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Breaking the pain-sleep cycle

11/01/2017 • Michael Breus

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Dr. Michael Breus

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We all want to wake feeling rested and refreshed, body and mind ready to dive into the day. For people with chronic pain, that’s often not how mornings begin. Both the physical discomfort of pain and the anxiety that often accompanies pain at bedtime pose real challenges for restful sleep. Together, pain and sleep problems can interfere with the quality of our daily lives, compromising performance, limiting physical activity, and undermining relationships.  Breaking the pain-sleep cycle can be complex, but is something you can handle with the right therapy and support.

Pain and sleep share a complex, bi-directional relationship: each has a powerful influence over the other.  Chronic pain and sleep problems frequently occur together—some research shows more than 50 to 90 percent of chronic pain patients also suffer from sleep problems. A single night of poor sleep can worsen pain, and a single day spent coping with pain can interfere with sleep, according to research.

The presence of pain can make falling asleep and staying asleep more difficult. Pain leads to more fragmented, restless, lighter sleep, with more frequent awakenings—and less time spent in the deeper stages of slow-wave and REM sleep. During these sleep stages, the body does some of its most important work to repair itself, strengthening immune function, encouraging healing, processing memory and emotions.  When you’re in pain, you risk missing out on the all of physically rejuvenating and mentally restorative powers of sleep—just when you need them most.

In turn, poor sleep exacerbates pain. As important new research indicates, both sleep quality and sleep quantity affect pain. Insufficient sleep is linked to increased inflammation, including an increase in pro-inflammatory markers and the stress hormone cortisol. Poor sleep quality is associated with higher risks for future chronic pain conditions. It’s important to pay attention to both the quantity and the quality of your sleep, to protect against aggravating pain.

Losing sleep also lowers pain thresholds, heightening sensitivity to pain. Sleep plays a role in our perception of pain, and sleep deprivation increases the intensity of pain perception.
Left untreated, chronic pain and poor sleep can both escalate, in a cycle that’s both physically and mentally challenging. Anxieties about persistent pain and the inability to sleep well are common. I listen to these worries regularly from my patients. Research shows that how we perceive pain and sleep—and our capacity to manage them—matter a great deal. Fears about our inability to rest well while in pain bring about more sleeplessness, and with that sleeplessness comes increased pain.

What are the most effective ways to break the pain-sleep cycle?

Drug therapies for pain can help temporarily reduce inflammation and soothe discomfort. But both over-the-counter and prescription analgesic and sedative medications have side effects, and may pose health risks when used long-term. Some are habit-forming.

Recent research offers promising avenues for non-drug treatment to improve both poor sleep and chronic pain. Regular, moderate exercise can reduce inflammation, lower pain perception, and improve sleep in people with chronic pain. Cognitive-behavioral therapy (CBT) is another effective form of treatment, helping to establish new habits and to alleviate anxiety about pain and sleep. These therapies use the body and mind’s innate and adaptive skills to improve sleep and help reduce pain. Like exercise and CBT, Quell is non-drug treatment for pain that harnesses the body’s natural capabilities to provide relief from chronic pain.

Tackling pain issues can help improve your sleep, and that better sleep can help protect you against pain. That’s a cycle worth repeating.

Sweet Dreams,
Michael J. Breus, PhD, DABSM
The Sleep Doctor™
NeuroMetrix compensated me to share my thoughts on sleep and chronic pain. The thoughts and opinions in this blog post are sincere and my own.

About The Author
Michael Breus

Michael J. Breus, Ph.D., is a Clinical Psychologist and both a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine. He was one of the youngest people to have passed the Board at age 31 and, with a specialty in Sleep Disorders, is one of only 163 psychologists in the world with his credentials and distinction. Dr. Breus is on the clinical advisory board of The Dr. Oz Show and appears regularly on the show. Learn more about Dr. Breus’ work at www.thesleepdoctor.com.

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