Pain Picks On Sleep; The Whys And Hows Are Discussed
January 9th, 2009

Twenty percent of Americans report that some type of pain or discomfort disrupts their sleep a few nights per week or more. This sleep disruption in turn causes degradation of mood, energy level, behavior, and safety. In the NSF's 1997 Survey on Sleeplessness, Pain and the Workplace, it was reported that back pain and other body aches or joint pain were the leading types of pain conditions experienced at night. The consequences of pain with sleep include: difficulty maintaining alertness, lack of energy, impaired mood, and trouble handling stress. A lack of sleep puts a person at a higher risk for injury, poor health, and accidents. Sleep studies in patients with acute pain, such as postoperative patients, and chronic pain, such as neuropathic & rheumatologic conditions, show frequent arousals, a hard time going back to sleep, and reduced time in REM sleep.

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.

The International Association for the Study of Pain delineates 3 major types of pain: (1) acute pain, such as that resulting from an injury; (2) cancer-related pain; and (3) chronic nonmalignant pain. Chronic nonmalignant pain, which may be a result of injury or of unknown causes, is the type of pain most frequently associated with alteration of sleep.

Pain is the major cause of insomnia. Sixty-five percent of pain with sleep sufferers reported being awakened during the night by pain and waking up feeling unrefreshed.

Pain and sleep correlate on so many levels. Chronic pain sufferers experience less deep sleep, more arousals and disruptions, and less efficient sleep. A poor quality of sleep mixed with waking pain creates a vicious cycle that affects mood, energy, behavior, and safety. Pain with sleep sufferers are hardly ever at the top of their game. A full night's sleep leaves a person's mood, energy, and behavior at their maximum potential.

Back pain is the most common type of pain-related sleeplessness. Eighty percent of Americans at some point report having been affected by back pain. One in fifty American workers suffers a back injury and low back pain. Back pain disables some 5.4 million Americans every year. The more severe the pain the more sleep disruption occurs. Sleep disruption seems to make the pain feel worse. So what can be done to stop the madness?

Headaches are the second most common type of pain. Migraines can occur following a period of sleep deprivation or too much sleep. Headaches are also associated with sleep apnea which is defined as frequent pauses in breathing along with loud snoring during sleep. Cluster headaches are even worse and can impair a good night's sleep as well.

Rheumatic and arthritic disorders also correlate with sleep problems. Osteoarthritis, which affects the hips and knees, causes patients to sleep lighter and have restless sleep. Rheumatoid arthritis patients have disturbed sleep with stiffness in the morning as well as a decrease in energy, weakness, and function. Flare-ups can lead to arousal of sleep. Fibromyalgia causes aches and pains throughout the entire body. It leaves patients feeling fatigued and unable to feel refreshed. These patients experience light, unrefreshing sleep, daytime fatigue, and problems with thinking and mood. This poor sleep pattern seems to worsen symptoms. Fibromyalgia can also cause chronic headaches, irritable bowel syndrome, jaw pain, tingling legs, and sleep apnea. The poor sleep quality can be attributed to unrelenting muscle pain, tenderness, and low energy. One study showed the occurrence of sleep apnea in 80% of fibromyalgia patients. Sleep apnea tears the sleep cycle into bits and pieces, thus reducing slow wave sleep.

Sleep problems interact with the disease and pain process. Heart patients have less deep sleep, more fragmented and less efficient sleep. Poor sleep affects other body systems as well. Gastrointestinal problems lead to great difficulty getting a good night's sleep. There are a few pain management methods to consider. Relaxation and stress management, as well as a massage by a licensed physical therapist may help ease the pain. Medications are available but seem to have a limited effect. For best results, consult your medical doctor for a professional treatment plan

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