Pain and Sleep

Credit: David Mao

Did you know that pain affects more Americans than cancer, heart disease, and diabetes combined? An estimated 50 million American adults deal with chronic pain, and nearly 20 million suffer from high-impact chronic pain. It should come as no surprise that if you endure chronic pain, you may also have a hard time sleeping well at night.

Pain and sleep have a reciprocal relationship. That is, those with chronic pain are more likely to get less sleep — and those who don’t get enough sleep are also more at risk of chronic pain syndromes. Because these two problems feed off each other, it can be hard to pinpoint the root of the problem. However, studies suggest that lack of sleep may be the biggest catalyst driving chronic pain. 

While sleep and pain do have a reciprocal relationship, studies have shown that lack of sleep more reliably predicts chronic pain than the other way around.

Pain preventing sleep is a legitimate concern, but having good sleeping habits and sleep hygiene will help determine how your body deals with chronic pain.

Here are some good sleep hygiene practices you can put into place to help you sleep better and address your pain at night:

• • Know how much sleep you need – Adults typically need about 7 to 7.5 hours of sleep a night, but some require even more.
  • Go to bed at the same time every night – A regular sleep schedule will help you stay on track. You can even use sleep tracker apps to keep you honest.
  • Find a quiet place to sleep – It should go without saying that noise inhibits quality sleep. White noise machines help if you need to drown out the city or other background noise.
  • Keep your bedroom dark and cool – Keeping your room in the low- to mid-60s helps your body thermoregulate and stay asleep.
  • Dedicate your bed only to sleep and sex – Using your bed for other purposes is psychologically prohibitive. Of course, having a comfortable mattress and comfortable bedding is an important factor as well.
  • Limit screen time – Computer and tablet screens trick your brain into thinking it’s daytime. Ditch the electronics an hour before bed, and install apps that offer a red light filter.
  • Follow a bedtime routine – Whether you decide to take a warm bath, use aromatherapy, or meditate, following a bedtime routine will tell your body and your mind it’s time to fall asleep.
  • Eat well, exercise, and get sunshine during the day – Taking care of your body throughout the day will prime it for rest and rejuvenation at the proper time. Even a bit of sunshine will help with your circadian rhythm and tell your body when it’s time to rest.
  • Avoid substances like caffeine and alcohol before bed – Stimulants and barbiturates don’t pair well with sleep. Try not to consume alcohol or coffee four to six hours before you go to bed.
  • Relax when you can’t sleep – Feeling frustration about your lack of sleep won’t help. Get up and do something different that’s relaxing, then come back to bed and try again.

Both acute and chronic pain can cause sleep difficulties. However, there is a notable difference between the two.

Chronic Pain- Chronic pain is different from short-term or long-term acute pain. The biggest differentiators are two-fold: first, chronic pain lasts longer than six months. Second, it occurs in addition to the original pain. Whether or not the original condition has healed, chronic pain is independent of the injury that started it.

Acute Pain- Acute pain can be sudden or severe. But unlike chronic pain, it resolves within a certain period of time and shouldn’t last longer than six months. Injuries like broken bones, burns, dental work, or surgery are common causes of acute pain.

The following disorders can make it harder for people to sleep well:

Chronic Pain

Chronic pain lasts more than six months and incurs additional pain on top of the original injury. A handful of chronic pain examples include:

• Arthritis
• Lyme disease
• Chronic fatigue syndrome
• Fibromyalgia
• Lupus
• Pinched nerves
• Restless leg syndrome
• Sleep apnea
• Vascular pain
• Raynaud’s syndrome
• Gout

Chronic pain can affect sleep habits in a variety of ways, depending on the condition. People who suffer from sleep apnea — there are two kinds — suffer from airway blockage while sleeping, and so are woken up throughout the night by lack of oxygen. And those with pinched nerves may have difficulty sleeping in certain positions without increased pain.

Addressing chronic pain and sleep depends on the condition; however, practicing good sleep hygiene and treating the root of the problem with a physician or physical therapist are the first steps to improving the condition.

Back Pain

Back pain is a common problem in the U.S. Up to 50% of working Americans report back pain symptoms each year. The causes range from ruptured discs to muscle strain, arthritis, and even skeletal irregularities.

Sufferers of back pain report muscle aches, pain that radiates down the leg, or worsens with standing, walking, lifting, or bending. Such symptoms can easily affect sleep, especially with uncomfortable mattresses, or difficulty finding a comfortable position to sleep in. Standing and sitting with healthy back support, selecting an ideal mattress for back pain, exercising, and building muscle flexibility and strength all help alleviate this condition.

Neck Pain

Neck pain can occur due to a variety of factors such as arthritis, disc degeneration, and a narrowing of the spinal canal. Often, it’s not just limited to the neck, either. People who experience neck pain may also find tingling, weakness, or numbness in their limbs, shooting pains, and even leg weakness.

