For years, Ellen has been battling various aches and pains that she attributed to getting older. A retired school teacher in her seventies who stays active looking after several grandchildren, her biggest challenge for the past several months has been finding the energy to keep up with her busy schedule. Despite giving herself more time to sleep at night—or trying to take a nap whenever she’s able—Ellen wakes up still feeling tired. She schedules an appointment with her doctor to see if there is anything wrong and what might be done to improve the quality of her sleep.
Tossing and turning at night due to pain is a common situation: 40-70 million people in the U.S. are affected by chronic pain, and 25% of adults have pain that disrupts their sleep at least ten nights a month. Age also plays a significant role: among adults, about 15% will report experiencing some chronic pain—among the elderly, however, the figure rises to over 50%. Two-thirds of those who deal with chronic pain regularly report disrupted or non-restorative sleep.
Surprisingly, one of the most frequently used remedies to address the problem of chronic pain—medication—often causes significant disruptions to sleep. For example, a common side effect of powerful pain relieving drugs such as codeine and morphine is frequent arousals from sleep. General insomnia can develop as well.
The relationship between pain and sleep
One of the challenges when examining the topic of pain and sleep is the fact that there are multiple ways pain can disrupt sleep. Common pains that will affect sleep include back pain, headaches, and facial pain, particularly of the jaw. However, pain can also take other forms, such as arthritis or fibromyalgia. Some pain can occur both from the disease and its treatment, as is common in the case of cancer.
Although the severity of the pain might be the obvious indicator as to how it would affect sleep, researchers have found that there are actually a variety of other factors that better explain how pain will affect a person’s rest at night. The mental aspects of dealing with pain—such as anxiety and frustration over being able to sleep—were found to be a better predictor of sleep quality than the severity of pain itself for people suffering from chronic pain. Physical functioning, duration of pain, and age have also been found to more accurately project how long it takes for people to get to sleep, and the quality of sleep they will get.
How sensitive a person is to pain makes a significant impact as well: in a study on sleep quality and pain thresholds in patients with fibromyalgia, increased pain sensitivity was found to be associated with greater sleep disturbances and a greater likelihood to report poor sleep.
Getting a better night’s rest
Fortunately, there are a variety of tips that can be effective for people trying to limit the impact of pain on their sleep. Perhaps the most important is practicing good sleep hygiene: avoid consuming food or drinks with caffeine, limit alcohol intake (particularly, no alcohol in the evening), and avoid vigorous exercise close to bedtime. Taking a brief nap in the afternoon can be helpful, but make sure it’s limited to ten or twenty minutes (longer naps make it more difficult for the brain and body to relax for sleep later at night). Although medications such as pain relievers can be effective, they should only be used under the supervision of a doctor, as the side effects can sometimes be very disruptive to sleep. Relaxation techniques—such as abdominal breathing—can also be beneficial.
Another area to examine is the bedroom environment. Since people with chronic pain may wake up from sleep more easily, it is important to ensure that the bedroom is sufficiently dark and quiet to limit environmental disturbances. Additionally, make sure pillows and mattresses offer proper support for the head, neck, back and body during sleep.
After talking with her doctor, Ellen made several changes. “I gave up my evening glass of iced tea,” she says, “and made sure I had at least an hour to relax by reading a book before going to sleep.”
She also started doing some light stretching in the afternoon, and got a new pillow. “I didn’t stop to think about how long I’d had my pillow—at my age, you just get comfortable with certain things. I have to admit, though, I do feel much better when I wake up in the mornings now!”