Few things in life are more aggravating than not being able to sleep. And one of the most common and disturbing side effects of chronic pain is the lack of restful sleep. Many of my patients grapple with fatigue and burnout as their sleepless nights begin to stack up. Desperate, they often search for a “magic pill,” hoping it will provide them with some bona fide shut-eye. Unfortunately, it’s not the path to better sleep, at least not in the long run.
Fortunately, there are some genuinely helpful ways to refresh, recharge, and achieve a deep slumber, all of which will be discussed in this chapter. We’ll also explore the important links that exist between sleep and pain, stress, mood, medications, and food.
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During those hours of physical and mental rest we refer to as “sleep,” the brain and body repair and restore themselves. Various hormones are released, brain activity slows, body tissues grow and repair themselves, and blood pressure falls. Sleep also bolsters the immune system and helps it remain strong. It is so crucial to physical and emotional well-being that depriving prisoners of sleep has been used as a form of torture, and laboratory animals forced to stay awake for too long will die.
Pain is the number one cause of insomnia, with some 65 percent of chronic pain patients experiencing difficulty falling asleep and staying asleep, and losing an average of 42 minutes of sleep per night to pain, according to the 2015 Sleep in America Poll. But did you know that the reverse is also true: that a lack of sleep can increase your pain levels? New results from the Tromso 6 Study, a large-scale Norwegian health study, showed that people who have difficulty sleeping are more sensitive to pain.1 In brief, study participants were separated into those who had insomnia and those who did not, and asked to thrust their hands into water that was so cold it was painiful. Those with insomnia were, on average, likely to pull their hands out sooner than those who slept well, indicating that they had increased pain sensitivity. And the more severe or frequent their insomnia, the less able they were to tolerate the pain.
The most striking finding was that those who had insomnia coupled with chronic pain were more than twice as likely to yank their hands out of the cold water early, compared to those who were healthy and slept well. This suggests that chronic pain and insomnia are “synergistic miseries,” each making the other worse.
Most people are well aware of the benefits of getting a good night’s sleep on a regular basis: better mood and memory, improved weight control, a more powerful immune system, a better sex life, and better health overall.2 And now we know that there’s another important benefit: more sleep equals less pain. This phenomenon is apparent even in healthy people. In a recent study,3 healthy volunteers—who did not suffer from pain but complained of being sleepy during the day—were assigned to two groups. One group was to stay in bed for 10 hours per night, while the other would continue with their regular sleep schedules.
Members of the “10 hour” group ended up sleeping 8.9 hours per night, compared to 7.1 hours for those in the other group. The extra sleep functioned as a pain killer: Afer just four nights, members of the “10 hour” group could hold a finger next to a heat source for a longer period of time than they could when the study began—and longer than those who did not get the extra sack time. More sleep provided increased resistance to painful stimulation.
We certainly need more research, but a strong connection seems to exist between a lack of restful sleep and increased feelings of pain. We don’t know exactly why, but fatigue seems to reset our sensitivity to pain, increasing it and making everything hurt more.
A lack of sleep also alters the emotional state, triggering mood swings, irritability, and anxiety. And studies have shown that prolonged insomnia is strongly linked to clinical depression.4 The pain sensitivity, anxiety and depression negatively affected by sleep are major parts of the pain equation: sensory + affective + cognitive-evaluative ^ your unique body and brain = your unique experience of chronic pain
The increased sensitivity to pain caused by fatigue is part of the “sensory” element; the mood swings tie into the “affective” component of the equation. And the resulting feelings of exhaustion and burnout impact how the pain is interpreted and perceived, the “cognitive-evaluative” element. In sum, the negative effects of poor sleep fit right into the equation, ramping up your pain.