Does pain or its treatment affect your sleep?

A frequent cause of insomnia is pain. It is of course part of the human existence to experience pain. Each of us has at one time or another tried to fall asleep with a painful body part and later realized the sleep was interrupted by pain or at least felt less fulfilling the next day. The ability to cycle through the usual stages of deeper and dream-filled sleep necessitates continuity of sleep, which is often not possible if pain causes arousals of our sleeping consciences.

There are several painful medical conditions that may contribute in distinctive ways to poorer sleep continuity and sleep depth. Notably, certain rheumatologic conditions such as fibromyalgia and rheumatoid arthritis may cause a particular brain wave (EEG) disturbance that is readily apparent during a formal sleep study (polysomnogram) performed in a sleep lab. The invasion of normal sleep brain waves by a wakeful-drowsy brain wave, a phenomenon known as “alpha intrusion”, can be a tip-off that the person studied has a pain condition of a particular type. Identification of this disorder can lead to an effective medical treatment, and the resulting sleep is more satisfying and causes a lessening of daytime pain symptoms. Individuals with fibromyalgia are known to have clinical improvement in pain symptoms if the sleep quality is improved.

The National Sleep Foundation has surveyed Americans for decades and has concluded that over 60% of chronic pain sufferers have subjectively poorer quality of sleep. In the past decade, there has been a dramatic increase in the management of chronic pain with such opioids as methadone and oxycodone. Long-term use of these medications has now been shown to create a type of irregular respiration during sleep that can, in some persons, lead to serious consequences — doctors call it “central sleep apnea”.  The long-acting opioids essentially numb the brain in these persons during sleep, causing a reduction in the automatic drive to breathe. This can last from 10 seconds to over 40 seconds. Only relatively recently has this connection of medication use and possible sleep apnea been considered a cause of concern and a source of disruption in the sleep of  persons on these medications.

If pain is causing your insomnia, treat the condition causing pain judiciously for better sleep. Try to sleep in a more comfortable position or with supports to the injured body part. Consider sleeping in an easy chair temporarily. Possibly a bedboard between the mattress and box spring will improve support for your back. Allow your doctor to prescribe medication to address your pain at night. If significant dosages of narcotic pain medication are being used, be aware that interruption of breathing at night can be treated if  it is identified. Pain may be universally a part of the human condition, but it can usually be addressed enough to allow a more comfortable sleep.