Many kinds of pain can be controlled with medications, exercise and alternative therapies. But some kinds of pain, especially those arising from chronic conditions, can interfere with sleep and thereby affect many other functions in the body.
Prashanti Gogoi, 29, a communications professional from Delhi, started having back pain all of a sudden one day after she returned from office. She was prescribed painkillers and later physiotherapy.
She says the back pain affected her sleep quality and duration a lot, and she would wake up in the middle of the night when the pain spasms started. “It was like a nightmare but thankfully, after a few months, I got relief with my treatments,” she says.
“The first casualty is a good night’s sleep that working men and women so require to wake up with renewed zeal,” says K Madhavan, a sleep expert from Bengaluru. “Aches and sleep make for a debilitating combination as fatigue and body pain can persist. Using a mattress that supports the back and the curves of the body can, to a large extent, rid you of such nagging problems or stop them from happening in the first place.”
Lack of sleep can cause anxiety and, in the long term, lead to insomnia — which comes with other related problems.
A 2019 study in the Clinical Journal of Pain attributes poor quality sleep to chronic pain issues. It was found that those with chronic pain are 18 times more likely than those with no pain to get a clinical diagnosis of insomnia. Although there is interdependence between the two, evidence suggests that poor sleep is a greater source of worse pain rather than vice versa.
How sleep loss affects the brain
It is known that the brain needs a certain amount of sleep for a person to be physically and mentally healthy. When one sleeps, the body gets to rest and restore energy.
During the night, there are two main types of sleep: non-rapid eye movement (nREM) sleep and rapid eye movement (REM) sleep. When a person is in pain, deep sleep is not possible and that can affect one cognitively.
According to a study by the National Center for Biotechnology Information, US, sleep deprivation not only impairs attention and working memory, but it also affects other functions such as long-term memory and decision-making. Partial sleep deprivation is found to influence attention, especially vigilance.
Chronic pain: types and management
The types of pain that can interfere with sleep include arthritis pain, orthopaedic pain, chronic back pain and even post-surgery pain.
“Chronic back pain is most common painful condition seen in the general population,” says Dr Vikas Tyagi of Noida Pain Management Clinic. “Unfortunately, a great majority of these patients suffer from poor sleep quality, which is mostly the result of back pain but also due to anxiety related to this. In clinical practice, most of the patients rely heavily on the use of sleeping pills, which can provide short-term relief but are usually ineffective over long periods in most patients.”
Dr Jyoti Bala Sharma, director, neurology, Fortis Hospital Noida, Uttar Pradesh, says, “If you have chronic pain, then it is possible that you often find problems sleeping. Research details that approximately 50 to 80 per cent of patients with chronic pain experience ongoing sleep difficulties, with most of them exhibiting symptoms of insomnia.
She adds that chronic pain disrupts the sleep cycle by making a person spend too much time in the light-sleep stage. As a result, the other sleep stages are shortened.
Dr Tyagi says that if there is chronic back pain and insomnia, it is imperative to focus on the root cause. “I had a patient around 27 years of age who had a slipped disc in 2020 but it was only last year that she came to me with severe insomnia as her back pain worsened at night,” says the doctor. “She had taken a lot of sedatives without any relief. We gave her an injection in the back which decreased her pain by 70-80 per cent. I also stopped all sleep medicines and just put her on a night-time dose of melatonin, and strictly made her follow sleep hygiene. She is fine now and is off medications. So, insomnia is due to pain, and unless we remove this stimulus, we won’t have long-lasting results.”
Dr Tyagi advises a few practices that can help a person get quality sleep:
- Limiting daytime naps to 30 minutes
- Avoiding stimulants such as caffeine, nicotine and alcohol close to bedtime. All of them have been shown to result in a poor quality of sleep with frequent awakenings. Their effect may persist for up to eight hours.
- Exercising regularly promotes good-quality sleep. As little as ten minutes of aerobic exercise, such as walking or cycling, can drastically improve night-time sleep quality by releasing melatonin, especially in sedentary individuals.
- Ensuring adequate exposure to natural light. Exposure to sunlight during the day, as well as darkness at night, helps to maintain a healthy sleep-wake cycle.
- Establishing a regular relaxing bedtime routine. This could include taking a warm shower or reading a book, or light stretches before sleeping.
- Increasing melatonin levels. Studies have shown that using bright light from lamps, cell phone and TV screens can decrease melatonin release by 50 per cent, making it difficult to fall asleep.
