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Pain and Sleep: A Disastrous Cycle

Pain and sleep are two things that, understandably, don’t go very well together. Whether it’s because of the pain itself, or the stress and worry that pain tend to cause, the detrimental effects on sleep are undeniable. Understanding the true state of sleep among pain sufferers – and what can be done to address it…

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Pain and sleep are two things that, understandably, don’t go very well together. Whether it’s because of the pain itself, or the stress and worry that pain tend to cause, the detrimental effects on sleep are undeniable. Understanding the true state of sleep among pain sufferers – and what can be done to address it – may help everyone get a few more Zzzs.

The Issue

According to a study in The Journal of Pain, sleep complaints are present in 67%-88% of chronic pain disorders.[1] And among those with insomnia, more than 50% suffer from chronic pain.

The National Sleep Foundation’s 2015 poll determined that pain is associated with lower sleep quality more sleep problems and greater “sleep debt,” or the difference between how much sleep people think they need to function properly and how much sleep they are actually getting from night to night.[2] On average, those with chronic pain sleep only 6.7 hours, and the more severe the pain, the lower that number becomes. In addition, the sleep debt is 42 minutes a night for chronic pain sufferers and a full hour for those with severe pain.

The quality of sleep we get is also an issue for pain sufferers. Only 37% report good or very good sleep – meaning 63% are facing issues with their sleep quality.[2] This may be because, as the National Sleep Foundation found, environmental factors – like noise, light, temperature and even the mattress – affect those in pain to a higher degree than those not in pain.

It’s also the case that people in pain feel less in control of their sleep and tend to worry more about the effect that poor sleep will have on their health. This kind of stress, in turn, can actually lead to poorer sleep quality and greater sleep debt.[2]

Medications and Sleep

The question may arise: How do pain medications play into the interaction between pain and sleep? In theory, reduced pain levels would mean better sleep – but, unfortunately, that’s not the case. Among those experiencing chronic pain, only 32% of people who took pain medication during the past 7 days described their sleep as good or very good. In contrast, 47% of those with chronic pain who never took pain medication reported good or very good sleep quality.[2]

A similar outcome occurred for those taking sleep medications. Of all the respondents taking sleeping pills, only 33% of them described their sleep as good or very good and 66% of them reported sleep difficulties. On the other hand, 58% of those who never took sleep medications had good or very good sleep, with 42% of them experiencing no sleep difficulties whatsoever.[2]

Effects on Life

It’s no secret that lack of sleep can severely affect your life. But it seems this is even truer for those experiencing chronic pain. For instance, 52% of chronic pain sufferers have had their lack of sleep affect their work. In contrast, only 23% of those without pain have experienced the same. In all the categories measured by the National Sleep Foundation – mood, daily activities, enjoyment of life, relationships and work – those in chronic pain experienced significantly more difficulty.  And the problems were even worse for those with severe pain: 63% experienced problems completing daily activities, 59% had trouble at work and 54% had trouble simply enjoying their lives.[2]

The Sleep and Pain Cycle

Sleep and pain form a dangerous circle. According to a study in the journal Sleep Medicine Reviews, “Experimental studies … suggest that the relationship between sleep disturbance and pain might be reciprocal, such that pain disturbs sleep continuity/quality and poor sleep further exacerbates pain.”[3] In other words, pain leads to lack of sleep, which causes stress, fatigue and even more pain, which leads back to less sleep.

This can actually be seen on a daily basis. A study in the journal Pain discovered that those sleeping less than six hours a night had greater pain levels the next day.[4] This extremely close relationship between the two, the study concluded, illuminates “the importance of considering sleep when assessing and treating pain.”

Treating the Problem

From less sleep in general to more sleep disruptions, pain clearly has a widespread impact on our sleep and on our lives. Addressing both aspects are important when it comes to regaining quality of life.

The National Sleep Foundation found that those who made sleep a priority in their lives achieved 36 more minutes of sleep per night compared to those who weren’t motivated to get enough sleep. They also experienced better sleep quality and fewer sleep difficulties. Plus, those whose bedtime routine included going to bed at a suitable time each night got an average 18 minutes more sleep per night, with 60% of them reporting good or very good sleep quality.[2]

But addressing stress and pain are equally important aspects. That’s where a multidisciplinary approach comes in. The interventional treatment options available from physicians can decrease your daily pain levels, while a behavioral health provider can provide you with ways to cope with pain, stress and their effects on your life. Thus, an interdisciplinary treatment plan can provide both the pain relief and stress relief needed to reclaim your sleep and your life.

References

[1] Finan, Patrick H., Burel R. Goodin, and Michael T. Smith. “The Association of Sleep and Pain: An Update and a Path Forward.” The Journal of Pain 14, no. 12 (December 2013): 1539-552.

[2] National Sleep Foundation. “2015 Sleep in America Poll: Sleep and Pain.” Washington, D.C.; The Foundation; 2015 Mar.

[3] Smith, Michael T., and Jennifer A. Haythornthwaite. “How Do Sleep Disturbance and Chronic Pain Inter-relate? Insights from the Longitudinal and Cognitive-behavioral Clinical Trials Literature.” Sleep Medicine Reviews 8, no. 2 (April 2004): 119-32.

[4] Edwards, Robert R., David M. Almeida, Brendan Klick, Jennifer A. Haythornthwaite, and Michael T. Smith. “Duration of Sleep Contributes to Next-day Pain Report in the General Population.” Pain 137, no. 1 (July 2008): 202-07.

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