Chronic pain

The Relationship Between Pain and Sleep

It’s 2am and I am wide awake. I can’t get comfortable because my hip is killing me. My three ibuprofen have worn off and I really should get up and take more, but I just don’t want to move. Sometimes, if I lay very still, the pain decreases. But not tonight, so I drag myself out of bed, pop three ibuprofen and come back to bed and eventually go to sleep.

In the morning, I wake up and lay very still and realize there is no pain. Then I move and it’s back. I lay there thinking, “Why does it seem like my pain is worse in the middle of the night?” I get up and find my laptop to find out why.

“Pain is a sensation you feel when nerves are stimulated to an intense degree,” says Tracey Marks, MD, an Atlanta-based psychiatrist. Marks is author of Master Your Sleep: Proven Methods Simplified. “This stimulation activates the brain, which keeps you awake.

“You need a certain amount of each stage of sleep to feel rested and for proper memory,” Marks says. These stages include light sleep, deep sleep, and REM (rapid eye movement) sleep. “We normally go through four to six cycles of these stages per night. But if pain wakes you up, you spend too much time in light sleep,” she explains. This reduced sleep – in particular, shortened REM – may increase sensitivity to pain.

Pain affects sleep position.

Certain types of pain, such as arthritis pain and orthopedic pain, may prevent you from getting comfortable at night, says Reena Mehra, MD, of University Hospitals Case Medical Center in Cleveland. The medical director of adult sleep services says joint and muscle pain usually results in problems staying asleep (called sleep maintenance insomnia) rather than falling asleep (called sleep onset insomnia).

Sleep deprivation makes you more sensitive to pain.

A study in the April 2009 issue of Sleep Journal showed that normal, healthy individuals are more sensitive to pain when they are low on rest. The reasons why aren’t known for sure. “Some research studies show that sleep deprivation causes increased production of inflammatory chemicals in the body called cytokines,” Marks says.

How to Get the Sleep You Need

Calm yourself with meditation and other relaxation techniques.

When done effectively, as little as 10 minutes of daily meditation can help your mind ignore the pain. The Pacific Rehabilitation Centers’ web page has mindfulness videos that can help.

Gentle massage is also beneficial for both insomnia and chronic pain. In a study published in the International Journal of Neuroscience, participants who had two 30-minute massages a week for five weeks experienced better sleep and less lower back pain.

Additional tips for improving sleep include:

  • Forgo daytime naps or limit yourself to a brief 10- to 20-minute nap in the afternoon.
  • Take a warm bath or shower before bed to wind down.
  • Lull yourself to sleep with relaxation CDs that play a babbling brook, gentle waves, or other soothing sounds.
  • Abstain from alcohol in the evening; it may help you fall asleep, but the effects of a cocktail quickly backfire, disrupting sleep cycles a few hours into the night.
  • Avoid caffeine, which disrupts sleep patterns; if you must have a caffeine boost, enjoy it before noon.
  • Do not exercise or eat within three hours of going to bed.

If pain is preventing you from getting a good night’s sleep, then it is time to go see your doctor.

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