Did you know that approximately 65% of adults with chronic pain have insomnia or a diagnosed sleep disorder? It’s true. And, guess what? Older adults are especially prone to chronic pain and insomnia.
The truth is chronic pain and insomnia make for a bad mix. In fact, chronic pain disrupts sleep in approximately 20% of Americans three or more nights a week. Regardless of the origin of the distress (back or hip pain, headaches, gastrointestinal, or even emotional pain), chronic pain not only robs you of your energy and happiness, but also prevents you from properly resting your mind and body. Rest is crucial for repairing your body and easing your pain. And, guess what? When you are fatigued from a lack of sleep, you feel pain more intensely.
And, when you are in constant pain, oftentimes, the best way to get relief is to go to sleep.
Unfortunately, however, people who struggle with chronic pain often have a hard time relaxing long enough to fall asleep. This can lead to pain and even more sleepless nights. The result? Crankiness, mood swings, extreme fatigue, disorientation and confusion, cognitive delays, poor short-term memory, high blood pressure, weight gain, low productivity, aches and pains, depression, anxiety, etc. Sleep helps your body refill its energy reserves and heal from daily stresses.
But, if you suffer from chronic pain and happen to fall asleep, the pain may worsen throughout the night, causing you to wake up periodically in agony. And, if you are able to get back to sleep once you prematurely awaken, you may be extremely tired the next morning. These “mini-arousals” can prevent you from drifting into a sound sleep, leading to daytime fatigue upon awakening. When you’re unable to get the sleep you need to function properly, you become hypersensitive to pain. In other words, your pain worsens.
The good news is you can break this continuous cycle of pain and “sleeplessness”. There are ways you can get sound sleep – even if you are struggling with chronic pain. How? Well, by developing positive sleep habits that you can stick with indefinitely and by relying on your body’s natural instinct to “shut-down” when its energy reserves are depleted. Addressing your pain and insomnia simultaneously can help you get the relief you need to be your “best self!”
- Is There a Link Between Sleep, Chronic Pain And Mental Health?
- What Prevents Some People with Chronic Pain from Falling and Staying Asleep?
- Can Lying in a Certain Position Worsen Chronic Pain and Disturb Sleep?
- Can a Lack of Sleep Trigger or Exacerbate Chronic Pain?
- Can Chronic Pain & Insomnia Be Treated with Psychotherapy?
- How Can I Naturally Fall Asleep or Back to Sleep When I Have Chronic Pain?
Is There a Link Between Sleep, Chronic Pain And Mental Health?
Studies suggest that people with chronic pain may experience an endless cycle of pain, insomnia, and depression or anxiety. For instance, a person with chronic pain may experience anxiety if he or she is unable to fall or stay asleep.
Once this person finally falls asleep and awakens the next morning, he or she may feel groggy, depressed, moody, extremely tired – and even achier than before. If this individual is unable to get proper rest the next night, he or she will experience a repeat cycle of chronic pain, poor sleep (insomnia) and mental health issues (depression or anxiety).
In fact, researchers found that approximately 33% of people who have chronic pain also struggle with anxiety or depression. Thus, study results suggest that people, who suffer from chronic pain and depression, not only have elevated levels of pain and poor sleep habits, but also have a hard time “shutting down” when it is time to relax and go to sleep.
What Prevents Some People with Chronic Pain from Falling and Staying Asleep?
The truth is chronic pain impacts sleep patterns differently, depending on the individual and the severity of the symptoms. For instance, some people experience night time flares (increased pain) that are triggered by their sleep positions. While others may experience constant pain that doesn’t ease up once bedtime hits. Sometimes, the bed (too soft or too hard pillows, heavy covers, a lumpy or too hard mattress, etc.) itself is uncomfortable or the environment is too chilly, hot, quiet, or noisy, preventing sleep.
However, stress is a major culprit in the never-ending chronic pain/insomnia saga. Stress worsens everything, so it just makes sense that it could ramp-up your pain and prevents you from falling and staying asleep. Add in frequent “wake-ups” and you end up with an individual, who is functioning on little-to-no fuel. In fact, a 2013 study found that frequent “nighttime wake-ups” was the most common sleep concern in people struggling with chronic pain.
To fully grasp the cycle of chronic pain and insomnia, you must first understand the sleep cycle process. Once you fall asleep, you go through several stages – light sleep, deep sleep (slow-wave sleep), and REM (rapid eye movement) sleep. To feel fully refreshed and ready for the next day, you have to successfully move through all three stages (light sleep, deep sleep (slow-wave sleep), and REM sleep). If your chronic pain disrupts one or more of these stages, it can cause you to awaken the next morning feeling worse than you did the night before – “pained” and tired, unmotivated, and irritable.
