The Relationship between Insomnia and Pain
At OSR, in the Medical Department we are often asked by patients whether they could be vitamin deficient as a reason for their pain or injury.
In fact, the most common deficiency we see in patients with acute or chronic pain would be a lack of “Vitamin Zzz” (sleep)! Here are the facts about Vitamin Zzz deficiency state (known as Insomnia), and the critical role of proper sleep in your treatment program at OSR.
First: What is insomnia?
Insomnia is defined as difficulty falling asleep, difficulty staying asleep, or waking up early in the morning and not being able to return to sleep. In general, people with insomnia sleep less or sleep poorly. The poor sleep may lead to trouble functioning during the daytime. Interestingly, not everyone suffering from insomnia complains of having disturbed sleep. Some patients have fatigue, difficulty concentrating, irritability, depression… and you guessed it, worsening of chronic pain symptoms.
Insomnia is NOT defined by the number of hours slept, because “sufficient sleep” can vary from one person to another, or with age.
Second: How are insomnia and pain related?
There are relationships between pain and insomnia that most people are aware of, and make intuitive sense. For example, pain can cause difficulty getting into a comfortable position for sleep. Pain can also cause awakening from sleep – for example, in someone with a left sided rotator cuff tear who rolls onto their left side while sleeping – they’d wake up due to pain triggered from a noxious stimulus to their injured body part. Makes perfect sense.
However, there are probably also other relationships between insomnia and pain that are less obvious at first.
That is, sleep-pain relational pathways may in fact be bidirectional. One study suggests that sleep can ‘gate’ pain perception. That is, the experience of pain while awake can cause or worsen sleeplessness, and in turn, poor-quality sleep then makes pain worse. This makes sense from what we know about anatomy, because areas of the brain involved in pain perception also can regulate and help maintain sleep. Patients can therefore find themselves in a vicious circle of increasing pain and sleeplessness, one amplifying the other over time. Not good! This may explain why up to 2/3 of all patients which chronic spine complaints experience chronic sleep problems.
BOTTOM LINE: Because of the strong association between pain and insomnia, sleep problems need to be treated together, simultaneously, along with pain care, to avoid a vicious cycle in which neither ever get better.
Questions to ask yourself, and to discuss with your provider:
- How well do I sleep?
- Does my pain interfere with me getting a good night’s rest?
- Did my sleep change at all as a result of my OSR treatment plan?
Avoid the temptation of ‘quick fix’ sleep medicines. Long term, these medications have not been shown to be effective for chronic insomnia or pain and they don’t improve quality of your day. These medicines may even lead to a worsening of insomnia when they are discontinued or other serious side effects. Try to learn about Sleep Hygiene Practices to improve your sleep patterns, based on the following National Institute of Health and National Sleep Foundation recommendations:
These recommendations include:
- Sleep as long as necessary to feel rested (usually 7 to 8 hours for adults) and then get out of bed
- Maintain a regular sleep schedule
- Avoid caffeinated beverages after lunch, and avoid alcohol near bedtime. Some very sensitive patients may need to avoid caffeine and alcohol completely.
- Avoid smoking or other nicotine intake, particularly during the evening
- Adjust the bedroom environment as needed to decrease stimuli (eg, reduce ambient light, turn off the television or radio, no computer or internet work in bed)
- Resolve concerns or worries before bedtime as much as possible
- Exercise regularly for at least 20 minutes, preferably more than four to five hours prior to bedtime
- Avoid daytime naps, especially if they are longer than 20 to 30 minutes or occur late in the day
Other tips for a good night’s sleep:
- You should spend no more than 20 minutes lying in bed trying to fall asleep.
- If you cannot fall asleep within 20 minutes, get up, go to another room and read or find another relaxing activity until you feel sleepy again. Activities such as eating, watching TV, or studying for a test, which “reward” you for staying awake, should be
- When you start to feel sleepy, you can return to bed. If you cannot fall asleep in another 20 minutes, repeat the process.
- Set an alarm clock and get up at the same time every day, including weekends.
- At first try, you may not sleep much on the first night. However, sleep is more likely on succeeding nights because sleepiness is increased due to your changing habits.
Please don’t hesitate to schedule an appointment with the Medical Department at OSR at any time if you are concerned about your sleep. We also recommend touching base with your Primary Care Physician to discuss any recurrent or severe sleep issues (rarely, insomnia can have an underlying medical cause that may need evaluation).
Don’t let Vitamin Zzz deficiency prevent you from reaching your treatment goals! Contact Us Here if you have any further questions!
McBeth et al., Predictors of Widespread Pain, Arthritis and Rheumatology 2014 online journal, 2/25/14.
Smith M. et.al., How do Sleep Disturbance and Chronic Pain Inter-relate? Sleep Med Rev 2000;8:119-132