Chronic pain affects many people, with 1 in 5 Australian adults over the age of 45 suffering from chronic pain. It represents an enormous burden for those suffering, as well as society overall (1).
Sleep and pain are two words that don’t play well together, with many people experiencing pain which worsens at night. This can especially be the case for people suffering from mild arthritis and mild osteoarthritis. When this happens, it can be difficult to fall asleep, and stay asleep. A study conducted in 2020 found that online searches for information about pain management peak between 11:00pm and 4:00am (2).
This highlights the number of people who lay awake at night, looking for ways to manage their pain and get a good night’s sleep!
People with chronic pain are more likely to be diagnosed with a sleep disorder, with 67-88% of people presenting with sleep complaints (3). For many, ‘painsomnia’ or difficulty sleeping caused by persistent pain is a common and dreaded issue.
Pain can affect sleep for a few different reasons. Some people may experience pain that worsens at night, some may have persistent pain throughout the day, or others may have pain that is affected by certain sleeping positions. This can lead to difficulty falling asleep, however the most common sleep complaint for people experiencing pain is waking frequently throughout the night (4).
The link between poor sleep and painful conditions such as arthritis has been established in many studies.
Consistent poor-quality sleep has been linked to a decrease in a person’s pain threshold, meaning poor sleep makes an individual less able to tolerate pain (5).
It is unclear exactly what can cause pain to worsen at night, however a 2019 study found a potential reason as to why pain worsens after a particularly bad nights sleep. The researchers demonstrated that sleep deprivation causes certain pain centres in the brain to be more active than they normally would be, amplifying the experience of pain (6).
This was reflected in a 2018 study which found that pain worsened after a bad night’s sleep, but improved after a particularly good night’s sleep (7).
The good news is that there are some steps you can take to help break the vicious cycle of poor sleep (8,9).
- Begin a routine – as often as possible, try to go to bed at the same time every night and get up at the same time each morning. Your body will adapt to the routine, and you may find it easier to fall asleep each night.
- Manage your pain – if you are experiencing persistent pain, chances are you are taking some steps to improve and manage your pain. You can talk to your healthcare professional about the best pain management strategy for your needs.
- Try some relaxation techniques – to unwind from your day and prepare your body to fall asleep, it can be beneficial to try some relaxation techniques. This could include reading, a warm bath, deep breathing, mindfulness or listening to some relaxing music.
- Remain active – some form of exercise throughout the day has benefits for helping you fall asleep and stay asleep. Even a gentle walk can have numerous heath benefits.
- Consider your sleep hygiene – sleep hygiene is the term given to good sleep habits. Some sleep hygiene habits to consider are avoiding technology before bed (as this can be stimulating and cause you to easily lose track time), avoiding stimulants like caffeine in the lead up to bedtime and avoiding napping through the day to ensure you are tired at bedtime. It is also a good idea to evaluate your sleep environment to ensure it is as comfortable and conducive to sleep as possible.
- Seek advice – if you are struggling to manage your pain, and experiencing prolonged periods of pain and sleeplessness, it is always a good idea to speak to a suitably qualified healthcare professional, who can develop a plan to help you manage your pain and get a good night’s sleep!
References:
- Australian Government Australian Institute of Health and Welfare. (2020). Chronic Pain in Australia, Accessed 14 Aug 2022 < https://www.aihw.gov.au/reports/chronic-disease/chronic-pain-in-australia/summary >
- Fuggle, N, Masefield, N, Dennison, E, et al. (2020). Does pain peak at night? The daily rhythm of musculoskeletal searches on the NHS website. Rheumatology, 59(2) doi: 10.1093/rheumatology/keaa111.063
- Finan, P, Goodin, B & Smith, M. (2013). The association of sleep and pain: An update and a path forward. The Journal of Pain, 14(12) doi: 10.1016/j.jpain.2013.08.007
- Sleep Foundation. (2022). Pain and Sleep. Accessed 15 Aug 2022 < https://www.sleepfoundation.org/physical-health/pain-and-sleep >
- Tang, N. (2008). Insomnia Co-Occurring with Chronic Pain: Clinical Features, Interaction, Assessments and Possible Interventions. Reviews in Pain, 2(1), 2-7 doi: 10.1177/204946370800200102
- Krause, A, Prather, A, Wager, T, et al. (2019). The Pain of Sleep Loss: A Brain Characterization in Humans. Journal of Neuroscience, 39(12) 221-2300 doi: 10.1523/JNEUROSCI.2408-18.2018
- Wei, Y, Blanken, T & Van Someren, E. (2018). Insomnia Really Hurts: Effect of a Bad Night’s Sleep on Pain Increases with Insomnia Severity. Frontiers in Psychiatry, 9:377 doi: 10.3389/fpsyt.2018.00377
- Sleep Foundation. (2022). Sleep Hygiene. Accessed 15 Aug 2022 < https://www.sleepfoundation.org/sleep-hygiene >
- Victoria State Government – Better Health. (2022). Sleep hygiene. Accessed 15 Aug 2022 < https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/sleep-hygiene >