Understanding Night Pains and How to Improve Sleep when in Pain

Is Pain Worse at Night?

The answer lies in studies that found there is some proof that our sensitivity to pain may follow our sleep and wake pattens (called our circadian rhythm), peaking in the middle of the night and at its lowest in the afternoon. But pain and lack of sleep can affect each other. Studies have suggested that disturbed sleep may affect our body's response to pain. We're likely to feel pain less in the morning after a good night’s sleep but become more sensitive to pain the longer we're awake, feeling the most pain just before bedtime. Pain is likely to decrease during sleep. However, when we don't sleep, our sensitivity to pain can increase. It has also been suggested that lack of sleep increases the release of a type of protein (cytokines) that’s involved in the body’s inflammatory response which may make people more sensitive to pain.  Disturbed sleep can affect not only how we feel pain (sensitivity), but also how our body reacts to pain. In some cases it may affect us physically, emotionally and potentially worsen some types of pain. That’s why it is believed that improving our sleep can lead to reduced long-term pain.

Which Types of Pain Can Affect Sleep?

Chronic Pain

Chronic pain is pain lasting longer than 3 months and affects over a third of people living in the UK. It can be disruptive, particularly since people living with chronic pain tend to sleep less and experience poorer sleep quality, than people without pain. Treating disrupted sleep may help to prevent and treat chronic pain.

Arthritis pain

If you have arthritis, you might have achy, stiff, and possibly swollen joints. Arthritis pain can affect your sleep and poor sleep can make your joint pain feel worse. If you have arthritis pain, it’s important to get a good night’s sleep but it can be hard, managing this type of pain.

Headache Pain

Headaches like tension type headache and migraine can affect sleep. Sleeplessness and its relationship to headaches and migraines is complicated, since these can all be affected by other types of pain, tiredness, stress and other symptoms. And the more severe or frequent your headaches, the more likely it will affect your sleep. Getting a good night’s sleep can help manage headaches.

Low back pain

Studies have shown that there is a link between sleeplessness (insomnia) and low back pain. If you have low back pain, as well as daily stresses or anxiety, it may also have a negative effect on your sleep. Sleep disturbance from low back pain can be managed with good sleeping habits and certain types of therapies.

Besides pain, there are several reasons you may be unable to get a good night’s sleep, such as stress, depression, medicines you’re taking, amongst others. Telling your doctor if you're struggling to sleep, may help you uncover the possible reasons.

Ways to get a better night’s sleep

Pain is a signal to your body, of harm. Sleep is important for our body and mind to repair and vital for good physical and mental health. Humans need pain and sleep to survive, but long-term pain combined with ongoing problems with sleep, can be bad for your health. Improving sleep when you’re in pain, can help you cope better, may reduce pain and can help improve your health. Here are some ways that may help to improve your sleep and cope better with pain at night:

Sleep Quantity and Quality

It’s important to find the right balance of sleep. A healthy adult usually needs around 7 to 9 hours of sleep per night. However, age, health and personal circumstances affect how much sleep we need, plus some people naturally sleep more than others. Recent research has shown that sleeping too much can be just as damaging as sleeping too little. Don't wait until you get rid of pain to improve your sleep.  Not being able to sleep might not be a result of your pain.  You should still follow healthy sleeping habits, even when you’re in pain.

Eating, drinking and smoking

What you eat, drink and other lifestyle factors like smoking, can affect your sleep.

• If you haven’t slept, avoid the temptation to use caffeine as a “pick-me-up” the next day. Drinking something like coffee, tea or an energy drink containing caffeine, particularly within 3 to 4 hours before your bedtime, can influence your sleep – you may take longer to fall asleep or have a restless night’s sleep.
• Cigarettes can have a similar effect to caffeine because they contain a stimulant called nicotine. Smoking at night can keep you awake and may make it harder to stay asleep. If you’re unable to give up smoking, it’s a good idea to reduce your smoking before bedtime.
• Eating rich food and drinking or eating large quantities before bedtime, can also disrupt sleep because it activates your digestive system and may wake you during the night to use the toilet.
• Avoid alcohol before bed. Alcohol might make you feel sleepy, but it can make your sleep quality worse.

Exercise and routine

Our daily “body clocks” also known as our circadian rhythm, need to be reset during the day through exposure to sunlight, exercise, and social activities. If you’re in pain and avoiding activity or socialising, it can disrupt your “body clock”.

• Try to keep a regular routine by going to bed at the same time every evening, even if you’ve had disrupted sleep the night before. It’s also a good idea to get out of bed at the same time every morning.
• In the long-term, napping during the day may make it harder to sleep at night. Avoid napping for more than 2 hours during the day. Some experts advise to keep naps between 15 and 20 minutes in length and within the early-to-middle part of your day.
• Regular exercise not only keeps your joints moving and muscles strong, but it’ll also help you sleep better. However, try to avoid exercising to the point of sweating within an hour of going to bed. Find exercises that are fun, enjoyable and suits your personal goals or pain condition. Building your strength and stamina, can reduce how much pain you feel.

