How Does Sleep Affect Chronic Pain?
Does chronic pain affect our ability to get quality sleep? Or does lack of sleep make chronic pain worse? It’s actually both.
It is estimated that 50-80% of chronic pain patients report sleep disruption. For obvious reasons, suffering from persistent pain can make it difficult to get a good night’s sleep. This lack of sleep can then make the severity of chronic pain much worse. On the other hand, the intensity of pain tends to decrease when a person is well rested.
But why? How are sleep and chronic pain connected?
Chronic Pain and Sleep
During a normal night’s sleep, we cycle from light sleep to deep sleep to REM (rapid eye movement) sleep up to five times. When you feel tired in the morning, it’s normally because you didn’t get enough deep sleep and REM sleep.
SIDE NOTE: The REM sleep stage is when dreams are most common and most vivid.
Sudden severe pain flare ups can wake you up from a deep sleep. Even people without chronic pain have likely experienced this in the event of a bad headache or a sudden muscle cramp (commonly called a charley horse). But persistent, mild pain can negatively impact sleep quality as well. Milder pain can cause microarousals. Microarousals are periods of time when you are shifted back into light sleep. Though you’re not likely to be aware of these microarousals happening, or remember them the next day, you will probably wake up feeling like you didn’t sleep much at all.
This is not new information. It is no surprise that pain can make falling asleep and staying asleep difficult. However, less obvious is how lack of sleep can make chronic pain worse.
Why does lack of sleep make pain worse?
Studies have shown that a bad night’s sleep can result in increased sensitivity to pain the next morning. This is particularly common in conditions like rheumatoid arthritis. Additionally, poor sleep has been linked to increased likelihood of developing fibromyalgia and migraines.
It is believed that pain and sleep share similar brain activity. For example, melatonin is a chemical involved with regulating circadian rhythm. Circadian rhythm is another term for your “internal clock” and helps your body know when it is time to sleep and when to wake up. Researchers are beginning to find evidence that melatonin also plays a sizable role in our perception of pain.
Poor sleep also appears to cause inflammation in the immune system. This can lower the body’s overall resilience, sometimes increasing the sensation of pain. It may also harm the body’s ability to fight whatever is causing the pain in the first place.
Does Chronic Pain Make You Tired?
Yes, chronic pain can very easily lead to consistent feelings of fatigue. There are several reasons for this.
It is hard to get a good night’s sleep when you have chronic pain. Constant aches and pains can make falling asleep difficult. Even if you do manage to fall asleep, it is common to be jolted awake again by a flare up. This general lack of sleep will naturally lead to fatigue.
But there are more indirect ways that chronic pain can make you tired. First of all, chronic pain tends to reduce your activity levels. The more severe your pain, the more difficult it is to get up and about. A sedentary lifestyle can lead to degeneration of your musculoskeletal and cardiovascular systems as well as anxiety or depression, all of which can result in chronic fatigue.
Additionally, fatigue can be a side effect of certain pain medications. While this is not true of all pain medications, it can still be a contributing factor in some cases.
How else does lack of sleep affect health?
To drive home just how important quality sleep truly is, there are many other negative consequences to lack of sleep. Unfortunately, many of these consequences can enhance the effects of chronic pain, making everything that much worse.
Poor sleep can cause migraines.
Lack of quality sleep can increase the likelihood of migraine attacks. The relationship is not fully understood, but experts have found that sleep and migraines are linked because they share common brain mechanisms. Lack of sleep is believed to cause a chemical imbalance that can trigger migraines.
Poor sleep can make you vulnerable to infections.
When you close your eyes and fall asleep, your brain can attend to other issues within the body. If there are areas that need to heal, the brain can trigger the release of hormones that encourage tissue growth to repair blood vessels. This helps wounds to heal faster but also restores sore or damaged muscles. While you sleep, your body can make more white blood cells that can attack viruses and bacteria that can hinder the healing process.
Your immune system relies on sleep to be able to fight harmful substances. When you don’t get enough sleep, your immune system is not able to properly protect the body from infection.
Poor sleep can make you sick in the long run.
Sleep disturbance is associated with a wide array of distress and symptoms spanning from obesity, insulin resistance, type 2 diabetes, metabolic syndrome, and cardiovascular disease risk.
