How your sleep patterns could be contributing to your back pain
Poor sleep can be a cause of persistent pain. We hear from four experts
Sleep, like diet and exercise, is closely linked to general health and wellbeing. The amount and quality of sleep we get affects our health in many different ways.
Research has strongly linked sleep problems to heart disease, high blood pressure, obesity, stress, anxiety, depression and poor level of concentration. Poor sleep is also linked to poor immune system function, leading to complaints including cold sores, mouth ulcers, skin reactions, colds and feeling run down.
The critical role of poor sleep in the development and increasing of pain is only being explored in detail in recent years. While many realise that being in pain can cause poor sleep, studies now show that poor sleep among people without any pain at all also increases the risk of developing pain.
This has consistently been found in a range of painful conditions such as lower back pain, neck pain, shoulder pain and widespread pain (pain in many different places).
How sleep can contribute to pain
Sleep is an essential function for survival, like eating or drinking. Therefore, when your body is not getting enough quality sleep, your body can react. It does this by creating an inflammatory response which can make you feel sick, tired and irritable.
Critically, pain is also one of the body’s responses to poor sleep. Think of how sore you have felt in the past when you have a cold or flu, even though you did not hurt yourself. Muscles, bones and nerves can feel more sensitive, sore and painful at times like this, even though they are not damaged. For example, it is common for people with back pain to say that their pain was triggered by something quite harmless (like putting on their shoes) which could not possibly have injured a structure as strong as the back.
In this situation the back pain is typically the person’s body being overprotective due to other factors, such as poor sleep, which makes the body vulnerable to pain. For people who already have pain, it is important to note that the pathways for sleep and pain are linked and affect each other. Thus, poor sleep can turn the volume switch up on pain.
How do I know if I have enough sleep?
Most healthy adults need between 7.5 to 8 hours of sleep per night to function at their best. For some, less than 6 hours per night can lead to worsening back and or neck pain.
Most of us should not only consider the length of sleep, but also questions such as ‘do you feel refreshed in the morning, and throughout the day?’ ‘Do you not always need an alarm clock?’ ‘Do you have enough energy throughout the day?’ If you answer yes to these, you probably have enough sleep.
Improving sleep can reduce pain
It might sound obvious, but sleep and pain cannot be improved if you do not get to the bottom of why you are not sleeping well. This may explain why many treatments fail to help some people — they may not address the reason for the sleep problem. Many people spend a lot of money on things that were not worth changing in the first place. A change of mattress and pillow is often trialled, though for many people these are not very effective. Picking apart the reasons for poor sleep should be the first step and this should guide your plan to help your sleep, pain and overall health. These are some suggestions for sleep which to consider to reduce pain:
1. Consider relevant medical problems
If you are in doubt as to why you are not sleeping, it may be a good idea to talk to your GP. They can help identify and/or address any specific medical conditions that should be considered as part of a better sleep programme.
2. Sleep schedule
Going to bed at the same time every day (or most days) is important to establish a routine (the same goes for waking up). This rhythm will help keep you refreshed throughout the day. This can be difficult when our work or other commitments vary frequently. Sometimes people in pain go to bed very late, as they seek to make themselves exhausted before bedtime so that they sleep when they go to bed.
Unfortunately, this cycle can further exacerbate their pain. Similarly, people in pain can spend long periods in bed not sleeping. In this case, they should try to stick to their regular routine to help their sleep cycle.
3. Exercise more regularly
Even though exercise has been consistently shown to help both sleep patterns and pain, many people in pain avoid it as they are afraid that it will make things worse. But exercise is very helpful for a range of different painful conditions, including back pain and shoulder pain.
When you are not sleeping, exercise and movement can be harder than usual and you might find you get sore and tense quicker than usual. If this occurs, it is important to remember that feeling stiff and sore after exercise does not indicate damage to your body — it simply reflects your body is not used to the activity. Therefore, you should not fear exercise, but rather build it up gradually to let your body get used to it.
4. Boosting mood and reducing stress
If someone suffers from stress, depression, or anxiety, the chances of them having pain and sleep problems are much higher. While realising that addressing these issues is not always easy, taking steps to address stress, mood, and anxiety could have a significant effect on your quality of sleep and on your pain. While certain life events can create a lot of stress, learning strategies to help you cope with these stresses is very important.
Methods to help these will vary as each person has their own personal preferences on what makes them feel good: talking to somebody, exercising, reading, music, dancing, meditation, spending time with family and friends. People in pain often avoid these things for fear of doing damage to their body. However, these things are safe (even if sore initially) and people should feel confident to try them out.
Finally, sleep problems are not relevant for every person with pain. People can have pain and not have a sleep problem, or have poor sleep and not have any pain. However for many people, taking steps to improve sleep could be important to help reduce pain.
Dr Mary O’Keeffe (University of Limerick), Dr Kieran O’Sullivan (Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar), Professor Chris Maher (The George Institute for Global Health, Sydney Medical School), Dr James McAuley (Neuroscience Research Australia)
Health & Living