The Relationship Between
Sleep and Pain

Animated image of man waking up due to chronic pain
Disclaimer – Nothing on this website is intended to be a substitute for professional medical advice, diagnosis, or treatment… Read More Here.

Sleep and pain are closely related because pain can negatively affect how well you sleep. Pain is an uncomfortable feeling that can result from injury or health complications, and it’s usually described as throbbing, burning, stabbing, aching, or pinching. The severity of pain varies, with most people having to rate their pain according to a scale.


The way you sleep may cause pain as well. Lying in certain positions or having a bed that doesn’t provide adequate support could trigger achiness. Therefore, if your rest is impacted by pain or causing it, you’ll likely need a combination of treatment and good sleep habits.

Section 1

How Does Pain Affect Sleep Quality?

Section 2

Sleep Disorders Caused by Pain

Section 3

Tips for Sleeping With Pain

Section 4

What is the Effect of Sleep on Pain?

Section 5

Better Sleep May Improve Pain

Section 6

Conclusion

01

How Does Pain Affect Sleep Quality?

Along with impacting your daily life, pain can have a negative effect on sleep quality. There are multiple ways that pain affects sleep, including more sleep interruptions, anxiety, and longer sleep latency.

 

A diminished quality of rest creates a problematic cycle because this leaves you feeling tired and frustrated the following day. As a result, it may be harder for you to focus on school or work, and if it’s a chronic issue, this could lead to long-term health complications.

A Woman Having Migraine Trying to Sleep Animation

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.    According to research, chronic pain is linked to sleep disturbances[1], and these sleep interruptions can end up worsening pain.

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[2]. 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.

Prolonged Sleep Latency

Pain can increase the time it takes for you to fall asleep at night. 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 2000 study[3], this is probably due to a state of hyperarousal before bedtime. 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.

Does Pain Affect Your Sleep Position?

Yes, pain can affect your sleep positions. Experiencing pain can alter how you sleep because the discomfort will likely force you to adjust positions to feel more comfortable.

 

Lying on your back or your side is considered the best position for sleeping. Back pain could make it uncomfortable to rest in the supine position, though, and pain in the shoulder or hip could cause discomfort for side sleepers. Stomach sleepers with neck pain may need to move to the back or side sleeping for a more comfortable night’s rest.

 

Learn More: Best Mattress for Back Pain 

Does Sleeping in the “Wrong” Position Cause Pain?

Yes, sleeping in the wrong position can cause pain because it can lead to pressure build-up or poor spine alignment. The three sleep positions are the side, back, and stomach. The least recommended sleep position by experts is on the stomach because it puts pressure on the spine and forces you to turn your head to the side, which could lead to back and neck pain.

 

Sleeping on your back or side could cause pain, too, particularly if your mattress does not provide sufficient pressure relief or support for your body frame. For example, heavier back sleepers could develop back pain if their mattress doesn’t prevent their heavier areas from dipping. When these areas sink too much, it throws off spine alignment, which could result in back pain.

02

Sleep Disorders Caused by Pain

Animated Image of a Woman who Suffers from Delayed Sleep Phase Syndrome and Can't Fall Asleep

The main sleep disorder caused by pain is insomnia. Insomnia is when a person has trouble falling or staying asleep. Pain can lead to insomnia by creating discomfort that delays sleep onset or prompts the individual to wake up throughout the night.

 

Chronic pain is considered one of the most common causes of insomnia. Other sleep disorders that may occur alongside chronic pain include sleep apnea and restless legs syndrome.

Does Chronic Pain Have an Effect on Sleep?

Yes, chronic pain can affect sleep. These effects include poor sleep quality and reduced sleep duration. Chronic pain is characterized by ongoing issues that last for weeks, months, or even years according to the National Institute of Health[4]. People may experience chronic pain from an injury or health conditions such as cancer, fibromyalgia, or arthritis. Sometimes these conditions cause pain to flare up at night, resulting in sleep discomfort.

 

Chronic pain could lead to long-term sleep problems that exacerbate pain symptoms and worsen your mental and physical health. Good sleep is imperative for optimal health. When you don’t get enough quality rest, you can experience symptoms such as irritability, daytime drowsiness, trouble focusing, and less physical energy. Chronic sleep issues are also associated with long-term complications such as hypertension, heart attack, stroke, diabetes, obesity, and memory loss.

03

Tips for Sleeping With Pain

If you’re dealing with achiness that’s hindering your rest, consider trying out one or several of the following tips to help you sleep better with pain.

1. Relaxation techniques

2. Pain medications

3. Practicing good sleep hygiene

4. Adjusting your position

Relaxation Techniques

illustration of a person meditating
Before bed, you can practice relaxation techniques and take any pain medications necessary. Relaxation techniques can help calm your mind and distract you from pain symptoms. When you’re anxious or stressed, even about the pain you’re experiencing, this can interfere with your ability to wind down, which is necessary for sleep. Examples of relaxation techniques include meditation and deep breathing exercises. A California study[5] found that mindfulness meditation practice can reduce chronic pain and depression, and increase the quality of life in some patients.

Pain Medications

The drugs that can relieve pain and induce sleep include over-the-counter and prescription medications. Opioids are prescription medications for severe pain that can also cause sleepiness. Over-the-counter medications can also help mitigate pain for better sleep. You can purchase these medications at your local pharmacy without a doctor’s prescription. Certain sleeping medications specifically target nighttime pain and promote sleepiness, such as AdvilPM.

