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Tired of Pain? Try Our Top Tips to Break the Pain-Sleep Cycle

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Everyone has days when they’re tired — we all know what that’s like. It’s hard to focus. Your body is sluggish. You might feel more irritable, sensitive, or hungry. But have you ever noticed how sleep (or lack thereof) impacts your musculoskeletal pain?

The relationship between sleep and persistent pain is bidirectional. Pain often interferes with sleep (maybe it wakes you up in the middle of the night or makes it hard to find a comfortable position in bed), and poor night sleep seems to intensify persistent pain. In fact, experts estimate that 50-80% of people with chronic pain have trouble sleeping, and the less people sleep, the more likely they are to have pain the next day. Some people have coined the term painsomnia to describe this phenomenon.

This can be a tough cycle to break. We know that getting enough sleep (and good quality sleep) is much easier said than done.

So if you suspect pain is affecting your sleep (and sleep is affecting your pain levels), what can you do about it?

Hinge Health’s clinical specialist Claire Hsing, DPT, doctor of physical therapy, recommends small changes. She says, “Getting more sleep is already a challenging endeavor. Habits are most effective when they accrue over time, so I recommend focusing on no more than one or two small changes to start. This will allow for better success maintaining consistency of that habit. Often, people can surprise themselves with the impact of that first small change.”

Whether it’s pain, stress, a snoring partner, or a newborn baby or pet that interferes with your sleep, there are always small steps you can take to get better, more restorative sleep at night, which in turn can help turn down the volume on your pain.

Take a Look at Your Daytime Habits

How you sleep at night impacts how you feel during the day. What you do during the day impacts how you sleep at night. Just like knocking down one domino affects everything after it, a small change to your daytime habits might make a big difference in your evening sleep. Here are a few ideas:

  • Get outside during the day. Exposure to natural sunlight (or bright light) during the day helps keep your circadian rhythm ‒ or sleep cycle ‒ on track. It might help to take breaks throughout your day for short walks or simply for time spent outdoors.

  • Exercise! Even 10 minutes of movement (like the length of a Hinge Health playlist) can make a difference in your sleep. It’s worth noting that strenuous exercise close to bedtime can interfere with sleep for some people, so it may be best to do higher-intensity workouts earlier in the day.

  • Avoid napping during the day if possible as this can “confuse” your sleep cycle. Sometimes naps feel necessary to get through a high-fatigue day, so try to limit them to 20 minutes or less and earlier in the day (say, before 3:00 p.m.) rather than close to your usual bedtime.

  • Reduce your caffeine intake throughout the day. If you do have caffeine, just make sure it’s not within six hours of going to bed.

  • Quit or cut back on smoking if you can. Many people don’t know that nicotine is actually a stimulant. In addition to helping your heart and lungs, there’s the added bonus of improving sleep and reducing pain.

  • Avoid foods that can cause heartburn close to bedtime. Think: spicy foods, onions (especially raw onions), citrus foods, tomatoes (including ketchup), fried foods, peppermint, chocolate, alcohol, caffeine, and carbonated beverages.

  • Avoid alcohol before bed. It might help you fall asleep, but alcohol can actually disrupt the quality of your sleep, wake you up in the middle of the night, and contribute to fatigue the next day.

  • Limit liquids before bed. Research shows that roughly 16 - 20% of people under the age of 40 consistently wake up in the middle of the night to go to the bathroom, and many struggle to fall back asleep afterward. (And that number is even higher for people over 40 years of age.) If this is you, it’s best to do everything you can to avoid nighttime disruptions.

Repurpose Your Nighttime Routine

Try to be intentional and consistent with your evening routine. Consider setting an alarm 30 minutes to an hour before bed as a reminder to begin your “wind down time.” During that time you can:

  • Dim the lights. Bright lights are stimulating and can decrease levels of the hormone melatonin, which helps you sleep.

  • Take a bath or shower. This can help you relax and cool your body temperature down, which increases melatonin levels in your body.

  • Try aromatherapy. Calming scents, like lavender and cedarwood, can promote good sleep. Consider using essential oils in a bath, in a diffuser in your bedroom, or putting a few drops on your pillow before bed.

  • Get your bedroom to a cooler temperature. Experts say that most people sleep best when their room is dark and the temperature is between 60 and 67 degrees Fahrenheit.

