How to Sleep with Chronic Pain

We've mentioned before that there's a vicious cycle between pain and emotional health. In other words, many patients with chronic pain are also depressed and depression make pain worse. Similarly, those who live with pain usually have trouble sleeping. In turn, poor sleep contributes to pain and pain makes sleeping a challenge. Ugh, talk about kicking people while they're down! Isn't life cruel sometimes (sigh)?

It's been estimated that 50-80% of people with chronic pain also have ongoing sleep difficulties.

Trouble sleeping is very common for those with chronic pain, lower back pain, hip or knee pain, joint pain etc. In fact, in the US, "pain" is cited as the number one cause of insomnia. Insomnia (less formally referred to as "sleeplessness") is defined as a pattern of trouble falling asleep, staying asleep, or difficulty returning to sleep. Chronic insomnia is insomnia that happens more than 3 times a week for 3 months in a row.

Whether or not you suffer from occasional sleeplessness, full on insomnia, or some deathly chronic insomnia, there are things you can do right now to make tonight's sleep better. Read on as we explain how sleep and pain are connected, share why you may not be sleeping well, and offer tips on getting to sleep with chronic pain.

Why Sleep Matters for Your Pain

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Anyone who's spent the night of tossing and turning, counting sheep, or internally auctioning off their first born for a few hours of peace, knows that NOT being able to sleep is the absolute worst. In fact, insomnia feels like torture. Lack of sleep not only makes you irritable, more likely to get into an accident, decreases your drive/ work performance, affects your mental health, and alters your mood, it actually negatively contributes to physical healing and pain. So, how does sleep affect your pain?

Research has demonstrated that poor sleep makes feelings of chronic back pain worse. According to a study in Review of Pain, pain patients who have trouble sleeping "report more severe pain, longer pain duration, greater levels of anxiety, depression and health anxiety, and worse impairment in physical and psychosocial functioning." In other words, compared to patients with chronic pain who sleep normally, the insomnia group experiences far more physical and mental symptoms. Chronic pain and sleep deprivation are an evil duo.

In addition, if your pain is associated with a known cause or physical injury, sleep is necessary for physical healing. Sleeping lets your body rest, cuts down inflammation (a leading cause of pain), reduces bruising and swelling, and even releases hormones that promote tissue growth.

But enough about why sleep matters for your pain, here's why you may be having a tough time sleeping.

Why You're Having Trouble Sleeping

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If you've ever thought "I'm in too much pain to sleep", you're not alone. As we know, pain is the leading cause for sleeplessness and insomnia. For a host of reasons, people living with pain face countless more challenges falling asleep. Here are the top reasons people with pain have trouble sleeping:

  • Pain is uncomfortable: It's simple, when you're in pain it's tougher to find a comfortable position. In addition, pain may be so bad that it will wake the sleeper up in the night, making it difficult to fall back to sleep.  

  • Narcotic pain medication: Although pain medication will temporarily relieve pain and help you fall asleep, narcotic pain meds can also cause insomnia. Prescribed painkillers can affect the body's REM cycle and irregular sleep patterns. Changing doses of medication can also affect your ability to sleep. Ask your doctor about the side effects of any narcotic pain medication you're taking.

  • Stress/ Anxiety: People with pain also report higher levels of stress. Stress can also lead to insomnia since it's hard to "turn off your mind" and wind down. A busy mind can keep your cortisol levels high, which make it more difficult to shut down.

  • Depression: Pain and depression are deeply linked. Similarly,  your emotional state and insomnia are closely tied. Trouble sleeping is not just a symptom of depression, it can sometimes be a cause.

Breaking the Cycle of Chronic Pain and Insomnia: 10 Tips for Better Sleep

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Like the number of factors that are working together and causing you to lie awake at night, a bunch of things work together to help you sleep better. By employing a handful of tactics that are proven to promote better sleep, you should be able to catch more zzz's at night. Here are some tips you can follow ASAP, to rest easy.

  1. Create a Timed Bedtime Routine - Set an alarm for 45 minutes or so before bedtime. This will keep you consistent and will help your form a "winding down" habit before bed. If you've been prescribed pain medication or sleeping medication, take it during this pre-bedtime routine. After a few days, your body will get the memo that it's time to fall asleep at the same time each night. During your routine, turn off all stimulating electronics and try reading, journalling, or listening to to an ebook or podcast instead.

  2. Exercise - Running through low-impact exercises at home as well as keeping active during the day has many benefits. "Motion is lotion" which helps with physical pain, but it also helps combat stress, depression, anxiety, and helps with sleep. Here's a list of at-home exercises safe for lower back pain.

  3. Ice, Ice Baby- If you have joint pain or specific parts of your body causing you pain, ice before bed. Icing numbs your painful area, and can reduce pain naturally. Read more about icing after surgery (the information helpful tips are applicable even if you haven't had a procedure).

  4. Lights Out! - Artificial light confuses the part of the brain, affecting the circadian rhythm. Having lights on can disturb your natural sleep pattern. It's important to always sleep in a dark room, without the glow of electronics or other artificial lighting. A blackout curtain may be a helpful investment.

  5. Say "No" to the Drink- Alcohol should never be taken with pain medication. It's been estimated that 20% of Americans use alcohol to fall asleep at night. Although people often say that a glass of wine or nightcap helps put them to sleep, in reality, alcohol negatively impacts your sleep. Alcohol activates parts of the brain that will wake you up in the night and blocks REM sleep. In other words, you won't have restful, high-quality sleep if you've been drinking.

  6. Limit Your Liquids!- It's very simple: what goes in, must come out. Drinking too much water, juice, soda etc., before bed will inevitably lead to a bathroom break. Avoid drinking more than a mouthful or two in the hour leading up to bed.

  7. Avoid Stimulants- Teas, sodas, chocolate bars, and other foods contain caffeine. Caffeine builds up in the body, meaning that even if you drink an extra cup of coffee at 10am, it can still affect your sleep at night. Read labels of your foods and drink because their may be a surprising amount of caffeine. Nicotine is also stimulant that can keep you awake.

  8. Keep it Cool- Dr. Christopher Winter, Medical Director at Charlottesville Neurology & Sleep Medicine, says that "a temperature between 60 and 67 degrees Fahrenheit is optimal for sleeping." This is likely cooler than what you set the rest of your house at. Consider opening the window during cooler months, or using fan or window AC in your bedroom. Bonus: a fan or AC also has the added benefit of creating white noise which can be helpful for sleeping too!

  9. No Napping- This is easier said than done if you're exhausted. However, napping during the day will 100% impact your ability to fall asleep (and stay asleep) at night. Fighting through the day without napping could offer the full night's sleep you've been longing for!

  10. Take Sleep Aids...With Caution- Always ask your doctor about taking any sleep aids like Benadryl or Melatonin. Take prescribed medications with great caution. Sleeping aids can be habit-forming with serious side effects. However, taking sleep aids may be necessary if you've developed regular or chronic insomnia.

Are you experiencing lower back pain or other back problems? Get early access to great articles about managing your back pain:

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Hi, I'm Grace. I write and research about hip and knee replacements, PreHab before orthopedic surgery & ReHab. Content advised or co-authored with physicians (MD) and orthopedic surgeons (OS).

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