Relaxation before bedtime

Spending time relaxing before bedtime can help you prepare your body and mind for sleep but try to avoid going to bed before you feel sleepy. Resting in bed can be comforting but spending excessive time in bed without sleeping will upset your body clock. Avoid anything that might stimulate you like work, planning or worrying before bedtime, and try avoiding going to bed feeling angry, upset, nervous or stressed. Using devices like phones or laptops before bed can make it harder to sleep because they give off light that can make your brain think it’s daytime. To help you relax before bedtime, you could try:

• Taking a warm or cool shower
• Doing some gentle yoga or stretches
• Several minutes of deep breathing exercises

Your bed and bedroom

Healthy sleep practices include having the right environment to sleep in. These include:

• Checking your bed and mattress, for example a supportive, comfortable mattress and pillows may put less strain on painful joints if you have arthritis pain.
• Considering using supports or pillows for areas of your body that have pain, like under your knees, if you have back pain.
• A comfortable bedroom that is the right temperature, light and noise, for instance, you may prefer a dark, quiet and cool environment to sleep in.
• Keeping your bedroom for sleeping and make it a calm, space without work or recreational areas, like a desk, TV, radios or stereos.

Thoughts and emotions

People with long-term pain often worry about their pain, which may increase their stress and anxiety or make them fearful of not falling asleep. Using relaxation techniques such as mindfulness, meditation and music can improve sleep quality and decrease sleep disturbance for people with long-term pain.

Sleep positions

You may not give much thought to the position of your body when you’re asleep but changing sleep positions can help with some types of body pain. Here are a few tips about the 3 popular sleeping positions and their impact on pain:

1. Sleeping on your side:

This position can help with back and neck pain because it helps with keeping your spine aligned. Your head pillow thickness must match the distance between your neck and shoulder. If you sleep on your side, shift positions occasionally and try to sleep more on your left side as this puts less pressure on your organs. It may also help to put pillows on either side of your body and a small pillow between your knees to align your spine and even out your hips.  Sleeping on your side is not suitable for shoulder pain.

2. Sleeping on your back

Sleeping flat on your back keeps your spine aligned and evenly distributes your body weight, helping with neck or back (lumbar) aches or pain. Using a supportive pillow, a memory foam pillow or a rolled-up towel underneath your neck may also help with neck pain. Keeping both of your arms by your side while sleeping on your back will help to avoid unevenness that may lead to shoulder or neck pain. Sleeping on your back, might not be suitable for some types of back pain. Speak to your doctor or a physiotherapist if you’re unsure.

3. Sleeping on your stomach:

This position is not recommended for people with neck or back pain. Sleeping on your stomach usually causes misalignment of your spine because your neck and head must twist to the side.  An unfirm mattress can also cause your stomach and hips to sink into the mattress, stretching your spine out of alignment.  To avoid pain from sleeping on your stomach use a thin pillow or sleep without one. Place a pillow under your hips to even out your spine and relieve pressure.  It's also advisable to sleep on a firm mattress to help keep your spine aligned.

Medicines

It is important to discuss the medicines you’re taking, with your doctor or pharmacist There may be potential risks when using medications for both pain and sleep disorders. Medication used to treat pain can have both positive and negative effects on your sleep, that should be considered when discussing options with a healthcare professional.

NSAIDS are commonly used pain relievers. Ibuprofen is a type of NSAID, which when studied, has shown that it has no significant impact on sleep. Nurofen Express 400mg Liquid Capsules contain ibuprofen. It's quickly absorbed for rapid relief from pain and lasts up to 8 hours, providing relief while you sleep. If your pain is not effectively controlled with pain relievers, your doctor may also suggest ways of improving your sleep to help with pain.

FAQs

Why is pain worse at night for some people?

Studies have found that there is some proof that our sensitivity to pain may follow our sleep and wake pattens (called our circadian rhythm), peaking in the middle of the night and at its lowest in the afternoon. It has also been suggested that disturbed sleep may affect our body's response to pain and that lack of sleep increases the release of a type of protein (cytokines) that’s involved in the body’s inflammatory response, which may make people more sensitive to pain.

What types of pain can affect sleep?

Chronic pain like arthritis, affects sleep and poor sleep can affect pain. Headaches like a tension type headache and migraine can affect sleep.  The more severe or frequent your headaches, the more likely it will affect your sleep. Studies have shown that there is a link between sleeplessness (insomnia) and low back pain.

Can you sleep while in pain?

It is possible to sleep when you’re in pain. Sleeping better can also help you cope with pain, may reduce pain, and can help improve your health. There are several ways that may help to improve your sleep and cope better with pain at night in this article .

How can I sleep comfortably with pain?

There are several ways that may help to improve your sleep and cope better with pain at night.  From getting the right amount of sleep, having a calm and peaceful sleeping environment to avoiding certain foods before bed, you can read about them in this article .

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