How Does Pain Affect Sleep?
There is nothing quite like the feeling of waking up refreshed and rejuvenated after a good night’s sleep. There are a plethora of benefits to sleeping well, with sleep playing a particularly important role in helping your body heal. Your body releases hormones during sleep that help repair cells and control the body’s use of energy. Unfortunately for people who experience an injury or have ongoing pain, getting a good night’s sleep can be difficult and frustrating.
Research shows a close relationship between pain and sleep disturbance, with sleep complaints present in 67-88% of chronic pain disorders and at least 50% of individuals with insomnia suffering from chronic pain.
In this article, we explore the function of sleep, the relationship between sleep and pain and strategies for improving your sleep quality.
The function of sleep.
A good night’s sleep involves moving through several sleep cycles during the night. Stages 1 and 2 are light and stages 3 and 4 are your deeper cycle of sleep. From deep sleep, you move back into light sleep, then into rapid eye movement (REM) sleep, where dreaming occurs. This cycle is repeated numerous times throughout the night.
There are a variety of sleep tracking apps that can show you your sleep habits and give you an indication of your sleep quality. If you have a smart watch or activity tracker, you may find more accurate results.
Whilst sleeping, your body is undertaking a number of processes to keep you well. These include:
Hormones are released: melatonin helps control your sleep patterns and growth hormone assists with repair and restore the within body;
Our sympathetic nervous systems relaxes, with heart rate, blood pressure and breathing rates reducing, dampening our body’s fight or flight response and encouraging a restorative state; and
Our immune systems release inflammation fighting cytokines to help repair the body;
REM cycle is our “dreaming” phase and allows our brains to sort out and process information from our day.
What factors interfere with sleep?
As health professionals, we often find that when people experience pain or injury, there is a good chance they are not sleeping well. As part of pain management, it is important to be aware of the factors that interfere with sleep, such as:
Sleep hygiene, i.e. the habits and behavioural factors that impact sleep;
Medications;
Sleep disorders;
Reduced physical activity;
Stress and worry about not getting enough sleep.
Exercise, recreation, work and general daily activities help exert our energy and make our body feel tired. Engaging in such activities can be difficult when you suffer from a painful condition or injury. It is important to find support and advice about what you can do to keep active, which will have flow on effects of managing stress, maintaining weight and reducing deconditioning.
During a busy day, our mind may not have time or space to process thoughts and ideas. If you don’t allocate some “quiet time” each day, where you block out some distraction free time to process and deal with your daily concerns, you may find yourself tossing and turning when you should be sleeping.
It is normal to wake up several times a night, usually following the REM stage of sleep. Most people do not realize they have woken up, and quickly fall back asleep.
How does sleep impact pain?
Sleep deprivation heightens pain sensitivity by negatively impacting the brain’s ability to regulate its natural reward system through dopamine release, which assists with pain relief. Lack of sleep also increases inflammation in the body, compromises your immune system and increases fatigue levels which consequently reduces our body’s ability to repair and restore energy. These factors in turn reduce our ability to effectively perform our normal daily and physical activities, which contributes to a negative cycle of poor sleep.
So we know that poor sleep increases our susceptibility to pain, but what about the effect of pain on our sleep? As mentioned previously, the majority of people who suffer from chronic conditions experience poor sleep, consisting of frequent nighttime wakings and shorter overall sleep times. Long term quality sleep can improve chronic pain, however it is difficult for those with chronic conditions to break free of the cycle that is pain related sleep disturbances and increased pain due to poor quality sleep.
How do you improve your sleep quality?
While it is difficult for those with pain to break out of a pain-poor sleep-increased pain-poor sleep cycle, there are a number of strategies you can implement to promote quality sleep.
Develop a consistent bedtime routine.
Going to bed and waking up at the same time each day is helpful for training your body to relax and expect sleep, which is especially useful if you have trouble initially falling asleep. You should spend at least half an hour - or more if you have a particularly active lifestyle - doing the same thing in the same order each night, i.e. prepare what you need for the next day, shower, brush your teeth, read a book. Try to avoid screens. If you get into bed and you haven’t fallen asleep within 20 minutes, get out of bed and engage in a non-stimulating activity until you feel sleepy enough to try again.
Monitor your exercise and diet habits.
While even low levels of exercise throughout the day are beneficial for sleep, you shouldn’t exercise within 2-3 hours of going to bed. Your elevated heart rate and body temperature will make it harder to fall asleep. You should avoid heavy, fatty or sugary foods within 4 hours of bedtime, and try not to drink caffeine less than 6 hours before you are planning on going to sleep.
Work on your sleep hygiene.
Light, noise and temperature are all important factors that you can manipulate to help promote restful sleep. Try to make your bedroom as dark as possible (try blockout curtains), try to minimise noise, and adjust to a cooler temperature. A warm shower before bed can be helpful in increasing your body’s surface temperature before rapidly cooling it. Cooler temperatures promote better sleep.
Only use your bed for sleeping (and sex).
Using your bed for activities such as work, study or watching television can confuse your body, making it harder to identify the difference between active time and sleep time. Using your bed for only sleep (and sex), allows your body to recognise your designated sleeping environment, making it easier to fall asleep. You should also try to avoid napping as this causes your night time sleep to be lighter and more disrupted. Consequently, you’ll be more tired the next day, require another nap, and a vicious cycle begins.
Implement relaxation techniques.
If you are still struggling to fall asleep, consider listening to some relaxing music or sounds as you drift off. There are a wide range of sleep and meditation apps available that give you access to a plethora of different relaxation sounds and guided meditations. If this isn’t your style, try to help yourself relax by individually relaxing each part of your body. Start at your toes and slowly work your way up to your head, taking time to focus and relax each body part before moving onto the next.
Improving Sleep Quality for Pain Management.
Understanding why sleep is important is a crucial component in helping your body recover and have the best chance of healing. If you are struggling with sleep, we strongly recommend discussing these issues with your health practitioner, as this could be contributing to or exacerbating your pain.
If you would like to book in with one of our health practitioners, you can do so here.