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Pain and Sleep - a Two-Way Street

Pain and Sleep – a Two-Way Street

Below is a screenshot from my phone. It shows a recent night of sleep tracking from my Fitbit. The red parts are when I was awake. It’s pretty easy to tell from this picture when I got up, took two (more) Tylenol®, and finally got some decent sleep.

We’ve all been there. All those little aches and pains that we don’t notice (or simply ignore) during the day when we’re busy seem to magnify themselves in the dark quiet of the night. That slightly sore ankle, knee, hip or shoulder suddenly takes over your whole attention and will not let you get comfortable and go to sleep.

I’ve complained (to whoever would listen) about pain keeping me awake. Various doctors have prescribed various pain medications, which have had various results. I’ve always contended that the problem wasn’t the pain, the problem was the lack of sleep. If I’m asleep, I don’t realize that I’m in pain.

There is no question that pain interferes with sleep.

What I didn’t realize is that it’s a two-way street. According to the research, sleep complaints are present in up to 88 percent of chronic pain disorders1,2 and at least 50 percent of individuals with insomnia—the most commonly diagnosed disorder of sleep impairment—suffer from chronic pain.2

Specifically, a study published by the National Institute of Health tells us that impaired sleep is a better predictor of pain than pain is of sleeplessness. This is true for both the short term and the long term.

I know that when I’ve had a rough night’s sleep, I feel worse the next day. Everything seems to hurt more. This is not a coincidence. It turns out that sleep disturbance actually disrupts key processes that your body needs to combat pain. It is complex and various studies have included things like dopamine and opioid receptors that help your body manage pain. And, based on the study, people with chronic pain seem to be especially affected. In addition, a study of fibromyalgia patients indicates that sleep acts as sort of a controller between pain and depression. The better the patient’s sleep, the fewer depressive symptoms they had – even with pain.

Further, there appears to be a long-term association between sleep disturbance and certain conditions. In various studies, people with sleep disturbances were more likely to eventually develop conditions like fibromyalgia, headache (including migraine), and chronic musculoskeletal pain months or years in the future.

So what does all this mean?

To me, it means there is a stronger link between pain and sleep than I ever imagined. But for scientists, and those of us with chronic painful conditions, there is good news. One of the things that is being considered is whether treating sleep disturbance would be a preventative treatment for chronic pain or perhaps even be able to prevent people from developing painful conditions. If you treat the sleep disturbance early, can you lessen chronic pain or avoid things like fibromyalgia? To me, sleep seems like an easier issue to address than pain or long-term conditions. I hope this is one of the answers we’re looking for.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Mork PJ, Nilsen TI. Sleep problems and risk of fibromyalgia: Longitudinal data on an adult female population in Norway. Arthritis Rheum. 2012;64:281–4.
  2. Smith MT, Haythornthwaite JA Sleep Med Rev. 2004 Apr; 8(2):119-32.


  • Lawrence 'rick' Phillips moderator
    1 year ago

    My back (and wife) with the study and your observations. I may ask her if my pain interferes with her sleep. I know the answer however.

  • Richard Faust moderator
    1 year ago

    Glad the article resonated with you cannonsplash. The decision to get a joint replacement is truly a personal one and glad you are seeking information. Thought you might be interested in this article from one of our contributors on the decision process and things to consider: Best and keep us posted on how you are doing. Richard ( Team)

  • kat-elton
    1 year ago

    Thanks Carla, for another great article, that is very timely right now. Sleep has been such a strong force for my ability to feel good, even with pain, and it also has been such a struggle because of the pain and inflammation. Currently I’m doing okay but I never take my sleep for granted because it can be challenged without warning. I agree, sleep is the best medicine and a great place to start when you want to control your pain.

  • cannonsplash
    1 year ago

    Carla – Pertinent. Didn’t sleep much the past 2 nights. Decided this morning to call the surgeon to talk about replacing my left shoulder. Why put it off? Tylenol isn’t really touching the pain right now. Thanks for once again being right on topic!!

  • Kelly Mack moderator
    1 year ago

    Great article Carla! Really good to understand a little better how pain and sleep are deeply intertwined. Hopefully doctors can keep this in mind when treating RA patients. At one time, I had a doctor instruct me to take certain medications right before bed because it would help with my pain and let me sleep better. Getting good sleep with RA is so hard, yet so important! Best, Kelly ( Team)

  • Wren moderator
    1 year ago

    Like you, I hurt more when I haven’t slept well. But even when my RD pain is relatively quiet, poor sleep an aoften takes an all-over physical and mental toll on me. Insomnia is a serious problem for many of us. I hope science will soon come up with a way to help lull us into a deep, healthy sleep at night so we can start our days better equipped to approach them with joy.
    Thanks for a great article, Carla! 😀

  • GinaB
    1 year ago

    I agree. I feel a lot better the next day with a good nights sleep. I believe I have master a routine to a good nights sleep (7) nights in a row. At 9:30pm take my night meds (two Gabapentin’s and one 2.5 Lorazepam) and I still use to wake up now I have added One cup of Sleepy Time tea and within 20 min of finishing the tea I am out for the night. For all of you who cannot sleep try the tea, worth a shot. Happy Dreams ZZZZZ

  • Alesandra Bevilacqua moderator
    1 year ago

    Thanks for sharing with us, GinaB! Glad you found a sleep routine that gives you some rest. Warmly, Alesandra ( Team)

  • Larry Sawyer
    1 year ago

    Sleep is. the best medicine

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