Sleep

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The Neuroscience of Pain
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Pain Rehab
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Family & Parenting

Why is Sleep So Important?

Sleep is your body’s way of letting the brain rest. Getting the recommended 8 hours of sleep a night has a number of positive effects: improved concentration, metabolism, immune system functioning, reduced depression, and inflammation. A lack of sleep can block signals in the nociceptive pathways, which increases the perception of pain1.

In chronic pain conditions, sleep is even more important because the body is working harder than usual to maintain functioning2. The body needs to recover before you try to exert it more. Long-term lack of good sleep increases experienced pain, which leads to feeling more unable to function properly3, 4.

The key to managing sleep in chronic pain conditions is not the duration of sleep, but the quality of it. Even if 8 hours is not possible every night, if the sleep you are getting is high quality then your body will still heal.

What Should I do if I Can’t Sleep?

Frustratingly, getting sleep can be difficult if you are in chronic pain. Sleep disorders and chronic pain are highly comorbid. with too little sleep leading to higher bodily pain while too much can result in higher rates of headaches5. Sleep and chronic pain can form a negative cycle where poor sleep will increase pain, leading to poor sleep for more pain and so on.

Additionally, certain medications can negatively impact sleep. Some painkillers contain stimulants that reduce pain experience but stimulate the nervous system, keeping you up at night. Beta-blockers and other medications that target blood pressure suppress REM sleep, the phase in which the brain actually rests. Medications that make you drowsy, such as opioids, can throw your circadian rhythm off, making you more tired during the day but awake at night.

The National Sleep Foundation recommends limiting the intake of certain medications that may interfere with your sleep cycle unless you feel they are necessary. Medications that make you drowsy can help you sleep at night, for example, but may not be ideal to take in the afternoon unless you cannot make it through the day without them.

The NSF also recommends that you should not worry about how long you are able to sleep, just how well you can.

What Can I do to Improve My Sleep?

For better sleep quality, mindfulness can help train the mind to be more relaxed. Acknowledge your thoughts and stressors, and let them flow away as you are preparing to fall asleep to reduce the cognitive load on your brain.

Body-centric meditational can also help relax the body if you are able to manage small movements of specific areas. Tense up concentrated areas of muscle, then relax them.

What you do before going to bed impacts how well you can fall asleep. Limit stimulating activities such as playing video games and watching TV to about half an hour before going to bed, as the brain will be less stimulated.

Sleep Resources

National Sleep Foundation: United States’ national authority on sleep research. Has up to date research and resources for getting better sleep.

https://www.sleepfoundation.org/articles/national-sleep-foundation-launches-free-sleep-disorders-online-resource-guide-primary-care

References

1 Kukushkin, M. L., & Poluektov, M. G. (2018). Current Views on Chronic Pain and Its Relationship to the State of Sleep. Neuroscience and Behavioral Physiology49(1), 13–19. https://doi.org/10.1007/s11055-018-0684-3

2 Tham, S., Daley, L., & Palermo, T. (2019). (113) Sleep Deficiency and Disability in Adolescents with Chronic Abdominal Pain. The Journal of Pain20(4), S5. https://doi.org/10.1016/j.jpain.2019.01.032

3 Evans, S., Djilas, V., Seidman, L. C., Zeltzer, L. K., & Tsao, J. C. I. (2017). Sleep Quality, Affect, Pain, and Disability in Children With Chronic Pain: Is Affect a Mediator or Moderator? The Journal of Pain18(9), 1087–1095. https://doi.org/10.1016/j.jpain.2017.04.007

4 Sardi, N. F., Lazzarim, M. K., Guilhen, V. A., Marcílio, R. S., Natume, P. S., Watanabe, T. C., … Fischer, L. (2018). Chronic sleep restriction increases pain sensitivity over time in a periaqueductal gray and nucleus accumbens dependent manner. Neuropharmacology139, 52–60. https://doi.org/10.1016/j.neuropharm.2018.06.022

5 Yamada, K., Kubota, Y., Shimizu, Y., Shibata, M., & Morotomi, N. (2019). Association of sleep sufficiency and duration with chronic pain prevalence: A population-based cross-sectional study. Journal of Psychosomatic Research120, 74–80. https://doi.org/10.1016/j.jpsychores.2019.03.005