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The Vicious Cycle of Chronic Insomnia and Pain

Almost everyone will have experienced a disturbed night of sleep as a result of pain. Sore muscles after a heavy training session, an aching body during a bout of flu, headaches or abdominal premenstrual cramping can all cause sleep loss. For some, the pain can be associated with illness such as cancer and its treatment, or a musculoskeletal condition such as arthritis or fibromyalgia.

Whatever the source, pain has the ability to intrude sleep with constant micro-arousals reducing its depth and quality and causing us to wake up feeling unrefreshed the next day.
However, the link between poor sleep and pain is not as obvious as first thought. Whilst poor sleep is well documented as a symptom of pain, like many other mental and physical health disorders, insomnia is now being suggested to play a significant causal role.

The link between sleeplessness and pain

Pain sufferers have long described the negative impact of poor sleep on daytime pain levels. Fibromyalgia sufferers report sleeplessness to be one of the most aggravating factors, impacting on their ability to manage pain and get through the day. Migraine sufferers report a link between how well they’ve slept and whether they will suffer from a migraine that day. Increases in pain sensitivity following sleep deprivation can also be displayed in healthy individuals, which suggests that a good night’s sleep can actually protect us from pain. One reason for this could be that, following sleep deprivation, there is an increase in the production of inflammatory chemicals in the body called cytokines. This inflammation could certainly help explain the bidirectional association between pain and sleep.

The strong link between poor sleep and poor mood means that the way we perceive pain during the day is also affected, with research reporting that after poor sleep we have an increased tendency to view negative experiences more negatively. In fact, insomnia is increasingly being seen as a ‘canary down the neurological mine’ type of early warning sign for many mental health disorders such as depression and anxiety, and it’s reported as one of the most common early symptom of an active psychotic phase in Schizophrenia patients.

This causal effect of insomnia has recently been reported with chronic pain, with a recent research study reporting that insomnia sufferers are nearly one-and-a-half times more likely to suffer from back pain. Importantly, the relationship was not reciprocal, and back pain was not shown to increase the chance of insomnia.

 Top tips to for good quality sleep with pain

Achieving good quality sleep on a regular basis should play an essential role in any pain-management strategy. Outlined below are three ways to ensure good quality sleep when suffering from pain.

1. Keep your sleep on time. Going to bed and getting up at roughly the same time every day helps keep your body clock on time and helps you avoid any ‘jet lag type’ stress. A regular sleep/wake schedule will help strengthen the association between the night time and sleep, increasing sleep quality. Furthermore, it will boost your immune system and reducing inflammatory chemicals.

2. Take a power nap. Taking a power nap during the day will help you manage daytime energy after a poor night, as well as lessen your pain levels. New research suggests that a 30-minute snooze can help relieve stress and bolster the immune system by restoring hormones and proteins to normal levels. Aim to keep it less than 30 mins and not after 3 pm.

3. Be mindful. Practising mindfulness both in the day and night can help untangle you from the unwanted thoughts and feelings that keep you awake at night. Regular practice has been proven to reduce the time taken to fall to sleep and increase overall sleep quality. It has also been shown to be an effective way of managing chronic pain.

ACT for Chronic Pain: Click here to read a research review of the use of Acceptance and Commitment Therapy for Chronic Pain.