Living with chronic pain is a daily struggle, especially when it comes to getting restorative sleep. Many chronic pain sufferers are also trapped in a cycle of long-term sleep deprivation. This condition not only affects their physical health but also increases the risk of developing anxiety and depression. Prioritizing sleep when living with chronic pain is not just a choice but a crucial factor that affects your quality of life.
The Relationship Between Sleep Disturbances and Chronic Pain
Our sleep patterns consist of several cycles (light sleep, slow-wave sleep and rapid eye movement). To achieve restorative sleep, we must cycle through each stage several times at night. When this cycle is disturbed, you won't get the rest you need, leading to fatigue the next day.
Patients dealing with chronic pain often find their problems are made worse by accompanying insomnia and other sleep disorders. However, pain can be both a cause and a consequence of not getting enough sleep. Studies show that poor sleep quality and insufficient sleep are risk factors for developing chronic pain.
Additionally, evidence shows that shortened or disturbed sleep may cause an increased sensitivity to painful stimuli. This bidirectional relationship between pain and sleep deficiency means sufferers are often locked in a vicious cycle where a difficult night's sleep amplifies pain the following day, which makes it hard to fall asleep again the following night. This cycle can go on indefinitely.
For some chronic pain conditions, the intensity may flare up at night or be made worse by sleeping in certain positions. Chronic pain may also cause you to wake frequently at night. A meta-analysis found that an inability to stay asleep and waking up too early were top concerns for those suffering from chronic pain.
Some people with chronic pain also deal with other sleep disturbances, including restless leg syndrome. Although medication for pain management or a chronic illness may carry some side effects that interfere with a good night's sleep, one study found that individuals suffering from chronic pain are more likely to also experience sleep apnea.
How Pain Affects Sleep Positions
Chronic pain can greatly limit your sleep position options, further complicating your struggle for restorative sleep. For example, those with hip, shoulder or knee pain may need to avoid side sleeping, while those with lower back pain may need to avoid sleeping on their back or stomach.
Multiple sclerosis is another condition that causes various pains, including neurogenic, dysesthetic and musculoskeletal pain. People with MS may need to switch sleep positions more often to avoid numbness and tingling sensations. Unfortunately, continuously waking up to avoid pain is a significant cause of fragmented sleep.
How Sleep Affects Pain Sensitivity
Emerging evidence suggests that sleep's impact on pain is more significant than pain's effect on sleep quality. Those with chronic conditions like rheumatoid arthritis often experience more pain after a night of poor sleep. These findings underscore the importance of identifying and treating sleep disturbances among those living with chronic pain.
Sleep deprivation also increases one's susceptibility to developing migraines. In healthy people, sleep deprivation can also cause symptoms of fibromyalgia, including tenderness and fatigue.
The association between sleep and pain goes deeper than once realized. For example, sleep and pain share a similar neural network. While melatonin is most associated with regulating circadian rhythm, new research suggests it also affects pain perception.
The Connection Between Sleep, Pain and Mental Health
Many people living with chronic pain deal with a constant cycle of pain, insomnia and mental health issues. If you struggle with chronic pain and insomnia, you may become anxious the longer you toss and turn at night. In the morning, you may then wake up feeling depressed, which increases your pain sensitivity. If not addressed, this cycle can continue indefinitely and worsen chronic conditions.
An important psychological factor in this cycle is the tendency for some to catastrophize. Catastrophizing is a cognitive distortion that causes you to assume a situation is worse than it is or will lead to a worst-case scenario. Catastrophizing can also affect the central nervous system and may enhance the processing of painful stimuli, increasing its intensity.
Chronic pain sufferers have a higher risk of depression. More than half of all adults living with chronic pain also experience heightened levels of anxiety and depression. This combination can increase pain levels, making it more difficult to switch off at night.
How To Get Better Sleep When Dealing With Chronic Pain
Those who are permanently sleep-deprived due to chronic pain must do what they can to try to prioritize sleep. The nightly struggle of trying to get comfortable, dealing with pain and attempting to fall asleep can cause you to dread bedtime, worsening the situation. Cognitive behavioral therapy for insomnia can help chronic pain sufferers who cannot fall asleep. By addressing the perpetuating factors behind insomnia, you may find the relief you need to improve your sleep quality. The following coping strategies may also help:
- Try practicing deep breathing and mindfulness techniques while lying in bed.
- Avoid caffeine, stimulants and alcohol close to bedtime.
- Exercise early in the day to ensure your body is ready for sleep at night.
- Keep the room cool, dark and quiet.
- Create a soothing atmosphere in your bedroom with comfortable linens.
- Have a consistent bedtime routine (bathing, brushing your teeth and reading a book).
- Consider using Pillow to monitor your sleep quality so you can make adjustments as necessary.
If you cannot sleep due to pain or worry, get out of bed for a while and do something else. Return only when you start to feel sleepy again. Learning how to fall asleep while in pain can be challenging, but by retraining your brain with cognitive behavioral therapy and working with your doctor to find effective pain management solutions, you can start looking forward to experiencing restorative sleep again.
