Why you can't sleep when you're in pain
January 17th, 2012
11:14 AM ET

Why you can't sleep when you're in pain

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs regularly on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

Patients often come to me with symptoms they describe as "fatigue" or "tiredness." The first task is to tease out exactly what they mean. To a sleep doctor, fatigue and tiredness usually mean the body needs or wants to rest, whereas "sleepiness" suggests that the mind wants to rest.

Patients with any pain syndrome often come in complaining of fatigue or tiredness. Their bodies have trouble falling and staying asleep. Sleep and pain are both ultimately controlled by the central nervous system. Poor sleep and pain form a vicious cycle - uncontrolled pain makes sleep difficult (if not impossible) and, in turn, the resulting poor sleep makes it more difficult to adequately control the pain.

Most physicians know very well that poorly controlled pain will cause difficulty sleeping. But they often don’t think about the patient having a separate sleep disorder that may be fueling the pain.

For this reason, it is important for people with chronic pain to first have a thorough sleep evaluation in order to determine if there is an underlying cause. If a patient has something like sleep apnea or restless legs syndrome, then the diagnosis and treatment of these disorders can make a huge impact on  sleep and, as a result, on his or her quality of life.

Unfortunately, many times people with chronic pain syndromes do not have sleep disorders that are easily diagnosed, but they do have sleep disruptions of unknown origin.

They also tend to spend a lot of time in the light stage of sleep and have a characteristic, but non-specific, finding on their EEG (electroencephalogram, which measures the brain's electrical activity) during the sleep study. This finding is called "alpha intrusion." The cause of this particular brain wave pattern is not known, but it has been associated with different disorders that lead to chronic fatigue or chronic pain. There are no specific treatments that are aimed at alpha intrusions - we just try to treat the underlying pain syndrome and any primary sleep disorder that patients have.

The question remains whether sleep disturbances can actually lead to fatigue or pain syndromes. In fact, recent research has shown that people who complain that their sleep is disturbed or not refreshing have three times the risk of developing fibromyalgia. Fibromyalgia is poorly understood, but there is a specific pattern of musculoskeletal pain with the involvement of common anatomic sites, or trigger points, that can be tested on physical exam.

The persistent myalgia, or muscle pain, and the fatigue are thought to result from a disturbance in the functions of the central nervous system. Since sleep is a function of the central nervous system, it makes sense that the CNS dysfunction might start with sleep and then affect pain receptors and pain perception. And it is often the case that the healing can’t really begin until the patient can get the right amount of good quality sleep.

The take-home message here is this: If you have chronic pain, for whatever reason, and feel tired or sleepy in the daytime, get a sleep evaluation. Pain doesn't explain everything.

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Filed under: Sleep

soundoff (667 Responses)
  1. chuck

    When I am in pain or sick all I want to do is sleep.

    January 17, 2012 at 14:34 | Report abuse | Reply
    • lawl

      I agree, sleep is the ultimate pain killer.

      January 17, 2012 at 15:33 | Report abuse |
    • lauren

      Agreed! The problem is, when you have a chronic condition like fibromyalgia, you do WANT to sleep, and you may even sleep a normal 7 hours a night. The problem is that stages of sleep are disrupted (the "alpha intrusions" mentioned), so when you wake up, you don't FEEL rested. Your body has trouble getting the "restorative sleep" that normal people have.

      May 12, 2012 at 00:53 | Report abuse |
  2. docdewitt

    Never underestimate the value of a good night's sleep. I have to mention that the sleep which follows Ambian or some of the other sleep aids, just isn't the same...

    January 17, 2012 at 14:51 | Report abuse | Reply
    • Shawn

      I tried legal lean syrup for sleep, it seemed to help a lot better than other remedies and it's all natural! https://www.legalleans.com/single-post/2017/06/07/Legal-Lean-Drink-Mixes

      June 17, 2017 at 10:17 | Report abuse |
  3. Coaster

    Well, that seemed like a waste of advice. Unless you are in danger, like with sleep apnea, then she just came right out and said there is nothing they can do if you have other sleep issues. So WHY BOTHER with the test? Sleep studies are already canted to look for sleep apnea.

    Sure, pain doesn't explain everything. Neither does poor sleep. What about stress? Illness? Allergies? What about just having a bad night?

    January 17, 2012 at 15:56 | Report abuse | Reply
    • johnkeating

      Eh, more dependency-mongering by medical doctors. They want you to see them for every little issue you have[, so they can control you]. The one issue I have is, I thought fibromyalgia (which I have been suffering from for years) led to sleep degradation, not the other way around, as she states? Maybe it's a vicious cycle. I've tried Cymbalta so far and hated the way it made me feel. I've been told sleep deprivation lowers your immunity, and you can die from lack of sleep. Bipolar people going through mania can go for days or weeks or even months without sleep. Some say that during sleep you actually leave your physical body and go to 'other places' [for educational purposes].

      January 18, 2012 at 00:19 | Report abuse |
    • Devin Gray MD

      John, we don't all want to control you, I promise. Some of us just want to give you all the information so that you can make an informed decision.

