Sleeping well despite chronic pain

April 27, 2016 Gordon A. Irving, MD


Pain disrupts our sleep, and a lack of sleep increases our pain. It’s a vicious circle. If you have chronic pain, you may be nodding drowsily. While there may not be an immediate solution to your pain, you can partly manage it by managing your sleep.

Aside from pain, what could be causing your sleepless nights? A number of medical conditions, habits and behaviors. In most cases, you can address them.

Sleep apnea

This chronic disorder causes pauses in breathing or shallow breaths during sleep. Snoring can be a symptom. People with this condition have poor quality sleep and often feel sleepy during the day.

You may be able to ease sleep apnea by:

  • Shedding pounds if you are overweight. In some cases, losing weight can even cure the condition.
  • Quitting alcohol and smoking
  • Cutting back on opioids (narcotics). These can be prescribed for pain, but overmedication can cause excessive drowsiness and poor sleep.
  • Undergoing a sleep study with a CPAP (continuous positive airway pressure) breathing device
  • Using nightly nasal devices placed just inside the nose to increase the back pressure when breathing out during sleep.
  • Isometric tongue exercises to strengthen face and throat muscles. Watch a video about these exercises.

Restless legs syndrome

RLS is a neurologic disorder that causes an irresistible urge to move your legs. Unpleasant sensations in the legs trigger these urges, which usually occur when a person sits or lies down. The sensations can intensify at night, making it difficult to sleep.

Treatments for RLS may include:

  • A blood test to see if you have an iron deficiency
  • Medications such as gabapentin, or dopamine agonists such as ropinirole or pramipexol
  • Changing an antidepressant or lowering the dose
  • Avoiding caffeine, nicotine and alcohol in the evening

Periodic leg movements

These are repetitive movements of the foot or leg. A bed partner may notice restlessness or kicking during sleep. The treatment for this condition is similar to treatment for RLS.

Worry and anxiety

Excessive worrying keeps many of us up at night. Medication usually is not needed to tamp down these feelings—and in the long run, medication could worsen sleep patterns.

Many people can ease anxiety and make way for sleep by:

  • Discussing problems with their partner or a trusted friend, therapist or religious leader
  • Practicing mindfulness and relaxation techniques, which also can directly relieve pain
  • Doing yoga

Too much sleep

Overmedication, especially from opioids (which can be prescribed for pain), can cause excessive drowsiness during the day and poor sleep at night.

Depression also can affect our sleep. Consider talking to your health care provider about a short-term antidepressant, which may help with sleep as well as pain.

Other ways to improve sleep

If a medical condition isn’t responsible for your sleep problems, there are other steps you can take to increase your chances of healthy slumber. One is cognitive behavioral therapy for insomnia (CBT-I).

This therapy is aimed at helping people develop healthy sleep habits. Studies have shown it to be effective, but it comes with homework, including tracking your sleep patterns. There also are rules about when you can sleep, consume alcohol and caffeine, and exercise.

CBT-I therapists work on the cognitive aspects of insomnia by teaching patients relaxation techniques and how to cope if they do have sleepless nights.

Watch this video to learn more.

Sleep aids: Do they work?

While commonly prescribed, so-called sleep medications are, at best, mildly effective.

When compared with a placebo:

  • People taking hypnotics fall asleep 12.8 minutes sooner on average.
  • People taking benzodiazepine medications fall asleep 10 minutes sooner.
  • People taking tricyclic antidepressants fall asleep 7 minutes sooner.

These medications also come with risks. People taking benzodiazepine medications can become dependent on them and suffer from “rebound insomnia”—an even worse time sleeping after stopping the medication.

People who take hypnotics have a slightly increased risk of sleepwalking and eating while they are asleep.

Tips for better sleep

To get the best sleep possible and manage your pain:

  • Avoid stimulants before bed: Eliminate or restrict your caffeine consumption – and none after noon. Don’t forget that chocolate contains caffeine. Limit alcohol and don’t drink within four hours of bed. Avoid nicotine before bed.
  • Set a sleep schedule: Go to bed at the same time each night and get up at the same time each morning.
  • Gentle exercise: Do some relaxing exercises such as gentle yoga before bed to help prepare your body for sleep.
  • Make your bedroom a restful place: Aim for pleasant and relaxing, with a comfortable bed in a room that is quiet, not too bright and not too hot or cold.
  • Avoid napping during the day: Naps can disturb your normal patterns of sleep and wakefulness.
  • Watch what you eat: Stay away from large meals near bedtime, but a warm milky drink might help.
  • See the light: Exposure to light can help maintain a healthy sleep-wake cycle. When you wake up in the morning, move to a bright room or go outside to get natural light. This is particularly important for older adults who may not venture outside as frequently as children and other adults.
  • Establish a relaxing bedtime routine: Try to avoid upsetting conversations and activities before bed, and try not to dwell on problems in bed.
  • Use your bed only for sleep: Watching TV, listening to music or the radio, and reading in bed don’t promote sleep.

If you need more guidance on managing pain, we can help. Visit Swedish Pain Services to learn how to schedule a consultation at one of our convenient locations.

If you need help managing a condition that may be preventing you from sleeping, visit Swedish Sleep Medicine or call 206-386-4744 to schedule a consultation.


Previous Article
Comforting your child during a medical procedure
Comforting your child during a medical procedure

Going to the doctor’s office can be scary for your child. But there are ways you can support your child dur...

Next Article
Be kind with yourself. Be patient with yourself.
Be kind with yourself. Be patient with yourself.

Swedish’s first priority is the quality of the care we provide to patients and survivors, which means carin...