Treating insomnia not only improves sleep but also pain

Lack of sleep, whether due to pain or whatever other reason, and poor quality sleep can lead to more serious health complications.

As most people would know, pain can cause insomnia – which makes it hard for one to fall asleep, and hard to stay asleep, among other things.

But the relationship between sleep and pain is a lot more complex than most of us realise, says Dr Alison Bentley, a Restonic Sleep Expert.

“The relationship between sleep and pain has been studied extensively and in one survey, nearly half of patients complain of insomnia,” says Bentley.

“Insomnia doesn’t just mean struggling to fall asleep, it means not being able to get enough hours of sleep to function well during the day and includes waking up during the night and being unable to fall asleep easily, or experiencing poor sleep quality, where you wake up after enough hours of sleep, but still feel unrefreshed.”

She says the problem with sleep and pain is that while the pain affects sleep, not getting a good night’s rest also increases the pain the following day – resulting in a vicious cycle.

There are several types of sleep problems, including insomnia – shift work, which occurs in people who work nontraditional hours like graveyard shifts, rotating shifts or split shifts.

“A lack of sleep means that the body is unable to restore itself during the night. Like a car that needs servicing, if you don’t service it then it gradually falls apart until finally something breaks. If you don’t sleep well for years then one system, or many, start to break,” says Bentley.

“So, the consequences can be to any of the body systems and the breakdown happens earlier than expected. This applies to heart diseases, diabetes, depression, dementia, liver disease – literally any other disease happens earlier than it should.

“All sleep disorders, including sleep apnoea, and restless legs syndrome are more common in patients with pain. The implication from this is that it might be the sleep disorder creating poor quality sleep that started or worsened the painful condition, particularly if the pain is located in the muscles. Fibromyalgia, for example, is a condition where the sleep-pain relationship is very closely linked and difficult to untangle.”

Obstructive sleep apnoea is a condition “where you stop breathing temporarily and your body wakes you up so you can start breathing again”.

However, she says that not all pain is the same when it comes to poor sleep.

“Waking up with back or neck pain may simply mean that your mattress is too old and not supporting your body comfortably during the night. You might also find you’re waking regularly with headaches or jaw pain, she adds.

“Assuming you don’t sleep alone, ask your bed partner if you snore and appear to stop breathing, as these symptoms may indicate obstructive sleep apnoea.

“The repeated waking from apnoea can cause headaches and treating the sleep apnoea often relieves the headaches as well.”

She says when doctors are trying to manage the combination of sleep and pain, they usually treat the pain and assume the sleep problem will resolve.

“That won’t happen if the sleep problem is due to sleep apnoea or restless legs syndrome. These two conditions need to be diagnosed properly and treated specifically – and not with sleeping tablets – to improve sleep directly.”

Bentley says better sleep after treatment of a sleep disorder may directly improve pain during the day and there is also good evidence now showing that treating insomnia directly not only improves sleep, but also improves daytime pain.

She says there’s one symptom that tells you there is something wrong with your sleep and that is when you’re feeling tired, sleepy or fatigued during the day.

“Either because of a lack of hours of sleep or enough hours but of poor quality. It is really important that you wake up feeling refreshed, which indicates that your sleep has done what it is supposed to do during the night.

“You need to break the cycle – either treat the pain better so it doesn’t interfere with sleep or give some treatment for the sleep such as a sleeping tablet to improve sleep to make the pain better the next day. Treating the pain better is important as people often try to ration their pain killers and then the pain is not well treated.

She says other than medical treatment, one can try to treat the pain with exercise and meditation, among other things.

“Make sure you focus on your sleep to make it as good as possible and don’t short-change your sleep for social activities. If you have pain, your sleep is more important.

“Most importantly, don’t change your routine around sleep because you have pain. Many people go to bed very early because they have pain and find it harder to go to sleep. Rather rest on the couch in the lounge and only go to bed when it is bedtime, which should only be when you’re sleepy.

“Make sure you have a good environment for sleep – a comfortable bed, reduced noise [ear plugs] reduced light [eye shields] to maximise your sleep. Get up early in the morning and don’t lie in bed for hours resting – again on the couch,” she says.

Bentley says treatment for either sleep or pain is affordable.

“If there is a full sleep disorder that needs an overnight assessment then that can be pricey. Something the new Restonic Ezintsha Sleep Clinic is trying to address by making sleep medicine more available.”

Ezintsha is a “multidisciplinary research centre that specialises in advancing research in HIV and non-communicable diseases, including sleep and related health issues, with a focus on finding innovative solutions and improving healthcare outcomes for SA”.

She advises that if you are struggling with the pain and poor sleep combination, make sure that your treatment plan for pain includes a specific plan to tackle your poor sleep – particularly to exclude and treat specific sleep disorders.

“Tackling both sides of the problem may be needed to get a full resolution of the pain,” Bentley says.

mashabas@sowetan.co.za