Experiencing aches and pains? Then you know sleep and pain are not a good combination, especially chronic pain. The unfortunate reality for 50 million Americans suffering from chronic pain is significant sleep loss, poor sleep quality, and sleep deprivation. 

If your pain is preventing you from getting the restorative sleep you need, we’re sharing our best tips for getting good sleep even if you experience chronic pain. This includes what to do if your pain medications are causing sleep disturbances.

Many people experiencing chronic pain take medications or have a prescription to treat the symptoms, but it may not be helping you sleep. While some medications may address your disrupted sleep, others may actually hinder your ability to get a full night’s rest.

One thing we do know is that getting the right amount of quality sleep each night can be instrumental in actually helping reduce your chronic pain symptoms. If you’ve been dealing with pain for a while that may feel impossible— but these recommendations help improve sleep and can get you feeling rested again. 

So how can you get the restful sleep you need each night, even if you’re experiencing chronic pain?

How Sleep Affects Pain

Chronic pain and sleep deprivation can create a vicious cycle— pain can affect your ability to sleep, and a lack of sleep can worsen your pain. 

Poor sleep and chronic pain can also contribute to mental health disorders like depression or anxiety. This can also create a terrible cycle of pain, poor sleep, and poor mental health, which can further make your pain and sleep issues even worse.

In short, poor sleep increases pain risk and pain sensitivity, but restful sleep can reduce pain intensity and reduce the pain severity.

What Causes Chronic Pain?

We’ve all experienced pain, so what makes chronic pain different? 

The difference between normal, acute pain and chronic pain is that acute pain goes away after a while. Chronic pain is much more persistent, and can last for years. 

Most chronic pain is caused by an initial condition, such as a sprain or infection, or results from a current condition causing ongoing pain. There are some people though who experience chronic pain without any past injury or illness.

Some common, non-disease causes of chronic pain can include:

  • Being overweight or obese
  • Normal aging of the human body
  • Poor posture
  • Improperly lifting, carrying, or moving heavy objects
  • Sleeping on a bad mattress

Diseases and conditions that can cause chronic pain include:

  • Fibromyalgia
  • Arthritis
  • Shingles
  • Nerve damage
  • Cancer
  • Multiple sclerosis

Chronic Pain and Common Sleep Disturbances

It is common for pain to get worse at night. A 2020 study found that online searches for information about pain management peaked between 11:00 PM and 4:00 AM.

Chronic pain can make falling asleep and staying asleep difficult, and if you’re experiencing conditions like arthritis pain, even just adjusting your sleep position can cause a lot of aching and discomfort that can wake you up.

It’s very common if you have chronic pain to experience significant sleep disturbance, and delayed sleep onset latency— meaning it takes you much longer to fall asleep than it should. Additionally, you also tend to have poor sleep efficiency, lower total sleep time, and increased respiratory-related events and periodic limb movement.

One review of multiple studies found that if you have chronic pain and experience sleep disturbances, your pain severity is greater, experienced longer and with greater disability. You’re also less physically active than if you didn’t have those sleep disturbances. 

In addition to the increased physical symptoms you may experience with sleep disturbance, there are also more common mental and emotional symptoms when both conditions, chronic pain and sleep disturbance, occur. These symptoms can include depression, anxiety, catastrophizing, and even suicidal ideation. 

When you sleep poorly, your tolerance for pain decreases, and you become more sensitive to pain— not a great combination when your pain is chronic. 

How Your Pain Medication Can Impact Your Sleep

For many, pain medications are needed at night to help induce sleep and prevent middle of the night awakenings, but some pain medications can actually contribute to sleep deprivation.

Along with being habit-forming, opioid painkillers can disrupt your natural sleep cycle, causing disturbed sleep and reduce how much deep sleep you get each night. In a study published by the Association of Anesthetists, participants on high doses of opioid medication showed “distinctly abnormal” brain activity during sleep, as well as reduced REM sleep and irregular sleep patterns.

Benzodiazepine medications like Ativan, Valium, and Klonopin can also reduce the amount of REM sleep you get each night, as well as cause daytime sleepiness and cognitive impairment.

Over-the-counter pain and sleep medications like Tylenol PM and Advil PM help you rest by using an antihistamine in their formulas. These may help you sleep during the night, but may have unpleasant daytime side effects including daytime sleepiness and reduced cognitive function.

If you’re concerned about how your pain medication is impacting your sleep, talk to your doctor. They can help you come up with a plan that helps you sleep while working with your prescription, or help you find an alternative if necessary.

Chronic Pain and Sleep Disorders

Sleep disorders such as obstructive sleep apnea (OSA), restless legs syndrome (RLS), and insomnia are much more common in people with chronic pain. According to an analysis by the Journal of Sleep Medicine, 72 percent of participants with chronic pain were also diagnosed with insomnia, and 32 percent of them were diagnosed with either RLS or OSA. 

