Most people wouldn’t be surprised to hear that pain can cause insomnia – but the relationship between sleep and pain is a lot more complex than most of us realise.
So says Dr Alison Bentley, Restonic Sleep Expert. “The relationship between sleep and pain has been studied extensively,” she says, “and in one survey, nearly half of patients complain of insomnia.”
Insomnia doesn’t just mean struggling to fall asleep, Dr Bentley clarifies – it means not being able to get enough hours of sleep to function well during the day, and includes waking up during the night and being unable to fall asleep easily, or experiencing poor sleep quality, where you wake up after enough hours of sleep, but still feel unrefreshed.
The problem with sleep and pain, she says, is that while the pain affects sleep, not getting a good night’s sleep also increases the pain the following day – resulting in a vicious cycle.
“All sleep disorders, including sleep apnoea and restless legs syndrome (RLS), are more common in patients with pain,” she says. “The implication from this is that it might be the sleep disorder creating poor quality sleep that started or worsened the painful condition, particularly if the pain is located in the muscles. Fibromyalgia, for example, is a condition where the sleep-pain relationship is very closely linked and difficult to untangle.”
However, she points out that not all pain is the same when it comes to poor sleep. Waking up with back or neck pain may simply mean that your mattress is too old and not supporting your body comfortably during the night.
You might also find you’re waking regularly with headaches or jaw pain, she adds. “Assuming you don’t sleep alone, ask your bed partner if you snore and appear to stop breathing, as these symptoms may indicate obstructive sleep apnoea – a condition where you stop breathing temporarily, and your body wakes you up so you can start breathing again.
“The repeated waking from apnoea can cause headaches and treating the sleep apnoea often relieves the headaches as well.”
Dr Bentley says when doctors are trying to manage the combination of sleep and pain, they usually treat the pain and assume the sleep problem will resolve. “That won’t happen if the sleep problem is due to sleep apnoea or restless legs syndrome,” she notes. “These two conditions need to be diagnosed properly and treated specifically – and not with sleeping tablets – to improve sleep directly.”
She adds that better sleep after treatment of a sleep disorder may directly improve pain during the day, and there is also good evidence now showing that treating insomnia directly not only improves sleep, but also improves daytime pain.
Finally, she advises that if you are struggling with the pain/poor sleep combination, make sure that your treatment plan for pain includes a specific plan to tackle your poor sleep – particularly to exclude and treat specific sleep disorders. Tackling both sides of the problem may be needed to get a full resolution of the pain.
