Sleep and Its Relationship to Pain

I recently attended the annual American Academy of Orthopedic Manual Physical Therapy conference in Orlando, Florida, where I got to learn from a lot of leaders in the field of physical therapy on a variety of topics. One of the presentations that I was eager to attend was one regarding a topic that is very near and dear to my heart these days: the importance of sleep and how Physical Therapist’s play a role in discussing sleep with our patients!

The presenters did a great job outlining the role that sleep plays for our health, especially the relationship between sleep deprivation and increased risk of cardiovascular disease. Furthermore, and strongly related to what we deal with each day in physical therapy, the relationship between sleep and pain was discussed. There are multiple research studies performed in the past couple of decades attempting to find out the relationship between sleep and pain. For example, a 2015 study of over 10,000 participants found that impaired sleep (reports of insomnia more than once a week, sleep latency greater than one hour, or decreased sleep efficiency) was associated with increased pain sensitivity.(1) Another study that was published this year (2019) showed that baseline sleep disturbance negatively affects pain response to treatment of chronic pain, even with the use of opioid and nonopioid medications.(2) Things that qualified as “sleep disturbance” in this study included difficulty falling asleep and trouble staying asleep.(2)

Ultimately, the research shows that sleep- or rather, difficulty sleeping- has a relationship with multiple bodily functions, including our pain experience. For anyone who has experienced a poor night’s sleep (or experiences this frequently), this isn’t surprising news. The big question to ask is, “How can I improve my sleep?”. The presentation that I attended in October gave some great suggestions for better sleep hygiene:(3)

  • Consistent timing: plan to go to bed and wake up around the same time every day
  • Limit bedroom activity: the bedroom should be for sleep and intimacy only (not reading, work, watching TV, etc.)
  • Eliminate pre-bedtime stimulation
  • Try not to exercise within 2 hours of bedtime
  • Eliminate caffeine at least 4 hours before bedtime
  • Avoid large meals, spicy food, and liquid 2-3 hours before bedtime
  • Eliminate electronics at least 30 minutes before bedtime
  • Create a dark, cool environment
  • No sleeping pills
  • No naps
  • Refrain from alcohol 3-4 hours before bedtime

If you’re struggling with sleep, start by looking at this list of suggestions and identify areas where you currently do things differently. Think about one to two changes you can make in your pre-bedtime habits to start to work toward better sleep and, ultimately, better function. Remember to mention disturbed sleep to your health providers, including physical therapists, to get further individualized suggestions to help your sleep hygiene.

  1. Sivertsen B, Lallukka T, et al. Sleep and pain sensitivity in adults. Pain Journal. 2015;156:1433-1439.
  2. Koffel E, Katz AM, et al. Sleep Disturbance Predicts Less Improvement in Pain Outcomes: Secondary Analysis of the SPACE Randomized Clinical Trial. Pain Medicine. Doi: 10.1093/pm/pnz221
  3. Shepherd M, Dickerson C. Sleep Quality Assessment and Intervention in OMPT. American Academy of Orthopaedic Manual Physical Therapists Annual Conference. Orlando, FL. October 26, 2019.