Does pain leave you tossing and turning at night? You’re not alone. Severe pain affects nearly 40 million adults in the U.S., and stats also show up to 80% of those people with chronic pain deal with sleep disturbances, and more than half experience insomnia.
“Most patients with chronic pain report intermittent sleep disturbances as their most common problem,” says Shamin Ladhani, Psy.D, a pain psychology specialist who has designed pain management programs. “The pain wakes them up, even if they can get to sleep easily.”
Focusing on the frustration of pain, however, can turn into a cyclical series of anxiety and racing thoughts at night. Research notes that pain is not always an indicator that you’ll get bad sleep, but bad sleep can make pain worse. The theory is that sleep deprivation lowers dopamine and opioid receptors, and increases negative moods, which makes people more sensitive to pain.
Knowing sleep can help mitigate pain can either help or hurt the situation. Some may find that knowledge to be the motivation they need to focus on sleep. But for others, it might increase anxiety about the importance and elusiveness of sleep, causing an even greater challenge to get a good night’s rest. Whichever camp you’re in, we have tips and strategies for breaking up this complicated relationship between pain and sleep.
Mental Barriers: Why Pain Affects Our Ability to Sleep Well
Anyone with chronic pain can tell you that feeling zingers, aka sudden flashes of pain, in bed while constantly shifting around to avoid pressure on certain spots can certainly make it a struggle to drift off. This tension can create mental barriers that get harder to break down over time. That’s why fully understanding the impact and link between chronic pain and insomnia can help.
“Pain can make someone toss and turn, but it can also become a psychological dysfunction because you know you won’t be able to sleep, so you start to fear it,” says Dr. Jyoti Matta, medical director at the Center for Sleep Disorders at RWJBarnabas Health.
Worrying about how you’ll sleep can also create a type of performance anxiety that leads to bad sleep as well, according to Dr. Chris Winter, MD, president of Charlottesville Neurology and Sleep Medicine, author of “The Sleep Solution,” and Sleep Advisor to Sleep.com.
“The way we feel about our sleep is often reflected in how we perform. You might not even notice a bit of back pain throughout the day, but when it’s time to go to bed, it creates tension and doubt that you’ll be able to go to sleep,” Winter says.
There are also other mental health aspects to consider. Pain, insomnia, and depression, which often occur together, can feed into each other, making each of the three conditions worse. Same goes for anxiety and substance-use disorders, which people with chronic pain are more likely to experience. Hence why a multi-pronged approach might be required to break the cycle.
“Frustration with sleep can be amplified in pain patients. They hear that sleeping better will help with pain, and they feel like they must get eight hours or else, and that makes it hard to sleep,” says Winter. “We don’t want a fear-based model of sleep in anybody’s life.”
As frustrating as fatigue is, remember to be gentle with yourself around your sleeping habits. Winter recommends focusing on the next best thing: rest. “If you’re in a comfortable position and your mind is in a good place and meditative, that’s quite restorative. If you sleep, that’s awesome, but if not, that’s OK too. You’re still succeeding by resting,” he says.
Physical Challenges: Conditions and Disorders that Disrupt Sleep
Knowing specifically where your pain comes — or how much of the pain is physical or emotional — from help you formulate a more effective pain-management plan for short- and long-term pain. Even after healing from acute pain, which lasts up to six months, your sleep schedule may remain disrupted.
Certain conditions and disorders, however, are known culprits for poor sleep and insomnia, such as:
- Lower back pain: Affects 80% of adults; 59% report sleep disturbances.
- Neck pain: 54% of people with neck pain report mild to severe insomnia.
- Arthritis: As many as 8 in 10 people with arthritis face difficulty with sleeping.
- Restless leg syndrome: 88% of people with restless leg syndrome have at least one negative symptom related to sleep, and most show signs of insomnia.
- Sleep apnea: Although not classified as a “painful” condition, sleep apnea is associated with chronic pain and fatigue.
- Shoulder pain: One of the most common types of musculoskeletal pain, this can be difficult to resolve. People who seek care for shoulder pain only have about a 50% chance of resolving it within six months.
- Hip pain: Chronic hip pain is a common issue among adults age 60 and up, as well as younger adults who play sports. Some research shows that more than 15% of adults over the age of 40 also experience hip pain. People with hip pain from osteoarthritis often have poorer sleep quality.
- Sciatica: Caused by the compression of the sciatic nerve, sciatica is a frequent symptom of lower back pain. It’s rare among people under the age of 20, and research shows that it tends to affect men slightly more often than women.
