Pain & Sleep

Pain & Sleep

There are a number of ailments that could possibly be keeping you from getting good sleep.

From gout and arthritis to headaches, menstrual cramps, and back pain, the list is long.

Sleep is often a great way to escape the pain, but if you’re in too much pain to sleep at all, this is ironic at best.


Chronic Pain & Sleeping

Chronic Pain & SleepingA surprisingly high number of patients who suffer from chronic pain talk about disturbance to their sleep. The worst case scenario is when pain and sleep loss leads to a decrease in your overall quality of life.

Pain makes it difficult to fall asleep, and a lack of sleep can make the pain more acute. Both of these factors can lead to depression, which also affects the amount of sleep you get and your experience with pain. One possible solution for this is cognitive behavioral therapy to help with both alleviating pain and issues around sleeping.


Pain Medication & Sleep

Prescription pain medication can have a significant influence on sleep. Opioids, in particular, causes fragmenting of the sleep cycles. Even though it may feel like you’re getting more sleep initially, the quality of the sleep is actually lower.

Pain medication that you can get over the counter like aspirin and ibuprofen also impact the sleep cycle – however, this isn’t to the same extent. If the medication allows you to fall and stay asleep, then it’s not entirely bad.


Cause and Effect is a Two-Sided Street

People who suffer from insomnia are more likely to be in chronic pain than those who don’t. Experts claim that up to 40% of patients experiencing chronic pain also have insomnia. This is quite a lot higher than the rate of those without.

So, is it the pain that makes your sleep worse, or the poor quality of sleep makes the pain worse? The answer is both. Don’t be too quick to discount the positive effect a good night’s sleep can have on someone’s ability to cope with chronic pain.

The acute concentration of pain may decrease if the person has had a good night’s sleep.



Hyperalgesia, which is a sensitivity to pain, is directly related to a lack of sleep – notably a lack of REM sleep.



Opioids can suppress vital REM sleep, ironically causing patients to increase their sensitivity to the pain that they’re in. Certain types of anti-depressants also work to suppress the REM cycle, which may cause the patient to complain more about an overall lack of quality sleep. Ultimately, low sleep quality is directly linked to an increase in fatigue and chronic pain.


Rheumatoid Arthritis

Patients who suffer from rheumatoid arthritis say that they suffer from sleep problems on a regular basis and this is a result of a vicious cycle with the chronic pain that they’re in.

It is well known that there is a correlation between mood and pain, as well as sleep disorders and depression. Researchers studied a group of patients with arthritis using the HAQ pain scale among other measurements. The results found that a lack of good quality sleep was directly linked with general disability in these patients.


Lower Back Pain

Lower Back Pain & SleepLower back pain is another medical issue that’s known to affect your sleep – both the frequency and the quality.

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Once you recognize that sleep disorders and pain are often grouped together, you also start to realize that pharmaceutical companies have introduced what is known as combination drugs. These over the counter drugs contain both pain medication and a sleep aid.

One of the most popular over the counter drugs like this is Tylenol, among others.

The topic of sleep and pain can also be closely linked with age and sleep. There is a much higher number of seniors who experience ongoing pain than younger adults. In conjunction, there is a much higher number of seniors who suffer from sleep disorders as well.


Experiencing Pain During REM Sleep

People have reported experiencing pain during their dreams that isn’t happening in real life.

It’s called dream pain, and it goes away when they wake up. A more common scenario is real pain that a patient is feeling, that is incorporated somehow into their dream narrative.

When you experience vivid dreams like this, it means that your brain is in a REM cycle. During REM, your muscles are paralyzed. This paralysis could possibly contribute to bodily pain and make it worse than when the body isn’t in REM sleep and can quickly move around.

Psychologists conducted a test. In the trial, they caused mild pain to participants who were in the middle of a REM cycle. When the test subjects woke up, 30% of them reported having a dream where they experienced pain in the same part of the body the researcher applied mild pressure to.

The subjects reported experiencing a higher level of pain in the dream than that which was administered in real life.

Interestingly, burn victims report experiencing about the same percentage of dreams involving pain, even if the level of pain they’re in in real life is higher than what was administered in the study.


Sleep and Noise

Unpredictable or loud noises may often interrupt sleep, causing you to either wake up or shift into a different sleep cycle. If you are in slow wave sleep and you are woken up by noise, you will feel groggy and unrefreshed. You may also feel tenderness and pain, even if you’re healthy.

This being said, each person has a different response to noise. Because of this, researchers have even been able to predict which patients will wake up from hearing sounds, based on EEG readings. People who show more sleep spindles on their readings during a regular night’s sleep have a higher tolerance for noise. This means that people who have more active minds when they’re asleep tend to be able to sleep through noises.

White noise, which can be described as a constant, regular background hum at a low volume, can help many people sleep. This is assumed to be because white noise can drown out other, less predictable sounds when they occur. There are even commercial products that you can purchase that can generate this type of white noise for a better night’s sleep. Another option is using a dehumidifier because of its constant, rhythmic hum. White noise is often used to help infants get to sleep.

Rain is another element that can help people sleep. You may have heard people say that they sleep better when it’s raining. This may be a combination of things, which include the white noise generated by the rain, the lowering of outdoor temperature, and changes in the air, like electrostatic characteristics. Furthermore, the air that follows rain is usually fresh and linked with better sleep.

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Aircraft noise is a common sleep disturberAircraft noise is a common sleep disturber and can even cause sleep-deprived behavior during the daytime. The World Health Organization say that up to one in three Europeans have issues with their health as a result of being subjected to excessive levels of traffic noise. One in five Europeans is said to be risking their health due to hearing too much nighttime sound.

What can be said of birds singing and other natural sounds, often heard in the morning? Many people find listening to these sounds pleasant when they are calm and relaxed and say that the quality of their sleep improves, especially around dawn when they are most likely experiencing REM.

What about the effect of rocking on sleep? Parents often resort to rocking their babies to sleep – there are even cribs that can be set to rock the baby as well. There are many people who relax by swinging in a hammock as well. A Swiss study found that rocking actually helps the transition between stage one and stage two sleep.


The Sound Sleeper

When you describe someone as a sound sleeper, you usually mean someone who is capable of sleeping through even the most disturbing of noises.

In fact, resistance to sound and acoustic disturbance is actually a way to measure how deep someone may sleep. This varies throughout the night, depending on what stage of sleep you’re in.

Even for those more sensitive to sounds, if they are experiencing deep sleep, they may be harder to wake up.


References and further reading

1. Behavioral Therapy Improves Sleep and Lives of Patients with Pain
2. The impact on sleep of a multidisciplinary cognitive behavioural pain management programme: a pilot study
3. Sleep Quality and Functional Disability in Patients with Rheumatoid Arthritis
4. The association between chronic low back pain and sleep: a systematic review
5. The Phenomenology of Pain During REM Sleep
6. Spontaneous brain rhythms predict sleep stability in the face of noise
7. Secrets of Sleeping Soundly Uncovered
8. Noise: Data and statistics
9. Aircraft noise effects on sleep: mechanisms, mitigation and research needs.
10. Rocking synchronizes brain waves during a short nap
11. White noise and sleep induction.
12. Covert Waking Brain Activity Reveals Instantaneous Sleep Depth

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