In this article:
What is Chronic Pain?
Read how disrupted sleep contributes to the condition of Chronic Pain, Rheumatoid Arthritis and Fibromyalgia.
The steps that will help improve your sleep and reduce chronic pain.
Chronic pain affects the quality of life for millions of people worldwide. In the U.K. alone this figure is up to 8 million. There is a bidirectional link between pain and sleep: poor sleep quality exacerbates pain, and pain disrupts sleep. Addressing this cycle is crucial for effective pain management and improving patient’s overall health outcomes [1]
Chronic Pain (CP) contributes significantly to poor sleep quality, with pain-related arousals leading to fragmented and non-restorative sleep, up to 88% of people with CP report sleep difficulties. This high percentage shows the importance of simultaneously working to formulate treatment strategies for addressing chronic pain and sleeping issues relating to CP of insomnia (72% of individuals with CP), obstructive sleep apnoea (32%) and restless leg syndrome (32%) [1]
At Sleep-Focus.com, we specialise in resolving sleep difficulties through the use of
Cognitive Behaviour Therapy for Insomnia (CBT-I).
How better sleep helps in our pain regulation
Short or disturbed sleep can cause hyperalgesia (when we are more sensitive to pain). [2]
When we sleep well our bodies release healthy quantities of neurotransmitters and hormones such as serotonin and endorphins. These have a natural analgesic (painkilling) properties.
CBT-I has been found to result in lower levels of C-reactive protein (CRP) [3] (CRP) is a blood marker associated with inflammation, and research indicates a strong link between elevated CRP levels and the presence of chronic pain. [3]
Good sleep can also improve the health outcomes of tension-type headaches, migraines and chronic musculoskeletal pain too. [4]
Indeed, The clinical management of pain in patients with rheumatoid arthritis should include a focus preventing sleep disturbances in their treatment. [5]
Fibromyalgia is the second most common pain condition affecting the bones and muscles. The pain often effects the muscles ligaments and tendons presenting as multiple tender points in the neck, spine, shoulders and hips. [6]
Checklists for a better night’s sleep
Insomnia
The World Health Organization (WHO) defines insomnia as a sleep disorder in which you have trouble falling and/or staying asleep.
The condition can be short-term (acute) or can last a long time (chronic). It may also come and go. Acute insomnia lasts from 1 night to a few weeks. Insomnia is chronic when it happens at least 3 nights a week for 3 months or more.
Clients report of unsatisfactory quality or quantity of sleep-in terms of difficulty in falling asleep and staying asleep, or early final awakening (also known as initial, middle, and late insomnia).
Cognitive Behaviour Therapy for Insomnia (CBT-I) is the gold standard treatment for treating Insomnia.
Obstructive Sleep Apnoea
Obstructive sleep apnoea (OSA) is when the muscles and soft tissues in the throat relax and collapse sufficiently to cause a total blockage of the airway; it’s called an apnoea when the airflow is blocked for 10 seconds or more and is a serious medical condition that often goes undiagnosed. 1.5 million people in the U.K. are likely to have OSA, 85% of these remain undiagnosed!
The lack of oxygen experienced in OSA leads to:
High blood pressure leading to stroke, heart disease and heart attack, atrial fibrillation, type two diabetes, depression, and mood changes.
The symptoms of OSA are:
· Snoring
· Waking up chocking or gasping
· Unrefreshed Sleep
· Excessive Daytime Sleepiness
· Morning Headaches
· Nocturnal Sweating
If any of these symptoms are indicated, and your bed partner can help you diagnose these, then it is crucial to consult with your GP who can refer you to a sleep clinic for treatment.
Restless Leg Syndrome (RLS)
When you try to relax in the evening or during sleep at night, do you experience unpleasant restless feelings in your legs?
If you do -
Would this feeling be relieved by walking or movement?
Is it worse at night or at rest?
Do you find this is worse with antihistamine medication?
Restless Legs Syndrome (RLS) gives an unpleasant tingling sensation in the legs that is relieved by moving them. The unpleasant feeling makes it harder to fall asleep and increased number of sleep awakenings during the night.
Dopamine levels naturally fall towards the end of the day, which may explain why the symptoms of RLS are often worse in the evening and during the night.
Some studies report that RLS can be the cause of a lack of iron or indeed difficulty processing iron, which is an important mineral to many of our brain activities. Other conditions such as diabetes and medications like antihistamines which when controlled or stopped can help relieve the symptoms of RLS.
Treatment: here it is advised to consult with your GP to assess if there is a ferritin (amount of iron in the brain) deficiency and what treatment is available.
References
[1] Science Direct. (2024). Chronic pain management and sleep disorders. https://www.sciencedirect.com/science/article/pii/S2666379124004919
[2] Neuropsychopharmacology. (2019). Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. https://www.nature.com/articles/s41386-019-0439-z
[3] Science Direct. (2024). C-Reactive Protein (CRP) is Associated With Chronic Pain Independently of Biopsychosocial Factors. https://www.sciencedirect.com/science/article/pii/S1526590023005370#:~:text=Highlights&text=In%20the%20UK%20Biobank%2C%20chronic,systemic%20inflammation%20in%20chronic%20pain.
[4] National Library of Medicine. (2014) The association of sleep and pain: An update and a path forward. https://pmc.ncbi.nlm.nih.gov/articles/PMC4046588/
[5] Sleep Research Society. (2012). Sleep Loss Exacerbates Fatigue, Depression, and Pain in Rheumatoid Arthritis. https://academic.oup.com/sleep/article-abstract/35/4/537/2558898?redirectedFrom=fulltext&login=false
[6] Novous Spine and Pain Centre. (2020). Fibromyalgia Pain Management for Fibromyalgia. https://novusspinecenter.com/pain-conditions/fibromyalgia
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