Pain and Sleep
DDS, MSc, FRCD
How significant is the pain and sleep problem?
In the adult population, about 15% of those surveyed report experiencing chronic pain. However, in older adults, that number rises dramatically to over 50%. Among those experiencing chronic pain, about 2/3 report poor or unrefreshing sleep. The problem of pain and sleep becomes even more complicated as commonly prescribed medications used to relieve pain, such as morphine and codeine can fragment sleep.
How does pain affect sleep?
First, we know from numerous studies that the problem of sleeplessness caused by pain is preventable with appropriate strategies. When pain is first experienced, most people do not experience sleeplessness. However, when pain becomes a problem, it can be a vicious cycle. If someone experiences poor sleep due to pain one night, he or she is likely to experience more problems the next night and so on. It gets worse and worse every night.
Also we know that pain triggers poor sleep. For instance, someone experiencing lower back pain may experience several intense microarousals (a change in the sleep state to a lighter stage of sleep) per each hour of sleep, which lead to awakenings. However, microarousals are innocuous for a person not experiencing chronic pain. Pain is a serious intrusion to sleep. Pain is frequently associated with insomnia and these coexisting problems can be difficult to treat. One problem can exacerbate the other.
What are the most common causes of the pain and sleep problem?
The major causes of sleep loss due to pain are back pain, headaches, facial pain caused by temporomandibular joint (TMJ) syndrome, which is characterized by pain in and around the ears and soreness of the jaw muscles. Also, muscoloskeletal pain, which includes arthritis and fibromyalgia, can lead to poor sleep. Women report problems with visceral and abdominal pain as well as premenstrual cramping. It's important to note that overall impact of visceral and abdominal pain in women is misunderstood. We need more studies in this area. Pain from cancer, the disease itself and its treatment, is also a major offender in causing poor sleep.
What can people do at home?
Practicing good sleep hygiene is key to achieving a good night's sleep. Some tips for people with chronic pain are:
- Stop caffeine consumption.
- Limit alcohol intake, with no alcohol in the evening.
- Avoid vigorous exercise. However, light exercise in the afternoon can be helpful.
- Take a brief nap in the afternoon, no more that 10–20 minutes.
- Use of pain killers and/or sleeping pills are effective, but should be used under the supervision of a physician.
- Practice relaxation techniques, such as deep abdominal breathing.
When is it time to see a doctor?
It is time to seek professional help when pain causes sleep problems two to three times a night, and you are unable to fall asleep again. There are a variety of treatments available to ease the sleep problems of chronic pain sufferers, including medication and physical therapy. Doctors may also recommend seeing a psychiatrist or psychologist.
--Dr. Lavigne is a professor of dentistry and psychiatry at the Université de Montréal.
This article originally appeared in the Summer 2003 issue of sleepmatters.