  • Steer clear of electronic devices. Rather than scrolling social media or watching TV, read, journal, make a to-do list for tomorrow, reflect, color, do a deep breathing exercise, or listen to soothing music, a podcast, or guided meditation.

Change Up Your Sleep Position

People come in all different shapes and sizes, so it’s natural that everyone prefers different sleep positions. Surprisingly, there’s no right or wrong sleep position. The best position is the one that allows you to have the most comfortable, deep sleep.

There’s no need to change something that’s already working. But if you struggle to get comfortable when laying in bed or wake up in pain, it might be worth trying a new position. Here are some tips on how to make different sleep positions most effective for reducing pain.

On Your Stomach

  • Place a pillow under your pelvis and lower abdomen to alleviate some of the pressure on your back.

  • Depending on how this position feels, you may or may not want to use a pillow under your head.

  • Add a firm pillow under your shins to put your knees and ankles in a loose, mid-range position.

On Your Back

  • Place a pillow underneath your knees to reduce pressure on your spine.

  • Keep your knees in a loose, mid-range position.

On Your Side

  • Allow your shoulder and the side of your body to make contact with the mattress.

  • Try placing a pillow between your knees.

  • If there’s a gap between your waist and the mattress, consider adding a small pillow there for added support.

  • Switch which side you sleep on periodically to relieve pressure from certain parts of your body.

We’ve all been there. Whether it’s a couple of nights of bad sleep or an ongoing struggle, exhaustion tests your mental and physical well-being as well as your resilience to pain. Maybe you already do some of the things mentioned above. But if you’re having trouble sleeping or feel tired during the day, try one or two new sleep-promoting tips this week. If it improves your pain even slightly, it’s worth it, right?

References

  1. Cheatle, M. D., Foster, S., Pinkett, A., Lesneski, M., Qu, D., & Dhingra, L. (2016). Assessing and Managing Sleep Disturbance in Patients with Chronic Pain, Anesthesiology Clinics, 34(2), 379-93. doi: 10.1016/j.anclin.2016.01.007

  2. Sivertsen, B., Lallukka, T., Petrie, K. J., Steingrímsdóttir, O. A., Stubhaug, A., & Nielsen, C. S. (2015). Sleep and pain sensitivity in adults. Pain, 156(8), 1433-1439. doi: 10.1097/j.pain.0000000000000131

  3. Rudd Bosch, J. L. H. &. Weiss, J. P. (2013). The Prevalence and Causes of Nocturia. The Journal of Urology, 189(1S), S86-S92. doi: 10.1016/j.juro.2012.11.033

  4. The best temperature for sleep: Advice & tips. Sleep Foundation. (2022, March 11). Retrieved from https://www.sleepfoundation.org/bedroom-environment/best-temperature-for-sleep#:~:text=The%20best%20bedroom%20temperature%20for,for%20the%20most%20comfortable%20sleep.

  5. Van Dongen, H. P & Dinges, D. F. (2003). Investigating the interaction between the homeostatic and circadian processes of sleep-wake regulation for the prediction of waking neurobehavioural performance. Journal of Sleep Research, 12(3), 181-7. doi: 10.1046/j.1365-2869.2003.00357.x

  6. Gooley, J. J., Chamberlain, K., Smith, K. A., Khalsa, S. B., Rajaratnam, S. M., Van Reen, E., Zeitzer, J. M., Czeisler, C. A., & Lockley, S. W. (2011). Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans. The Journal of Clinical Endocrinology & Metabolism, 96(3). doi: 10.1210/jc.2010-2098

  7. Viola, A. U., James, L. M., Schlangen, L. J. M., & Dijk, D.-J. (2008). Blue-enriched white light in the workplace improves self-reported alertness, performance and sleep quality. Scandinavian Journal of Work, Environment Health, 34(4), 297–306. doi: 10.5271/sjweh.1268

  8. Drake, C., Roehrs, T., Shambroom, J., & Roth, T. (2013). Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. Journal of Clinical Sleep Medicine, 9(11), 1195-200. doi: 10.5664/jcsm.3170

  9. O’Sullivan, P. B., Caneiro, J. P., O’Keeffe, M., Smith, A., Dankaerts, W., Fersum, K., & O’Sullivan, K. (2018). Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain. Physical Therapy, 98(5), 408-423. doi:10.1093/ptj/pzy022

  10. Weiss, J. P. (2012). Nocturia: Focus on Etiology and Consequences. Reviews in Urology, 14(3-4): 48–55.