When Sleep and Pain Collide: The Vicious Cycle of Chronic Pain and Chronic Insomnia
Can’t sleep due to chronic pain, or is poor sleep making your pain worse?
Let’s explore the relationship between chronic insomnia and chronic pain and how CBT-I may help alleviate both conditions.
What Is Chronic Pain?
Acute pain is short-term pain from a lesion, disease, or surgery (e.g., cut, fracture, pain after a medical procedure). It resolves as soon as your body has recovered from the issue.
Chronic pain lasts beyond what might be expected, typically more than three months, and is considered a neurological disorder. It can show up in different parts of your body along with an underlying health condition or injury, long after you have otherwise healed, or without an apparent cause.
Common examples of chronic pain include:
Headaches and migraines
Muscle, bone, and joint pain (e.g., fibromyalgia)
Temporomandibular pain (TMJ)
Neuralgic pain (i.e., damage to nerves or nervous system),including pain with no apparent physical cause due to central sensitization
Chronic pain may deplete your body, mind, and spirit. It can make working, moving, and living extremely challenging, carrying added mental health issues such as anxiety, depression, and sleep problems.
What Is Chronic Insomnia?
Insomnia consists of problems falling asleep, staying asleep, or getting enough quality sleep despite having the adequate opportunity to do so. There are two categories:
Short-term or acute insomnia typically resolves within a few days or weeks.
Chronic insomnia happens at least three nights a week for more than three months.
Like chronic pain, chronic insomnia can infiltrate many areas of your life and become a vicious cycle. It may involve fatigue, anxiety, depression, difficulty focusing, irritability, and often pain.
The Sleep and Pain Interaction: Does Sleep Affect Pain? Does Pain Affect Sleep?
Chronic pain may disturb sleep.
Many chronic pain patients seek relief by going to bed, yet pain makes sleeping a struggle. Although it’s not a clinical term, some people call this painsomnia. Research indicates that 60% of chronic pain patients attribute insomnia to pain, with 53 to 90% reporting sleep problems happening around or after chronic pain started.
According to a critical review, people experiencing chronic pain may:
Take longer to fall asleep
Have shorter total sleep time
Experience more frequent and prolonged awakenings
Have poorer sleep quality But why does this happen?
Studies state that pain may disturb sleep by triggering arousal and a series of neurobiological processes of stress. This activates an ongoing cycle where disturbed sleep and pain can increase one another. Research shows that pain disrupts sleep, while sleep loss can result in an increase in pain intensity, flare-ups, and a 2.5-fold increased risk of new onset chronic pain.
Sleep disruptions may contribute to chronic pain.
While all stages of sleep are important for various functions, SWS is the deep, restorative sleep phase, critical for cellular, muscle, and tissue repair, and for supporting your development and immune function.SWS helps regulate pain systems. Lack of SWS can interrupt your body’s natural ability to inhibit pain and cause increased pain sensitivity. Evidence shows that disrupted SWS may also be associated with reduced pain threshold, increased discomfort, fatigue, and inflammatory flare-ups.
Other conditions can also fuel the vicious cycle.
If you struggle with chronic pain and/or chronic insomnia, not surprisingly, you may also grapple with depression, anxiety, stress, and fatigue. All of these challenges can exacerbate insomnia and impact your pain regulation systems.
Challenging the linear connection between pain and sleep.
Traditionally, it was believed that pain itself caused sleep disturbances. And while that’s certainly true, you can see that it’s more complex than that.
Could improving sleep reduce the need for opioids and other medications?
One of the main challenges of chronic pain treatment is the lack of safe, long-term options. Many people suffering from debilitating pain resort to prescription opioids, desperately longing for relief.
Given the opioid crisis, organizations like the CDC offer prescribing guidelines to make opioid use safer (if necessary). These policies highlight that nonopioid therapy is preferred for chronic pain and that providers should only consider opioids if the benefits for pain and function outweigh the risks.
CBT for insomnia (CBT-I) may reduce pain.
Cognitive behavioural therapy for insomnia (CBT-I) is the first line of treatment for chronic insomnia. It’s an evidence-based and drug-free approach as effective as sleep medications within a few weeks but safer and longer lasting.
While this gold standard insomnia therapy may need some modification for chronic pain patients, it can often help break down the vicious loop between insomnia and pain. For example, lying in bed too long can actually condition the body to associate the bed with insomnia, instead of sleep. It’s called “conditioned arousal” and tends to fuel worse insomnia in the long run. Ever feel exhausted all day, but as soon as bedtime nears, tiredness becomes “tired, but wired”? That’s likely conditioned arousal at play. But people with chronic pain often need to lie down and rest. So, then what? Here are a few harm reduction strategies:
When possible, lie in a different room, a different bed, a couch during the day – or when you can’t sleep at night
If that’s not an option, sit up in bed, or arrange your comfy pillows (preferably different pillows) in a different position than you use at night
Lie on the opposite side of the bed
Lie on top of the covers, instead of between the sheets
Lie on top of a different coloured blanket
Wear daytime clothes, instead of sleepwear
Use different lighting during the day
Keep the blinds open
Anything that creates a different ambience can be surprisingly helpful to avoid further training the body to have insomnia in bed at night.
Why not give CBT-I a shot? Worst-case scenario—you learn how to improve your sleep. Best-case scenario—you help alleviate your pain. Improved pain can be a welcome side effect for many!
Always consult with your physician about the best treatment for your pain.
If you are struggling with chronic pain and chronic insomnia and believe that better sleep may relieve your pain, we are here for you.
We know it’s been a long ride, but there is hope. If you’re interested in one-on-one sessions, contact us for a free consultation.
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