Do you have trouble getting to sleep or staying asleep because of pain?
Does your pain feel worse after a bad nights sleep?
If you said yes then you’re not alone. These complaints are more common than you might think. Furthermore, there is strong evidence that sleep and pain are related. Pain can affect sleep and poor sleep can exacerbate pain.
The effect of pain on sleep:
Pain may affect you getting off to sleep. It might be difficult to get into a comfortable position in order to get to sleep. It may also cause you to wake during the night. Sometimes it is easy to get back to sleep by changing your sleeping position and other times this can be hard. This can be frustrating as it is recognised that sleep is important for health, and that lack of sleep causes fatigue, which in turn can affect daily functioning and mood. This may cause people to worry when they are not getting enough sleep.
The effect of poor sleep on pain:
Poor sleep has also been identified as a possible contributor to increased pain. Studies have shown that when the deep sleep of healthy people is interrupted they can develop pain symptoms. What this means is that managing sleeping issues is an important part of pain management, and especially the management of chronic pain. It is therefore important to let your health professional know if you have any issues with sleeping.
Other factors that can interfere with sleep include:
- Poor sleep hygiene
- Sleeping environment
- An active mind
- Worrying about not getting enough sleep
- Reduced physical activity
- Sleep disorders
- Some medications
- Sleep cycle
Sleep hygiene refers to particular habits, behaviours and lifestyle factors that can impact sleep. These include bed and waking times, day time napping, activities you do before going to sleep, eating and drinking habits, and allowing pets into the bedroom.
Some behaviours can help promote sleep and some behaviours can make sleep harder. For example, stimulants like caffeine and sugar can make sleep more difficult. Alcohol can interfere with normal sleep rhythms, so whilst you think you are getting a good sleep the reality is that you are not. Unhelpful behaviours and habits surrounding sleep can be changed with practice, so this is considered a good place to start if you want to improve your sleep.
Sleep environment refers to factors like temperature, noise, mattresses, pillows and lighting. Significant others (partners and kids) and pets also fit into this category. Most of these factors can be changed, so identifying what environmental factors might be hampering your sleep, and solving these issues, is important for achieving a better nights sleep.
Active mind, stress and worrying about not getting enough sleep:
It is difficult to get to sleep when the mind is actively trying to process thoughts and ideas. Often the mind becomes active at night because this tends to be the “quiet time” of the day, when other activities are no longer a distraction. Racing thoughts can be comprised of trying to reflect on what happened during the day, remembering things to do tomorrow, or specific worries and concerns. Dealing with any concerns and relaxation strategies can help.
Stress causes the release of stress hormones in the body. This leads to physiological responses like increased muscle tension, rapid breathing and heart rate, and increased mental alertness, all of which can contribute to poor sleep.
Not getting enough sleep is one cause of worry, stress and frustration. Watching the clock can be tempting but this often leads to more worry, frustration and stress, which will most likely cause more sleep loss. To break or avoid this negative cycle it is recommended to try not worrying about sleep loss … and definitely don’t watch the clock!
Reduced physical activity:
Physical activities like exercise, recreation, work or household chores help make the body feel tired which can help with sleep. There are many reasons why people reduce physical activity. Painful conditions can make physical activity more difficult. This is one way pain interferes with sleep. Therefore it is important to keep active. Finding suitable fun activities and exercises can assist with maintaining activity levels. This can also have other benefits for managing stress, maintaining weight levels, maintaining relationships and preventing physical deconditioning.
Sleep disorders will interfere with the amount of sleep you get. If you have poor sleep, and are concerned you have a sleep disorder, then you will need to see your doctor for a proper assessment and referral.
Some medications can negatively affect sleep. This includes long-term use of sleeping tablets and pain medications. If you have concerns regarding your medications speak with your doctor or specialist. Never stop taking prescribed medications without consulting your doctor first. If you wish to try natural therapies for sleep (for example St John’s Wart) make sure you also discuss this with your doctor, as there can be interactions with medications and natural therapies.
Physiotherapy for pain and sleep:
Physiotherapy can help with your pain and make sleeping easier. Make sure you mention any sleep issues to your doctor or Physiotherapist, as this may be contributing to or exacerbating your pain. There are many sleep strategies you can try to improve your sleep, and this may even help in the management of your pain.
For further information please check out some of the useful resources below regarding the relationship between sleep and pain, as well as some useful strategies for improving your nights sleep.
Relationship between pain and sleep:
- Pain Management Network. Pain and sleep. Retrieved from https://www.aci.health.nsw.gov.au/chronic-pain/for-everyone/pain-and-slee
For links to fact sheets regarding general sleep:
For information about Insomnia and other sleep disorders.
- Sleep Health Foundation. (2011). Insomnia. Retrieved from http://www.sleephealthfoundation.org.au/pdfs/Insomnia.pdf
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About the Author:
Megan completed her Bachelor of Physiotherapy with honours in 2005 and has been working in musculoskeletal physiotherapy ever since. Megan has a keen interest in the field of Pain Management (acute and chronic), which she developed whilst working as a physiotherapist in the United Kingdom in an occupational pain management rehabilitation setting. Megan is currently completing her Master’s in Pain Management at Sydney University and she contributes to various multidisciplinary pain management programs.
Her other main professional interests include occupational rehabilitation and Clinical Pilates.