According to the National Center for Health Statistics, approximately one in four Americans have suffered from chronic pain. At any given time, millions are experiencing acute pain following an injury. While pain significantly disrupts everyday life and lessens our ability to perform daily activities, it also has a serious effect on sleep. People with sleep disorders cite pain as one of the most common factors that prevents them from getting adequate sleep.
Pain and Its Effect on Sleep
The science exploring the relationship between pain and sleep continues to expand. In the early years of these studies, it was commonly believed that there was an unidirectional relationship between pain and sleep: being in pain makes it difficult to fall asleep and remain asleep.
More recently, however, accumulated scientific evidence suggests that pain and sleep are correlated, possibly reciprocal (Smith and Haythornthwaite, 2004). Pain disrupts your ability to get good sleep, and sleep deprivation can also exacerbate the experience of pain. This creates a vicious cycle in which the effects of poor sleep and chronic pain can worsen.
Interestingly, the severity of pain is not always the main factor causing poor sleep quality. In one study of outpatients with chronic pain, 88% of them reported some sleep disturbance (Smith et al., 2000). However, it was presleep cognitive arousal that was most predictive of sleep problems. Cognitive arousal includes worrying, feeling like you cannot shut your mind off, mental alertness, being distracted by sounds in your environment, or reviewing events from the day. The study suggests that pain is associated with mental alertness or worrying that makes it difficult to sleep; independent of the subjective amount of pain a person is in.
Common Conditions that Cause Chronic Pain and Disrupted Sleep
Any type of pain can lead to sleep disruption. From dull, nagging neck pain to chronic back problems to a sharp pains of an acute injury, any amount of pain can have negative effects on your sleep. However, certain medical conditions are particularly likely to result in pain-induced sleep problems, including:
Fibromyalgia- Although a leading cause of chronic pain among American adults, Fibromyalgia remains poorly understood by the medical community. The key symptoms of fibromyalgia include widespread musculoskeletal pain and chronic fatigue. Symptoms may wax and wane depending on environmental factors. Sleep disruption is often severe in patients with fibromyalgia.
Arthritis- Arthritis is inflammation of the joints, leading to severe pain. It can affect any joint but is most common in the knees, hips, back, and hands. Although the pain may be managed through over-the-counter medications, many patients with arthritis have difficulty sleeping because of symtomatic pain.
Low back pain- Low back pain is one of the most common sources of chronic pain. Many different factors can lead to low back pain, including overuse injury, compressed nerves, or damage to the intervertebral discs.
Neuropathy- Neuropathy, or nerve damage, can arise from several sources. One of the most common causes is diabetic neuropathy, which emerges in individuals with advanced diabetes. Patients with diabetic neuropathy report numbness or tingling, prickling, or burning sensations in their hands and feet. These distracting pain symptoms can make it very difficult to fall asleep, stay asleep, and get good quality sleep.
Multiple sclerosis-Multiple sclerosis is a disorder in which the nerves cannot communicate as efficiently as they used to. Patients with multiple sclerosis experience pain, weakness, chronic fatigue, numbness and tingling, and changes in their gait. Sleep difficulties often accompany these other symptoms and may exacerbate their severity.
Type of Sleep Dysfunction Observed in Chronic Pain Conditions
There is not a single true “signature” of the effects of chronic pain on sleep. However, certain disruptions to the sleep cycle are more common than others.
During healthy sleep, we cycle through several sleep stages throughout the night. These stages are characterized by the frequency of brain waves that are emitted during each particular stage. Alpha waves occur during wakefulness. As we drift off to sleep, our brain waves slow. The first stages of sleep are known as “non-REM” sleep (non-rapid eye movement sleep). Gradually, we enter “deep” sleep, which is characterized by its slow, low frequency delta waves. During this deep sleep, we are less responsive to changes in the environment and it is difficult to be awoken. We then enter rapid eye movement (REM) sleep, which has higher frequency waves and is characterized by dreaming. A typical person will go through numerous cycles of non-REM and REM sleep each night.
For patients with chronic pain, sleep studies have shown disruptions to this regular sleep cycle. For instance, patients reporting significant pain are more likely to experience nocturnal myoclonus, or periodic limb movement disorder (Wittig et al., 1982). Nocturnal myoclonus means that movements occur periodically during sleep, typically involving uncontrollable movements of the legs. These jerking movements occur during non-REM sleep and lead to a disruption in the sleep cycle. As a result, individuals report excessive sleepiness during the day and may never feel fully rested.
Another sign of sleep disruption is called alpha rhythm intrusions. As mentioned before, alpha waves are higher frequency waves that are associated with a wakeful state. Patients with chronic pain sometimes show a pattern in which they have alpha waves when they should be in deep (delta wave) sleep. This results in non-restful sleep and overall poor sleep quality. Additionally, alpha intrusion can exacerbate the effects of other sleep difficulties. Alpha intrusion is not associated with any particular sleep disorder; however, it is commonly seen in patients with fibromyalgia, chronic fatigue, and related conditions.
What to Do to Treat Chronic Pain and Sleep Problems
Due to the reciprocal relationship between chronic pain and sleep problems, it is important to treat both of these conditions simultaneously. Working with a pain specialist can help you find helpful approaches to pain management. As the use of certain pain medications can further disrupt your sleep, it may be useful to discuss non-pharmacological approaches with your medical team.
For instance, cognitive behavioral therapy (CBT) has been shown to help with both pain and co-occurring insomnia (Smith and Haythornthwaite, 2004). Special forms of CBT have been developed to specifically address the issues. Many patients with chronic pain and sleep disturbance face. This may be particularly useful if cognitive symptoms, such as worrying, racing thoughts, or difficulty “turning your mind off” are making it challenging for you to get to sleep.
It is also important to practice good sleep hygiene to increase your likelihood of getting a good night of rest. This includes turning off electronic screens at least 30 minutes before going to bed, maintaining the same bedtime and wake-up time each day, avoiding caffeine for at least 3 to 4 hours before going to bed, limiting your alcohol consumption, and creating a relaxing pre-bed ritual. Engaging in these sleep hygiene practices can help to improve your sleep quality, which may in turn reduce the severity of your pain symptoms during the day.
One of the best things to do if chronic pain is affecting your sleep is to work collaboratively with your pain physician and a sleep specialist. Together, these medical professionals can help you find treatments that optimize your sleep while effectively managing your pain.
Our Seattle sleep center works collaboratively with patients and their medical care team to help them achieve higher quality sleep. This may include a sleep study to better understand the underlying causes of your sleep problems and to diagnose any potential sleep disorder.
Knowing what is causing your poor sleep can help you make an informed decision about treatment plans that address your sleep and pain issues. Make an appointment today to learn more about how to get better sleep when you are struggling with pain. Call us today at (425) 279-7151 or click the link below to request a free Sleep Assessment over the phone!