Waking Up to Chronic Pain’s Unwanted Bed Partners

Fibromyalgia. Headache. Back Pain. If you live with one of these chronic conditions, you probably don't take sleep for granted. Here's why and how to get a good night's rest.

Researchers estimate that as many as two-thirds of people with common pain conditions also suffer from insomnia, which is the formal name for difficulty falling asleep or staying asleep. The fatigue they feel the next day can make the pain feel worse, creating a vicious cycle that can be hard to break.

“We know there is a bidirectional relationship between sleep and pain,” explains Jennifer Martin, PhD, a professor of medicine at the David Geffen School of Medicine at UCLA and a member of the American Academy of Sleep Medicine’s

Board of Directors. “Having a chronic pain condition contributes to poor sleep. And poor sleep impacts pain and functioning, so the two can be difficult to separate,” she says.

Exploring the Pain-Sleep Link

There are several ways that pain impacts sleep. First, with some conditions, just the act of lying down can increase pain symptoms. Second, when people live with chronic pain, they typically reduce their activities during the day, and this can make it harder for them to fall asleep—or stay asleep—at night. Third, when people lie in bed quietly waiting to fall sleep, they become more aware of their pain, which can make it hard to relax into a sleepy state.

Despite the pain–sleep connection, it’s common for many pain specialists to focus treatment on addressing the cause of their patient’s pain while leaving the sleep issues for a later date. However, Dr. Martin stresses that this can be a short-sighted approach. “You actually need to address both pain and sleep problems in order for the person to feel better,” she says.


Fibromyalgia, low back pain, and headaches are three common chronic conditions impacting sleep. (Image: iStock)

3 Pain Conditions That Interfere with Sleep

While there are many causes of pain that can interfere with a good night’s rest, fibromyalgia, chronic back pain, and headaches are particularly likely to keep you up at night. Here’s why:

1 - FIBROMYALGIA: This syndrome causes widespread musculoskeletal pain that makes people feel tired during the day but also makes it hard to relax and fall asleep at night. This condition also seems to interfere with a person’s sleep patterns, especially during slow wave sleep (SWS), which is the deepest part of the sleep cycle. An older but cited study looked at the impact of disrupting SWS for three consecutive nights found that participants’ pain threshold decreased by 24%, further supporting the link that a sleepless night could make individuals with fibromyalgia feel more pain symptoms during the day. In addition, those with fibromyalgia are often prone to restless leg syndrome, which causes a strong urge to move one’s legs when at rest.

Tip: If you have fibromyalgia and sleep problems, Dr. Martin suggests keeping a diary of your symptoms and your sleep habits, so your healthcare provider can help you manage both problems in the most effective way.

2 - BACK PAIN: If you suffer from chronic low back pain, you may find the pain keeps you up at night. One reason for the connection is that back pain can cause you to restrict your activities during the day. Being sedentary during daylight hours can then make it harder to sleep when the lights go off. Patients with back pain can also feel very uncomfortable lying down flat in bed, and this can keep them from falling asleep. Dr. Martin suggests using extra pillows or foam wedges to create a position that allows you to rest. Putting the pillow between your knees can relieve the pressure on your lower back and put your body more at ease.

Also, if you are taking pain medications during the day that help you to work or perform daily activities, then at night, your muscles may tighten, resulting in worse pain that leaves you lying awake. In addition, some experts believe that even when people with low back pain do fall asleep, they are more aware of the body shifting from a deeper sleep state into lighter sleep (also called microarousals) throughout the night, leaving them feeling overly tired the next day.

Tip: Investing in a good mattress can be beneficial for people who suffer from back pain. If the mattress provides better support, you may be able to get more comfortable, which can improve sleep patterns.

3 - HEADACHESChronic headaches also greatly impact sleep quality. “Sleep deprivation can actually have a direct impact on headaches,” says Dr. Martin. Before you can address the condition, you need to identify what kind of headache you are dealing with, such as tension headache or migraine, so you can determine the underlying cause (Take Our Quiz). For instance, some headaches can be related to sleep apnea (a serious condition that causes people to start and stop breathing while they sleep). “When headaches are worse in the morning, sleep apnea should be considered as a possible cause,” she says, adding, “When people get treatment for sleep apnea, often the headaches get better.” When the headache is directly caused by insomnia, they will typically get worse later in the day as your fatigue increases.

Tip: Keep a diary of your symptoms to try to home in on your headache triggers. This can help you avoid them so you can get more Zzz’s.

Other Causes of Pain and Insomnia: Other chronic conditions that may come with a pain-sleep deprivation effect include multiple sclerosis, menstrual cramps, arthritis, bladder and prostate issues, and depression.


Ways to Address Pain and Sleeplessness
Regardless of what is causing your pain and insomnia, you can try to use these strategies from the National Sleep Foundation to improve your sleep hygiene and ultimately get some rest.

  • Turn your bed into a comfortable and relaxing environment. This means getting soft blankets and pillows, and if you have back pain, make sure you have a supportive mattress.
  • Designate your bed for sleeping only. Avoid taking naps or lounging in bed during the day.
  • Follow a regular bedtime routine to help you wind down at night, such as reading, meditating, or taking a bath to start the relaxation process.
  • Establish morning rise times and bedtimes so your body gets into the habit of sleeping at a certain time. (See also, how cognitive behavioral therapy can help with insomnia.) 
  • Limit caffeine use. People with insomnia may find themselves overusing caffeine to try to compensate for their lack of sleep, and they can end up with a caffeine withdrawal headache. The experts recommend limiting caffeine to 3 servings or fewer in a 24-hour period. Especially avoid caffeine in the evenings, since it can make you feel more awake.
  • Avoid taking opioid pain medications if possible as these can also increase the risk of sleep apnea and have been linked to other health risks.
  • Talk to your healthcare provider about your risk for sleep apnea. People with pain are often more sedentary during the day, which can cause them to gain weight, and this can make them at higher risk for sleep apnea. In fact, Dr. Martin also encourages people with chronic pain and insomnia to see a specialist who can perform a thorough sleep evaluation. This assessment is important for determining if the sleep issue is independent of the pain disorder. The American Academy of Sleep Medicine offers a search tool  to help find a sleep center near you.

The good news is that when you get to the root of your sleep disorder, you can create a strategy to address it so you can improve your sleep quality. Medications, cognitive behavioral therapy (a therapy that helps change your thought patterns), and physical therapy can be effective in some cases.When you address the sleep issue, Dr. Martin says you may also find your pain also improves, too.

Updated on: 01/19/21
Continue Reading:
Insomnia and Pain: A Chronic Cycle