Recent studies have concluded what many of us already knew; pain and sleep are reciprocal. Pain can interfere with sleep, which can lead to a sleep deficit. Dr. David Hanscom, orthopedic surgeon, says, “Poor sleep escalates the misery of chronic pain. Even if you feel calm and you have no major stresses in your life – it’s critical to get at least seven hours of uninterrupted sleep to go free of any kind of chronic pain. Not sleeping is not an option.” Night after night of poor sleep can cause aching backs, sore joints, headaches, and neck aches, as well as exasperate existing pain. Inadequate sleep can also reduce the body’s tolerance to pain and worsen inflammation. Like chronic pain, a sleep deficit can lead to feelings of hopelessness and depression.
Sleep is a basic human need, like eating, drinking, and breathing. When sleep is compromised, it affects our physical and mental health, makes us prone to injury, and increases our risk of death, according to the National Heart, Lung, and Blood Institute. “Pain can have a significant impact on sleep, depending on its duration and severity. Our bodies need to be able to relax in order to dive into a deep sleep which is quite impossible when our bodies are stressed and tense due to severe pain,” Dr. Nikola Djordjevi MD explains.
Effectively managing pain can improve the quality of sleep. But environmental factors— such as room temperature, noise, light, and bed comfort —play a role as well. The good news is that resources are available to help you get the good night’s sleep you need to regain and keep a good quality of life.
The back is a complicated structure that runs from the base of the skull to the pelvis. This pillar of support for our body weight is made up of bones, joints, ligaments, and muscles that can be sprained, strained, inflamed, or ruptured due to injury or accident. Sometimes, the simple act of bending over to tie your shoes can trigger a staggering jolt of pain that can make standing straight, lying down, or even moving feel impossible.
Factors such as poor posture and obesity can also cause back pain, as well as issues that affect us internally, like kidney stones, blood clots, or bone loss. The intensity of back pain runs along a spectrum that ranges from a dull ache to a stabbing or shooting sensation, depending on the source.
With so many elements that can affect the back, it’s no surprise that back pain is the single leading cause of disability, costing Americans at least $50 billion in annual health care costs, according to the American Chiropractic Association.
For some back-pain sufferers, getting a restful night’s sleep can be difficult because they end up tossing and turning throughout the night in search of a more comfortable position.
Many people with back pain resort to anti-inflammatory medication such as nonsteroidal anti-inflammatory drugs (NSAID), like over-the-counter Advil (ibuprofen) and prescription Celebrex. On rare occasions, NSAIDs themselves can cause sleep difficulties and interfere with deep sleep.
Some may also take opioids to manage their pain. While these medications have sedative qualities, they disrupt sleep architecture, blocking access to rapid eye movement (REM) sleep and the deeper restorative stages of non-REM sleep.
The neck is the start of the spinal column and spinal cord and provides movement and mobility of the head. This delicate yet strong body part includes the tiniest of our vertebra as well as the muscles that run from the base of the skull to the upper back.
Having neck pain can be a real “pain in the neck.” It can limit mobility and make you feel fatigued. Causes are varied and include degenerative disc disease, herniated disc, pinched nerves, neck strain, osteoarthritis, or neck injuries like whiplash. Symptoms of neck pain vary depending on the issue and can feel like a throbbing, stabbing, or shooting sensation.
In rare cases, neck pain can be a sign of something more serious. So, if you experience neck pain for six weeks or longer; if it is severe, not improving, or getting worse; or if you have other symptoms such as fever, pain when the spine is tapped, severe headache, or unusual dizziness, seek medical attention as soon as possible.
Like back pain, neck pain is closely linked to sleep problems and other disorders. Sleeping on your stomach can aggravate neck pain because it forces you to sleep with your head turned. Pillows that are too thick can also strain the neck.
Some people who suffer from neck pain may require over-the-counter or prescription medication, such as NSAIDs (Advil, Aleve), or even opioids if the pain is severe. Both these drugs (more so with opioid painkillers) can interfere with REM sleep and deep sleep—both of which are vital for waking refreshed and restored.
Osteoarthritis and rheumatoid arthritis are some of the most common causes of hip pain, especially in older adults. Arthritis is an inflammation and stiffness in the joints that can lead to the breakdown of cartilage that cushions your hip bones. Over time, the pain increases and can leave you limping and struggling to walk properly.