      January 18, 2012 at 13:47 | Report abuse |
  4. palintwit

    Sarah Palin likes to sleep during sex.

    January 17, 2012 at 16:14 | Report abuse | Reply
  5. Abot Bensussen

    I've had fibromyalgia for 30 years, the last five I've been treated with Xyrem, (sodium oxybate) for deep sleep. Now that I get the 3rd and 4th stages of sleep, I have less pain and more life. I was bedridden before sleeping well. I also use a vpap machine for breathing while sleeping, something my brain forgets to do.

    Now I can exercise, drive my car, enjoy my grand children, my life has been returned to me.

    January 17, 2012 at 18:14 | Report abuse | Reply
  6. Memo

    You can sleep in pain. I once got a sprained wrist at summer camp, where they are not allowed to give you any drugs that your parents didn't provide. I just lie (laid?) down on the bunk, and before I knew it, I was awak the next morning. I think the trick is to be dead tired from forced playing all day.

    January 17, 2012 at 22:51 | Report abuse | Reply
    • In pain for 30 years

      You obviously have never had ongoing severe pain for more than a day or so. I imagine that it is easy to sleep in that situation. Try hurting all over your body for 30 years and then even YOU might get the hint that the article is not talking about minor/temporary pain but pain that completely overtakes or consumes your life – in fact kills your prior life. Those of us that have to endure this type of pain (and exhaustion) only exist – and not in a fun way.

      January 18, 2012 at 11:27 | Report abuse |
    • Pam

      I have arthritis and fibro; when they are screaming, there is no good sleep for me. I have a heated mattress pad that helps, but when my shoulders are hurting and wake me up, it takes a while to get comfortable enough to get back to sleep. Pain meds and muscle relaxers help lower the threshold, so that I get at least six hours.

      January 31, 2012 at 19:23 | Report abuse |
    • MsTrice

      Memo....you are an IDIOT. A hurt wrist does not compare to something like Fibromyalgia or chronic back pain which I personally have. I have not had a good nights sleep in years. Anyone could sleep if they were really dead tired. Anyone with kids knows that! If you don't have anything intelligent to say you should just keep it moving!

      February 14, 2012 at 14:10 | Report abuse |
  7. Memo

    Gee, this author is a little sensitive. Deleting comments a bit much?

    January 17, 2012 at 23:49 | Report abuse | Reply
    • Memo

      Oh wait, never mind.

      January 17, 2012 at 23:50 | Report abuse |
  8. Bill

    Gee, and here I thought my sleeplessness was caused by my busted up shoulder and hip. Who'da thunk it came from all those other fancy things??

    January 18, 2012 at 07:30 | Report abuse | Reply
  9. portland tony

    Why can't you sleep when you are in pain? CAUSE IT FRIGGING HURTS! Although the body will normally shut down and allow you to rest when it senses an injury.

    January 18, 2012 at 09:28 | Report abuse | Reply
    • Devin Gray MD

      Tony, the point that Dr. Shives is making is that the time spent "sleeping" when you are in pain is not restful sleep. People sleep more lightly and sometimes wake up more than 100 times per night but don't remember waking up. All they know is when they get up in the morning they feel even more tired than when they woke up.

      January 18, 2012 at 13:38 | Report abuse |
    • Devin Gray MD

      Sorry,,,typo. When they wake up in the morning they feel even more tired than when they went to bed.

      January 18, 2012 at 13:39 | Report abuse |
    • Shawn

      AMEN! I agree with you, it's figgin impossible. You should try relaxation syrup (legal lean), it even helps a bit with the pain. https://www.legalleans.com/legal-lean-blog

      June 17, 2017 at 10:18 | Report abuse |
  10. CFS Facts

    When I went to a doctor complaining that I was not sleeping due to constant pain, he handed me anti-depressants and insisted that I didn't need either x-rays or a sleep study because "sometimes when we think we are awake, we are really asleep!" He refused to listen that if that ball of yarn at midnight is a scarf at 6 AM, I am not confused about how much I slept. Eventually, I got to a chiropractor, who asked how the other doctors had all missed 3 fractured vertebrae. Easy ... none of them wanted to do x-rays, all they wanted to do was relate my constant pain to the fact that I was divorced.

    January 18, 2012 at 11:09 | Report abuse | Reply
  11. dom

    i pretty much agree with bill. i always figured my pain was caused by being tossed across a bus due to bad driveing, injuring my neck shoulder and back. some nights i can eventualy get some sleep while other nights like last night i just can't find a reduced pain possition so was up all night even tho i am tired and sleepy as heck.

    i don't recomend takeing sleeping pills, i have lost 3 friends to sleep medication, and they DID NOT OVERDOSE. it was explained each time that if they hadn't taken the pills they would have just woken up and not died.

    January 18, 2012 at 11:24 | Report abuse | Reply
  12. Devin Gray MD

    Dr. Shives, your shameless plug that all patients with chronic pain need a sleep study has poisoned an otherwise well-written and informative article. Perhaps you should disclose in the article that your primary source of income is doing sleep studies?