Remember that completely eliminating pain or achieving full sleep every night isn't a realistic metric for success. Winter advises resetting your expectations, which can go a long way with reducing sleep anxiety. “Don’t judge success or failure in bed in terms of consciousness. That’s where a lot of people get hung up,” Winter says.
Physical Strategies for Managing Pain and Sleep
Getting better sleep when you have pain often starts with changing what you do with your body— both in bed and out of it.
Try these tricks:
- Adjust your sleep position. Depending on where your pain is located, you may find it helpful to train yourself to sleep in a new position. A side sleeper with shoulder pain, for example, might catch more Zzz’s if they learn to sleep on their back instead.
- Movement and exercise. Winter recommends that people with pain start with an exercise routine that’s “impossibly easy” to set you up for long-term success. That might mean taking a 10-minute walk or raising a 2-pound weight above your head 10 times before gradually increase the intensity every few weeks or months.
- Breathing. No, not just regular inhales and exhales, but carefully controlled, mindfully paced breathing can help with both chronic pain and sleep. Consider trying the 4-7-8 breath relaxation exercise, diaphragmatic breathing, or the Papworth method to see which works best for you.
- Try new products. Upgrading some key sleep products could lead to better rest. Slipping a bolster or wedge pillow under your knees, for example, could alleviate back pain that might otherwise disrupt sleep, says Ladhani. A firmer (or softer) mattress could also help certain types of pain. Even the pajamas you wear can help with the positions and quality of your sleep.
Psychological Strategies for Managing Pain and Sleep
Your mindset matters when it comes to setting expectations and realistic goals for restorative sleep. Here are some ways you can break out of the thought patterns that exacerbate both your pain and sleep:
- Pain acceptance. Acceptance of pain is a psychological flexibility practice to help reframe moments of distress. This includes a willingness to experience pain and choosing to continue positive activities despite pain, all through a nonjudgmental mindset. Research shows pain acceptance helps lower levels of pain and negative emotions.
- Cognitive behavioral therapy for insomnia (CBT-I). With this program, you’ll meet with a trained therapist or other healthcare professional regularly for four to 10 weeks. The sessions are designed to help you “learn what sleep behaviors you have that don’t promote healthy sleep and how to modify those, as well as how to work on underlying processes that might interfere with sleep,” says Ladhani.
- Mind-body movements. Deep and controlled breathing is shown to help with pain processing, so finding a meditative exercise (rather than an intensive one) may be a better choice for sleep and pain improvement. You can get a sense of mind-body movements by trying a yoga, tai chi, or qigong class.
- Self-care. Prioritizing feeling good throughout the day (and especially right before bedtime) can help improve your sleep and make predictable pain less dreadful. That might mean soaking in a hot bubble bath, reading a book, tuning into relaxing music, or even a going through a hair-care ritual.
- Relaxation techniques. Other relaxation techniques, like progressive muscle relaxation, “the wave,” visualization, and even sleep hypnosis, might also help take your mind off pain long enough for you to achieve sleep more quickly and consistently.
Lifestyle Strategies for Managing Pain and Sleep
Getting better sleep when you live with pain also depends on practicing a healthy lifestyle.
Here are some easy lifestyle tweaks you can try today:
- Avoid inflammatory foods. Certain foods, like sugar, saturated and trans fats, refined carbs, and gluten, can trigger inflammation that worsens pain. Explore ways to swap these foods with more anti-inflammatory foods, like brightly colored fruits and veggies. A dietitian might also be able to help.
- Practice sleep hygiene. Incorporate good sleep habits into your routine. This includes getting up when you can’t fall asleep within a half hour and doing something that makes you drowsy (like reading a boring book) before trying to sleep again.
- Develop a daily schedule. Mapping out time to get some sunshine, eat consistent meals, exercise, and finish other daily tasks can help keep your circadian rhythm on track, says Winter. Use a sleep diary to help pinpoint what’s working and what isn’t.
- Get a massage. Getting a professional massage has been shown reduce joint pain and improve sleep for people with arthritis. It may also soothe pain in the lower back, neck, and shoulders. Can’t afford to splurge on massages all the time? Try a self-massage at home, using basic tools like tennis balls and a pillow.
Fine Tune Your Treatment with Your Doctor
If you’ve tried everything, but pain and insomnia are still disrupting your everyday life, consider connecting with a medical professional for help. Depending on your personal challenge, this professional can be a pain specialist, physical therapist, or psychologist. They can help you develop personalized strategies for better sleep and pain relief, including prescribing medications (if necessary) for both conditions.