Fractures can be another source of hip pain and can occur more easily with age, as bones become weak and brittle. Pain can also arise from inflammation in the bone, tissue, or tendons. Strains of the muscles, tendons, or ligaments are also sore subjects for hip pain sufferers. Even sleeping in awkward positions — often caused by a worn-out mattress — can cause hip pain.
The symptoms experienced with hip pain are varied and can originate in the groin and radiate down the inner thigh, or migrate to the knee. Sometimes hip pain can fool you into thinking the problem is in your knee.
Hip pain not only can keep you from drifting off into a peaceful night’s sleep, but it can also jolt you awake at night and cause you to suffer from inadequate sleep.
Hip pain is generally treated with anti-inflammatory medication, or NSAIDs, such as over-the-counter medicines like Advil, Motrin, or Aleve, or prescription medications like Mobic and Lodine. In some cases, these medications can interfere with deep sleep or cause insomnia.
Post-surgery pain — the pain that occurs after undergoing an operation — is an unpleasant sensation. It is caused by the damage to tissue that occurs by the incision or by the procedure itself. Some people also experience throat pain upon waking from anesthesia, due to irritation caused when a breathing tube was inserted into the throat.
Post-surgical pain can be described as deep somatic pain, originating deep within the ligaments, bones, muscles, or tendons, such as the pain that comes from a broken bone or when a surgeon makes an incision through the muscles of your abdomen. The pain can be visceral, rising from internal organs, such as gas pain or the pain from an inflamed appendix. Or, the pain can be neuropathic, caused by damage to nerve cells.
People recovering from surgery often need extra sleep to help them recover. Yet, post-surgical pain can make falling asleep and staying asleep difficult, as any sudden movements in sleep can trigger jolting pain. It is common for post-surgical pain to interfere with restorative REM and short-wave sleep for up to seven days after undergoing surgery, according to a study published in the journal Current Opinions in Anesthesiology.
Surgeries that require longer hospital stays can also be a deterrent to good sleep because patients are often awakened several times during the night to have their vitals taken by hospital staff. Finally, medications prescribed post-surgery, like opioid painkillers or steroids to lessen inflammation may interfere with the quality of your sleep.
Fibromyalgia is a chronic disorder characterized by symptoms such as muscle aches, profound exhaustion, and moodiness. More than six million Americans have been diagnosed with fibromyalgia, but many with this chronic condition remain undiagnosed, opting to suffer in silence for fear they won’t be taken seriously or others will think they are complaining or faking symptoms, according to an online study by the American Osteopathic Association. Those who do seek treatment often visit multiple doctors before finally getting a diagnosis.
Fibromyalgia pain is felt throughout the body and, for some, in all quadrants of the body. “Sleep and fibromyalgia directly affect one another. The more pain you have the less you can sleep and the more sleep you get, the less pain you have. So the importance of good sleep is critical in managing your pain from fibromyalgia,” says Dr. Yasmin Rahimi, DC, of BackFit Health and Spine. The pain is often described as “deep muscular throbbing, shooting, stabbing, or intense burning,” according to the American Fibromyalgia Syndrome Association, Inc. Patients often report disruptions in sleep and worsening pain and stiffness in the mornings. Says Dr. Moshe Lewis MD, MPH, CEO of Golden Gate Institute of Integrative Medicine, “Fibromyalgia is the hardest to treat because exquisite sensitivity to pain and sometimes depression play a role in magnifying pain. Thus exercise … has to be low impact. While we will sometimes use meds, we prefer daily stretching. This is helpful for almost all painful conditions affecting the joints. It only needs to be two to five minutes. Then slowly adding in easy exercise such as walking or swimming or bicycling helps to get several muscles moving in concert.”
According to the National Sleep Foundation, fibromyalgia is a double-edged sword, combining pain with sleep disruption. The pain associated with this disorder aggravates pain makes it difficult to sleep, while sleep deprivation amplifies the pain of this condition.
