Sleep is essential. It’s the time when your body gets the much-needed rest it needs to recover, heal, and stay healthy. Unfortunately, people with chronic pain know the struggle of the pain-sleep vicious cycle. Their chronic pain does not get any better because they do not sleep enough and they cannot sleep well because of their chronic pain. Over time, this sleep deprivation can lead to additional long-term side effects that can not only worsen the underlying condition causing the problem but also create new issues. This short guide will help you to understand insomnia caused by chronic pain and what you can do to solve it.
Understanding insomnia caused by chronic pain
It’s essential to know this isn’t your average insomnia. Most people eliminate distractions before they go bed such as turning off lights and music and making themselves comfortable. For a healthy person, this an ideal sleep environment. But for those suffering from chronic pain, this quiet environment often makes the pain seem more intense. In other words, the perception of pain increases while trying to go to sleep.
Your pain-sleep relationship
Both pain and sleep affect each other. 60% of pain clinic patients have reported insomnia following the onset of chronic pain. Even in otherwise healthy research participants, found the introduction of a pain stimulus to cause sleep disruption. These people not only have problems falling asleep, but also staying asleep.
Likewise, people who have intense difficulty falling asleep are found to be three times more likely to suffer from a chronic pain condition. Sleep deprivation and/or sleep disruption for more than three nights has been linked to decreased pain tolerance, poorer physical functioning, depression, and even symptoms that mirror those of fibromyalgia in healthy volunteers.
Quality vs. quantity of sleep
We generally hear that adults need 8 hours of sleep each night. But for some people, 6 hours can feel like more than enough while others may need 9. The most important thing is that you wake up feeling refreshed. There are 4 stages of sleep:
- Stage 1: This stage is non-REM sleep. It moves us from wakefulness to sleep. “During this short period (lasting several minutes) of relatively light sleep, your heartbeat, breathing, and eye movements slow, and your muscles relax with occasional twitches. Your brain waves begin to slow from their daytime wakefulness patterns.”
- Stage 2: This stage is also non-REM sleep. It is a period of light sleep. “Your heartbeat and breathing slow, and muscles relax even further. Your body temperature drops and eye movements stop. Brain wave activity slows but is marked by brief bursts of electrical activity. You spend more of your repeated sleep cycles in stage 2 sleep than in other sleep stages.”
- Stage 3: This stage is also non-REM sleep. This period gives you the deep sleep that will help you feel refreshed. “It occurs in longer periods during the first half of the night. Your heartbeat and breathing slow to their lowest levels during sleep. Your muscles are relaxed and it may be difficult to awaken you. Brain waves become even slower.”
- Stage 4: This is REM sleep. It first occurs about 90 minutes after falling asleep. “Your eyes move rapidly from side to side behind closed eyelids. Mixed frequency brain wave activity becomes closer to that seen in wakefulness. Your breathing becomes faster and irregular. Your heart rate and blood pressure increase to near waking levels. Most of your dreaming occurs during REM sleep. Your arm and leg muscles become temporarily paralyzed, which prevents you from acting out your dreams. As you age, you sleep less of your time in REM sleep.”
The last two are essential for physical and mental health. Patients with chronic pain, however, often take medications that interfere with the sleep cycle. And this lack of restorative sleep results in increased pain and other problems.
Approaching insomnia holistically
Overall, a multi-disciplinary approach is vital in treating insomnia caused by chronic pain. There are many different ways to do this. First, it is essential to rule out any other causes of sleep disturbance. For example, are you suffering from sleep apnea or do you have poor sleep hygiene?
Good sleep hygiene includes going to bed and waking up at the same time each day, avoiding excessive caffeine and alcohol intake, not exercising 2-3 hours before bed and so on. Once you have gone through this process, then there are two primary methods of treating insomnia.
Solution 1: Take the psychological approach
Nowadays, many doctors prefer this method. With chronic pain patients who often are already on numerous medications, it’s not always a good idea to add another. This often further disturbs the sleep cycle.
What happens is that the pain often causes anxieties and additional worries over the pain itself, your finances, relationships and so on. Over time, this can become a terrible self-defeating pattern with thoughts like “I’ll never be able to sleep” or “tomorrow’s going to be terrible if I don’t fall asleep soon.”
Cognitive behavioral therapy teaches you how to recognize these thought patterns and how to avoid them. Instead of focusing on problems, your brain is redirected to a calmer direction.
It also helps you learn to not focus on the pain so it doesn’t worsen once you remove other distractions. This approach will take some time and several sessions with a specialist but can pay off for those dealing with long-term pain caused by conditions like arthritis, diabetes and more.
Solution 2: Try medication
We’ve all seen the commercials for medications promising to treat sleep problems. There’s a wide range of products available on the market. From anxiety medications like diazepam (Valium) and alprazolam (Xanax) to sleep inducers like zolpidem (Ambien) and zaleplon (Sonata), these can be highly effective.
However, these are typically only good short-term options. Long-term usage can cause numerous side effects and dependency. You’ll want to consult with your doctor to see if these can be helpful alongside any other medications you may be taking. Some other medications worth considering for short-term insomnia caused by chronic pain include:
- Melatonin and other natural supplements
- Melatonin receptor agonists: non-habit forming medications like Rozerem can help.
- Antidepressants: These can be taken in much lower dosages than when treating depression and can be used in treating insomnia and chronic pain
Experts recommend avoiding the use of antihistamines to help you when you have trouble sleeping. They also recommend speaking with your healthcare team for long-term solutions.
The bottom line on insomnia and pain management
Good sleep and health go hand in hand. If you are suffering from insomnia caused by chronic pain, your doctor will recommend a combination of these treatments including medication, cognitive behavioral therapy and other steps to improve not just your sleep habit but your overall health as well.
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