Harvard Health Columns

How to sleep better with chronic pain

Rely on your natural sleep rhythms as much as possible instead of sleep medications and painkillers.

Chronic pain and insomnia are an unhealthy combination. According to the National Sleep Foundation, chronic pain disturbs the slumber of one in five Americans at least a few nights per week. But you can start to break the vicious circle of pain and insomnia by maintaining sleep-friendly behaviors, known as sleep hygiene.

"For chronic pain conditions, what you need is good sleep habits from the beginning—things that will last," says Dr. Padma Gulur, a pain medicine specialist at Harvard-affiliated Massachusetts General Hospital. That means relying on the brain's natural sleep drive as much as possible, rather than medicating pain-related insomnia with sleep aids or pain relievers.

Relaxing yourself to sleep

Whether from a bad back, arthritis, or headaches, chronic pain puts you in double jeopardy: The pain both robs you of restful sleep and makes you more fatigued and thus more sensitive to pain. "When you lose the restorative sleep, it enhances your subjective perception of pain," Dr. Gulur says.

During the day, people with chronic pain can manage with activities that take the mind's focus off the pain. But when they lay down to go to sleep, the lack of distraction can make the underlying pain more noticeable.

Dr. Gulur tells her patients to use "relaxing distraction" to get to sleep. This can come in the form of widely available audio recordings. Some teach basic rhythmic breathing meditation; others focus on guided imagery, in which you imagine being in a calm, relaxing location. Find something that appeals to you and helps you fall asleep. Group or individual training and sleep education is also available. Ask your doctor for a recommendation.

For people who experience interruptions in sleep due to pain, taking medications right before bed can help. Make sure you discuss this with your doctor to ensure that you stay within safe daily limits for pain relievers.

Getting back to sleep

Pain conditions can flare up at night and wake you. Simply shifting position in bed can trigger pain from a back condition or arthritic knee. What you do next is important, Dr. Gulur says.

First try meditation, visualization, or whatever relaxing distraction you favor. But if it doesn't work, getting up to read a book in a quiet room with low light can help you to get back to sleep. Avoid loud sounds and bright light, such as you might encounter from watching TV or a video. "Do things that are mind-numbing to you, like organizing the sock drawer," Dr. Gulur says. "The next thing you know, you will go back to bed and want to sleep."

Staying on a regular sleep schedule is also highly recommended. Go to bed at the same time every night and, no matter how the night goes, rise the next day at the same time and remain awake until your planned sleep time. This helps to set your internal sleep clock and enhances the natural sleep drive.

The role of sleep drugs

Ideally, sleep aids should be used for temporary relief of insomnia. Dr. Gulur discourages people from becoming dependent on sleep medications over the long term. "Every time you medicate the sleep, you are actually taking away the body's intrinsic ability to shut down and fall asleep," Dr. Gulur says.

Pain relievers are essential for pain control but can be counterproductive if the doses needed to allow you to sleep escalate over time. Opioid pain relievers like codeine, hydrocodone (Vicodin), and oxycodone (Oxycontin, Percocet) can disturb sleep. If you have chronic pain and are unsatisfied with the level of control you have over it, consider visiting a pain clinic for more specialized and intensive counseling and care.

Sleeping better with arthritis

Mattress: A firmer mattress may provide more support. Some people say they are more comfortable sleeping on "memory foam" mattresses and pillows
(Tempur-Pedic, others).

  • Neck: Sleep with no pillow or a single flat pillow to place the neck in the most neutral position, avoiding extremes of rotation and sideways bending. Avoid sleeping on your stomach; sleep on your back or side.
  • Low back: Sleep on your back or side with your knees and hips both flexed to about 90 degrees. This position can relieve pressure on lumbar discs for people with degenerative disc disease or disc herniation. Use a heating pad at bedtime to relieve pain.
  • Knee: Sleep with a pillow between your legs to reduce strain on the joint.
  • Hip: Sleep on your side with a pillow between your legs or sleep on your back to avoid a position that rotates the hip. 

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