A 2018 study confirmed that people with chronic pain are at risk for sleep disorders, such as insomnia, restless legs syndrome (RLS), sleep apnea, and/or narcolepsy. Although prescription pain meds are available to help with chronic pain, these medications typically come with side-effects and serious risks like addiction and overdoses. So, most experts recommend seeking help for the pain and trying natural means to help you fall and stay asleep at night.
Can Lying in a Certain Position Worsen Chronic Pain and Disturb Sleep?
Your sleeping position can influence how much sound sleep you get each night, especially when grappling with chronic pain. For instance, if you have an arthritic condition like lupus or rheumatoid arthritis, you may find some relief by lying on your back. Why? Because this takes most of the pressure off of your joints.
When you lie on your side, the pressure falls directly on those joints, increasing your risk of discomfort and pain – and preventing you from getting sound sleep. On the flip side, however, if you suffer from lower back pain, you probably want to avoid sleeping on your back or stomach, because this can put pressure on your back muscles, nerves, and spine, triggering or worsening your back pain.
So, you may want to consider sleeping on your side if you suffer from lower back pain. You may also want to invest in pillows or a mattress that can relieve pressure from your joints and support your spine.
Some health conditions, like multiple sclerosis (MS) and fibromyalgia can trigger “diffuse pain” or “widespread pain” that can be felt all over your body or in several different areas. This type of chronic pain typically occurs when a condition irritates your nerves, causing tingling, pain, or numbness. Thus, a person who has chronic “diffuse pain” may need to change positions multiple times throughout the night to reduce or stop his or her discomfort. He or she may also want to opt for pillows and an adjustable mattress or memory foam mattress that supports movement.
Note: If you are unable to change positions on your own, ask a loved one or caregiver to help you adjust your sleeping position.
Can a Lack of Sleep Trigger or Exacerbate Chronic Pain?
Yes, it can.
There appears to be a positive correlation between sleep and pain, however, current research suggests that inadequate sleep may actually be worse for chronic pain, than the impact chronic pain has on sleep quality.
A 2012 study found that shorter sleep times, broken sleep, and poor sleep quality can cause a next-day hypersensitivity to pain, especially in chronic conditions like rheumatoid arthritis or lupus. Researchers also found that people with sleep problems have an elevated risk of one day developing chronic conditions (i.e. fibromyalgia, chronic fatigue syndrome, or migraines). Thus, study results suggest that adequate sleep may actually reduce chronic pain over time.
How are chronic pain and sleep connected? Well, pain and sleep share similar neural pathways and neurotransmitters (brain chemical messengers). In fact, a recent study found that melatonin, a hormone responsible for regulating a person’s circadian rhythms, can influence how we perceive or “see” our pain.
Researchers suggest that a lack or loss of sleep can lead to or exacerbate inflammation and autoimmune conditions. However, adequate levels of dopamine and vitamin D appear to help some people with chronic pain sleep better at night.
Overall, however, studies have garnered varying results on the effects of a lack of sleep on a person’s pain threshold and the brain’s ability to reduce or stop the sensation of pain. Thus, some researchers have concluded that addressing certain neural pathways may impact sleep by reducing or stopping pain, but more studies are needed to definitively determine if this theory is valid.
Still, when trying to determine the link between sleep and chronic pain, it is also important to examine the role sociodemographic factors play in this relationship. A 2006 study found that women are more sensitive to sleep-impacted chronic pain than men, and older adults are more sensitive than younger ones.
Researchers suggest that people with chronic pain are more likely to experience daytime fatigue (due to a lack of sound sleep), but less likely to exercise and consume healthy foods, which are necessary for pain reduction and proper sleep. As a result, pain and insomnia typically rotate in a continuous cycle until the pain and “sleeplessness” are properly addressed. Keep in mind, however, that a person’s “sleeplessness” (due to chronic pain) can also negatively affect a partner or spouse who shares the bed, causing health issues for that individual, as well.
Studies indicate that both children and adults with chronic pain may have a hard time falling and staying asleep at night, and as a result, experience more intense pain than those, who experience restful sleep on a regular basis. Researchers also assert that psychological factors (i.e. depression or anxiety), can, in part, lead to “sleeplessness.”
Can Chronic Pain & Insomnia Be Treated with Psychotherapy?
Yes, it can!
Cognitive-behavioral therapy (CBT) is a common psychotherapy used to treat chronic pain and cognitive-behavioral therapy for insomnia (CBT-I) is a common psychotherapy used to treat insomnia. These two forms of CBT are often used simultaneously to help people with chronic pain get a good night’s sleep.
CBT can help change how you perceive (thought processes) and cope with (behavior) your chronic pain. While CBT-I can help change any thoughts and behaviors that may be disrupting your sleep. Most practitioners prefer the CBT/CBT-I combination over prescription painkillers and sleep aids because CBT/CBT-I does not have side-effects and can offer a long-term remedy to chronic pain and insomnia.
