Thread: When Pain Interrupts Your Sleep

Whether it’s from a sore lower back or throbbing tooth, pain is hard enough to deal with in the light of day. But pain at night that robs you of your much-needed sleep can be downright exhausting.

“An individual simply cannot get comfortable to fall asleep due to the discomfort of pain,” says Frank. J. Falco, MD, who specializes in pain management and sleep problems in Newark, Del. Plus, pain causes anxiety, which disrupts sleep even more.

In addition to preventing a person from falling asleep, pain also results in difficulty staying asleep. And once pain keeps you awake one night, it is likely to do the same thing again and again. Pain-related insomnia gets worse over time.

If pain keeps you up, take comfort in knowing you are not alone. According to the National Sleep Foundation, two out of three people with chronic pain have trouble sleeping.

Many types of pain can interrupt sleep, from the chronic pain of arthritis to the acute pain that follows surgery.

“But no matter what the cause, it is the intensity and quality of the pain, not necessarily the type, that determines the impact on a person’s quality of life, including sleep,” says Falco, who heads Mid-Atlantic Spine and Pain.

The Relationship Between Pain and Sleep
“Pain is a sensation you feel when nerves are stimulated to an intense degree,” says Tracey Marks, MD, an Atlanta-based psychiatrist. Marks is author of Master Your Sleep: Proven Methods Simplified. “This stimulation activates the brain, which keeps you awake.”

Some of the ways pain causes insomnia include the following:

Pain at night disrupts sleep architecture.

“You need a certain amount of each stage of sleep to feel rested and for proper memory,” Marks says. These stages include light sleep, deep sleep, and REM (rapid eye movement) sleep. “We normally go through four to six cycles of these stages per night. But if pain wakes you up, you spend too much time in light sleep,” she explains. This reduced sleep -- in particular, shortened REM -- may increase sensitivity to pain.

Pain affects sleep position.

Certain types of pain, such as arthritis pain and orthopedic pain, may prevent you from getting comfortable at night, says Reena Mehra, MD, of University Hospitals Case Medical Center in Cleveland. The medical director of adult sleep services says joint and muscle pain usually results in problems staying asleep (called sleep maintenance insomnia) rather than falling asleep (called sleep onset insomnia).

Sleep deprivation makes you more sensitive to pain.

A study in the April 2009 issue of Sleep Journal showed that normal, healthy individuals are more sensitive to pain when they are low on rest. The reasons why aren’t known for sure. “Some research studies show that sleep deprivation causes increased production of inflammatory chemicals in the body called cytokines,” Marks says.

Pain medications interrupt sleep. Unfortunately, some of the medications prescribed for pain, such as codeine and morphine, can cause insomnia. These opioid pain medications can cause apnea, brief pauses in breathing, during sleep. “Therefore, people who take these kinds of medications for chronic pain are at a higher risk for sleep problems,” Falco says.

People with chronic pain may have trouble exercising. Lack of exercise leads to weight gain. Excess weight then restricts exercise, which leads to more pounds gained. “This vicious cycle can lead to sleep apnea, which prevents a restful night’s sleep,” Falco says.

Different Types of Pain

According to the National Sleep Foundation, the types of pain that most commonly cause insomnia are back pain; headaches; and temporomandibular joint (TMJ) syndrome, which causes pain around the ears and jaw muscles. Muscoloskeletal pain, including arthritis and fibromyalgia, can also cause sleep problems. Cancer pain, resulting from the disease itself and treatment, also leads to trouble sleeping. Pain that follows surgery can also prevent much-needed rest.

As Falco points out, current research shows that there are more commonalities than differences between types of pain when it comes to insomnia. A few of the nuances researchers have identified include the following:

The intense nature of pain after surgery and other acute pain seems to affect both the length and quality of sleep.
Chronic arthritis pain appears to interfere with circadian rhythms. A recent Japanese study found a relationship between a person’s body clock and arthritis symptoms. More specifically, researchers discovered that certain genes affecting circadian rhythms may activate a molecule that sparks inflammation in people with arthritis. The relationship between this molecule, called TNF-alpha, and circadian rhythms may explain why people with arthritis have worse joint pain in the morning.
In people with fibromyalgia, a chronic condition that causes joint and muscle pain, there are constant bursts of “awake” brain activity which prevents deep sleep. In a study published in the Journal of Rheumatology, people with fibromyalgia had two times as many awakenings per hour as people without the disease.

Managing Pain That Steals Your Sleep

The first step is to reduce the pain, Falco says. “Pain control reduces anxiety and depression, improves sleep, and makes for better overall quality of life.”

Falco adds that people with pain and sleep problems should undergo a diagnostic sleep study.

When it comes to medications, tell your doctor about the sleep problems you’re having as a result of your pain. Then follow his or her orders. Painkillers and/or sleeping pills can work for some people, but they should only be used under the supervision of a doctor.

And in terms of pain that follows surgery, banking up on sleep a few weeks beforehand may help. “People don’t intuitively think they need to rest up for surgery; but they really should as it can help with pain control,” Marks says. Research has shown that people who get enough rest before surgery require less pain medication afterward.

Once the surgery has taken place, narcotic pain medications can make the first few nights of sleep more restful. “Try to time your last dose around the time you go to bed so it will last through the night,” Marks says.

How to Get the Sleep You Need

Calm yourself with meditation and other relaxation techniques.

When done effectively, as little as 10 minutes of daily meditation can help your mind ignore the pain, Marks says. There are many different types of meditation, including guided meditation, tai chi, and yoga. But you can also improvise. “Use deep breathing exercises, progressive muscle relaxation, or focus on an object or scene,” Marks says

Gentle massage is also beneficial for both insomnia and chronic pain. In a study published in the InternationalJournal of Neuroscience, participants who had two 30-minute massages a week for five weeks experienced better sleep and less lower back pain.

Exercise the right way.

Regular exercise can improve both pain and sleep issues, Falco says. However, activity within three hours of bedtime can keep you up, so the earlier in the day you work out, the better. For pain, the best exercise is moderate and low-impact. Try walking, yoga, or swimming.

Additional tips for improving sleep include:

Forgo daytime naps or limit yourself to a brief 10- to 20-minute nap in the afternoon.
Take a warm bath or shower before bed to wind down.
Lull yourself to sleep with relaxation CDs that play a babbling brook, gentle waves, or other soothing sounds.
Remove all light-producing appliances from your bedroom, including the TV; if you must have them, choose ones that emit red rather than blue light.
Abstain from alcohol in the evening; it may help you fall asleep, but the effects of a cocktail quickly backfire, disrupting sleep cycles a few hours into the night.
Run a fan or other non-specific white noise machine in your bedroom to dampen street or other sounds.
Avoid caffeine, which disrupts sleep patterns; if you must have a caffeine boost, enjoy it before noon.
Do not exercise or eat within three hours of going to bed.
If pain is preventing you from getting a good night sleep, it’s time to see a doctor.

There are a number of treatments available, including medication, physical therapy, and talk therapy. Consider tracking your sleep habits in a sleep journal. This simple tool can give your doctor valuable information about your quality of sleep and how many hours you log each night.

Could be worse. I vomit in my sleep. Acid reflux as evolved into me completely emptying my stomach during the night. I'm tired of waking up gasping for breath and coughign up vomit that went down the windpipe.