HEALTH: Understanding sleep and pain

Sleep is an essential function, allowing our minds and bodies to recharge, develop and heal from illness. Despite its importance, as many as 16 million adults in the UK experience sleepless nights with nearly a quarter having no more than five hours of sleep each night.

Dr Neil Stanley is a sleep expert with nearly four decades experience working in sleep research with everyone from the RAF Institute of Aviation Medicine to the British Sleep Society and now Sleepstation, a sleep improvement programme backed by science.

Throughout his career, Dr Neil has had an interest in the relationship between sleep and chronic pain. It is estimated that as many as 89 per cent of patients with chronic pain experience sleep disturbances.

“If I tell you that pain causes poor sleep then that’s pretty obvious, but what is perhaps not as obvious is that poor sleep directly affects your perception and your sensitivity to pain,” explains Dr Neil. “The vast majority of people living with chronic pain have sleep problems, usually different types of insomnia and the inability to fall asleep, they’re often waking up in pain in the middle of the night.”

Finding out how to get better sleep can help your sensitivity to pain and emotional resilience when dealing with pain.

Cope

“One of the things that poor sleep does is it can slow down healing, but it can also affect you from a sort of emotional point of view: if you have poor sleep you’re less able to cope,” reveals Dr Neil. “Poor sleep can affect any of us but it really adds to the situation for people with chronic pain.

“A better night’s sleep won’t always improve pain, but it can help you deal with it better.”

A lack of sleep or bad quality sleep has been linked to higher levels of stress, depression and anxiety – studies have shown more activity in the brain’s centre of fear and anxiety for people who are sleep deprived – but even short-term bad sleep can have an effect on your health.

“Even one poor night’s sleep reduces your immune system leaving you four times more likely to catch a common cold the next day,” shares Dr Neil. “In the longer-term poor sleep has been related to things like obesity, diabetes and stroke, there’s a whole host of concerns.”

The crux of this problem is often a lack of understanding about the role sleep plays in your health from healthcare professionals who don’t specialise in the area. With a strong connection between sleep and the body’s ability to cope with pain, more awareness and training is needed in this area for chronic pain patients.

Holistic

“It’s not really good enough to look at only addressing the pain because you can reduce a pain score but if your sleep is still bad you aren’t going to be getting better,” offers Dr Neil. “You really need to target both the pain and the sleep disorder in order to allow you to cope.”

In order to do this, healthcare professionals need to approach sleep and pain in a holistic way, paying attention to how they are linked and treating them simultaneously.

“If you tell your doctor that you’re in pain and you can’t sleep then they will likely treat the pain, it’s what they have been trained to do. We often have this compartmentalisation in western medicine,” explains Dr Neil. “I’m very much a fan of empowering the patient: if people with chronic pain are in this situation they need to go to their doctor and say I have a sleep problem and I want to use this session to talk about my sleep rather than just my pain.

“Talk about how it affects your day, how it affects your performance, your mood, your ability to do activities in daily life: everything from driving your car to chopping a cucumber. Don’t just accept that because you’re disabled, because you live with chronic pain that you have to live with bad sleep.”

Treatment

Based on his experiences, Dr Neil would recommend cognitive behavioural therapy for insomnia (CBTI) as a course of treatment.

“The first line of treatment for insomnia in adults of all ages should be CBTI, it’s about things like sleep hygiene but it’s also about addressing the thoughts, concerns and behaviours that come with poor sleep,” reveals Dr Neil. “If you go to bed thinking I’m in pain and therefore I will have a poor night’s sleep then you’re going to have a poor night’s sleep.

“This type of anxiety is going to keep you awake so you need to be relaxed in both body and mind.”

While your GP or a member of your healthcare team can refer you for CBTI, you can also implement some of its practises at home.

“You could get up out of your bed and do something relaxing until you feel sleepy again or use a blocking method like subtracting seven from 1,000 repeatedly or naming an animal for each letter of the alphabet,” recommends Dr Neil. “You don’t necessarily have to do a full course of CBTI to feel the benefits of it.”

By self-advocating and looking into treatment methods like CBTI, people living with chronic pain can take steps towards better sleep, but more training and awareness is needed in healthcare to make a real difference.

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