Poor sleep can negatively affect various aspects of brain function.
This can include cognition, concentration, productivity, and performance. Getting good sleep then, can actually help improve problem-solving skills and enhance memory performance.
Poor sleep can wreck your mood.
40% of psychiatric mood disorders are preceded by insomnia, and insomnia sets in at the same time as another 20% of mood disorders.
Simple Steps to Help You Sleep Better
While there is no one-size-fits-all approach to better sleep, there are a variety of easy steps you can follow to make sleep easier to come by:
Don’t eat a big meal before bed
Your digestive system still works when you’re sleeping, but it slows down considerably because you’re not eating or drinking. Like many other bodily processes, your digestive system uses this “down time” to heal and rebuild. However, if you eat a large meal immediately before going to bed, your digestive system has to keep working, and doesn’t have enough time to rest and repair. As a result, you may experience symptoms that can disturb your sleep, such as heartburn, indigestion, or acid reflux.
Make sure you keep yourself fed, but eat your dinner earlier in the evening. This will help make sure your digestive system doesn’t keep you up all night.
Put away anything that has a lit screen at least an hour before bedtime
Looking at the bright screen on your phone, tablet, or computer can have a significant impact on your ability to fall asleep. Dr. Joanna Cooper, a sleep medicine specialist with the Sutter East Bay Medical Foundation, says that the blue light produced by our device screens is the part of the light spectrum most active in our sleep cycle. Stimulation of this part of the brain suppresses production of melatonin. This lack of melatonin makes it difficult for many people to “turn off” their brains and fall asleep.
Laying in your comfy bed at the end of the day feels like a great time to view your screens. But if you are looking to get a night of quality sleep, try reading a book or listening to soothing music instead.
Try relaxation techniques to reduce stress
We’ve all been there before. You’ve got something on your mind that is stressing you out and you can’t think about anything else. This is especially problematic when you are trying to sleep. Focusing on stressors makes it almost impossible to “switch off” your overactive mind and fall asleep. You are going to need something to help you relax.
Luckily, there are many simple ways to calm yourself before bedtime. Try a quick yoga session – it will take your mind of your anxiety without putting you into full workout mode. You can also try meditation – this can help you to focus on breathing and reorient your thoughts. Or you could take a warm bath with the lights dimmed. Whatever you choose, giving your body some relaxation time can go a long way toward good sleep.
Don’t consume caffeine in the evening
This one is pretty obvious. Many of us love our caffeinated beverages, but there is a reason we generally consume them at the start of the day instead of the end. Caffeine is a powerful stimulant that keeps you awake and alert. It accomplishes this by blocking sleep-promoting receptors in your brain called adenosine receptors. This is great for getting your day started, but the exact opposite of what you want before bed.
Now, staying hydrated is actually great for getting good sleep, so having a drink at night is just fine. But instead of caffeinated beverages, try some soothing herbal tea or the classic choice of water. Just don’t drink so much that you end up having to run to the restroom all night.
Keep your room dark, cool, and quiet
It is important to create an environment in your room that promotes sleep.
First of all, make it as dark as you can. Darkness is the natural state your body experiences while actually sleeping, so simulating that state will help you fall asleep more easily.
Keeping your room cool is a good choice as well. If your room gets too warm, you can very quickly get sweaty and sticky, which is terribly uncomfortable and makes it hard to sleep. Keeping your room cool prevents this, and if you get a little too cold, just snuggle up under your blanket.
Finally, most people will have trouble sleeping when it’s noisy. Loud, annoying, or sudden sounds can trigger the production of adrenaline and increase heart rate. Keep it quiet in your room to avoid these sleep hazards. If you are the kind of person who can’t sleep when it’s totally quiet, use a white noise machine or sleep sounds app on your device.
Finding a nightly routine can help with getting better sleep. Find what works for you, whether it’s reading before bed, practicing breathing exercises, or taking a bath. Better sleep may not happen instantaneously, but with practice and consistency, sleep can improve over time. And when you get better sleep, you may be able to reduce your pain as well.
But if you continue to experience chronic pain, despite improved sleep, reach out to us. Twin Cities Pain Clinic specializes in pain management care and we can help relieve your pain and get you back to living your best life.
