Written by Alexis Ordelheide PT, DPT, CMTPT
Do you experience difficulty falling asleep?
Once you are asleep, do you awake multiple times through the night?
If you have a bad night’s sleep, do you struggle functioning throughout the day?
Do you suffer from chronic pain?
Have you noticed a correlation between your pain and the amount of sleep you are receiving?
If you answered yes to any of these questions, you may be experiencing insomnia. Insomnia is defined as more than 30 minutes of sleep latency and/or minutes awake after sleep onset for more than 3 days per week for more than 3 months. Around 25% of the population suffer from some sort of sleeping disorder.
Insomnia can become a barrier for effective chronic pain management. Evidence-based studies have shown that sleep disturbances may have a bidirectional relationship with chronic pain. A bad night's rest can make your pain worse or a day full of pain can disrupt your sleep.
Impaired sleep can result in a low-grade inflammatory response that could potentially affect brain function and an increased sensitivity to pain. If you sleep less than 5 hours per night for 5 days, your cognition is lowered by 20%. That is equivalent to a blood alcohol level of .08 which is considered legally impaired.
When someone suffers from insomnia with chronic pain, they experience difficulty with daily functional activities, a decrease in life satisfaction, and limited participation in physical activity. If you are not sleeping well, you are less likely to participate in physical activity, likely resulting in an increase in your pain. As we discussed in our blog post, Motion is Lotion, proper exercises can reduce your pain. Research shows that individuals who have chronic pain are more likely to participate in physical activity after a good night of sleep. Do you see how sleep, physical activity, and chronic pain are intertwined? It is similar to a domino effect. When one is affected, the whole chain is altered.
So where do you begin? As evidence continues to grow, practitioners are seeing excellent results with Cognitive Behavioral Therapy-Insomnia (CBT-I). “CBT-I includes sleep and bedtime restrictions, stimulus control instructions, education for sleep and promoting good sleep habits, teaching relaxation skills, and cognitive therapy.” When individuals have participated in CBT-I, they are experiencing improvements with different sleep parameters and sleep and pain interference with daily functional activities with chronic pain. At their 3 month follow-up, individuals were still reporting an improvement with their sleeping habits and a reduction in their chronic pain.
Knowing where to start can be overwhelming. Treating chronic pain is like putting a puzzle together. There are multiple pieces that you need to complete the puzzle but once you start and you begin to observe progress, you begin to see the picture come together. And what a beautiful picture it will be when it is completed.
If you are experiencing changes in your sleeping habits, mention it to your physical therapist. They will be happy to provide resources, education, and guide you in the right direction.
References:
Nijs, Jo, et al. “Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice.” Physical Therapy, vol. 98, no. 5, July 2018, pp. 325–335., doi:10.1093/ptj/pzy020.
Rhon, Dan. “The Relationship Between Sleep and Pain.” MedBridge, www.medbridgeeducation.com/courses/details/relationship-between-sleep-pain-dan-rhon.