Why Pain Keeps You Up at Night

If you’re living with chronic pain, chances are you’ve had trouble sleeping more than once. As anyone who has experienced pain can attest, when something hurts, it’s difficult to fall — and stay — asleep. 

When it comes to pain and sleep, though, it’s often a “chicken and egg” scenario for doctors. Research shows that not only does pain interrupt sleep, but sleep disorders themselves can actually lead to chronic pain.

About 65 percent of patients suffering from chronic pain report sleep disturbances as well — and among those who have trouble sleeping, most report at least some difficulties with mood, work, relationships, and overall enjoyment of life. That’s why it is so important to assess sleep habits and problems when investigating pain, as addressing sleep issues could help reduce pain — and vice versa.

Sleep and Pain Tolerance

The central nervous system (CNS) controls both pain and sleep. Some doctors suspect that problems with the CNS actually start with sleep disturbances, and eventually progress into pain and increased perception of pain.

According to researchers at the Detroit-based Henry Ford Hospital, prolonged sleep deprivation actually reduces tolerance for pain, even in healthy individuals. Study participants who slept for nine hours without interruption could withstand pain an average of 25 percent longer than the subjects who only slept for seven hours. This study supported the findings of a previous study, which suggested that just one night of reduced sleep could significantly reduce pain tolerance.

Scientists aren’t exactly sure why sleep deprivation reduces pain tolerance, but suggest that a lack of adequate sleep increases inflammation in the body, leading to pain and discomfort. If the sleep disturbance is temporary, then the pain tolerance returns to normal levels. If the sleep deprivation is ongoing, though, then the pain increases — and the problem becomes chronic.

Pain That Causes Insomnia

While losing sleep can make you more sensitive to pain, living with certain conditions are more likely to interrupt sleep. These conditions include:

  • Headaches. Both migraines and pain in the jaw and ears caused by TMJ (temporomandibular syndrome) can interrupt sleep.

  • Fibromyalgia. Also known as chronic fatigue, fibromyalgia causes joint and muscle pain that causes one to awaken more often during sleep.

  • Arthritis. Studies have shown that arthritis can disrupt circadian rhythms, making it more difficult for sufferers to fall asleep and stay asleep.

  • Cancer. Pain from cancer and its treatments can interrupt sleep.

  • Musculoskeletal issues. Herniated discs, degenerative disease, and carpal tunnel syndrome are just a few conditions that can cause pain and interrupt sleep.

Of course, not all pain-related sleep issues are due to chronic pain. Short-term illnesses or injuries can disrupt sleep as you struggle to get comfortable, and pain from surgical procedures can lead to sleep disturbances. Those interruptions are usually temporary, though, and diminish once the injury heals. Additionally, medication taken for pain can also interrupt sleep, making it even more important to treat the underlying cause of pain to reduce the need for medication and improve sleep.

Treating Pain for Better Sleep

Because pain and poor sleep are so closely intertwined, it’s important to work with pain treatment centers that assess sleep quality when treating chronic pain. Many sleep experts recommend that patients who are living with chronic pain undergo a full sleep assessment as part of their pain treatment plan to determine if a sleep disorder is actually at the root of the pain or worsening pain from other conditions.

Sometimes, an easily diagnosable condition like restless leg syndrome or sleep apnea is responsible for poor sleep quality and resulting pain, and treating that condition can make a significant difference in reducing chronic pain.

In many cases, however, the problem is not easily diagnosed or treated. But by recognizing the interplay of sleep and pain, and working on improving sleep quality, pain symptoms can lessen. This usually involves taking a multifaceted approach that includes identifying and addressing the underlying causes of the pain to start, but also providing guidance in other practices to improve sleep. These include sleep hygiene (practices that help improve the quality of sleep, such as maintaining the proper temperature and light levels in the bedroom), behavioral modification and psychological approaches to better sleep (such as learning visualization and breathing techniques), and in some cases, medications or equipment to improve sleep, such as a CPAP machine to help control apnea.

If you are having trouble sleeping — either falling asleep or staying asleep — and are dealing with chronic pain, it’s important to address your sleep issues as soon as possible. Ignoring them or resigning to simply accept them as part of your condition is only going to make things worse, and getting relief from the pain will be more difficult in the long run. Talk to your doctor about your sleep, and over time you may be able to rest easier with less pain.

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