Sleeping Soundly with Chronic Pain

If you live with chronic pain, whether from pounding headaches, an autoimmune disorder or an old injury gone awry, you know how difficult it can be to get to sleep. And when you can’t rest, pain increases, making it harder and harder to break the cycle of escalating pain and sleeplessness.

Pain doesn’t just make it harder to fall asleep and stay asleep, but can also impact your quality of sleep. For example, you may sleep less efficiently, spending less time in the most restorative phases of sleep.
Yet sleep has so many health benefits beyond staving off pain. It helps the brain learn and remember new things, bolsters the immune system, keeps moods stable and reduces stress. ­­­­­­Restful sleep can even reduce the intensity and duration of pain. So, how can people with pain take charge of sleep? Try the tips below to take the stress out of bedtime and harness healthy ZZZs.

Adjust your pillow
If you have neck or back pain, sleeping on your stomach can exacerbate your problem because it causes your spine to arch and your neck to twist. Your sleeping position should take any health conditions (such as acid reflux) into account, so check with your physician before switching your routine.

Ready for a change? Body pillows can help reinforce a new sleeping position by preventing you from tossing and turning. If you have back pain, sleeping on your back with a pillow under your knees can take pressure off of the spine. Holding a body pillow between your knees can also prevent those bony joints from touching and help align your hips for greater comfort.

If you have neck pain, an orthopedic (contoured) pillow can help provide support. Remember that any time you sleep, your positioning is important, so consider a travel pillow if you have a long flight or if you plan to sleep while riding in the car.

Practice Mindfulness
If you have a hard time turning your attention away from pain while lying in bed,  remind yourself that a thought is just an idea; you don’t have to believe in it or act on it. Instead, try this simple, pain-reducing exercise:  
  • Set a timer for 5 minutes.
  • Find a comfortable position to lie down.
  • Focus on your lungs expanding and contracting as your breathe in and out for a few moments.
  • Put yourself in neutral frame of mind. It may help to imagine cares and worries from the day sailing or floating away.
  • Observe your thoughts without labeling them "good" or "bad."
  • If a negative thought ("This pain will never end" or "The pain is too awful, I can’t bear it") pops up, acknowledge it, then turn your attention back to your breathing.
We know that the brain and body are connected, and stress, depression and anxiety play a part in how we perceive pain. Try allowing yourself to experience these thoughts without embracing them to prime your body for healing, restorative sleep.

Relieve Muscle Tension
Carve out time in your schedule for pain-management techniques that work for you, such as a hot bath, an ice or heating pack or a few minutes of slow, even breathing. Regular relaxation rituals, such as calming music or aromatherapy (try lavender to aid sleep), relax aching muscles to break the cycle of pain and help you drift off to sleep more easily.

Get Strategic
Simple sleep hygiene, or the habits you follow around bedtime, can make a big difference in how well you sleep. When pain is bothersome, it can be easy to overlook these basics. But the fewer factors you have to contend with in addition to pain, the more likely you'll be able to fall asleep and stay asleep. Remember to:
  • Limit environmental noise or wear earplugs.
  • Make your bed a place for sleep and sex only, not work or screen media.
  • Go to bed and wake up at the same time each day (even on the weekends).
  • Avoid long naps, especially in the late afternoon and evening
  • Limit alcohol and caffeine intake in the hours before bed.
  • Exercise regularly, but avoid working out within three hours of your bedtime.
  • Limit time spent staring your computer, phone, TV or other screen before bed.
  • Don't share your bed--or your room--with pets, which can disrupt sleep.
Rethink Your Attitude
Thinking about pain frequently and dwelling on its negative effects on your life can make it harder to go to sleep. Scheduling a fun distraction, even something as simple as reading a favorite magazine, can take your mind off worrisome pain and make it easier to fall asleep.

Consider Supplements
Sleep-promoting supplements, such as melatonin, may help you get much-needed shut eye without a prescription. Gather information about how tiredness impacts your pain and daily activities and consult a healthcare provider to see if an over-the-counter product could help.

