Pain and Sleep, or Sleep and Pain. Which Way Does the Relationship Work?

Pain. We have all had pain, but for some people, pain is an ongoing concern.

And, just like insomnia, longstanding pain is something many wish they could live without. Let's take a look at the relationship between pain and sleep.

What is the relationship between pain and sleep?

Many people hold back on the things they want to do in life entirely because of their pain or their insomnia.  And it's a vicious circle.  Pain leads to wakefulness, and wakefulness leads to anxiety about being awake – which leads to insomnia.  That's how many client stories go anyway...

Exhaustion and pain

People may indeed complain of more pain when they are exhausted from the grind of their insomnia. This might be partly because they are tired, emotional, frustrated, and at their wits end with it all. However, research supports that lower sleep quality actually increases people's sensitivity to pain.¹

This phenomenon of pain-somnia may be a consequence of feeling more pain and a tendency toward more emotionality about pain, all wrapped together.

Pre-sleep pain

On the other hand, other research shows that pre-sleep pain is a poor predictor of sleep quality – but cognitive arousal is a very good predictor. This is consistent with the understanding that reduction of arousal (through many various means) improves people's sleep.^2,3

It sounds to me like poor sleep makes people more sensitive to pain and therefore feel more pain...but that this pain then doesn't predict poor sleep quality the following night.  Sleep seems key to people's pain experience – but perhaps it's not so clear in the pain/sleep direction. It's way more complicated than 2 sets of studies can describe, and there's clearly a lot left to untangle. I'm sure we can all find our personal anecdotes either support this or refute either of these angles.

Improving sleep can help pain

Researchers do know that improving people's sleep can help with certain kinds of pain, particularly longstanding pain.⁴

And in a large study of cognitive behavioral therapy (CBT) for insomnia in those with fibromyalgia, CBTI was effective in helping people have sustained sleep improvement, and more than one-third had immediate reductions in pain that lasted quite some time. Though there's still a lot to learn about the condition, one study suggests that working with sleep in those with chronic fibromyalgia pain can improve sleep and pain even more than pain-specific CBT (CBT-P).⁴

What seems to be more consistent is the commonly held assumption that someone with pain and insomnia cannot improve their sleep until their pain is gone.

But the research on this is really clear: It doesn't support this "common sense" idea that you have to eliminate pain to get better sleep.^5-7

Are you surprised?

Of course, studies look at the broad consistencies and there will always be people who fall outside the curve. For them, the fact that CBTi could help both the pain that is getting in their way and the sleep they miss so much should be heartening.

What is your experience with pain and sleep? I would love to know, or share your experience in the forums.