Patients suffering from chronic pain often find their problems compounded by insomnia and sleeping disorders. Among those with chronic pain, an estimated 50% to 80% have ongoing sleep difficulties.

See Chronic Pain As a Disease: Why Does It Still Hurt?

Back pain is the most common type of chronic pain problem and is the most common medical disorder in industrialized societies. Back pain is also the chief cause of disability among those younger than 45. Not surprisingly, more than half of individuals with back pain frequently report significant interference with sleep.

See Types of Back Pain: Acute Pain, Chronic Pain, and Neuropathic Pain

Research has demonstrated that disrupted sleep will, in turn, exacerbate chronic back pain. A lack of restorative sleep also hampers the body’s immune response and can affect cognitive function. Thus, a vicious cycle develops in which the back pain disrupts one’s sleep, and difficulty sleeping makes the pain worse, which in turn makes sleeping more difficult, etc.

Pain Is the Top Cause of Insomnia

The term “insomnia” includes all types of sleeping problems, such as difficulty falling asleep, difficulty staying asleep, and waking up earlier than desired. Of all medical conditions, pain is the number one cause of insomnia.

See Treating Insomnia with Sleep Aids

For people with chronic pain, trouble falling asleep is one of the most prevalent types of sleep disruption, but waking up during the night and waking earlier than desired are also frequent problems. In addition, many patients with chronic back pain problems do not feel refreshed in the morning when they awaken, a sleeping problem termed “non-restorative sleep.”

How Does Sleep Affect Pain?

“There is an unquestionable link between sleep and pain, but emerging evidence suggests that the effect of sleep on pain is maybe even stronger than the effect of pain on sleep”.

Researchers have found that short sleep times, fragmented sleep, and poor sleep quality often cause heightened sensitivity to pain the following day in chronic conditions like rheumatoid arthritis. People with sleep problems also appear to be at a higher risk of eventually developing conditions like fibromyalgia and migraines. Encouragingly, many studies have also found that in the long term, quality sleep may improve chronic pain.

Sleep and pain appear to share similar pathways and neurotransmitters. For example, melatonin is best known for its role in regulating our circadian rhythm, and new research is starting to uncover melatonin’s role in our perception of pain. Sleep loss also causes inflammation in the immune system, with corresponding effects on our body’s resilience. Vitamin D and dopamine also appear to play a role in both sleep and pain.

Studies have found differing results for the effects of sleep deprivation on our pain threshold and the brain’s capacity for pain inhibition. It may be that sleep alters pain through different pathways depending on the condition and the type of sleep deprivation.

The ability to deal with sleep disturbance and pain may have a sociodemographic aspect as well. Many studies show when it comes to increased pain due to insomnia, women are more sensitive than men, and young people are more resilient than older people.

People with chronic pain may feel fatigued during the day. Depending on their level of disability, they may be less likely to exercise or follow a healthy diet, both of which are important for getting a good night’s sleep. Unsettled sleep due to chronic pain can also disturb a spouse who shares the bed, with corresponding consequences for their sleep quality and health.