Pain and Sleep: Unfriendly Bedfellows
(ARA) - Insomnia often strikes out of the blue, sets up camp for a few nights and then vanishes just as quietly as it arrived. At least that's how it works for most people.
At a recent Select Comfort Sleep Advisory Board meeting, Dr. Miles Belgrade, a pain specialist at Fairview Riverside Hospital in Minneapolis, spoke about the role of sleep among pain patients. Interestingly, 89 percent of chronic pain patients report at least one type of sleep disturbance. And unfortunately, anxiety about not sleeping well can actually worsen the severity and duration of insomnia.
This is problematic for several reasons, but two rise to the top of the list quickly. First, sleep deprivation makes people irritable, unproductive, more prone to accidents and generally miserable. Second, sleep is very important to the human body's ability to heal itself. It's like adding insult to injury for a person experiencing chronic pain. Not only do they have a painful condition, they can't get a good night's sleep to help foster healing of the affliction.
Dr. Belgrade discussed the most common questions regarding chronic pain and the importance of a good night’s sleep.
Q: What types of sleep complaints do chronic pain patients report most frequently?
A: Generally, chronic pain patients have trouble falling asleep as well as waking up during the night due to discomfort. Patients frequently report that they sleep in a chair or recliner because their back or neck hurt too much when they lay flat. I suspect that the problem has less to do with lying flat than the type of surface they sleep on. Recliners tend to be much softer than the typical firm innerspring mattress.
Q: What impact does poor sleep have on recovery?
A: I find that patients who sleep poorly benefit less from traditional pain treatments. Poor sleep acts as a barrier to successful pain relief in part because it may distract the patient from daytime pain management techniques such as exercise, relaxation and stretching. Patients who are sleeping better often find that better pain control ensues. Furthermore, when we perform acupuncture in the pain clinic, we sometimes find that even before patients get improvement in their pain, they see improvement in sleep as the first sign that they are doing better. The improvement in sleep quality seems to open the door to better pain control.
Q: Does sleep deprivation have a negative effect on a patient's pain threshold or perceived level of pain?
A: Studies show that prolonged sleep deprivation can lead to a condition much like fibromyalgia -- total body aching, fatigue, tender points, and mood instability. Existing pain is amplified and tolerance for pressure is reduced (hence tenderness).
Q: Should sleep be a part of a prescribed recovery regimen in your opinion?
A: At the Fairview Pain Management Center, we ask about sleep issues in every patient evaluation and make sure our pain management strategies address sleep as an important contributing factor for pain. We do this by teaching sleep hygiene and assessing the sleep environment at home including the sleep surface. A recent article published in The Lancet, an international general medical journal, demonstrated the importance of not having too firm a mattress for those with the most common form of low back pain. Ideally, people with pain disorders should be able to make adjustments in their sleep surface to optimize comfort during sleep time.
