Does sleep affect my pain?
Updated: Sep 23, 2019
When you ask most people how much sleep they should be getting each night, they will typically tell you 7-8 hours. When you ask them how much they actually get, it is usually quite a bit less than this. In a world where we are constantly on the go, "grinding" as business professionals or small business owners, while taking care of our homes and families, it is difficult to find enough hours in the day to accomplish all of the tasks on our to do list. The first place many people steal time from is the hours they should be spending sleeping.
It is also sometimes challenging to sleep when we are experiencing high levels of stress, upcoming events or deadlines, or commonly what I see in my practice - pain and difficulty finding a comfortable sleeping position. I am frequently asked about the "best" sleeping position, the "best" pillow, and the "best" type of mattress. We'll come back to this.
A recent study assessed the link between sleep quality and low back pain. The study found that nearly 60% of individuals with low back pain reported having disturbed sleep. They also reported that 1 in 2 patients with chronic low back pain seeking care had insomnia complaints. Additionally, they reported that while a poor night of sleep is associated with increased low back pain the next day, a day of higher pain intensity can also lead to a poor night of sleep. Poor sleep quality has also been associated with a wide range of patient moods, pain catastrophizing, and physical function.
Although this study focused on patients with low back pain, the concepts can be applied to any pain or injury. Our body requires rest in order to function at its highest capacity. We need resources for healing, as well as to build strength and improve physical capacity with exercise. Unfortunately, as we mentioned before, when you have pain, it can be hard to sleep! So what can you do!?
The National Sleep Foundation recommends the following tips to help improve your sleep:
1) Limit daytime naps to 30 minutes.
2) Avoid stimulants such as caffeine close to bed time.
3) Exercise regularly to promote good sleep quality (as little as 10 minutes of aerobic exercise can improve sleep quality!).
4) Avoid heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, or carbonated drinks right before bedtime.
5) Get exposure to natural light during the day and darkness at night.
6) Establish a regular, relaxing bedtime routine.
7) Make sure the sleep environment is pleasant - comfortable mattress and pillows, keep the bedroom cool (between 60 and 67 degrees), keep the bedroom dark, and turn off TV's and cell phones.
When patients ask me about sleeping positions, pillows, etc, I am always honest that it's a tough question to answer! How do you control what position you stay in while you are asleep!? Also, different people are comfortable in different positions. My best advice is to find a pillow that allows you to keep your neck as close to neutral as possible, and to find a position where you are comfortable and able to sleep without disturbances. Try to keep your spine as neutral as possible, and use pillows for positioning as needed. If you have lower back pain, sleeping with a pillow between your knees can make you more comfortable. If you sleep on your side and you wake up with shoulder pain, try sleeping on your other side or on your back. Whatever position allows you to maximize sleep and doesn't increase your pain in the morning!
The bottom line is: don't underestimate the importance of sleep. It is just as important in your road to recovery from an injury as doing your therapy exercises!
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Morelhao, P., Kim, L., Pinto, R., Tufik, S., Anderson, M. (2019). Should Physical Therapists Assess Sleep Quality in Patients Seeking Care for Low Back Pain? Physical Therapy, 99(8), 961-963. https://doi.org/10.1093/ptj/pzz058