This often creates a problem when sleeping due to discomfort — especially if you’re sleeping in a way that further twists or exacerbates your neck pain. While stomach sleepers should use thin, soft pillows, sleeping on your stomach is not recommended. Instead, you should try to switch to back sleeping. Selecting a memory foam pillow with loft options can also help.

Hip Pain

Osteoarthritis is often the root cause of chronic hip pain. This happens due to inflammation of the joints and can cause pain, stiffness, and swelling. Sleeping with hip pain can be especially difficult if you can’t position yourself in a way that’s comfortable to sleep.

As always, it’s important to consult your physician before undergoing any treatment or medication. Taking anti-inflammatory medications, cortisone injections, and going to physical therapy are all ways to alleviate such pain. Some people also decide to get hip replacement surgery or go through chronic pain rehabilitation programs. Other day-to-day practices you may implement include strengthening your inner and outer thighs, working out in water, and avoiding high-impact activities.

Arthritis

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Arthritis is a common condition — over 50 million adults suffer from some type of arthritis. Symptoms include decreased range of motion, pain, stiffness, and swelling. Symptoms can range between mild, moderate, or severe, and may worsen over time.

Between infectious, inflammatory, and metabolic arthritis, you’ll need different types of treatments depending on the cause of your pain and where the symptoms manifest. The pain of arthritis may prevent you from sleeping, but studies have shown that getting more sleep and practicing good sleep hygiene will actually help alleviate arthritis-related pain. Regular exercise is also an important factor in keeping your joints healthy, and is the most effective non-drug treatment out there.

Fibromyalgia

Fibromyalgia causes chronic and widespread body pain. Symptoms can include severe pain and stiffness, deep muscular aching, and stabbing and shooting pains. If you suffer from fibromyalgia, you’re also more likely to experience additional conditions such as lupus, arthritis, or irritable bowel syndrome.

Unfortunately, fibromyalgia causes sleep disturbances and moderate to extreme fatigue. Studies have shown that people with fibromyalgia are interrupted by bursts of awakened brain activity, which makes a full night of deep sleep difficult to accomplish. In order to improve your sleep, finding ways to destress, getting psychological support for chronic physical pain, and getting physical therapy or therapeutic massage can help alleviate symptoms.

Diabetic Nerve Pain

Diabetic nerve pain (or neuropathy) may cause problems with your digestive system, blood vessels, or heart. You may also experience numbness and pain in your legs. There are four types:

• Radiculoplexus neuropathy (diabetic amyotrophy)
• Mononeuropathy
• Peripheral neuropathy
• Autonomic neuropathy

Tingling or weakness in your hands that interferes with sleep, changes in digestion, dizziness, or a cut that won’t heal are all symptoms that you should see a doctor. Severe pain from these symptoms may prevent your sleep. Taking good care of your feet and monitoring your blood sugar can prevent such pains that affect your quality of sleep.

Headaches/Migraines

Over 36 million Americans a year suffer from migraines. And migraines aren’t just your average headache — they can cause severe head throbbing, light sensitivity, nausea, blurred vision, fatigue, and even vertigo. You’re two to eight times likelier to experience sleep problems with migraines, in part because they can last over the span of days.

Migraine sufferers report experiencing insomnia and spend fewer hours sleeping than recommended. Practicing good sleep hygiene is always helpful to reduce these effects. Reducing your intake of headache-triggering substances like alcohol and coffee are especially important. Instead, drink plenty of water in the day but reduce your fluid intake right before bed.

Endometriosis

Women who suffer from endometriosis often feel pain before, during, or after menstruation, during or after sexual intercourse, or even in the lower back region. Heavy or irregular bleeding and fatigue also play a role. Inflammatory toxins can cause fatigue if you have endometriosis, along with the cramping pain that keeps you from sleeping.

Always consult your primary physician or OBGYN before deciding on a treatment. Because Estrogen exacerbates endometriosis, using hormonal treatments such as birth control have been shown to help reduce symptoms. A more invasive treatment is laparoscopic surgery, but this option is rarely used nowadays. Overall, eating a balanced diet, exercising regularly when possible, and avoiding stimulating substances can help you sleep better with this condition.

REM Pain

REM, or rapid eye movement, is the paradoxical moment in your sleep when your neurons and parts of your brain are active like when you’re awake, while other parts are dormant. While it’s still being explored, scientists believe REM is important for storing memories and responsible for vivid dreams.