People with chronic pain have a harder time getting comfortable in bed, falling asleep, and staying asleep— adding a sleep disorder to that can make any sleep issues even worse, and  your chronic pain too. This is why it’s so important to treat any sleep disturbances or disorders if you’re experiencing chronic nighttime pain.  

This is especially important for anyone suffering from insomnia. A recent study published by the Sleep Research Society found that your insomnia symptoms are a risk factor for developing pain. And when experiencing that pain, it has a significant effect on your insomnia symptoms. Although the study didn’t differentiate between acute and chronic pain, it does indicate that treating insomnia is important for pain relief. 

A 2014 study showed that short-term improvements in participants’ insomnia symptoms predicted long-term improvements in their sleep and chronic pain symptoms. While more information is needed about improvements to the participants’ psychological well-being, it demonstrates that good sleep is vital to reducing chronic pain symptoms.

To reduce your sensitivity to pain and improve your pain tolerance, implement our sleep recommendations listed below. Sometimes all it takes are a few simple changes to your sleep environment or routine to get the pain relief you’re seeking.  

Are Sleep Apnea and Chronic Pain Connected?

Yes— there is a connection between chronic pain and sleep apnea. Sleep apnea can both cause and worsen chronic pain. It can also make you more sensitive or less tolerant to pain.

If you’re experiencing chronic pain and poor sleep, it’s important to rule out any potential sleep disordered breathing with obstructive sleep apnea. Common symptoms for look out for include:

  • Loud snoring
  • Choking or gasping during sleep
  • Sleepiness or fatigue during the day

Although the exact reasons are unknown, according to Oxford University Press Pain Medicine, one hypothesis is that obstructive sleep apnea (OSA) patients experience increased pain sensitivity because of their fragmented sleep and hypoxemia, or below-normal levels of oxygen in their blood.

How Sleep Apnea Treatment Can Help Chronic Pain Sufferers

However, treating sleep apnea may also treat your pain. CPAP therapy, or continuous positive airway pressure therapy may improve pain sensitivity and reduce the need for medication. Also noted by Oxford University Press Pain Medicine, CPAP treatment improved pain tolerance and intensity in participants.

CPAP therapy can also help treat a number of comorbidities associated with OSA, including cardiovascular disease, diabetes, and erectile dysfunction. We have many resources on our site to help you determine if you’re at risk for sleep apnea. You can also reach out for a brief evaluation by a sleep specialist. If you’re experiencing sleep disordered breathing or other sleep problems along with your chronic pain, getting tested for sleep apnea may provide additional answers and options to reduce your chronic pain symptoms.

For more information about the benefits of CPAP therapy, check out our Why Choose CPAP resource.

How to Get a Good Night’s Sleep, Even with Chronic Pain

It’s important to prioritize your sleep each night, especially if you’re struggling with pain. Try some of these suggestions to help manage your pain and get the restorative sleep you need.

1. If You Take Pain Medication, Take it Before Bed

Taking your pain medication before bed can help ensure that it’s most effective while you’re trying to sleep. In turn, this can help you fall asleep and stay asleep much easier.

If you take any of the medications we mentioned above— benzodiazepines, opioids, or even over-the-counter medicines— pay attention to make sure that they’re not sabotaging your sleep. If they are contributing to your sleep problems, try taking them at a different time during the day or talk to your doctor about alternative prescriptions.

Note: Always consult your doctor before making any changes in your prescription schedule. Do not stop taking your prescription or change your schedule without your doctor’s consent.

2. Maintain A Regular Sleep Schedule

This next suggestion sounds easy, but for many, it’s not. If possible, go to bed at the same time each night and wake up at the same time every morning— including weekends. Maintaining a regular sleep schedule sets your internal clock, and helps train your body to be tired as well as wakeful at your desired times, which is important for quality sleep.

3. Exercise Proper Sleep Hygiene

In case you’re unfamiliar with the term, sleep hygiene is essentially a person’s sleep habits before they go to bed. Good sleep hygiene promotes healthy sleep— poor sleep hygiene contributes to subpar sleep.

How do you typically end your day? Does it include a consistent routine that allows time for you to relax, and signals your mind and body that it’s time to rest? If not, creating that routine can greatly improve your sleep at night. 

The right sleep habits make getting a good night’s sleep much easier, so give yourself time to wind down and relax before you settle into bed for the night— 30 to 60 minutes is ideal.

Before your desired bedtime, make sure you take the time you need to finish your responsibilities for the day so they aren’t weighing on your mind, take a warm bath or shower (there are additional sleep-inducing benefits as your body cools afterward), wash your face, brush your teeth, and anything else that is part of your nightly routine. After you’ve finished taking care of your personal hygiene, do something that helps you relax.

