Insomnia and Pain: Advice on How to Treat the Vicious Cycle

One of the leading causes of insomnia is chronic pain, and if you've ever suffered from back problems, fibromyalgia, or any other medical condition that causes great discomfort, you understand why you can't sleep. But it isn't a one-way street: Doctors now realize that insomnia actually enhances pain, as well.

Being awake for prolonged periods during the night may impair our natural pain-control mechanisms, according to a 2007 study from Johns Hopkins University. Researchers found that women who were woken several times throughout the night—a sleep profile similar to someone with sleep-maintaining insomnia, shift workers on call, or new parents caring for babies—had lower thresholds of pain than women who slept their normal hours.

Seek treatment for both sleep and pain problems
Instead of simply referring patients back to their doctors for pain management, sleep specialists now treat them for insomnia just as they would anyone else—with sleep medication, cognitive-behavioral therapy, or both. But they won't get involved in pain care.

"We try to keep the lines drawn," says James Wyatt, PhD, laboratory director of the Sleep Disorders Service and Research Center at Rush University Medical Center in Chicago. "We're happy to fix patients' sleep problems, but we'll point out that they might want to see their doctor for better pain management."

Relieving pain may improve sleep—but you might need help
Pat Skiba, RN, 45, of Shelton, Conn., became a patient advocate for chronic pain patients because of her own battle with injury and insomnia. After a car accident in 2000 damaged her spinal cord, she says she barely slept each night for more than a year—waking every half hour to sharp, electrocution-like stabs shooting from her lower back into her right foot.

There was no chance Skiba's sleep would improve until she got her pain under control, which she finally did with an implantable spinal cord stimulator device. But even after her pain decreased, she still had an overwhelming fear of going to bed, and her insomnia continued.

Try behavioral therapy and relaxation techniques
Skiba didn't seek the help of a sleep doctor, but instead taught herself meditation techniques, such as deep abdominal breathing and guided imagery. She turned her bedroom—which she had come to dread as a place of pain and suffering—into a peaceful haven, complete with a fountain, candles, and a rock garden.

"When you can't sleep, you can't do anything; it's exhausting and nerve-wracking at the same time," says Skiba. "I'd recommend that all chronic pain patients create some type of relaxation garden where they can go by themselves or with a loved one, and focus on the calming environment."

By spending quiet time reflecting before bed, Skiba has been able to make peace with her sleep issues. Now working with chronic pain patients, she teaches them the same techniques that have helped her.

As a nurse, Skiba is proud that she can reach patients in a way that doctors don't usually have time to. "I worked the last five years in a pain clinic and every single patient dealt with sleep loss," she says. "Everyone was on Valium, sleep aids, it ran the gamut. It's frustrating to see doctors just write prescriptions for sleeping pills and send patients away when there really are other things they could be doing."