Chronic Pain and Sleep

Chronic pain and sleep have a bidirectional relationship. Chronic pain can worsen sleep, and poor sleep can worsen chronic pain. Chronic pain can make it difficult to fall asleep, stay asleep, and have restful sleep, all of which can worsen sleep quality. And poor sleep can lower pain thresholds, increase pain sensitivity, and exacerbate pain symptoms. It is easy to get caught in a cycle where pain worsens sleep, poor sleep worsens pain, which, in turn, makes sleep even worse, and so on.

If you experience both chronic pain and poor sleep, you may have greater pain severity, longer pain disruption, and greater daily interference from pain. Also, both pain and poor sleep can worsen mood and lead to symptoms of anxiety and depression. Overall, you may have more difficulty functioning and a poor quality of life.

Ways to Aid Sleep When You Have Chronic Pain

While it is true that chronic pain can persist even when you practice strategies to manage it, pause and consider if you are taking steps to manage chronic pain. This may look like taking medications, engaging in physical therapy, or practicing relaxation exercises that decrease muscle tension, such as breathing slowly and lengthening the exhale portion of the breath.

Make your sleep environment as conducive to sleep as possible. Are there steps you can take to increase the comfort of being in bed and/or lessen pressure on your body? For example, would it be helpful to use pillows to provide support to certain parts of your body? I’m a side sleeper and place a folded towel under my hips when I get into bed to help take some pressure off my lower back. Also, try to make your bedroom as dark and as quiet as possible, and at a comfortable temperature. If you are cold or hot during the night, your pain may feel worse.

Be mindful of thoughts that may heighten sleep anxiety, arousal, and pain. For example, do you get into bed and think, “Why bother? I’m never going to sleep tonight. My pain is so annoying!” While this type of thought is natural, it is hard to think about it and feel calm, relaxed, and ready for sleep. Practice creating and repeating an alternative, more neutral thought, such as “I can’t force myself to sleep, and I can practice strategies to set the stage for sleep. Let me just take it as it comes. I am okay.”

Or, practice noticing your thoughts and letting them come and go in your mind using imagery. For example, you can imagine standing by a stream and placing your thoughts on leaves on the stream and letting them float downstream. Or, imagine you are standing by a long conveyor belt in a warehouse, and you can place your thought in a box and send it down the conveyor belt.

Take time to wind down before bed. Chronic pain can increase nervous system activation, making it more difficult to fall asleep. So, create a buffer zone routine before bed where you take about 30 to 60 minutes before your bedtime to engage in relaxing and soothing activities (try to avoid stimulating activities and screens during this time). Maybe you shower, brush your teeth, and read a book in dim light. Or, listen to a favorite podcast (just be careful not to listen to something that is going to stimulate you). Or, use a heating pad and engage in some gentle stretching.

If you can’t sleep, practice not fighting against it, as this can make your stress and anxiety worse. Yes, it is unpleasant not to sleep, yet fighting the fact that you are awake just makes it harder to sleep. Practice accepting what is happening in the moment, and don’t jump ahead to the future and tell yourself you will never sleep. Focus on the present moment only, and if you aren’t sleeping, get out of bed.

Tossing and turning in bed, in pain, and feeling frustrated about being awake, leads to more and more frustration. If it has been more than about 20 minutes (You don’t need to watch the clock), get out of bed and do a relaxing activity until you feel sleepy and return to bed.

While you may not be able to eliminate pain, it is possible to practice helpful strategies to set the stage for improved sleep.