Rule Out Other Underlying Conditions
When pain is out of control, sleep may be impossible. Talk to your physician about your daily pain levels and how best to balance day-to-day function with pain relief. Ask specifically about pain that spikes around bedtime, and how you might use medications for nighttime pain relief (as compared to your during-the-day regimen) if appropriate.

Even a quick chat with a general practitioner during a routine physical can help by ruling out sleep-limiting conditions such as sleep apnea, and ensure that existing medications you may be taking aren't interfering with your sleep.

Chronic pain can have so many implications for daily life, but chronically poor sleep doesn’t have to be one of them. Some sleep loss may be inevitable on bad days, but practicing good sleep habits on a regular basis will help you break the cycle of poor sleep and increased pain, and keep overall pain levels manageable.

Boody, Elisa. "Lavender as a Sleep Aid," Vanderbilt University Psychology Department, accessed on April 22, 2013.

Edwards, Robert R., Almeida, David M., Klick, Brenda, Haythornthwaite, Jennifer A., Smith, Michael T. "Duration of Sleep Contributes to Next-Day Pain Report in General Population," PAIN, 2008 (202-207).
Harvard Medical School, "Importance of Sleep: Six Reasons Not to Scrimp on Sleep,", accessed on April 22, 2013.
Health Promotion and Wellness,"Sleep,", accessed on April 22, 2013.
Healthy Sleep, "Benefits of Sleep,", accessed on April 22, 2013.
International Association for the Study of Pain, "Chronic Pain Management: Measurement-Based Step Care Solutions," December 2012.
Plante, David T., Sewell, Andrew R., Price, Bruce H., Cunningham, Miles. "Sleep, Fatigue and Pain: The Triad of Functional Somatic Syndromes." McLean Annals of Behavioral Neurology, 2006, 1:1-9).
UC Health Line, "Certain Sleeping Positions Can Impact the Quality of Your Rest,", accessed on April 22, 2013.
University of Utah Health Care, "Adjusting Your Attitude about Chronic Pain May Help You Sleep,", accessed on April 22, 2013.
Zhdanova, Iran V., Lynch, Harry J., Wurtman, Richard J. "Melatonin: A Sleep-Promoting Hormone," American Sleep Disorders Association, July 1997, 899-907.
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Member Comments

Great information Report
great informaton Report
I have trouble sleeping due to chronic pain, My body pillow and taking a hot bath help a bit. Report
I finally sleep better most of the time now that I have a bi-pap machine. I use it every night, sleep so much better. Found out my sleep apnea was severe that I need to machine to work with both inhaling and exhaling--hence bi-pap instead of C-pap. I put off being tested for several years, thinking there was no way I had sleep apnea,, boy was I wrong. So please don't hesitate to take to your regular Dr. they will know who you need to see and if you need a referral to see the specialist. Report
Wish someone would write an article like this who had a sleep issue and solved it, sharing their own experience. Report
thanks and do feel drowsy the next day after taking melatonin Report
Thank you for good suggestions. Report
I don't remember the last time I slept through the night! I'm another person who wakes up every couple of hours (if I'm lucky) all throughout the night. Pain is not for the weak! Thank you for sharing this article! Report
I've tried just about all of those tips through the years but the pain wakes me at intervals all night. I can fall asleep but pain will wake me no matter what I try. I sincerely hope it works for others! Report
I have a long history of actually sleeping better with my cats when 1 or more (especially in very cold weather) comes to sleep near me or on me. Report
This article is well documented with a lot of links. Report
great information Report
I just completed a chronic pain course and some of these suggestions were taught to us in the course. Thank you for giving us some new ones we can use. God Bless. Report
I will try some of these suggestions thanks! Report
I've had chronic pain since the mid-90s and now that I'm older and have had multiple fractures, I have even more chronic pain. I've tried all of the suggestions and for me, sleep is elusive because pain will wake me after 45 min all night. I don't get restorative sleep so now my memory and recall is suffering so much that I worry I have early Alzheimers. The same pain that keeps me awake at night also prevents naps so I rarely get more than 4-5 hrs of broken up sleep ever.
The suggestions are very good for others, tho. Thank you. Report


About The Author

Robin Donovan
Robin Donovan
Robin Donovan is a Cincinnati-based freelance writer and magazine journalist with experience covering health, medicine, science, business, technology and design.