Sleep and Chronic Pain

The Sleep-Pain Connection

Sleep and pain have a bidirectional relationship—pain disrupts sleep, and poor sleep increases pain sensitivity. Up to 88% of people with chronic pain report sleep problems. Addressing sleep is a critical part of comprehensive pain management.¹

How Pain Disrupts Sleep²

• Difficulty falling asleep due to pain
• Pain causes frequent awakenings
• Difficulty finding comfortable position
• Medications may affect sleep
• Worry about pain keeps mind active

How Poor Sleep Worsens Pain

• Increases pain sensitivity
• Reduces pain tolerance
• Impairs natural pain modulation
• Increases inflammation
• Worsens mood (which affects pain)
• Reduces pain medication effectiveness

Sleep Hygiene Basics³

• Keep consistent sleep/wake times
• Create dark, quiet, cool environment
• Use bed only for sleep (and intimacy)
• Avoid screens before bed
• Limit caffeine, especially afternoon
• Avoid alcohol near bedtime
• Regular exercise (but not too close to bedtime)

Pain-Specific Sleep Strategies

Physical Comfort

• Supportive mattress and pillows
• Body pillow for positioning
• Temperature regulation
• Reduce pressure on painful areas

Pre-Sleep Routine

• Gentle stretching
• Relaxation techniques
• Warm bath or shower
• Time medication appropriately

CBT for Insomnia (CBT-I)

• Most effective treatment for chronic insomnia
• Addresses thoughts and behaviors around sleep
• Sleep restriction therapy
• Stimulus control
• Works well even with chronic pain

Medication Considerations

• Some pain medications cause drowsiness—time appropriately
• Some cause insomnia—avoid taking late
• Sleep medications have pros and cons
• Tricyclic antidepressants may help both
• Discuss options with your doctor

Sleep Disorders to Consider

• Insomnia
• Sleep apnea (common in chronic pain)
• Restless legs syndrome
• Periodic limb movements
• May need sleep study evaluation

When to Get Help

• Sleep problems persist despite self-help
• Excessive daytime sleepiness
• Snoring or breathing pauses
• Taking sleep medications regularly

References

1. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-1552.
2. Haack M, Simpson N, Sethna N, et al. Sleep deficiency and chronic pain. Pain. 2020;161(2):259-266.
3. Tang NK, Lereya ST, Boulton H, et al. Nonpharmacological treatments of insomnia for long-term painful conditions: a systematic review and meta-analysis of patient-reported outcomes. Sleep. 2015;38(11):1751-1764.