re fighting intense postoperative discomfort, they could be a short term option. However, when you’re dealing with chronic pain, while you may get to sleep, it could mean that your problems could become worse rather than improving after a long night of rest, and the effect could compound. In any case, talk to your doctor about the side effects of your medication and the risk associated with using them for sleep.
Can you help with my anxiety?
Contrary to popular belief, most primary care doctors can screen for anxiety and prescribe medications, activities, and other treatments to help manage symptoms. If you feel that your anxiety is keeping you awake, it’s probably not a bad idea to ask your doctor how they can help.
Is CBD an option?
CBD works by helping the body raise levels of anandamides and reducing swelling in the brain. These two functions could help reduce insomnia and pain. Unlike other strands of the Cannabis plant, CBD shouldn’t produce a “high” or alter your state of mind, in fact, some children with epilepsy even use it to help control their seizures. If you’re in an area where CBD is legal, your doctor should know what your options are for the management of your condition through CBD.
07
Tips for Coping
In an article from Harvard Medical School, Dr. Padma Gulur, a specialist at Massachusetts General Hospital says, “For chronic pain conditions, what you need is good sleeping habits from the beginning — things that will last.”
You’ve probably heard before that attitude is everything, and while we think it can help you take control of your life and your condition, there are a few things you can do to help with your situation that don’t involve smiling or positive affirmations. We’ll get into a few of those lasting habits that could help aid your progress.
Maintain a Regular Schedule
Creating a schedule is a great way to help your body know when to wind down. This way, if you start to feel uncomfortable when it’s time to go to bed, you’ll at least have consistency on your side. Your schedule should consist of what’s right for you, and you could mold it to your schedule. The key is consistency, however, remember to get at least seven to eight hours of sleep.
If you struggle to stick to a schedule, try using an alarm or timer to let you know when to start winding down.
Take Meds Right Before Bed
If you use pain or sleeping pills, it’s always best to follow your doctor’s instructions on when to take them. However, when it comes to melatonin or other over the counter drugs, it’s often the best choice to take them right before bed, so you don’t keep yourself alert through the effects that should make you drowsy. Some come in the form of extended-release to help you stay asleep throughout the night despite disruptions.
Only Stay in Bed Awake 5-10 Minutes
Our brains associate activities with locations, so if you spend more time in your bed on your phone than you do sleeping, don’t be surprised when you get cozied up but the drowsiness won’t come. If you’re struggling to fall asleep, the experts recommend getting up and doing something else for a while.
Once you take a break to stretch, write down your thoughts, or complete another relaxing activity, you could try returning to your bed and falling asleep.
Try Relaxation or Meditation
Practicing mindfulness and meditation can draw us back to the present. When you’re dealing with pain, this could help calm the body, lower the heart rate, and improve mood regulation according to a Duke University study. However, the benefits extend further than just relaxation.
A California study found that mindfulness meditation practice can reduce chronic pain, depression, and increase the quality of life in some patients. While no method will work perfectly for everyone, we’d say it’s worth a try.
Reduce Caffeine
Caffeine is the most widely used legal psychoactive drug in the world, and it can be great for battling fatigue and getting you through a long day. Some studies even show it can help dull headaches and amplify the effects of painkillers. However, it can also get in the way of your rest.
As the caffeine has a half-life of 4 to 6 hours, an afternoon coffee could make it harder to fall asleep in the evening. So while after lunch it may be better to stick with decaf, a morning espresso might not be so bad.
Avoid Alcohol, Especially Before Bed
While pain and sleeping pills may be more controversial in their effects on sleep, alcohol is not. Research from Wayne State University shows that while alcohol may initially cause drowsiness and sedation, we rapidly develop a tolerance to these effects. Instead, alcohol begins to disrupt the second half of our sleep cycles and eventually can cause insomnia.
If you’re dealing with chronic conditions, we know sleep is essential to the recovery and management of that discomfort. As alcohol disrupts sleep, it’s probably a good idea to skip the nightcap and opt for drinking long before you tend to sleep.
Consider CBD
If you’re looking for a solution to help manage your discomfort and regulate your sleep, you may want to consider CBD. Keeping in mind that this drug is not regulated or legal in every country or state, various studies can vouch for its pain-relieving and sleep-inducing powers.
If you plan on using cannabinoids to treat your discomfort or sleep-related concerns, it’s best to speak with a doctor to discuss potential risk factors and the possibility of it interfering with the medication you are already taking. As always, we encourage you to use caution in where you purchase these meds as they are not regulated.
08
Conclusion
Sleeping with chronic pain may seem like an uphill battle, but with a few adjustments, it could become much more manageable. Whatever the cause, the important thing is to keep trying to find what works for you and do your best to avoid habits that self sabotage both your health and your rest. If there’s one thing we’ve learned from the research, it’s that better sleep means better management of your condition, and less discomfort means better sleep.
To get started on this upward cycle, we recommend talking to your doctor about the research to learn what’s best for your case.
Katie Harris
Katie is a content writer and serial hobby collector who enjoys naps almost as much as her pets do. When she isn't writing, she likes to ride her motorcycle, catch Pokemon with her hubby, and practice yoga with her dog.
