The Relationship Between Pain and Insomnia

Pain is tough to deal with. Chronic pain is even tougher because it is often a lifelong journey for many people. For some, managing their chronic pain is something requires a significant amount of patience, energy, and resources. One particularly big issue is the relationship between pain and sleep. People with chronic pain often find sleep to be particularly troublesome – and this subsequent exhaustion from poor sleep leads to lowered resources to handle their pain. Therefore, chronic pain and chronic insomnia are well-intertwined.

When we think about pain, there are two types of pain that have different effects on sleep. Short-term (acute) pain, such as bruises and cuts, impact time to fall asleep. It takes longer to fall asleep when you are dealing with acute pain. On the other hand, long-term (chronic) pain (e.g., lower pain back, shoulder impingements, arthritis, etc.), leads to reduced depth of sleep. That is, your sleep is lighter and it is more challenging to receive the deep sleep that you need to feel restored. We’ll talk more about how this impact leads to a vicious cycle of poor sleep, fatigue, and even greater pain.

A Vicious Cycle of Pain, Fatigue, and Sleep

The relationship between chronic pain and lightened sleep creates a vicious cycle:

1. Chronic pain lightens sleep and reduces sleep quality.

2. The light sleep reduces feelings of restoration when the person wakes up and they feel more tired and have less energy throughout the day.

3. The resultant reduced activity because of fatigue and chronic pain leads to reduced pressure to sleep (see this article on sleep drive) and can lead to muscle atrophy.

4. The reduced pressure to sleep impacts our ability to obtain deep sleep even more and the muscle atrophy can exacerbate chronic pain.  

5. Rinse and repeat

A basic visual diagram I created on the relationship between pain, sleep, and fatigue.

How do I break this cycle?

For some, there is solace in change through acceptance. That chronic pain is something that some people may have to deal with in their lives, but that there are strategies to mitigate its effects and live a fulfilling life consistent with your personal goals and values. Research suggests that the way that we think about our pain and our self-efficacy in dealing with pain can influence our perceptions of pain (Bazyar et al., 2017). What that basically means is that if we feel confident that we can deal with our pain, then the pain itself feels less intense and more manageable. Imagine two different thoughts in response to chronic pain: (1) “This pain sucks so much, I cannot handle it; it’s unbearable and there’s nothing I can do” vs (2) “I have to live with chronic pain and it sucks; but I also know there are some things I can do to reduce the pain and continue to do the things I enjoy”. Which person do you think might perceive their pain to be more intolerable? Probably the first. Below, I’ll talk about a few things you can do to improve the relationship between pain and sleep.

Strategies to manage chronic pain and improve sleep

1. Stay active. Pain and fatigue pull for rest. However, the issue is that when we are resting too much, we sabotage our ability to get deep sleep. Moreover, the lack of activity can actually contribute to fatigue (see here on an article on energy as a generator, rather than a battery). Staying active allows us to 1) build-up more sleep pressure for deep sleep; 2) increase energy throughout the day; and 3) strengthen our muscles, which has a positive effect of reducing pain. I would also encourage you to be active in a way that feels right for you. When I work with patients, I always want to meet them where they are currently. Perhaps for you, it’s taking a couple 10 minutes walks a week; or perhaps, doing some light yoga in the evening. Pick something you enjoy, is tolerable, and can stay consistent with.

2. Tackle your negative thoughts. If you notice some catastrophic thoughts (e.g., “I hate living with this pain”, “I can’t do anything to deal with it; it’s unmanageable”), consider using some of the evidence-based strategies to target these thoughts. I have a couple articles on using thought records and the use of mindfulness in addressing negative beliefs that may prove useful here.

3. Focus on what is important for you. Dealing with chronic pain is no easy task because it means doing something that causes short-term pain but has substantial long-term gain. And it is significantly tougher when we don’t what we are fighting for. Therefore, it’s important to take stock of your life and your values (i.e., what is important to you?). Find reasons to take steps towards your chronic pain. For some, it might be living a life where they can actively interact with their children or grandchildren; for others, it might be being able to travel and experience the world; for others still, it may be a combination of a bunch of different values. Figure out why it’s important for you to make a change. By doing so and writing it down somewhere, you begin to take ownership of your journey towards a fulfilling life in spite of chronic pain.

I hope this post was helpful in learning a bit more about the relationship between pain and sleep.

Best wishes,