 

Some over-the-counter medications like ibuprofen and acetaminophen can alleviate temporary pain, but you should consult your doctor to establish a healthy treatment plan for chronic pain.

Questions for Your Doctor

A Doctor Standing Next to a Woman on an Exam Table Illustration
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.  

 

Research has found that the use of opioids[6] can reduce the amount of time you spend in slow-wave (deep) sleep. depriving your body of restorative rest 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, you may get to sleep, but it could mean that your problems may become worse 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.

Is CBD an option?
Girl with a Questioning Look at CBD Oil Bottle

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[7] with epilepsy even use it to help control their seizures. Keeping in mind that this drug is not regulated or legal in every country or state, various studies[8] can vouch for its pain-relieving and sleep-inducing powers.

 

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. They can discuss potential risk factors and the possibility of it interfering with the medication you are already taking.   

Practice Good Sleep Hygiene

Sleep hygiene refers to good habits designed to optimize your rest. Practicing positive nighttime habits is helpful because they increase the likelihood of getting quality rest. In an article from Harvard Medical School[9], 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.” 

 

Some sleep hygiene best practices include a consistent sleep schedule, having a cool, dark, and quiet bedroom, keeping electronics out of your bedroom, avoiding large meals, caffeine, and alcohol before bed, and regular exercise.

Adjust Your Sleep Position

Lastly, adjusting your sleep position may be necessary to get some sleep while in pain. For example, if you usually sleep on your back but your pain is worse in this position, try sleeping on your side or utilizing pillows to feel more comfortable. Finding a position that feels good will give you the best chance at quality sleep.

04

What is the Effect of Sleep on Pain?

Woman awake rubbing painful arm

Sleep can affect pain in two ways. The first is that the way you sleep could exacerbate pain. For example, lying on your stomach could cause neck pain because your head is forced to turn to the side. A second example is that sleeping on your back without a well-supportive mattress could throw your spine out of alignment, triggering back pain.

 

The second way sleep affects pain is that worse sleep quality and sleep loss have been found to heighten pain symptoms. A 2018 study[10] found that pain symptoms in participants worsened after a night of poor rest.

Can You Feel Pain While Sleeping?

Yes, you can feel pain while sleeping, but it depends on the sleep stage you enter. There are four stages in a sleep cycle, and humans move through multiple cycles overnight. The first two stages are a lighter sleep, and therefore, you are more likely to be awakened by pain. The third stage is deep sleep, and the fourth stage is REM sleep. You are less likely to feel pain during these last two stages because your brain waves are at their slowest in a deep sleep, and the body is in a state of paralysis during REM sleep.

Do People Sleep More When They are in Pain?

No, people don’t sleep more when they are in pain because the discomfort can make it harder to fall or stay asleep, resulting in shorter sleep times. First, pain can delay sleep onset because it is distracting and can cause anxiety around sleep, making it more difficult to relax. A relaxed mind is necessary to fall asleep. Secondly, pain symptoms can cause someone to wake up more frequently during sleep, particularly in the lighter sleep stages.

05

Better Sleep May Improve Pain

infographic of recovery process with the proper rhythm of sleep

According to research from a study[11] 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 to improving pain. 

 

According to the Cleveland Clinic[12], 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.

06

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.

Sources:

[1] Levy Andersen, Monica., Araujo, Paula., Frange, Cristina., Tufik, Sergio. “Sleep Disturbance and Pain: A Tale of Two Common Problems”. National Library of Medicine. 2018.

[2]The pain-anxiety-depression connection”. Harvard Health. 2010.

[3] Smith, M. T., Perlis, M. L., Smith, M. S., Giles, D. E., Carmody, T. P. “Sleep Quality and Presleep Arousal in Chronic Pain”. Journal of Behavioral Medicine. 2000.

[4]Chronic Pain”. National Institute of Neurological Disorders and Stroke. Last modified July 25, 2022.

[5] Hilton, Lara., Hempel, Susanne, et. al. “Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis”. Annals of Behavioral Medicine. 2017.

[6] Rosen MD MS, Ilene M., Aurora MD MHS, R. Nisha., et. al. “Chronic Opioid Therapy and Sleep: An American Academy of Sleep Medicine Position Statement”. Journal of Clinical Sleep Medicine. 2019.

[7] Oakes, Kari. “FDA panel recommends CBD for pediatric seizure disorders”. MD Edge. 2018.

[8] Grinspoon MD, Peter. “Cannabidiol (CBD): What we know and what we don't”. Harvard Health. 2021.

[9]How to sleep well despite chronic pain”. Harvard Health. 2016.

[10] Wei, Yishul., Blanken, Tessa F., Van Someren, Eus J. W. “Insomnia Really Hurts: Effect of a Bad Night's Sleep on Pain Increases With Insomnia Severity”. Frontier in Psychiatry. 2018.

[11] Schjelderup Skarpsno, Eivind., Mork, Paul Jarle., Lund Nilsen, Tom Ivar., Nordstoga, Anne Lovise. “Influence of sleep problems and co-occurring musculoskeletal pain on long-term prognosis of chronic low back pain: the HUNT Study”. Journal of Epidemiology and Community Health. 2020.

[12]How to Beat Insomnia When You Have Chronic Pain”. Cleveland Clinic. 2020.

Sleep Advisor