Pain and Insomnia – breaking a vicious cycle

By Dr. Laura Katz, Psychologist, Hamilton Health Sciences’ Michael G. DeGroote Pain Clinic

The link between chronic pain and lack of sleep is widely understood among insomniacs. Lack of sleep can aggravate physical ailments, including pain, and in return, pain can make it difficult to sleep. The relationship creates a cycle with one feeding into the other. In fact, over 40 per cent of people with chronic pain also have insomnia compared to just 10 per cent of the general population.

There are many reasons for the relationship between chronic pain and poor sleep:

• Chronic pain changes the way the brain works
• Negative emotions, stress, and anxiety that accompany chronic pain can make it hard to “shut off” your brain
• Pain can lead people to be less active, which can lead to poor sleep
• Inconsistent sleep patterns can cause a cycle of trouble sleeping—poor sleep can make you need a nap, which makes it harder to fall asleep at night, and so on
• Pain can make it hard to find a comfortable sleeping position, or can wake you up during the night

The Effects of Poor Sleep

We can all agree that we feel pretty miserable when we have a bad night’s rest. Combining that with chronic pain can make daily life seem unmanageable at times. I like to say that sleep “debt” or lack of sleep charges interest. Over time, the impact snowballs, affecting both ability to sleep, and increasing the amount of pain you experience. It is common for patients with chronic pain to experience issues falling and staying asleep due to their pain. This tends to increase their experience of pain, tension, and symptoms throughout the day. In turn, patients feel more emotional, irritable, and distressed, and they will often feel like they have less patience because of their pain. Patients often describe feeling frustrated with themselves and those around them, potentially lashing out at their loved ones. Resulting relationship issues can again negatively affect sleep, leading to further issues with pain and mood. As you can see, it’s all part of a vicious cycle.

Sleep “debt” or lack of sleep charges interest

So, how do we break that cycle? Many strategies involved in treatment require behavior changes and are based on Cognitive Behavioural Therapy for Insomnia (CBT-I). Change can, of course, be difficult for a lot of people. Brief interventions, such as only going to bed when sleepy and re-associating the bed with sleep, can be very effective for patients to start getting better sleep. To maintain these improvements, patients need to be motivated to change their habits and behavior in order to improve their sleep.

Tips for Improving Sleep Quality

• Reduce time in bed and only go to bed when sleepy. This helps to re-associate the bed with sleep. Use your bed only for sleep.
• Turn off all electronics, and unplug from screens at least 30 minutes before bed.
• Go to bed and wake up at the same time every day. Our bodies like routine, and this helps to set our biological clock.
• Avoid day-time napping. If you need a nap because of fatigue or pain, nap between 1-3 PM for less than an hour.
• Let your body be tired. Engage in exercise and activities out of the house throughout the day.
• Avoid big meals before bed.
• Reduce substances such as alcohol, nicotine, and caffeine. All substances alter your sleep, and can lead to less restorative sleep.
• Manage your anxieties, worries, and stress before you go to bed. In the early evening (several hours before bedtime), try “clearing your head” by writing down what’s on your mind, categorizing your thoughts (e.g., finances, to do’s, shopping lists), and/or finding possible solutions.

If sleep or insomnia is an issue for you, be sure to discuss it with your family physician.