The goal of this CBT/CBT-I combination is to help you prevent, reduce, or manage any distressing or negative thoughts or sensations (chronic pain) that may be preventing you from falling and staying asleep. CBT/CBT-I aims to help you identify and understand how your thoughts are affecting your sleep. The hope is that once you understand what is prompting these thoughts, they will lose their power over you, easing your pain so you can fall into a peaceful sleep.
Keep in mind, however, that studies on the effectiveness of CBT/CBT-I for chronic pain and insomnia in individuals, who also struggle with mental health conditions like anxiety or depression, is currently limited. Still, studies suggest that being attentive to one’s sleep habits, quality, and thought processes can lower the risk of developing chronic pain.
Keep in mind that pain is an individual experience. In other words, it varies from person-to-person. Many times, psychological factors or past experiences or traumas can “color” how you comprehend your pain and inability to sleep. But, although psychological factors appear to be in-play when it comes to pain that does not mean the pain is not valid because many times it is. But, because pain is so individualized and complex, treatment often requires a varied approach that takes into account any psychological components.
How Can I Naturally Fall Asleep or Back to Sleep When I Have Chronic Pain?
Listed below are ways you can naturally fall asleep or fall back asleep once awakened:
- Address the Cause of Your Chronic Pain
Before you’ll be able to get a good night’s rest, you’ll need to address the root cause of your chronic pain. If the pain is keeping you awake at night, you won’t be able to sleep until you have it under control. So, if you are experiencing chronic pain so severe that it keeps you up at night, it is important to seek medical care.
- Participate in a Sleep Therapy Program
If you have a hard time drifting off to sleep – worry no more because help is on the way. Sleep therapy programs like Somnus Therapy can help you get the zzz you desperately need to be your best “self” every day. Somnus Therapy is a guided CBT-I sleep program for people who have a hard time falling and staying asleep at night.
Sleep programs use a range of techniques (i.e. guided or mindful meditation, sleep sounds, journaling, deep breathing, auditory sessions, etc.) to help you fall asleep quickly and sleep more soundly at night. The goal of a sleep program is to relax your mind and body so you peacefully enter the land of “sweet dreams.”
- Shift Your Position in Bed
Lying in certain positions can trigger or worsen chronic pain, preventing you from falling or staying asleep throughout the night. Changing your sleeping position can reduce chronic pain from a joint or muscle condition, so you can get some much-needed zzz.
- Consider a Natural Sleep Aid
Although prescription sleep aids can make you feel drowsy and disoriented the next day, natural sleep aids usually don’t come with many, if any, side-effects. They also tend to be non-addictive – unlike sleeping pills. Natural sleep aids may include herbal teas, CBD tinctures or edibles, melatonin, valerian, chamomile, cherry juice or tart cherry extract, zinc or magnesium. These natural aids promote sound sleep in a safe and effective manner.
- Engage in a Little Nighttime Reading
If you struggle with chronic pain and have a hard time falling asleep at night – read. Reading a juicy or interesting book can distract you so you’re not constantly thinking about your pain. Once distracted, your body will relax and you’ll eventually get sleepy and “clonk out.”
- Develop a Consistent Bedtime Routine
It is extremely important to develop a consistent bedtime routine, if you suffer from chronic pain. A consistent bedtime routine not only provides stability in your life, but also prepares your mind and body for bed. In other words, it helps you wind down and relax so you want to go to sleep.
- Make Time for Evening Strolls
If your pain has been keeping you up at night, it may be time to add some exercise into your daily routine. A low-impact way to exercise is to take evening strolls around your neighborhood. This will strengthen your joints and work out your muscles so you feel stronger and more energized. Exercise is also known for reducing pain, improving your mood and easing anxiety, so you can sleep better at night. And, guess what? Taking a stroll can be fun, especially when you invite a friend or loved one to accompany you.
- Practice Deep Breathing Exercises
Chronic pain can literally take your breath away at times; but, deep breathing exercises can help you get it back. If you experience pain once you lie down for bed, practice deep breathing exercises. Slow and steady rhythmical breathing can have a calming effect on your mind and body, easing your stress and reducing your pain so you can rest – all night long. In fact, research indicates that taking slow, deep breaths shortly before bed can help you fall asleep and get back to sleep quickly should you awaken in the middle of the night.
“Sleeplessness,” also known as insomnia can be a common occurrence when you struggle with chronic pain. Chronic pain and insomnia tend to be intertwined with the pain preventing you from falling and staying asleep at night and “sleeplessness” increasing your pain the next day. In other words, the pain keeps you up, triggering more pain (because you’re not getting enough sleep to repair your body and replenish your energy reserves) after you wake-up. The good news is you don’t have to suffer in silence – help is available. In fact, there are tons of traditional and holistic sleep tools (i.e. sleep programs, exercise, meditation, reading, deep breathing, etc.) that can help you dream of “sugar plums” all night long!
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