When Aches & Pain Disrupt Sleep

It's a vicious cycle -- pain keeps you awake, and sleeplessness makes pain worse.

From the WebMD Archives

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."

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."

Continued

Finding Solutions

Experts strongly recommend that people with chronic pain and insomnia practice good "sleep hygiene," a medical term for good sleep habits. These suggestions aren't specific to people with chronic pain -- they can help anyone with sleep problems.

  • Cut back -- or cut out -- the caffeine. If you're overtired, coffee, tea, and caffeinated sodas may help you get through the day. But in all likelihood, they're just worsening your problem, since they disturb your sleep at night. So struggle through a few days without your dose of caffeine and see how you do.
  • Avoid naps. "Napping during the day just reduces the amount you can sleep at night," says Roth.
  • Exercise, but not too late. While physical activity is good for everyone, intense exercise -- especially in the late afternoon and evening -- can rev your body up and make sleeping at night difficult. So try a more moderate exercise routine and make sure to do it before the evening.
  • Cut out the alcohol in the evening. A nightcap might seem like the perfect way to put yourself to sleep. But the problem is that alcohol can interfere with your sleep cycles and wake you up later.
  • Don't overeat in the evening. A stuffed stomach may make it harder to sleep, says Lavigne.
  • Make your bedroom a calming place. It's very easy to have your bedroom become a multipurpose dumping ground. It might be filled with baskets of laundry, your kids' toys, and a blaring TV. But experts say that you should make your bedroom a more neutral, soothing place. In fact, they recommend that you reserve you bedroom only for sleeping and sex. Get rid of the distractions.
  • Relax before bed. Don't do anything before bed that could get you anxious or excited. Avoid doing work in the evening or even getting into serious discussions with your spouse. Instead, try focused relaxation or breathing exercises.
  • If you can't sleep, don't lie awake in bed. Willing yourself to sleep won't work -- you'll probably just make yourself anxious. So if you're not asleep within 15 minutes of lying down, get out of bed and do something else. Read a book. Take a bath. Listen to soft music. Once you feel yourself getting tired, get back into bed.
  • Get up at the same time every day regardless of when you went to sleep. It's one way of getting yourself onto a schedule.

Continued

Using Medicines

Medication, either to ease pain or help sleep -- or a combination of both -- can be invaluable to people who have their sleep disturbed by pain.

For mild, temporary pain, over-the-counter painkillers -- like Tylenol, Advil, or Motrin -- may be enough. Some over-the-counter painkillers are sold with an antihistamine to help with sleep, such as Advil PM or Tylenol PM. However, over-the-counter medicines are not designed for long-term self-medication.

For more severe or chronic pain, your doctor may recommend prescription painkillers, like Ultram or opioids -- such as OxyContin, Vicodin, codeine, and morphine. Other drugs can also help with pain, such as some antidepressants and anticonvulsants.

To help with sleep, your doctor might recommend drugs typically prescribed for anxiety, called benzodiazepines (like Ativan, Klonopin, and Halcion.) A newer type of medicine called nonbenzodiazepine hypnotics are particularly helpful for sleep and appear to be better for longer-term use than benzodiazepines. They include Ambien, Lunesta, and Sonata.

Clearly, there are a lot of medicines out there that can help. But there's a nasty catch: Some medicines used to reduce pain or aid sleep can, in fact, have a bad effect on your sleep patterns.

"The painkillers morphine and codeine can interrupt your sleep pattern and decrease the amount of deep sleep you get," says Lavigne. There's evidence that benzodiazepines and nonsteroidal anti-inflammatory drugs -- like Advil and Motrin -- can also interfere with your sleep cycle.

However, don't despair. The fact is that all medicines have pros and cons. The key is to find the treatment that works for you. While it may take a few tries, you and your doctor will probably find the right approach that will ease your pain and get you some sleep.

Even if you get prescribed a medicine, don't give up on good sleep hygiene. A combination approach may be best.

"It's just like having high cholesterol," Roth tells WebMD. "You don't choose between going on a diet and taking a statin. You do both. You keep working on the sleep hygiene even if you're taking medicine."

Taking Action

Experts agree that you must take chronic pain and sleep problems seriously.

Continued

Cowan says pain can "throw your whole life out of whack." It's not just the feeling of pain that's the problem -- for instance, chronic back pain is more than just a pain in the back. Over time, it can spill over and affect every single aspect of your life. It can overwhelm you.

So don't assume that pain and insomnia will resolve on their own. Instead, get help from your health care provider. Unfortunately, many people don't.

"Patients often don't mention sleep problems to their doctor," says Roth. "They see insomnia as a moral failing, something that they should fix on their own. But that's not the case."

Cowan also cautions people not to become fixated on a single cure. "A lot of people get stuck on the idea that one pill or one more surgery will resolve their pain," says Cowan. But she says people need to look at the bigger picture.

"There's no magic bullet that can ease everyone's pain and put them to sleep," she tells WebMD. "But with the help of your doctor, you can find a treatment plan that will help."

WebMD Feature Reviewed by Leonard J. Sonne, MD on January 01, 2007

Sources

SOURCES: American Chronic Pain Association web site: "ACPA Medications & Chronic Pain Supplement 2005." Penney Cowan, executive director, American Chronic Pain Association. Gilles Lavigne, DDS, MSc, FRCD, professor in dentistry, physiology and psychiatry, University of Montreal. Principles and Practice of Sleep Medicine, 4th edition, 2005. National Institutes of Health web site, National Institutes of Health State-of-the-Science Conference Statement, Manifestations and Management of Chronic Insomnia in Adults, June 13-15, 2005. National Sleep Foundation web site: "Pain and Sleep." National Sleep Foundation web site: "Pain and Sleep: Gilles Lavigne interview." Thomas Roth, PhD, director, Sleep Disorders Center, Henry Ford Hospital, Detroit. Shaw, R. et al., Sleep 2005; vol 28: pp 677-682.

© 2006 WebMD, Inc. All rights reserved.

Pagination