This can be anything like reading a book, writing in a journal, or chatting with family members. You can even try some relaxation techniques like we list below. Make sure to avoid using your phone or other electronic devices at least an hour before sleep though— the blue light from your screens can inhibit melatonin production and make it harder for you to sleep.

4. Relaxation Techniques

Relaxation techniques can both relieve some pain as well as help you sleep. Techniques such as guided imagery, breathing exercises or meditation for pain relief and sleep can help take your mind off any discomfort and help you rest easier. If you wake up in the middle of the night, these relaxation techniques can help you go back to sleep also.

Practicing meditation for sleep and pain can be especially helpful for your chronic pain symptoms. Meditation can promote sleep by reducing your pain sensitivity by altering your perception of it— this is because meditating reduces pain-related activity in your brain, which reduces your discomfort.

Yoga also has many beneficial mental effects, and can help relieve some of your pain. Studies have shown that yoga helps improve mobility and reduce symptoms in people with arthritis, fibromyalgia, and lower back pain. Take it easy on yourself though— if a particular stretch or pose doesn’t agree with your body, you can alter the pose to be more comfortable.

5. Replace Your Mattress or Pillow

If your mattress isn’t helping you get a good night’s sleep, consider an upgrade. Your mattress should support your body, and your pillow should support your head and neck. Sleeping on the wrong mattress can create pressure points on the body and lead to soreness and pain. If you have neck pain, it’s probably time for a new pillow.

If you experience a chronic pain condition like back pain or arthritis, the right support can make a world of difference for pain relief and helping you get better sleep.

What to Do If You Still Struggle with Chronic Pain

The right lifestyle adjustments or the right changes in the bedroom can do wonders for your chronic pain, but if those don’t solve your pain symptoms, then it’s important to talk to a medical professional to consider other options.

If you don’t think that your pain is being worsened by an underlying sleep condition, consult your primary care provider. They can discuss your symptoms with you, create a new course of treatment for you, or help you adjust your current one.

However, if you think that an underlying sleep disorder is making your chronic pain worse, it’s important to consult a sleep specialist. Similar to your doctor, a sleep specialist can help you evaluate your symptoms and find the best treatment options for your needs, but with a sleep-targeted approach.

A potential sleep disorder should not be ignored if you’re still struggling to get the sleep you need. If you’re unsure if sleep disordered breathing is contributing to your chronic pain, check out our sleep apnea quiz. It will help you assess your personal risk, make sense of your symptoms and help you figure out the next steps towards treatment if needed.

Chronic pain and poor sleep can have a cyclical effect on each other that makes it vital to treat both, rather than one or the other. Contact the Sleep Centers of Middle Tennessee today to schedule a consultation so you can sleep peacefully and pain-free.

References

Fuggle, Nicholas R, et al. “P64 Does Pain Peak at Night? The Daily Rhythm of Musculoskeletal Searches on the NHS Website.” OUP Academic, Oxford University Press, 20 Apr. 2020, academic.oup.com/rheumatology/article/59/Supplement_2/keaa111.063/5822246. 

Friesen, Anne-Marie, and Avneesh Bhangu. “Pain and Sleep May Have a Bidirectional Causal Relationship.” 2 Minute Medicine, 16 Aug. 2021, www.2minutemedicine.com/pain-and-sleep-seem-to-have-a-bidirectional-causal-relationship/. 

Mathias, J.L., et al. “Sleep Disturbances and Sleep Disorders in Adults Living with Chronic Pain: A Meta-Analysis.” Sleep Medicine, Elsevier, 11 June 2018, www.sciencedirect.com/science/article/abs/pii/S1389945718302168. 

Robertson, J A, et al. “Sleep Disturbance in Patients Taking Opioid Medication for Chronic Back Pain.” Anaesthesia, John Wiley and Sons Inc., Nov. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5082544/. 

Charokopos, Antonios, et al. “Association of Obstructive Sleep Apnea and Pain Outcomes In Adults: A Systematic Review.” OUP Academic, Oxford University Press, 7 Sept. 2018, academic.oup.com/painmedicine/article/19/suppl_1/S69/5089424. 

Vitiello MV;McCurry SM;Shortreed SM;Baker LD;Rybarczyk BD;Keefe FJ;Von Korff M; “Short-Term Improvement in Insomnia Symptoms Predicts Long-Term Improvements in Sleep, Pain, and Fatigue in Older Adults with Comorbid Osteoarthritis and Insomnia.” Pain, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/24793909/. Shoen, Sarah. “How Sleep Meditation Works.” Sleep Foundation, 13 Aug. 2021, www.sleepfoundation.org/natural-sleep-aids/sleep-meditation.