Is There a Link Between Sleep Problems and Musculoskeletal Pain?

We know that a good night’s sleep is imperative to our health, but rest is even more crucial for people with chronic pain conditions, as it helps the body heal. However, good sleep can be hard to come by when pain is prominent. We spoke to several medical experts to get to the bottom of the link between sleep problems and musculoskeletal pain.

The link between sleep and pain

Sleep and pain share a complicated relationship. Pain can disrupt sleep, and poor sleep can increase the intensity of pain. Medical studies have identified a link between sleep problems and musculoskeletal pain. It is estimated that between 50% – 80% of those living with chronic pain experience sleep disruption. Insomnia is the most common sleep disorder associated with chronic pain, followed by restless leg syndrome and obstructive sleep apnoea.

What is musculoskeletal pain?

Musculoskeletal pain is a type of pain that affects the muscles, tendons, ligaments and bones. The causes are varied but include trauma (such as a fracture), postural strain and repetitive movements. Muscles often feel like they have been overworked, and the most common symptoms besides pain are fatigue and sleep disturbance.

Treatment for musculoskeletal pain can vary but often include:

• physical therapy
• acupuncture
• chiropractic care
• anti-inflammatory medication

Whilst it is common for musculoskeletal pain to stem from an injury, there are also chronic medical conditions that result in musculoskeletal pain. Conditions include fibromyalgia which causes muscle pain throughout the body, various types of arthritis and osteoporosis, a disease that causes bones to weaken. Whilst pain relating to an injury can often be treated effectively with a course of programmed physical therapy or medication, these conditions are chronic, and require consistent pain management.

Sleep and healing the body

According to Dr Nick Salinas, Doctor of Physical Therapy and owner at Functional Movement Training –

Sleeping is supposed to be our best time for healing and rejuvenation. As humans, we recover optimally when we are in REM sleep. The trouble for many is that REM sleep is hard to come by if you are in pain. Simply put, if you aren’t in a comfortable and deep sleep you aren’t optimizing your healing and recovery each night.

When you close your eyes and go to sleep, it gives your brain a chance to address other issues in your body. If you have sore or damaged muscles, the brain triggers a release of hormones that encourages tissue growth to repair blood vessels. Sleep also releases hormones that can slow breathing and relax your muscles, to reduce inflammation.

Dr Chun Tang, Pall Mall Medical

When you wake up from a good night’s sleep, your hormone, energy, and stress levels have all been recalibrated – the body is refreshed, and your mind feels more positive. The latter is particularly important, as research suggests chronic pain can be linked to depression. Getting a good night’s sleep is a gateway to those dark clouds lifting.

Dr Chun Tang from Pall Mall Medical says:

When you’re not getting enough sleep, this can have an impact on your pain threshold. This means that you can feel pain easier and with less strain. This can lead to increased pain for conditions that you already have, exacerbate the pain of a condition that wasn’t painful before, and spread pain to other parts of the body.

Approximately 80% of people who suffer with arthritis struggle to sleep. When your joints are swollen and sore, falling asleep and enjoying deep sleep can be a challenge. Studies have shown that people who are not sleeping well can have abnormalities in their central nervous system (CNS). The CNS pathways regulate pain, and they don’t always work the way we would expect when people are not sleeping well.

In addition, sleep problems can lead to increased inflammation. Sleep deprivation is associated with increased inflammatory markers in the bloodstream, which can lead to, or exacerbate, long term pain problems.

This is why treating insomnia and sleep deprivation is critical for managing musculoskeletal conditions such as arthritis and lower back pain.

What can be done to treat sleep disturbances and musculoskeletal pain?

Dr Nick Salinas, Functional Movement Therapy

There are several different ways to treating pain-associated sleep disorders, and treatment for any musculoskeletal pain should always take sleep disturbances into considerations. For example, opioids can be problematic for respiratory sleep issues like sleep apnoea but can still be effective in managing chronic pain.

Cognitive behavioural therapy is another method of managing sleep disturbances. For musculoskeletal pain, in particular, Dr Nick Salinas from Functional Movement Training advises making sure that you align yourself in a neutral position when you sleep.

As we sleep, we maintain a static position for some time, and this can either be a prolonged stretch, or a time without stresses placed on the spine. We want to afford our body the time and resources that it needs to heal from pain, so keeping your spine straight is crucial.

Sleeping on your back is the best way to alleviate pain, as it evenly distributes your weight. If you find it hard to sleep on your back or you’re prone to snoring, try sleeping on your side with a thin pillow in between your legs to align your spine, hips and pelvis.

The biggest sleeping position to avoid is lying on your stomach – it puts pressure on your joints and forces your head to the side, twisting your neck.

Sleep tips for musculoskeletal pain:

• Follow basic sleep hygiene techniques, including going to bed and waking up at the same time, even on the weekends.
• Practice mindfulness. Becoming more mindful will help you relax and manage your pain better.
• Try to be as active as possible throughout the day. Even gentle exercise will help you fall asleep.
• If your treatment isn’t working for you and you are finding that your sleep is suffering, make sure to speak to your GP.