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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

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Krause, A. et al. The Pain of Sleep Loss: A Brain Characterization in Humans. Journal of Neuroscience. March 20, 2019.
  2. DiSalvo, D. How Much Sleep You Get Influences How Much Pain You Feel, Study Suggests. Forbes. January 28, 2019.
  3. Eugene AR, Masiak J. The Neuroprotective Aspects of Sleep. MEDtube Sci. 2015;3(1):35–40.
  4. Vance CG, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control: the state of the evidence. Pain Manag. 2014;4(3):197–209. doi:10.2217/pmt.14.13
  5. Esposito, L. Chronic Pain Management: Finding the Right Treatment Mix. US News. October 5, 2018.
  6. Ersoy S, Engin VS. Risk factors for polypharmacy in older adults in a primary care setting: a cross-sectional study. Clin Interv Aging. 2018;13:2003–2011. Published 2018 Oct 15. doi:10.2147/CIA.S176329.


  • potter
    5 months ago

    My major problem with sleeping is vivid dreams, sometimes I don’t feel like I got enough sleep because of them. My dreams are like movies, sometimes I am involved in them or just a observer. They usually don’t involve people I know. Last night I was looking for a natural arena with a group of people. We we walking up a long sloping hill, I started gasping for air. I woke up and was gasping, I took a big breath and went back to sleep. This is the first time I had this happen. I don’t watch movies too hard to concentrate for 2 hours. I recently read the MSers can have problems with vivid dream. Anyone else have this problem? Potter

  • TK Sellman moderator author
    4 months ago

    I have to chuckle. I have had a lifetime of filmic dreams, myself. It seems to run in my family. I’ve even taken some of them, written them down, and sold them as bizarre short stories… they are THAT detailed!

    I am not sure if MS is the cause of vivid dreams… or it just could be part of your neurological makeup (like in my family)… or maybe a side effect of a medication you might be taking.

    Having good quality REM sleep (this is the stage when you dream) is actually really healthy. If your dreams aren’t nightmares, then I would take some solace knowing you are getting some really good quality sleep, even if your dreams are vivid. It is far worse to not have REM sleep at all, which is a problem for the sleep deprived and has some chronic consequences.

    Thanks for a great comment, potter!

  • Shelley D.
    5 months ago

    Wonderful article, T.K.! I really appreciate the advice & stats! I recently got a new TENS unit, & that has helped a lot. I can’t go to bed without a Tylenol PM though! Take care…

  • TK Sellman moderator author
    4 months ago

    I am glad to hear your TENS unit has helped, Shelley! I take mine everywhere I travel and even wear it under my clothes while on planes. It really helps against “hugs” and other spasms and is easy to pack and available even if pain meds aren’t readily accessible.

  • potter
    5 months ago

    How does your TENS unit work and what type is it? Potter

  • TK Sellman moderator author
    4 months ago

    Hi potter

    My TENS unit brand is AccuRelief. It’s not expensive; I got mine at a box store.

    You basically apply cordless electrode patches to areas of muscle spasm, then turn them on (there’s a remote control as well as buttons on the electrode patches).

    They deliver little electrical pulses in varying patterns that help the muscles release and bring a dopamine response.

    You can adjust the intensity and use it as frequently as you like and are comfortable with. Definitely follow the directions… there are areas of the body that you should avoid (like near the heart), but mostly I use mine of my calves, my wrists, and my back/shoulders.

    I’ve had mine for several years now and it’s definitely one of my go-to therapies when the muscles are not behaving!


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