Pain, Perception, and Sleep: A Vicious Cycle

As a registered sleep technologist and certified clinical sleep health educator, I learned early in my training that pain is the enemy of sleep.

But well before I entered the polysomnography program, I had already learned this fact through personal experience. I’m pretty certain most people understand how devastating it can be to be in pain while trying to get quality sleep… especially since sleep provides the ultimate opportunity for promoting natural healing at the cellular level.

Here’s what recent research says about pain and sleep and why you need to consider taking more and greater measures to take back the sleep you need if you have a chronic illness.

Pain and sleep: A two-way dead end

In March 2019, the Journal of Neuroscience published “The Pain of Sleep Loss: A Brain Characterization in Humans.” In the article, they describe how “acute sleep deprivation amplifies pain reactivity within the human (male and female) primary somatosensory cortex yet blunts pain reactivity in higher-order valuation and decision-making regions of the striatum and insula cortex.”¹

What this means in simple terms is that when we lose sleep (for whatever reason), the way we perceive the pain we feel changes. We react more dramatically to experienced pain, but our brain’s ability to process pain is disrupted.

Ultimately, we experience more pain, even if the pain we experience is not measurably greater than before. It’s a trick on the brain, one caused by dysfunctions caused by—you guessed it—sleep loss.

The study authors go on to assert that “consistent with this altered neural signature, we further show that sleep deprivation expands the temperature range for classifying a stimulus as painful, specifically through a lowering of pain thresholds.”

In other words, more pain leads to less sleep, and less sleep, per this and other studies, suggests a lower pain threshold as a result.

This makes the pain-sleep relationship a bit of a two-way dead end.
Author David DiSalvo, in a recent column in Forbes, writes: “We all have our versions of the connection in real time, and pain in turn makes sleeping more difficult. The cycle is real.”² No doubt this rings true for anyone living with a chronic illness.

Driving through the pain-sleep barricade

How to eliminate this dead end? Pain can delay sleep onset; some people may not sleep at all. They end up napping all day long, only to struggle with circadian disruption. This practically guarantees another night of lost sleep. Treating pain and insomnia and practicing good sleep hygiene are potential pathways to relief.

Treating pain

There’s no shame in seeking pain management, though solutions these days can be hard to find, given the current healthcare dilemma involving opioid and other drug abuse.

Still, treating your pain is essential to getting good sleep. During certain stages of sleep, your brain releases healing compounds which are directed to cells throughout the body for the purpose of repairing damage and cleaning up toxins. Sleep, itself, is a kind of pain treatment, in that respect.³

Pain relief options run the gamut from drugs (over-the-counter or prescribed) to cannabis products to topical medications to devices such as transcutaneous electrical nerve stimulation (TENS).⁴

Asking your doctor for help may be difficult; don’t be intimidated. The latest trend toward pain clinics, which help patients find safe alternatives for treating chronic pain, may be a new direction your physician will consider.⁵

Treating insomnia

Insomnia, even when not caused by pain, can still lead to daytime problems with pain misperception.

Talk frankly with your physician about your problems with sleeplessness. Drilling down to the root cause of your insomnia can be an important step toward healing.

Reasons for insomnia include:

• Anxiety or other untreated mental health concern
• Medication side effects
• Unrelieved chronic illness symptoms
• A hidden sleep disorder or other undiagnosed or untreated medical condition
• Poor sleep hygiene

Sleep hygiene

Many people with chronic illness already take so many medications; the last thing they want is to pop yet another pill. That’s not necessarily a bad thing: polypharmacy can contribute to pain and sleeplessness as much as any other health condition.

Practicing good sleep hygiene may not completely fix one’s problems with insomnia, but it can remove some obstacles to good sleep and take the edge off. The following might be able to give you some relief:

• Put away electronics one hour before bed to avoid insomnia-promoting blue spectrum light
• Practice bedtime relaxation: stretching, soft music, warm baths, massage, reading
• Learn cognitive behavioral therapy techniques
• Avoid caffeine after lunch and alcoholic after dinner
• Keep your sleeping space as dark, quiet, cool, and comfortable as you are able