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Sleep and Pain

Sleep is a vitally important part of all our lives.  Waking up in the morning feeling refreshed and ready to start the day is taken for granted by most of us.  The time we spend asleep is important in allowing the brain and body to restore function.

Having pain can frequently affect sleep patterns (and the opposite is also true, as discussed below).  A wide range of acute and chronic painful conditions can interrupt our normal sleep pattern.  Chronic pain conditions are more likely to lead to persistent sleep disturbance.  Among people experiencing chronic pain, about two thirds report poor or unrefreshing sleep.

During a normal night, we all go through cycles of light sleep, REM [rapid eye movement] sleep and deep (non-REM) sleep.  This cycle is repeated three to five times a night.  Getting enough deep sleep and REM sleep are key to our feeling refreshed in the morning.  Chronic pain can be associated with disturbance of this pattern, with even milder pain causing "microarousals", which are periods when pain breaks through and puts people back into the light sleep stage. They may not become conscious, and the next day won't remember waking up, but the fragmented sleep can leave them feeling as if they didn't get any rest at all. 

Sleep and pain have a close relationship in a vicious cycle, and it can sometimes be difficult to assess which is chicken and which is egg.  In one study, volunteers were placed in a sleep lab and stimulated when they went into the deep non-REM part of sleep, and developed widespread pain similar to fibromyalgia. 

Chronic sleep deprivation can also increase the chances of developing anxiety and depression as well as poor concentration, irritability and difficulty in managing chronic pain.

 

 What can I do to help myself?

 Some fairly simple things can be useful to help restore a healthy sleep pattern.  A sleep checklist such as the one shown can be helpful.

Think about:

  • Get up and go to bed at the same time each day, including at weekends
  • Avoid naps during the day that last more than about 20 minutes
  • Avoid caffeine, nicotine and alcohol for at least six hours before bedtime
  • Don't do vigorous exercise for at least four hours before bedtime
  • Limit fluids in the evening to avoid the need to get up to the toilet
  • Have bedtime rituals like setting the alarm, brushing teeth and briefly reading a book
  • Keep the bedroom dark and at a comfortable temperature
  • Use the bedroom just for sleep
  • Go to bed only when you feel sleepy
  • If you cannot get to sleep within 30 minutes, get up and do something relaxing for a bit.

 

 Treatments affecting sleep

Some of the medications we use in the management of chronic pain, such as tricyclic antidepressants and anticonvulsants, have some of their beneficial effects acting through modification of sleep patterns.

"Sleeping tablets" such as the benzodiazepines ("Valium" and related drugs) have mixed effects in pain, not all helpful. 

 

Links

A useful page on sleep, with downloadable resources that you may find useful, can be accessed here.

The inter-relationships of sleep and pain, and some useful approaches in management of these, are covered in an article on the Spine-Health website.

In a useful presentation from the Pain Community Centre in Cardiff Owen Hughes, a specialist psychologist working in pain, gives good information about sleep and pain and some of the things people can find helpful.

 

 

 

 

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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
email: pain.webmaster[at]glos.nhs.uk

Page updated 19/02/2016