One study involving healthy middle-aged women deprived for three days of slow-wave sleep — the deepest phase of non-REM sleep — found that the women expressed a decreased tolerance for pain and increased levels of discomfort and fatigue. Researchers theorized that such deprivations of slow-wave sleep may actually contribute to the development of fibromyalgia symptoms. Fibromyalgia is generally treated with antidepressants like Cymbalta and Savella, along with the anti-seizure medication Lyrica. In general, people treated with these drugs showed improvements in sleep.
Scoliosis is an abnormal sideways curvature of the spine that most often presents during prepubescent growth spurts, but can also develop in adulthood. Scoliosis can also be caused by conditions such as cerebral palsy and muscular dystrophy.
This curvature of the spine can be painful if it strains joints or irritates, stretches, or pinches nerves. The most common pain symptoms associated with scoliosis are lower back pain and stiffness, according to the Scoliosis Research Society. Other symptoms include numbness, cramping, and shooting pain in the legs, and fatigue. In some cases, scoliosis can impair sleep breathing. Some people with scoliosis must wear a brace to slow or stop the progression of the spinal curvature.
For people with scoliosis who are required to wear a brace, finding a comfortable sleep position may seem impossible because the pads can dig into the body or pinch the skin. Even scoliosis patients who don’t wear braces can have difficulty finding a comfortable sleep position because of pain that can be associated with their spinal misalignment.
For pain, people with scoliosis are often treated with over-the-counter anti-inflammatory medication such as Advil (ibuprofen) or stronger prescription anti-inflammatories like Celebrex. On rare occasions, NSAIDs can cause sleep difficulties and interfere with deep sleep.
Simply put, arthritis is an inflammation of the joints. It’s often thought of as an old person’s disease, but arthritis can affect people of all ages. More than 50 million adults and 30,000 children have some form of arthritis, according to the Arthritis Foundation. There are several forms of arthritis, including degenerative, inflammatory, infectious, and metabolic.
Symptoms of arthritis include swelling, pain, and stiffness in the joints, which can lead to a decreased range of motion. The pain can come and go, and can vary from mild to moderate to severe. For some, arthritis pain gets worse over time. Severe arthritis can make walking or climbing stairs difficult. In some cases, arthritis can cause visible symptoms, such as knobby finger joints. Some forms of the disease can also cause problems with the heart, eyes, lungs, kidneys, and skin.
Up to 80% of arthritis patients report having trouble falling asleep and staying asleep due to pain and discomfort. They often find themselves tossing and turning at night trying to find a comfortable position to sleep in. However, so much tossing and turning can actually increase their perception of pain.
People with arthritis are often treated with anti-inflammatory drugs, corticosteroids, opioids, or disease-modifying antirheumatic drugs, to reduce pain and slow disease progression. Unfortunately, many of these medications can cause insomnia or prevent users from achieving the deep sleep necessary for feeling refreshed and restored in the mornings.
The central nervous system is a complex system anchored by the brain and spinal cord, and branching off through the spinal nerves to the rest of the body. A pinched nerve can occur anywhere along the nervous system when there’s too much pressure on a nerve root from surrounding tissue. Most often, this causes pain in the neck, lower back, or buttocks, but can also cause pain to radiate down the leg, shoulder, and arm, according to the North American Spine Society. A pinched nerve in the wrist can lead to pain and numbness in the hand and fingers, a condition known as carpal tunnel syndrome.
Pinched nerves are often caused by overuse, but can also be the result of other conditions such as weight gain, pregnancy, or bone fractures. In some cases, pinched nerves can be caused by medical conditions like arthritis, thyroid disease, burns or tumors. Technically called radiculopathy, a pinched nerve can cause a rainbow of annoying symptoms, from sharp pain or a sensation of pins-and-needles to numbness or weakness.
People who suffer from pinched nerves don’t get to choose their sleep position. Whatever position gives them any bit of relief from the irritated nerve is the one they ultimately choose. Subtle movement at night can have those with pinched nerves jolting awake in a moment’s notice.
Anti-inflammatory medication or corticosteroids are often used to treat more severe neck pain, but these medicines can interfere with sleep architecture and create an unfortunate sleep deficit.
More than 18 million adults in the U.S. suffer from sleep apnea, a sleep disorder that occurs when breathing is briefly and repeatedly interrupted during sleep. Two types of sleep apnea are obstructive, which occurs when the muscles in the back of the throat close, forcing you awake to catch your breath; and central, which happens when the brain fails to properly control breathing while you sleep.