If you experience REM sleep behavior disorder, you may act out vivid and unpleasant dreams by:

• Kicking, punching, flailing arms in bed
• Making noises like laughing, shouting, cursing, or talking
• Remembering the vivid dream that caused you to act out

You’re more likely to experience REM disorder if you already experience narcolepsy, neurodegenerative disorders, are taking certain medications, or are a male over 50. Such symptoms can wake you from a deep sleep and prevent you from getting the full night’s rest that you need. Using natural or prescription sleep aids may help you sleep better, along with protecting yourself with physical safeguards during your sleep.

Sleeping on a bad mattress can drastically affect your sleep quality. A good mattress does wonders: it promotes spinal alignment, reduces pressure on the neck, shoulders, hips, and lumbar region of the lower back. That translates into alleviated aches and pains. Sleeping on the wrong bed can increase pressure on your troubled areas and cause additional pain.

Your weight and preferred sleeping position are crucial to determining the material and firmness of your ideal mattress. There are five main mattress materials that you can select from:

• Innerspring – This is one of the most common mattress types. They’re bouncier than most other mattresses, but some people complain they’re too firm. If you’re looking for a firmer mattress, this could be a good pick.
• Foam – Foam mattresses conform to your body for better spinal alignment and enhanced pressure relief. Memory foam sleepers report above-average pain relief, but aren’t ideal for heavier individuals.
• Hybrid – Hybrids can be a mix of two or more components, such as foam and innerspring or latex and wool. They offer above average edge support and minimal sinkage, but aren’t ideal if you want an extra-firm or extra-soft surface.
• Latex – Latex mattresses have at least one layer of latex in the comfort layer. They can include multiples layers of latex at different densities to provide a unique comfort and feel. They’ll provide you with quality spinal support and above-average pressure and pain relief. However, a lack of edge support can translate into spots of sinkage around the edges.

Airbed – Airbed mattresses are filled with air and can be deflated to create a different feel. They report high satisfaction ratings and effectively absorb motion transfer, but the noise they make can cause sleep disruptions and their materials easily break down.

Tuck has reviews on the best mattresses for:

• Stomach sleepers
• Side sleepers
• Combination sleepers

Many mattress companies will offer you a sleep trial to find the right bed. Certain mattress companies will allow trial periods and refunds. Make sure to check before you purchase if you can do this.

Selecting a different pillow or pillow topper is also a simple option to help you sleep well at night. Many of these pillows also offer free sleep trials.

Selecting the right kind of pillow is crucial if you have chronic pain. Material, loft,and thickness all play a role here, and can determine whether a pillow alleviates or increases your level of pain. You can find pillows that are made specifically to help with neck pain and help with back pain.

Diagnosing your pain disorder

Getting help for your pain might feel like a daunting task. The first step to addressing your pain and sleep issues is understanding the root cause. Although websites like WebMD make it tempting to self-diagnose, you should consult with a medical professional instead.

See a doctor so you can continue forward with a professional diagnosis and better understanding around the base of your pain issues. There are several resources you can take advantage of to get a proper medical diagnosis. Here are some options to explore:

Physical Therapy

Physical therapists are trained and licensed to develop, maintain and maximize your functional ability and movement. When you visit a physical therapist, they’ll exam your needs, formulate a diagnosis, and create a plan for intervention and therapy. That care plan may also include referrals to other professionals and recommendations for self-management.

Physical therapists treat all kinds of conditions, including but not limited to:

• Musculoskeletal
• Cardiopulmonary
• Women’s health/pelvic floor
• Sports injuries
• Hand therapy
• Pediatrics

You can find therapists in outpatient hospitals, gyms, private practices, research centers, occupational environments, and skilled nursing facilities. Insurance companies may cover such treatment depending on your provider and the timing and nature of the injury.

Medicine

Over-the-counter pain relief drugs such as aspirin and acetaminophen can help with mild to moderate injuries and be self-administered.

Aspirin can help address:

• Pain
• Headaches
• Swelling
• Fever

Acetaminophen can help provide relief from:

• Muscle aches
• Headaches
• Menstrual cramps
• Sore throats
• Colds
• Toothaches
• Backaches
• Fever

Taking too much acetaminophen can cause liver damage. As always, it’s important to consult a doctor to consider the side effects — especially if you have other health conditions or are already taking other medications.

Some pain is severe enough to merit prescription pain medication. Talk to your physician if you feel you need to explore this option to help treat your chronic pain. Your doctor should go over the potential side effects with you so you understand any risks involved, including the potential for addiction.

Psychological Methods

Pain disorders often cause psychological challenges in addition to physical challenges. Many people find psychological help essential in helping them cope with long-term or chronic pain.

Some different routes you can take include:

• Counseling – Professional, licensed counselors are there to help you accomplish mental health, education, wellness, and career goals.
• Cognitive Behavioral Therapy (CBT) – CBT is a school of therapy that combines both cognitive and behavioral therapy approaches. In sum, they believe that how we feel, think, and behave are all closely related.
• Hypnosis – At times controversial, some people swear by the practice of hypnosis to help them relieve stress, decrease pain, and even quit smoking or control weight.

