How to Sleep with Chronic Pain: Key Insights and Actionable Tips to Get Relief

In a recent Stanford Pain Science Lecture, Clinical Psychologist Dr. Sharon Maroukel shared how chronic pain sufferers can sleep better, and explained the intricate relationship between sleep and pain.

Let's recap the key highlights from the former Stanford Pain Psychology fellow’s virtual talk.

What does normal sleep look like?

In healthy adults, falling asleep usually occurs within 20–30 min of going to bed and initiating sleep. When you sleep, your body goes through different sleep stages, typically in about 90 minute cycles. Sleep stages fall under two major categories: Non-Rapid Eye Movement (NREM) and Rapid Eye Movement (REM) sleep. Each cycle typically includes both NREM and REM sleep stages.

During the "deep sleep" portion within NREM sleep, your body relaxes, your breathing slows down, and your brain waves become slower. This is the time when your body repairs itself and restores energy. REM sleep, on the other hand, is when most dreaming occurs. Your brain activity increases, your eyes move rapidly, and your muscles become temporarily paralyzed to protect you from acting out your dreams. REM sleep is believed to support memory consolidation and emotional regulation.

A typical night's sleep involves several cycles of transitioning between these different stages of sleep, and the first cycle tends to be a bit longer and include a good majority of our deep sleep. And so as adults, by definition, we spend a good majority of the rest of our sleep in what's considered lighter stages of sleep, making us prone to wakefulness. This is especially an important consideration when thinking about spikes in pain that may come up at night and wake us up.

What’s preventing good sleep?

Good sleep is obviously crucial for one’s health, so why can it be so difficult to hit the hay? Factors including lifestyle habits, substance use, and more can have a significant impact. Explore a few of them below:

Behavioral and Lifestyle Changes

1. Irregular Sleep Schedules: Frequently changing bedtime and wake-up times can confuse the body's internal clock.
2. Napping: Long or late-day naps can interfere with nighttime sleep.

Substance Use

1. Alcohol: While alcohol may initially induce sleepiness, it can lead to fragmented sleep and reduced sleep quality.
2. Stimulant Medications: Medications for ADHD and other conditions can interfere with sleep if taken later in the day.

Environmental Factors

1. Light Exposure: Exposure to bright light, especially blue light from screens, can inhibit melatonin production, making it harder to fall asleep.
2. Temperature: Extremes of temperature in the sleeping environment can lead to discomfort and disrupt sleep.

Use of Technology

1. Electronic Devices: The use of smartphones, tablets, and computers before bedtime can delay sleep onset due to blue light exposure and mental stimulation.
2. Sleep Trackers and Apps: Ironically, the use of technology to monitor sleep can sometimes lead to anxiety about sleep, making it more difficult to fall asleep.

Pharmacological Interventions

1. Sleep Medications: Using sleep aids or prescription medications can override natural sleep signals, potentially leading to dependence and alterations in sleep architecture.
2. Melatonin Supplements: Taking melatonin can shift the timing of the body's internal clock, useful for managing jet lag and certain sleep disorders.

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Actionable Strategies for Improving Sleep:

Maroukel cited the biopsychosocial model as a means to manage sleep problems and long-lasting pain. The model considers biology, like chemicals in your brain and how you sleep. It also looks at psychology, such as stress and feeling anxious. Plus, it considers social elements, like having a strong support system.

Emphasizing that “sleep is a biological process people can override,” Maroukel shared a variety of ways to improve one’s sleep.

1. Sleep Hygiene
   Examples of good sleep practices include having a consistent sleep schedule, making your sleep environment cozy, and cutting back on caffeine and screen use before bedtime.
2. Cognitive Behavioral Therapy (CBT)
   CBT helps patients recognize how their thoughts, emotions, and actions influence their experience of both sleep & pain, employing techniques such as restructuring negative thoughts, progressive muscle relaxation, guided imagery, and exposure therapy.
3. Social Support
   Social connection can be harnessed through avenues like support groups, vocational rehabilitation, patient advocates, and communication skills training.
4. Behavioral Sleep Medicine Interventions
   Above and beyond Cognitive Behavioral Therapy for Insomnia (CBT-I), interventions can also be geared toward other sleep conditions that may be further exacerbating the sleep and pain cycle, such as positive airway pressure (PAP) therapy for sleep apnea and chronobiotics for circadian rhythm disorders.

Implications for Practice:

As we delve deeper into the complex interplay between sleep and pain, it becomes increasingly clear that our approach to chronic pain management must evolve. By prioritizing sleep as a fundamental component of pain management strategies, we open new avenues for alleviating suffering.

This compelling body of evidence suggests that interventions aimed at enhancing sleep quality and addressing sleep disturbances could be pivotal in chronic pain management. It's not merely about managing pain but understanding and treating the interconnectedness of sleep and pain for holistic patient care.

Enjoyed this blog? Explore related topics to better manage your pain and the pain of others. 

“Pain & Sleep: Strategies to Improve an Important Relationship with Dr. Manoj Jagtiani”

“Mindfulness for Chronic Pain with Samsuk Kim PhD”

“Biopsychosocial Model of Pain Management with Dr. Mandy Conrad”