March is brain and sleep awareness month, so I couldn’t think of a more appropriate time to link the effects of chronic pain and sleep.
“I am the shore and the ocean, awaiting myself on both sides.”
The Brain on Pain
Because of the functional and structural changes of the brain of people who experience persistent pain, many experts consider chronic pain as a brain disease. Advances in neuroimaging and neurophysiology provide us important insight because we can see alterations in the brain.
Harvard scientists made a breakthrough in January 2015 stating, “For the first time, scientists have found evidence of neuroinflammation in key regions of the brains of patients with chronic pain, according to a new study from Massachusetts General Hospital (MGH), a Harvard affiliate.” The science is emerging.
Chronic pain = pain that recurs on and off for at least three months; and pain that accompanies a long-standing condition.
Chronic pain is an experience. It isn’t just physical; it involves cognitive and emotional processing. When the primary source of pain is successfully treated and pain persists, it is believed pain becomes centralized,
meaning it takes residence in the brain. This is thought to occur even when the initiating event (such as injury or disease) is outside of the brain or spinal cord in the peripheral nervous sytem. Understanding the intricacies of chronic pain is far too complex for me to teach, but experts agree they are learning a great deal about the way our brain processes pain, which will hopefully one day lead to a cure.
Chronic Pain and Sleep
Over 100 million Americans experience persistent pain. It wakes us up with a jolt; keeps us from getting to sleep, or causes microarousals leading to fragmented sleep that interrupts the slow wave healing stages. Persistent pain is a thug that commits robbery in the isolation of our bedroom. And, regardless of the cause of our pain, the cycle is the same, we don’t sleep and when we do, it isn’t that productive, makes us irritable, steals our energy, and causes depression. All of this lowers our pain threshold. So we ask, “Is lack of restful sleep causing our pain?” or “Is pain interfering with our sleep?”
When the Tide Is High
Maybe there is a primary sleep problem, like sleep apnea, restless leg syndrome, insomnia, a circadian rhythm disorder, or inefficient sleep cycle. Or, maybe there is underlying problem that can be treated such as, getting up in the middle of the night to use the bathroom. Maybe we are grinding our teeth in our sleep because of the pain, or maybe that teeth grinding is a primary problem that interrupts our sleep. Maybe the pain is just too much to allow us to get the sleep we need, or maybe it is a bit of all of the above. Regardless, sleep is a very important part of feeling better, because it plays a huge role in healing.
For the Love of Sleep
According to the National Sleep Foundation, microarousals are harmless for a person not experiencing chronic pain. Maybe that’s because chronic pain causes abnormal signaling between the body and the brain. There is a variety of reasons as to why this happens, cells (particularly glial cells) behave abnormally, neuro-hormone levels are different, and a variety of other things can happen. But, after reviewing the literature, three topics consistently emerge.
Chronic pain affects sleep quality and quantity.
Sleep quality and quantity has an effect on our pain threshold.
Persistent pain and non-restorative sleep both affect our physical, emotional, and mental well-being.
There are many tools available to us that are worth a try. I have interstitial cystitis and I was fortunate to have a referral by my specialist to a physical therapist specially trained in this field. She taught me to change my behaviors, my response being to get out of bed to urinate when I knew full well my bladder was empty, even though I felt the urge. She had me set a timer and resist getting up for five minutes, then ten minutes, and so—on. It worked. These are things a sleep therapist does. They help you find relaxation techniques and give you other tools that work best for you.
So, if you feel your pain is affected by your sleep or vice versa, please discuss it with your healthcare professional. Maybe a medication is interferring with your sleep, because sometimes they start to have an opposite effect. Or, maybe a side effect of one of your medications is sleep disruption. Leave no stone unturned so you can improve those delta waves of sleep that are so often intruded upon by pain.
I wish I had a cookie cutter answer for the pain-sleep conundrum, but the fact is that the problem must be addressed on an individual basis. We have different pain disorders, we are on different medications, etc. If your problem is significant, ask your healthcare provider about finding a sleep specialist. As Steve Job said...
"For you to sleep well at night, the aesthetic, the quality, has to be carried all the way through."
Please leave a comment if you have anything to add. We all learn by sharing. In healing, Celeste