Pain Relief Resources

Still looking for more help? Here are some pain relief resources to get you on the right path:

• American Chronic Pain Association
• U.S. Pain Foundation
• Community Health Association of Mountains/Plains States (CHAMPS)
• International Association for the Study of Pain
• Everyday Health resources for managing chronic pain

Holistic methods are another way to approach your problems with sleep and pain. Multiple studies have shown that meditation helps with >insomnia, depression, anxiety, and other mental health problems.

Different meditation methods include:

Progressive Muscle Relaxation (PMR)

PMR eliminates muscular tension by manipulating and scanning the body one muscle at a time. To practice this method, you’ll tense and then completely relax different muscle groups while breathing deeply.

Here’s how you do it:

• Get ready for bed.
• Lie down.
• Breathe deeply, observing your inhales and exhales.
• Start with the top of your head and slowly move down your body, progressively tensing or contracting each muscle group one by one. Hold contractions for at least five seconds and relax each muscle group for 30 seconds.
• Focus on the difference between tension and relaxation.
• Repeat twice if desired.
• Feel yourself relax.

Mindful Breathing

Deliberate breathing is at the heart of meditation. Direct your attention to the inhales and exhales of your breathing and focus on the subsequent sensations. Gently bring your mind back to your breath when it wanders.

If you’re still struggling to keep attention, certain meditation apps like Insight Timer use customizable bells and ambient sounds to help keep you on track. Another way to wade into this practice is to do short, five-minute sessions at a time. Finding a comfortable position, quiet setting, and relaxing your body will all help you focus on this practice.

Counting Meditation

Counting sheep is cliche for good reason. Whether you decide to count sheep or just the numbers yourself is up to you, but it’s a simple way to put your brain on autopilot and lull yourself to sleep.

Of course, you shouldn’t just start counting while you’re sitting up or in a light room. Here’s the best way to approach it:

• Get ready for bed and turn off the lights.
• Lie down in a comfortable position.
• Start counting slowly.
• Gently nudge your mind back to counting if it drifts to worries, pain, or anxiety about the day.
• Count to 100 (or as far as you need to) to fall asleep.

Guided Meditation

Many people use guided meditation to help them fall asleep (even with distractions, anxiety, or pain). You can download guided meditations for free or at a cost online, or you can get a guided meditation app.

Some of the most popular ones include Headspace, Calm, and 10% Happier. Calm specializes in Sleep Stories, which is made of a unique library from famous voices like Stephen Fry (Harry Potter narrator) and Bob Ross (Joy of Painting). Most guided meditations will direct your attention to your breathing and keep your mind from wandering.

Relaxation methods and meditation don’t work for everyone. Here are some sleep aids you can explore instead. But, as always, we encourage you to consult your physician first.

Antihistamines

Antihistamines are traditionally used for allergic reactions. However, some people use them for their  common side effect — drowsiness. You should take extra precautions with this medicine if you have glaucoma, epilepsy, diabetes, an overactive thyroid, or heart disease. You should also avoid taking antihistamines with alcohol.

Melatonin

Melatonin is a hormone that your brain naturally produces and signals to your body that it’s time to sleep. Small amounts of melatonin are also found in certain foods, such as bananas, pineapples, oats, cherries, nuts, and tomatoes. As always, it’s a good idea to check with your doctor to see if this is the right option for you.

Sleep Teas

Tea can have both a psychological and physical calming component. Some people compare drinking a warm cup of tea before bed to soaking in a warm bath. Make sure to pick a tea that is caffeine-free. Teas like chamomile, valerian, and lavender are some fan favorites.

CBD

CBD, or cannabidiol, is an oil found in cannabis plants. This tincture may be used to help with sleep, anxiety, pain, and insomnia. It’s available in five different strengths and accommodates a wide range of THC preferences. Check the state where you live in, as this is not legal everywhere.

Prescription Sleep Medicines

There are lots of different sleep medications available,  though the FDA hasn’t approved of any sleep medications for long-term insomnia use. You’ll want to carefully consider this option as it can be habit-forming and psychologically addictive. Your physician will also need to take into account the other medications you currently use.

Working through pain and sleep isn’t always an easy or straightforward solution. How you decide to approach this problem depends on an accurate diagnosis, finding the best treatment, and also implementing good sleep hygiene.

Thankfully, there are a lot of methods you can try to help yourself get a better night’s sleep. The first steps include picking out the right mattress and pillow to sleep on, exercising, meditating, using over-the-counter medications, and taking holistic care of your body.

And once you are able to relax and sleep better, that deep sleep and revitalization will help you to manage your pain as well.

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