“How do I get a good night's sleep when I’m in pain?”

We get asked this question a lot, and it can be a tricky topic, mainly because it can be related all the way back to the age-old question, which came first, the chicken or the egg.

So, what did come first, our poor night of sleep or our pain? The two are very bidirectionally linked and create a vicious cycle of pain and poor sleep which can seem impossible to break. In fact, the two are so intertwined that approximately 53-90% of individuals with chronic pain report a high level of chronic insomnia (Nijs et al, 2018).  

The most common way to address this issue is to try to tackle the pain side of the equation, often with pharmaceutical therapies, stretching before bed and way too many pillows. For some people, these interventions can help reduce their pain and drift off to blissful sleep. However, this focus on pain alone often leaves most of us feeling no better and more than likely lying awake at night cursing our body for how we feel.

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If we think about this problem again as the vicious cycle of poor sleep and pain, why should we only try to address the pain half of the cycle? What about the poor sleep component? Shouldn’t that be considered just as important?

Well, this is, in fact, what the current evidence suggests we do. By focusing on improving our quality of sleep rather than focusing only on reducing our pain, we can start to break the cycle (Tang et al, 2015). Now I can hear what you’re saying already “how am I meant to improve my sleep when I’m in so much pain” and you're right, it can be hard to shift our focus from how our body is feeling, but by helping the body achieve more rest, it can in fact help reduce overall pain not only at night but in our day-to-day life.

So, how do we achieve a better night's sleep? Here are some tips from renowned doctor and therapist Dr Russ Harris from The Happiness Trap on how we can improve our sleep hygiene.

1. Limit stimulants such as coffee, tea and chocolate before going to bed
2. Limit food and alcohol before bedtime
3. Try to keep to a regular sleep schedule with regular hours of sleep
4. Restrict ‘blue light’ from devices such as TV’s and mobile devices for one hour prior to sleep
5. If you have trouble falling asleep, develop a wind down routine to help you relax
6. Try to avoid vigorous exercise at least one hour before bed
7. Create a comfortable bedroom environment that promotes sleep
8. Restrict naps during the daytime to less than half an hour
9. Restrict activities in bed to sleep, relaxation, meditation or sex.
10. Try to avoid forcing sleep. If you can’t fall asleep try practicing some mindfulness or reflective tasks to allow your body to still rest even if you are not asleep.

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The current research supports that by utilising these non-pharmaceutical, behavioural change and educational treatments around sleep hygiene we can not only improve the quality of sleep but reduce pain as well (Pigeon et al, 2012). Not only that but by improving our sleep routines and hygiene we can reduce both levels of fatigue and depression in our daily life, improving our overall physical and mental wellbeing (Tang et al, 2015).

Another study looking at sleep and chronic pain found that individuals with chronic pain suddenly increased their levels of physical activity after a night of more restful sleep (Tang et al, 2014). This is great news for the treatment of chronic pain showing that by addressing sleep quality we can assist in increasing quality of life with improved engagement in exercise and social activities such as sport. Of course, improving our sleep is only one part of the complex equation of managing chronic pain and for anyone concerned about getting back to exercise I recommend giving this our blog about pain while exercising a read.

So, if you’ve been stretching like crazy before bed or found yourself spending a fortune on fancy pillows that seem to make no difference to your pain at night maybe it’s time to focus more on improving how you sleep and focus less on reducing your pain and see if you can break the cycle.

If you find yourself struggling to improve your sleep or pain is stopping you from enjoying life were always here to help. BOOK NOW with one of our allied health professionals to discuss the best individual strategies for you to improve your sleep and deal with your pain.

References:

• Nijs, J., Mairesse, O., Neu, D., Leysen, L., Danneels, L.,Cagnie, B., Meeus, M., Moens, M., Ickmans, K. and Goubert, D., 2018. Sleep disturbances in chronic pain: neurobiology, assessment, and treatment in physical therapist practice. Physical therapy, 98(5), pp.325-335.
• Tang, N.K., Lereya, S.T., Boulton, H., Miller, M.A., Wolke, D. and Cappuccio, F.P., 2015. Non-pharmacological treatments of insomnia for long-term painful conditions: a systematic review and meta-analysis of patient-reported outcomes in randomised controlled trials. Sleep, 38(11),pp.1751-1764.