Pain: The Sleep Thief

Coping With Excessive Sleepiness
What to do when pain keeps you up at night.

By Denise Mann
WebMD Feature

Your back is throbbing and has been for weeks. You can barely move from your bed, but you are not getting any sleep because of the intense pain.

This is a pretty common scenario, explains David Neumeyer, MD, the associate director of the Sleep Disorder Center at theLahey Clinic Medical Center in Burlington, Mass.
“Pain and sleep are integrally connected,” he says. “Chronic pain is very common in the population and even more common in people who have poor sleep, and it sort of becomes a vicious cycle.” Pain affects your ability to sleep, and the lack of sleep makes the pain seem worse.

The Link Between Pain and Sleep Problems

Exactly how the two conditions are connected varies from person to person. “You have to determine what is the chicken and what is the egg,” he says. “Is pain a manifestation of, or made worse by, a sleep disorder or is pain causing the poor quality of sleep?”

Charles Bae, MD, a neurologist in the Sleep Disorders Center at the Cleveland Clinic in Ohio, puts it this way: “Pain can be the main reason that someone wakes up multiple times a night, and this results in a decrease in sleep quantity and quality, and on the flip side, sleep deprivation can lower your pain threshold and pain tolerance and make existing pain feel worse.”

“If you have arthritis and roll or turn while you are sleeping, pain can wake you up,” says David S Kloth, MD, the founder, medical director, and president of Connecticut Pain Care in Danbury, and a past president of the American Society of Intervention Pain Physicians.

The first step is to figure out if the lack of sleep is causing pain or if the pain is causing a lack of sleep, and then you treat whichever came first, he says.

The Pain-Reducing Benefits of Better Sleep

Pain may not be the only problem interfering with your sleep. Some people may also have an underlying sleep disorder, such as sleep apnea. Neumeyer recommends an evaluation by a sleep specialist to be sure there is not underlying sleep disorder.

Once you’re correctly diagnosed, sleep experts say good treatment can significantly help those living with chronic pain.

Getting better quality sleep — and more of it — may improve your pain threshold so you will ache less, says Neumeyer.

“People in pain don’t sleep, and people who sleep have less pain,” agrees Michael Breus, PhD, author of Beauty Sleepand the clinical director of the sleep division for Arrowhead Health in Glendale, Ariz.

Treating Pain-Related Sleep Problems

Improving sleep in people with chronic pain such as low back pain, arthritis, fibromyalgia, and diabetic nerve pain is difficult because these individuals often don’t want to take any more drugs, says Breus.

These individuals are often already taking several medications to treat their pain disorder. What’s more, certain prescription sleeping pills may interact with their pain medications, so they couldn’t take them even if they wanted to, says Breus.

In essence, Breus becomes the Sherlock Holmes of sleep problems. He looks at each individual’s sleep habits and bedroom environment. “I have to investigate how old their mattress and pillows are, and make sure they are offer proper support,” he says. He asks about their diet and habits. Do they avoid beverages with caffeine after 2 p.m.? Do they exercise regularly? Do they use the bedroom only for sleep and sex? All these things may also help people in pain get their ZZZs.

The bottom line, according to Cleveland Clinic’s Bae, is “if you have chronic pain and trouble sleeping, bring it up to your doctor to see if anything can be done to help your sleep while getting your pain treated.”