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, including 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 it to be one of the most common aggravating factors, impacting on their ability to manage pain and get through the day. Migraine suffers report a link between how well they’ve slept and whether they will suffer from a migraine that day. This reported increase in pain sensitivity following sleep deprivation can also be displayed in healthy individuals too, suggesting that a good nights sleep protects us from pain.

One reason for this could be due to a reported increased production of inflammatory chemicals in the body called cytokines following sleep deprivation. Such inflammation would certainly help to explain the bidirectional association between pain and sleep.

The strong link between poor sleep and poor mood is also unlikely to help our perception of daytime pain, especially since research reports that after poor sleep we have an increased tendency to view negative experiences more negatively.

Insomnia is increasingly being seen as a ‘Canary down the neurological mine’ type early warning sign for many mental health disorders such as depression and anxiety and is 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. Surprisingly, the relationship was not reciprocal, with the incidence of back pain not increasing the chance of insomnia.

 Top tips to for good quality sleep with pain

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

1. Keep your sleep on time – Going to bed and getting up at roughly the same time everyday helps to keep the body clock on time and avoids any ‘jet lag type’ stress. It helps to strengthen the association between the night time and sleep, increasing sleep quality. As well as boosting immune function and therefore reducing inflammatory chemicals.

2. Power nap – Taking a power nap during the day can be a helpful way of managing daytime energy after a poor night, as well as lessening pain levels. New research also suggests a 30-minute snooze can help relieve stress and bolster the immune systems by restoring hormones and proteins to normal levels. Aim to keep it less than 30 mins and not after 3pm.

3. Be mindful – practicing mindfulness in the day and at night can help to 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 be 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

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