Sleep and Chronic Pain

Sleep is also affected by mental health. Anxiety, stress, and depression can prevent sleep, especially if catastrophizing is occurring. This when your brain is completely focused on the pain and you are convincing yourself that the pain will never get better. This creates a cycle of pain, insomnia, depression, and anxiety. Then there will be high levels of stress. These emotions lead to more pain and less sleep. Medications may also interfere with sleep depending on the side effects.

Shorter sleep times, waking up throughout the night, and an overall poor quality of sleep, leads to a heightened sensitivity to pain the next day. Sleep loss causes inflammation within the immune system. Dopamine plays a role in sleep/wake cycles, but pain directly effects our dopamine levels. Sleep deprivation also decreases the levels of endogenous opioids in our bodies and there is also a decrease in opioid receptors. There is also an impairment of pain-inhibition pathways. Overall, poor sleep leads to more pain.

People who have sleep problems are at a higher risk for developing fibromyalgia and migraines. After a night of poor sleep, people feel tired when they wake up because they experienced “non-restorative sleep”. Exhaustion during the day due to poor sleep causes people to be less motivated to work out and be healthy. Pain can be felt more intensely and there may be greater levels of disability. As time goes on, the pain and sleep quality will worsen if not treated effectively.

Fortunately, once the quality of sleep increases, there is less sensitivity to pain. Long term results have shown that sleeping well each night will continue to decrease the quality of pain. Receiving eight hours of sleep each night has a positive effect on physical and mental well-being.

Getting Better Sleep

There is a lot of advice for how to get better sleep. I recommend trying several techniques together, until you figure out which ones are the most effective.

• Cognitive Behavioral Therapy for sleep and pain

• Counseling and physical therapy

• Deep breathing, mindfulness techniques, and/or guided imagery

• Get sunlight during the day, exercise, and eat healthy

• Avoid screens, caffeine, and alcohol before bed

• Have a bedtime routine such as brush your teeth, wash your face, do some light stretches, read a book, go to bed

• If you can’t fall asleep, don’t just lie in bed and think about your pain. Get up and do an activity in another room. Once you’re tired, attempt going back to bed

• Avoid naps during the day, but don’t force yourself to stay awake if you’re really exhausted

• Talk to a doctor because you may require medications

My Experience

When I had chronic pain, I would fall asleep easily, but I would wake up every night around 3:00 AM and I would be unable to fall back to sleep. I would just lay in bed having catastrophizing thoughts and suicidal thoughts. I would become stressed out and anxious, and I felt incapable of resolving this problem. I knew that melatonin would not help because it only helps people fall asleep, not stay asleep.

Each night I would toss and turn which meant that muscles were not fully relaxing at night. They may have increased tension and muscle tension leads to more pain. The next morning, I would wake up with more pain and more depression. I did not want to do another day.

Someone referred me to try CBD and medical marijuana. I didn’t know what I was doing, but I took way too many edibles the first time and ended up in my bathroom throwing up for two hours. Then I found an edible that was known to help with sleep. It contained 5 mg of THC, 5 mg of CBD, and 3 mg of melatonin. Finally, I fell into a deep, eight hour sleep. I woke up feeling amazing. I still had pain, but a lot less. I didn’t want to take edibles forever, so I switched to an antidepressant called trazodone. It knocks me out cold every night and I have very little pain now.

Sources

Moawad, H. (2020, November 19). Sleep disturbances as a sequalae of chronic pain. Psychiatric Times. Retrieved October 25, 2021, from https://www.psychiatrictimes.com/view/sleep-disturbances-sequalae-chronic-pain.

How to sleep well despite chronic pain. Harvard Health. (2016, November 15). Retrieved October 25, 2021, from https://www.health.harvard.edu/pain/how-to-sleep-well-despite-chronic-pain.

Finan, P. H., Goodin, B. R., & Smith, M. T. (2013, December). The Association of Sleep and pain: An update and a path forward. The journal of pain. Retrieved October 25, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046588/.

Pacheco, D. (2020, December 4). Pain and sleep: Common sleep disturbances & tips. Sleep Foundation. Retrieved October 25, 2021, from https://www.sleepfoundation.org/physical-health/pain-and-sleep.