Insomnia and Pain: A New Perspective

It’s no secret that acute pain following an accident can interfere with sleep.

But new research shows that insomnia is actually a stronger, more reliable predictor of pain than pain is of insomnia.

Physical pain can keep people from sleeping deeplyMy worst bout of insomnia occurred two years ago after I fell and broke my wrist. I had an 8-year-old friend who liked to rollerblade, so I decided to buy a pair of used skates and join him one afternoon in skating around the cul-de-sac outside his house.

The sidewalks were a bit uneven. (A red flag, I’ll admit. I’ll incriminate myself further by admitting that because I was a confident ice skater, I had no wrist guards. Bad call!) Stepping over a curb onto an uphill stretch of sidewalk, I lost my balance and fell backward. Both arms flew back to break the fall, resulting in a messy break in one wrist and a sprain in the other. The pain was so intense I nearly passed out.

How the Pain Affected My Sleep

The morphine and codeine they gave me at the hospital kept me doped up around the clock, and for a few days, sleep was easy. But delays in the scheduling of my surgery resulted in my wearing a heavy splint for several weeks. A pain developed in my upper arm that the hydrocodone I was taking barely touched, and the problem with insomnia began.

In bed, no matter where I put my arm, I couldn’t find a position that was pain free. I turned from one side to the other–gingerly, to avoid jarring the wrist—but I couldn’t get comfortable. When I did drift off, the pain in my arm woke me every few hours.

Night after short night turned me into a zombie. I stumbled around the house cursing my heavy splint and the doctors whose spring vacations led to the postponement of my surgery. Lack of sleep made the pain worse, interfering with my concentration. Usually I’m so focused that an hour can pass before I glance at the clock, but I was looking up from my work every 10 minutes. Not knowing how long the situation would last was making me crazy.

The nightmare continued three weeks, until a physical therapist succeeded in helping me get rid of the pain with advice to sleep on my back with my arm resting on a low stool beside the bed.

Insomnia and Pain: A Two-Way Street

It’s no secret that acute pain like mine can interfere with sleep. Signals of distress coming from anywhere in the body can hinder the brain’s ability to shut down completely for the night.

Chronic pain, too, is linked to sleep problems. It can interfere with getting to sleep and also lead to micro-arousals during the night. These micro-arousals may result in wake-ups and sleep that is lighter and less restorative, in turn leaving people more vulnerable to fatigue, depression, and worse pain during the day.

But new research shows that insomnia is actually a stronger, more reliable predictor of pain than pain is of insomnia. A review paper published by the American Pain Society in December suggests that sleep disturbance may impair key processes that protect us from developing new pain and sustaining chronic pain.

What Kinds of Pain Are Insomniacs Susceptible To?

  • Headaches. Three large longitudinal studies show that insomnia tends to exacerbate the severity of existing headaches and increase the likelihood of developing new headaches down the line.
  • Musculoskeletal Pain. In a prospective study of over 1,300 Norwegian women, the presence of sleep complaints predicted the onset, persistence, and worsening of pain.
  • Fibromyalgia. In a larger prospective study of Norwegian women, poor sleep significantly increased the odds of women developing fibromyalgia within 10 years. Two-thirds of the new cases of fibromyalgia were explained by sleep problems, the authors said.

Pain is inevitable following an accident like mine, and disrupted sleep, part of the package. But research now suggests that some pain may be preventable—yet another reason that proactively treating insomnia and other sleep complaints makes sense.