    January 18, 2012 at 13:31 | Report abuse | Reply
    • Michael

      Well said and that's the problem with most medical advice these days!

      January 19, 2012 at 09:03 | Report abuse |
  13. Elizabeth

    I hope that much more research is done. My (adult) daughter has fibromyalgia, my husband has cancer, and I have rheumatoid arthritis. We are always dragging around, weak and non-functional. I agree that sleep is a factor, because all of us have trouble sleeping.
    There may be other factors too. How about the alpha wave disturbance caused by TV or computer screens or artificial light, especially florescent? Light affects the pineal gland, which affects sleep patterns.
    Some people with RA have found that they have low-grade infections, and if treated with low-dose antibiotics (not just any antibiotic, but one in the tetracycline family), over a period of months, they can overcome RA and the pain. Fibromyalgia is now considered to be related to rheumatoid arthritis. Our population is exposed to so many pathogens that a person could have a foreign bacteria, or just never get over an infection.
    Lack of sleep can also be caused by hormone imbalance: just think about "fight or flight;" oddly, adrenalin (also called epinephrine) causes sleepiness. Many people have a melatonin imbalance, thyroid imbalance, etc.
    As I said, I hope much much more research is done. Thank you for this article.

    January 18, 2012 at 13:37 | Report abuse | Reply
  14. John

    Sleep with pain, possible to some. With Cluster Headaches, sleep, laying down even, has a fear factor. After a few months no costume needed to play a zombie because 2 -4 headaches a night, even somewhat controlled, will leave you sleep deprived, and that again deepens the cycle. Don't know what Cluster HA's are, you are lucky!

    January 18, 2012 at 14:07 | Report abuse | Reply
    • Prasad

      The accdniet of finding this post has brightened my day

      June 30, 2012 at 20:58 | Report abuse |
  15. Samuel Getaneh Bogale Calgary Alberta

    As a pain sufferer and one who has difficulty getting a full night's sleep – I found your article very informative. Thanks for sharing!

    January 19, 2012 at 13:48 | Report abuse | Reply
  16. Bob

    This is very informative. My Dad suffered from severe sleep apnea, although he didn't know it at the time. He had chronic pain and was always tired because of the poor quality of his sleep. He had to sleep in a chair because laying down only made his symptoms worse. He tried to treat both problems with alcohol which of course only made things worse.

    January 19, 2012 at 15:43 | Report abuse | Reply
  17. Dee

    I have fibromyalgia, lupus, RA, diabetes & sleep apnea. I find myself just sitting zoned out. Pain & lack of pure sleep will make you nuts.

    January 21, 2012 at 06:50 | Report abuse | Reply
  18. Shannon

    I have had sleep issues most of my life but got a CPAP prescription about 5 yrs ago. It never really helped with refreshing sleep, but it did help me sleep longer. At that time. in 2010 I was diagnosed with costochondritis and suspected Fibromyalgia. My pain and fatigue has gone severely downhill since then. I sleep for days. I'm awake for days. It's a vicious sleep cycle I cannot seem to break, and one I have had for over a decade with less severity than now. I sleep better during daylight hours and have for decades too. So to me, this article simply re-iterates which came first, the chicken, or the egg?

    January 24, 2012 at 06:58 | Report abuse | Reply
  19. Adam

    Try http://www.gettosleep.org.uk for effective sleep tracks and CDs that can aid sleep. Tracks are guided visualisations that allow you to connect with and relax your entire body, calm your mind and allow you to sleep well throughout the night. Testimonials on the website http://www.gettosleep.org.uk

    February 4, 2012 at 12:51 | Report abuse | Reply
  20. Buckaroo Bill

    I have had eight surgeries due to athletic injuries during the course of my life. I also suffer from diabetes and manic depression. I think Fibromyalgia is psychosomatic. Try living in real pain and getting a good nights rest. It does not exist.

    February 15, 2012 at 14:46 | Report abuse | Reply
    • Mamalicious

      Buckaroo Bill, I have fibro & TMJ & Migraines & I'm bipolar. I promise I'm in pain 80% of the time, and I am not making it up in my head. I hurt. The 20% of the time that I'm not in pain, I'm exhausted from the 80% of the time that I am hurting. I have trouble sleeping and I have my entire life.

      February 16, 2012 at 14:57 | Report abuse |
  21. Rose

    I was diagnosed with alpha-intrusion sleep disorder (without a sleep study) and told to go on a tri-cyclic antidepressant. It helped me stay asleep, but now, decades later, I have had to discontinue it because I started getting up while asleep with frightening dreams and injuring myself crashing into walls, furniture, the floor. As soon as the drug was out of my system, the moving around while asleep stopped. But now my early-wakening insomnia is back with a vengeance. And the muscle spasms that may also have been caused by the drug, are still present.

    March 20, 2012 at 10:02 | Report abuse | Reply
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