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When Aches and Pains Disrupt Sleep

Sleep tips for women.

Medically Reviewed by Brunilda Nazario, MD on March 17, 2010
From the WebMD Archives

For millions of women in the U.S., pain -- whether it's back pain, menstrual pain, lupus pain, or fibromyalgia -- causes a lot of sleepless nights. According to the National Sleep Foundation, 25% of women say that physical discomfort interrupts their sleep at least three nights each week.

And while pain and sleep deprivation are bad enough individually, they're even worse in combination. Pain just hurts more when you're exhausted, experts say.

"It's a vicious cycle," says Thomas Roth, PhD, director of the Sleep Disorders Center at Henry Ford Hospital in Detroit. "Pain causes disturbed sleep, and insufficient sleep lowers your threshold for pain."

The combination of pain and sleep loss not only makes you feel crummy, it also affects every other aspect of your life. It may affect your performance on the job. It may affect your abilities as a mother. It can increase your risk of injury and disease. So if you woke up this morning exhausted and in pain -- again -- what can you do? How can you break the cycle? Here's what you need to know about pain and sleep.

Women, Pain, and Sleep

While chronic pain can be a problem for everyone, there's some evidence that pain might be more likely to disrupt a woman's sleep than a man's.

What sort of pain conditions can disturb sleep? Just about any of them, experts say.

"I don't know of a pain condition that doesn't affect sleep," says Roth. Common offenders include back pain, fibromyalgia, menstrual pain, lupus, headaches, osteoarthritis, rheumatoid arthritis, and neuropathic pain.

Obviously, extreme pain can make it impossible to sleep. If you're in agony from a bad back or a recent injury, falling asleep and staying asleep will not be easy.

What's less appreciated is how even mild or moderate pain can disrupt your natural sleep cycle. Pain can cause what's called "microarousals." These are periods when you're not fully awake, but when your pain is just bad enough to bump you out of deeper, restorative sleep into lighter sleep.

"The pain system in the body just keeps alerting the brain throughout the night, fragmenting a person's sleep," says Ronald Kramer, MD, a spokesman for the American Academy of Sleep Medicine and a specialist at the Colorado Sleep Disorders Center in Englewood, Colo.

Pain can also wake you up completely, of course. But if it's for a short enough time -- under a few minutes -- you might not remember in the morning.

"I see some patients with chronic pain who think that they're sleeping fine at night," Kramer tells WebMD. "But when you look more closely, it turns out that they're not sleeping well at all."

Treatment for Pain and Sleep Problems

To someone who doesn't have chronic pain and sleep problems, the solution might seem easy: Take a pain medicine. Sometimes, that works. But it's not always so simple. For example, a short-acting painkiller might be fine when you're awake. But at night, it could wear off long before morning.

Also, some of the most powerful chronic pain treatments we have, opioid medicines, can actually contribute to sleep apnea and thus disrupt your sleep. Other pain medications, like acetaminophen and NSAIDs such as ibuprofen and naproxen, might be less likely to cause problems.

If possible, it's important to treat the cause of the underlying pain, says Anne Louise Oaklander, MD, PhD, an associate professor of neurology at Harvard Medical School and director of the Nerve Injury Unit at Massachusetts General Hospital in Boston.

"Treating the cause is crucial," says Oaklander. "If you had a terrible toothache and your dentist just gave you a nerve block to numb the pain, you might be happy temporarily. But the next day, you'd be back where you started."

Experts say it’s also important to treat your sleep problem, which may indirectly help treat your pain.

In some cases, taking a sleeping pill will actually help you gain control of your symptoms better than a pain medication, says Kramer. If you can get just some sleep, the pain won't be quite as bad the next day.

Research bears this out, Roth says. "Some studies have shown that if you help people sleep better after surgery, they'll use lower levels of painkillers," he tells WebMD. Getting enough sleep can be crucial to help you managing your pain.

The bottom line? There are three key ways to deal with pain-related sleep problems:

  • Treat your pain with pain medicine.
  • Treat the underlying condition, such as arthritis or a toothache, that causes your pain.
  • Treat your sleep problem with a sleep aid.

See your doctor to devise the best treatment strategy for your situation.

Pain and Sleep: What You Can Do

While you and your doctor work on a treatment plan, here are some things you can do on your own to reduce pain and improve your sleep.

  • Exercise. Regular physical activity has all sorts of health benefits. But specifically, many studies have found that it may help you manage painful symptoms, boost energy, and improve your sleep. Just make sure not to exercise too close to bed, when it's more likely to rev you up.
  • Practice good sleep hygiene. While it won't directly help with your pain, doing everything you can to improve your sleep is a good idea. Make sure that your bedroom is a soothing, calming place. Take time to unwind before bed, maybe turning off the computer and television about an hour before. Reduce your caffeine intake during the day.
  • Be careful with alcohol and other drugs. Many people with chronic pain rely on alcohol to help ease their discomfort and fall asleep. But self-medicating with alcohol or other drugs is a bad idea in the long run. Even in the short-term, drinking alcohol before bed isn't wise. While it might help you nod off, it will disrupt your sleep cycle and wake you up a few hours later.
    What about cigarettes? While some people smoke to relax and deal with stress, nicotine is actually a stimulant. "Smoking anytime can be a problem," says Kramer. "Nicotine can affect sleep patterns for up to 24 hours after you smoke."

Pain and Sleep: Getting Help

Getting help for pain and sleep problems isn’t always easy. "Everybody tends to play down the significance of being sleep-deprived," says Roth, "including doctors."

And unfortunately, pain is often undertreated as well. Some doctors focus too much on trying to sort out the cause of the pain and too little on the pain itself. As a result, people can suffer pointlessly for weeks, months, or even years.

Getting the right treatment can take some determination. You can start with your family practitioner. But you might also want to seek out experts in either pain management or sleep disorders. You might need both -- tackling the problem often takes a collaborative approach.

Just remember not to underestimate the problem. The consequences of life with pain and sleep deprivation can be serious.

"If you're suffering with chronic sleep problems, get help," says Kramer. "There's just no reason to tough it out on your own."

Show Sources

SOURCES:

Ronald Kramer, MD, Colorado Sleep Disorders Center, Englewood, Colo.

Jodi A. Mindell, PhD, author of Sleep Deprived No More: From Pregnancy to Early Motherhood -- Helping You & Your Baby Sleep Through the Night; director, graduate program in psychology, St. Joseph's University, Philadelphia.

Thomas Roth, PhD, director, Sleep Disorders Center, Henry Ford Hospital, Detroit.

National Sleep Foundation web site.

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