Sleep has been a hot topic of conversation amongst two of my rehab patients over the last few weeks. Patient one had been having interrupted sleep for months, resulting in her waking up feeling tired and highly sensitised to her neck and shoulder pain. This was making her rehabilitation both in the gym and with her return to work programme difficult, as she was reporting high levels of pain and regular flareups. In recent weeks, with modification to her night-time routine, rehabilitation programme and medication, she has been able to have uninterrupted sleep, has excelled with her gym programme and is now trialling her pre-injury job role.
Patient two was initially progressing fantastically with all aspects of her rehabilitation. In recent weeks, she had been presenting with low mood, stress and reporting higher levels of pain. After a long discussion, we found that the only thing that changed in her daily routine was her sleep patterns – in terms of reduced number of hours and reduced quality due to stress. After reflecting on the opposing situations with my patients, I thought I would look at the research to further investigate the relationship between pain and sleep.
All the studies I read had strong supporting evidence of a direct relationship between sleep and pain. The research describes pain as a physical and emotional signal of bodily harm that strongly motivates behaviour. Sleep in all studies was defined as behaviourally regulated drive that broadly serves to maintain homeostasis and optimise function across multiple physiologic systems. Humans require both pain and sleep for survival. It was found that sleep complaints are present in 67-88% of chronic pain disorders and at least 50% of individuals with insomnia.
A particular study I looked at assessed the number of hours the participants slept and their reported pain symptoms daily over the course of one week. Results found that hours of reported sleep on the previous night was a highly significant predictor of the current day’s pain. Obtaining either less than 6 or more than 9 hours of sleep was associated with greater next-day pain. Another important point to note, is that overall, the evidence suggests that sleep disturbance is a stronger predictor of future pain, than pain is of sleep disturbance.
Based on this- it is significantly important to assess our sleep hygiene and look at ways we can improve this to improve sleep quantity and quality. Below are some tips to incorporate into your nightly routine.
- Limiting daytime naps to 30 minutes.
- Avoiding stimulants such as caffeine and nicotine close to bedtime.
- Exercising to promote good quality sleep.
- Steering clear of food that can be disruptive right before sleep (fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks)
- Ensuring adequate exposure to natural light.
- Establishing a regular relaxing bedtime routine – This could include taking warm shower or bath, reading a book, or light stretches.
- Making sure that the sleep environment is pleasant
- Limiting light- this also includes TV screens and mobile phones 30-60 minutes before sleeping.
Tayla O’Halloran (Bsc. Exercise Physiology)
Accredited Exercise Physiologist (AEP) (ESSAM)
- Edwards, R., Almeida, D., Klick, B., Haythornthwaite, J., & Smith, M. (2008). Duration of sleep contributes to next-day pain report in the general population☆. Pain, 137(1), 202-207. doi: 10.1016/j.pain.2008.01.025
- Finan, P., Goodin, B., & Smith, M. (2013). The Association of Sleep and Pain: An Update and a Path Forward. The Journal Of Pain, 14(12), 1539-1552. doi: 10.1016/j.jpain.2013.08.007
- What is Sleep Hygiene? – National Sleep Foundation. (2019). Retrieved from https://www.sleepfoundation.org/articles/sleep-hygiene