Sleep apnea can obviously disrupt sleep, but it can also cause low blood oxygen. This dangerous combination of fragmented sleep and oxygen starvation can lead to hypertension, heart disease, and mood and memory problems. Some studies show that people who suffer from sleep apnea may also suffer from widespread musculoskeletal pain, a condition similar to fibromyalgia that causes pain in the bones, muscles, ligaments, tendons, or nerves.
What happens when you experience an episode of sleep apnea? Your tongue falls to the back of your mouth and blocks your windpipe, forcing you out of a deep, restorative sleep.
Because sleep apnea can be dangerous, some sufferers must use devices like CPAP, a machine that increases the air pressure in your throat to prevent your airway from collapsing when you draw a breath in your sleep. The machine consists of a mask that creates an airtight seal around the mouth or nose or both and allows pressurized air to travel from a machine to the airway. CPAP machines are a bit clunky and uncomfortable, but users say that if you can become used to them you can experience improved sleep.
Restless leg syndrome, also referred to as Willis-Ekbom Disease or simply RLS, is characterized by a creepy sensation in the legs that causes an irresistible urge to move them.
This sensation in the legs — considered more unpleasant than painful — typically occurs in the late afternoon or evening hours and is often most severe at night when you’re trying to sleep. However, some people can experience RLS when they’ve been sitting for long periods of time, such as riding in an airplane or sitting in a movie theater. People with RLS describe their symptoms as itching, crawling, pulling, aching, throbbing, or pins and needles sensation.
RLS is most often classified as a neurological sensory disorder. But it is also considered a movement disorder because symptoms are relieved by moving the legs, as well as a sleep disorder since symptoms are generally worse at and can disrupt sleep.
About 7-10% of U.S. adults have RLS, and about 80% of RLS sufferers also experience periodic limb movement of sleep, or PMLS, a condition in which a person involuntarily twitch or jerk their legs or arms every 15 to 40 seconds during sleep. For some people, these movements continue throughout the night.
People with RLS can be treated with a class of medication called dopamine agonists, known by the brand names Mirapex (which has been linked to sleep difficulties) and Requip (which may improve sleep).
Nearly one-third of your life is spent sleeping — or at least trying to get a good night’s sleep. One reason why you may be waking with pain might be because of your mattress doesn’t offer adequate support. Memory foam mattresses or latex mattresses tend to offer better spine alignment than innerspring mattresses for issues like back or neck pain, hip pain, pinched nerves, and arthritis. Some studies suggest a medium-firm mattress is better at relieving lower back pain and improving overall sleep quality.
Sleeping on your back is optimal for limiting many types of pain, but it typically makes sleep apnea worse. It’s also not the most comfortable position. Most folks prefer to sleep on their sides, curled into a fetal position. Hip pain sufferers may feel more comfortable sleeping on their sides with a pillow between their legs to better align the spine. A quality mattress can also help with spine alignment. Stomach sleeping is one of the rarest sleep positions, and rightly so. This position causes the back to hyperextend, which leads to lower back pain, and forces you to sleep with your head turned, which can cause neck aches. Elevating the head or legs with an adjustable bed may provide relief for some pain sufferers while also helping reduce attacks of acid reflux.
Self-hypnosis, meditation, visualization, or relaxation exercises can help relieve tension, reduce the intensity of pain, and help lull you to sleep. According to Dr. Don L. Goldenberg, Emeritus Professor of Medicine at Tufts University School Of Medicine, “Sleep disturbances are best treated with non-pharmacologic approaches. These include regular exercise, but not late in the evening, relaxation techniques, such as meditation and yoga, and attention to good sleep ‘hygiene’.”
Doing targeted stretches or yoga can help relieve pain and tightness for many painful conditions. In fact, yoga is one of the more commonly recommended forms of exercise to help relieve pain in people with fibromyalgia.
Heating pads, hot patches, and body wrap warmers applied to the back, neck, or hip can help relieve pain, stiffness and muscle spasms.
