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When Aches & Pain Disrupt Sleep

It's a vicious cycle -- pain keeps you awake, and sleeplessness makes pain worse.
By
WebMD Feature
Reviewed by Elliot S. Katz, MD

Aches and pains give everyone a sleepless night now and then. It doesn't take much -- a pulled muscle from an overenthusiastic workout or an afternoon spent helping a friend move furniture. Next thing you know, you're lying in bed at 3 a.m., staring at the ceiling above your bed, aching, and praying for unconsciousness.

While most aches fade pretty quickly, painful and sleepless nights are the norm for people living with chronic pain. "Between 50%-90% of people with chronic pain say that they don't sleep well," says Gilles Lavigne, DDS, MSc, FRCD, an expert on the connection between sleep and pain and a professor of dentistry, physiology and psychiatry at the University of Montreal. "They wake up feeling like they never went to bed."

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Not getting enough sleep can have a poisonous effect on your whole life, says Penney Cowan, executive director of the American Chronic Pain Association. It makes you feel rundown and depressed. Your job and family life can suffer. If your sleeplessness is keeping up your spouse too, that can cause even more problems. And that's not all.

"There's very good data that suggests that disturbed sleep can worsen your pain," says Thomas Roth, PhD, director of the Sleep Disorders Center at Henry Ford Hospital in Detroit. It's a vicious cycle: pain prevents you from sleeping, and not sleeping makes the pain worse.

The good news is that there's a lot that you can do -- on your own, and with your doctor -- to break the cycle. With changes to your lifestyle and possibly medication, you can finally get the good night's sleep you crave.

Pain and Sleep

"During a normal night, we all go through cycles of light sleep, deep sleep, and REM [rapid eye movement] sleep," Lavigne tells WebMD. "This cycle is repeated three to five times a night." Getting enough deep sleep and REM sleep are key to feeling refreshed in the morning.

The problem is that pain interferes with this cycle. Sudden severe pain can make you bolt upright from a sound sleep. But even milder pain can cause "microarousals," Lavigne says. These are periods when your pain breaks through and bumps you back into the light sleep stage. You may not become conscious, and the next day you won't remember waking up. But your fragmented sleep can leave you feeling like you didn't get any rest at all.

Any pain can interfere with sleep. But some common causes of disturbed sleep are:

  • Headaches
  • Back pain
  • TMJ pain, which is pain in the temporomandibular joint of the jaw
  • Arthritis
  • Fibromyalgia, which can cause pain throughout the body's muscles, ligaments, and tendons
  • Neuropathy, or nerve pain
  • Premenstrual cramping

Acute injuries, surgery, and more serious diseases, like cancer, can also cause pain and sleeplessness.

It's not just the intensity of pain that can make it hard to sleep. Lavigne says that pain that varies -- that is worse some days than others -- is often the most likely to cause sleeplessness.

"It makes sense," he says. "If you have constant pain for six months, you figure out how to cope with it. But if the pain level goes up and down, if it's unpredictable, you can't get used to it and it can really interfere with sleep."

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