Pain, poor sleep: Relationship goes both ways

Anyone who has ever struggled for sleep while recovering from injury or surgery knows that pain can ruin a good night's rest. People who suffer from chronic pain know it all too well.

But fewer people may know that the relationship between sleep and pain seems to go both ways.

"People who have pain have more sleep problems, but people who have sleep problems also have more pain," says Daniel Clauw, a rheumatologist who directs a chronic pain and fatigue research center at the University of Michigan.

The sleep problems sometimes come first, Clauw says. Even when pain comes first, sleeplessness can make it worse, he and other experts say.

"Your body needs to rest and restore itself," says Penney Cowan, founder and executive director of the American Chronic Pain Association, a patient support group. "The more tired you are, the harder it is for a normal person to keep moving. It's even worse when you are in chronic pain."

A new survey from the National Sleep Foundation, a non-profit group, shows just how close and complex the relationship between pain and poor sleep can be. The survey of 1,029 adults found 21% suffered from chronic (long-lasting) pain and another 36% had acute (short-lasting) pain in the previous week.

Just 36% of those in chronic pain and 46% of those in acute pain reported good or very good sleep quality, compared with 65% of pain-free adults. About 23% with chronic pain had been diagnosed with a sleep disorder, vs. 5% with acute pain and 6% without pain.

People in pain got less sleep, felt less control over their sleep and worried more about the effects of lost sleep.

The survey did not ask whether people had been diagnosed with painful conditions such as arthritis, fibromyalgia, headaches or nerve damage. It also did not address whether sleeping problems or pain developed first.

But a growing body of research suggests a lack of sleep makes people more vulnerable to pain, says Timothy Roehrs, a psychologist who directs a research and sleep disorders center at Henry Ford Hospital in Detroit. He and Clauw were among researchers who worked on the poll.

In several experiments, Roehrs and colleagues have deprived people of sleep and then compared them to well-rested people on a pain-reaction test. The sleepy people are faster to pull their fingers away from a painful stimulus — a nearby hot light bulb — suggesting increased pain sensitivity, he says.

In another study, people assigned to get extra sleep in the week before elective knee or hip surgery ended up using fewer painkillers after surgery than those who did not try to get extra sleep.

That suggests that making sleep a priority might make a difference for people in pain, Roehrs says. The poll findings support that idea. Participants were asked how motivated they were to get enough sleep and how important they thought it was to go to bed on time. Those who were highly motivated and thought bedtimes were important slept more hours, even if they were in pain, the survey found.

"People have all kinds of reasons that extra sleep is not important — jobs, household duties, child care, elder care" and leisure activities, Roehrs says.

But, Clauw says, "if you do make it a priority, you may be able to make your pain better."

Of course, sleeping through pain can be a challenge. Pain often is worse at night, partly because people are left without the distractions of the day, says Edward Michna, a pain management specialist at Brigham and Women's Hospital in Boston.

Michna, who was not involved in the poll, says patients can work with doctors to find solutions, including adjusting the timing and dosing of pain medications to maximize sleep. It's important, he says, not to mix prescription and non-prescription medications for pain and sleep without a doctor's guidance.

People desperate to escape their pain with sleep may abuse medications and alcohol, Cowan says. But a comprehensive pain management strategy can steer people away from those dangers, she says.

For example, she says, some people have trouble finding a comfortable sleep position and may benefit from suggestions from a health professional. Some will find a white noise machine helpfully distracting, she says.

Cowan, who has fibromyalgia — a condition characterized by widespread pain and fatigue — says that her own sleep secret is "a nice warm bubble bath or shower" before bed.

Here are some of the sleep foundation's tips for improving sleep — whether or not you are in pain:

• Stick to the same sleep and wake times, even on weekends.

• Practice a relaxing bedtime ritual — away from bright screens and other bright lights.

• Exercise daily.

• Evaluate your bedroom. Make it cool (60 to 67 degrees Fahrenheit), quiet and dark.

• Avoid heavy meals in the evening.

• If you can't sleep, get up and go to another room and do something relaxing until you feel tired.