InsomniaPainsomnia: A Single Treatment Option May Not Be Enough

Painsomnia: A Single Treatment Option May Not Be Enough

Painsomnia Highlights

  • “Painsomnia” is a word used for insomnia brought on by chronic pain symptoms.
  • People with chronic pain may benefit from a multidisciplinary strategy using a combination of good sleep habits and behavioral or psychological techniques.
  • Cognitive-behavioral therapy (CBT) is a behavioral approach that can improve both insomnia and chronic pain.
  • Other psychological techniques, such as progressive relaxation and distraction, can also be helpful.
  • Certain dietary supplements (with a doctor’s approval) may also help.

What Is Painsomnia?

You’re lying in bed with a migraine. You know that ice to your forehead can help numb the throbbing, but you can’t even move your eyes or lift your head off the pillow to go for an ice pack.

Or you have burning pain in your back or legs. You turn one way, and the 10/10 pain resides just a bit, maybe to an 8, but in a short time, it’s back to a 10 (though you would swear it’s really a 12 or 13). You change your position again, but before you can nod off, the pain gets worse again. You’re forced to repeat the process far into the night. You finally fall asleep half an hour before the alarm goes off.

This is painsomnia.

Sleep Hygiene Isn’t Always Helpful for Painsomnia

Those of us with insomnia from chronic pain are all too familiar with stories like these. We’ve heard all the advice from doctors and sleep experts. We’ve read all about improving our sleep hygiene: a regular bedtime, a relaxing before-bed routine, avoiding alcohol and certain foods, and so on.

But we also know that advice like this is not working for us. We’ve tried all of it — along with medications — but we still lie awake for hours with pain that makes it impossible to find a comfortable position, then stumble through our obligations the next day in a state of exhaustion.

Complications of Painsomnia and Sleep Deprivation

Even if you’ve never heard the term, if you are a chronic pain sufferer, you probably know the effects of painsomnia and the many ways lack of sleep can negatively affect your health. It can cause anxiety and depression. It can lower your immune responses, making it harder to fight off colds, flu, and other infections. It can affect relationships with spouses, children, other family members, friends, and coworkers (for those who can work at all). It creates brain fog from chronic exhaustion. Painsomnia also increases your risk of accidental injuries.

The Chicken or the Egg?

But which comes first? Does the pain cause insomnia, or does lack of sleep worsen the pain?

In the middle of the night, of course, it doesn’t matter to us which came first. Once we get caught up in the cycle, we’re on a constant quest for effective ways to treat the pain and the insomnia.

But the distinction may matter. While there’s consensus that chronic pain and insomnia are related, it hasn’t always been clear which causes which. But a 2013 review study suggested that lack of sleep may drive pain more than the other way around. Since then, further studies have reinforced that theory, especially with the partial sleep deprivation that chronic pain sufferers are most likely to suffer from.

The researchers caution that more research is needed, but these results could be good news for many people, as it may be easier to improve sleep than to control long-term chronic pain.

Painsomnia Chart

Painsomnia Treatment

So, what other treatment options do we have? Do some treatments work better than others? What does the research say?

It turns out that many studies (like this one) suggest that the most effective nonpharmacological treatment plan for painsomnia may be a combination of sleep hygiene adjustments and one or more behavioral or psychological strategies.

Here are a few strategies that current research supports:

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy - PainsomniaMany studies have found that cognitive-behavioral therapy can be an effective technique for dealing with chronic pain, and it’s now considered the first-line treatment for insomnia. CBT trains participants to change negative thought patterns (such as catastrophic thinking) and negative behavior patterns.

Many studies have found that CBT works for depression, anxiety, mood disorders, and stress along with both insomnia and chronic pain. However, a 2019 study found that CBT specifically designed for insomnia was more effective at reducing participants’ pain perceptions than a similar program designed for pain. Insomnia-based CBT also brought longer-lasting relief. These results reinforce the research that lack of sleep is likely to come first in the insomnia-pain cycle.

Other Mind-Body Practices

Distraction: A simple psychological strategy that many people find helpful is distraction. Writing in a journal or doing something creative before bed, such as sketching or writing, can help distract your mind from your pain, allowing you to fall asleep more easily. Activities such as deep breathing or counting can also be helpful once while you’re lying awake.

Relaxation strategies: Many people find meditation techniques like progressive relaxation helpful, as they can ease pain while also distracting the mind long enough to fall asleep. If it works for you but you wake up later, you can easily do the exercise again without getting out of bed.

Dietary Supplements

Painsomnia Treatment - Dietary Supplements

Chances are good that if you’ve been dealing with chronic pain for a long time, you’ve tried several vitamin or herbal supplements. Again, on their own, they may not have offered you much relief, but they may be worth a second look in combination with other treatment options. Melatonin and ashwagandha are two popular options that have some clinical support and may be worth considering. Just be sure to talk with your doctor before trying any new supplement.

The Bottom Line on Painsomnia

Regardless of what we call it, lack of sleep from chronic pain can have devastating effects on a pain sufferer’s life. While opioid medication is the answer for some, it’s becoming less of an option for most of us and has never been the best option.

For many chronic pain sufferers, nonpharmacological treatment options can help. You may need to try a combination of strategies before finding a mix that offers noticeable relief, but don’t give up. The research indicates that the effort may be worthwhile, and study is ongoing.

What questions do you have about dealing with painsomnia?

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