For some patients, their pain can be so disruptive to sleep that medication is needed. Options include over-the-counter and prescription non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen (Advil), muscle relaxers, and drugs used to treat nerve pain. Opioids are often discouraged because of dependency and overdose risks. While pain relievers can help you fall asleep, they may also prevent you from achieving deep non-REM sleep. Sleep medications are also available both over-the-counter and by prescription. Since insomnia and chronic pain can be linked to untreated clinical depression, antidepressants may help, too.
Therapeutic massages can help reduce the intensity of pain by relaxing painful muscles, tendons and joints; relieving stress and anxiety; and stimulating competing for nerve fibers, thereby interrupting pain messages from traveling to and from the brain.
Several studies have found that people who suffer from chronic pain sometimes see an improvement in pain severity and quality of life with regular exercise or physical activity.
Getting a good night’s sleep can be a game-changer for people who suffer from chronic pain. Specialists, such as acupuncturists, chiropractors, physical therapists, cognitive-behavioral therapists, hypnotherapists, and pain management specialists may be able to help reduce your pain so you can sleep better. (See our list below for more information.)
Acupuncture is the practice of inserting thin, sterile needles into targeted areas of the body to stimulate specific anatomic sites in order to promote natural self-healing. This key component of Chinese medicine has grown to become a trusted a form of alternative medicine in Western culture, for relieving everything from back pain, nerve pain (such as from shingles rashes), fibromyalgia, and headaches.
Chiropractors manipulate the body’s alignment to relieve pain and improve the body’s function so that the body can heal itself. Some studies have found that chiropractic care is both safe and effective for a variety of pains, including back pain, neck pain, and headaches. According to Pittsburgh Chiropractor, Dr. Alex Tauberg DC, CSCS, CCSP®, EMR, there are some additional tips you can use to pair with chiropractic care in order to see results. “When someone sleeps on their side I often recommend that they put a pillow in between their knees and their arms. Patients often find that they are able to get more comfort and wake up with less pain in this position than when they don’t use the pillows. Similarly, people who sleep on their backs will often find putting a pillow under their legs to provide some low back pain relief. This allows the low back to be slightly more relaxed and in less of an extended position. This can be beneficial and allow for a better night’s sleep, although it is often dependent on what is causing the low back pain,” Dr. Taunberd explains.
Physical therapists typically work closely with medical doctors from different specialties and play an important role in pain management. They typically employ a multitude of therapies to manage pain as well as promote and restore normal function of all bodily symptoms.
The idea of seeking psychotherapy for chronic pain may give the impression that pain is “all in your head.” But that is far from the truth. Cognitive-behavioral therapy, or CBT, can serve as a method of pain management by helping people change their awareness of pain and develop better-coping skills. “The vast majority of individuals with chronic pain have sleep problems. Most pain sufferers believe that they first need to get rid of their pain to sleep better. This is not true,” says Clinical Psychologist, Dr. Evan Parks. “The body is meant for sleep and wants to sleep. Our job is to get out of the way so the body will do what it naturally does on its own. Pain sufferers who follow these seven principles for developing a healthy sleep pattern not only improve their sleep, they reduce their pain in the process. Good sleep improves our health.”
Hypnotherapy is a largely misunderstood type of complementary medicine that uses hypnosis to create a state of focused attention during which positive suggestions and guided imagery are used to help individuals deal with a variety of issues. Hypnosis has been found to be an effective tool for managing diverse forms of pain, according to the American Psychological Association.
A pain specialist is a physician specially trained in evaluating, diagnosing, and treating different types of pain. They can prescribe medication as well as coordinate additional care such as physical therapy, psychological therapy, and rehabilitation to offer patients a comprehensive treatment plan with a multidisciplinary approach.
Old, saggy, or worn-out mattresses not only can cause you pain, but they can also aggravate existing pain. When shopping for the right bed for your pain, consider the mattress type carefully:
Pain and sleep — or lack thereof — are closely intertwined. Both chronic and acute pain interfere with restorative sleep, and a sleep deficit can cause back and body aches, headaches, and joint pain. It’s no surprise that two-thirds of people with chronic pain also suffer from a sleep disorder.
Effectively managing pain through medication, alternative therapies, or meditation and mindfulness can make for more restful sleep, as can environmental factors such as noise, light, and bed comfort. People who suffer from pain can find hope in knowing that there are resources available to help them get a good night’s sleep so they can enjoy a good quality of life.
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