Sleep, pain and musculoskeletal conditions

Things to remember

Sleep is essential to your health and wellbeing
Pain can affect your ability to get good quality sleep
There are things you can do to change this so you can sleep well

Just as we need food, water and oxygen, we need sleep.

Although we don’t really know why we sleep, we do know that sleep is essential for our survival and our wellbeing.

Sleep helps you to recharge—both physically and mentally. While you sleep your body is busy doing important jobs to ensure you wake up refreshed and healthy. Your brain is cleaning itself of waste products and consolidating memories. Your muscles, bones, and organs are repairing themselves. Sleep also helps keep your immune system healthy.

So it’s important you get a good night’s sleep – both in quality and quantity.

When you have a musculoskeletal condition (e.g. arthritis, back pain) that causes you pain, getting that good night’s sleep can be more challenging. But there are things you can do to manage your pain and sleep better.

How much sleep?

The amount of sleep you need varies depending on your age. The average amount of sleep required for most adults is between 7–9 hours. However some people require more sleep and some require less.

The aim is to ensure you have enough quality sleep so that you wake up feeling rested and able to do the things you need to do. Don’t become anxious that you’re not getting enough sleep purely on the misperception that you need to get the ‘magic’ 7-9 hours!

What happens when pain interferes with sleep?

Many people who experience pain report problems:

going to sleep
staying asleep
waking too early.

Unfortunately, not getting enough quality sleep lowers your pain threshold. This in turn affects the quality of your sleep. Pain can affect your ability to be active – which affects your quality of sleep and your pain levels. This can make you anxious or stressed – which again will impact on your quality of sleep and the amount of pain you experience.

It becomes a vicious cycle.

Breaking the pain/sleep cycle

The good news is there are many things you can do to manage pain symptoms and improve your sleep:

Talk with your doctor about your pain and sleep problem. Is your condition being adequately managed? Is there something more you can be doing to ease the pain you’re experiencing? Managing your condition and your pain levels will help you get a better night’s sleep.

Try not to put too much pressure on yourself to go to sleep. This leads to anxiety and stress if you don’t fall asleep quickly. Feeling anxious or stressed will impact on your ability to sleep.

Develop a sleep routine. Try to go to bed and get up at the same time each day. This will help your body clock regulate production of the hormones needed to go to sleep (melatonin) or stay awake (serotonin). Limit your time in bed to the amount of sleep you think you need each night. This will reduce wakefulness during the night.

Get out of bed if you’re unable to sleep. Don’t stay in bed tossing and turning. Have a warm drink (e.g. milk, no caffeine), do some gentle stretches or slow breathing exercises and go back to bed when you feel more comfortable. You may need to do this a few times throughout the night if you have a difficult night sleep wise or pain wise.

Try some relaxation techniques. Consider mindfulness, visualisation (e.g. counting sheep), deep breathing or a warm bath before bed. These techniques will help you become more relaxed, and may help you manage your pain better so that you go to sleep, and sleep well.

Be active during the day. As well as the many other benefits of regular exercise (e.g. manage your weight, prevent disease, improve mood, improve bone health), regular exercise, even gentle exercises such as stretching, helps you fall asleep and stay asleep longer.

Eat well. Your body works best when you eat a wide range of healthy foods. A balanced diet and an adequate fluid intake can help provide you with better energy levels, help to maintain your weight, and give you a greater sense of wellbeing which may improve your symptoms.

Keep a sleep diary. This will help you and your doctor work out what may be causing your sleep problems because it tracks the things that may impact on your sleep.

Every day for a period of 1-2 weeks record things such as:

when you get up and when you go to bed
how often you wake during the night
the things you eat and drink during the day
your daily activities.

You can keep track in a notebook, or there are many apps you can download and use.

Avoid caffeine and alcohol for several hours before going to bed. They can affect your ability to fall asleep and the quality of your sleep.

Consider your bedding. Your bedding can make a big impact on the quality of your sleep and your comfort. Is your mattress or pillow affecting your sleep? Are they too hard, too soft, not providing enough support? Is your linen comfortable, clean and keeping you adequately warm or cool (depending on the season)?

Don’t look at the clock. Often when you can’t fall asleep, or you wake in the middle of the night, you look at the clock and start thinking about how many hours to go until you need to get up. This creates anxiety and anxiety makes it hard to sleep. Try removing your clock from the bedside, or cover it up at night.

Write it down. Thoughts, worries and anxiety can prevent good sleep. Don’t take them to bed with you. Keep a ‘worry journal’ instead. Choose a time during the day – away from your bedtime – to write down your key worries and consider options for dealing with them. At night in bed firmly tell yourself that bedtime is not worry-time and you’ll re-visit your worries tomorrow with your worry journal.

Light. Is your room dark enough to allow you to sleep well? Or do you have a street light, light from an alarm clock, or light from other rooms making your bedroom too bright for sleep? If this is a problem, look at solutions such as new window coverings, a dim switch on your alarm clock or closing your door. You might also want to try using an eye mask.

Noise. Just as light can interfere with your sleep, so can noise. If you have no control over the noise in your environment (e.g. a barking dog, loud party, your partner’s snoring), ear plugs may be an option. You can pick these up from your chemist. Some people also find that playing soothing, gentle music softly in the background can be helpful for cancelling out other more annoying noises.

Don’t use technology in bed. It’s easy to get caught up and lose track of time reading emails and checking social media on smartphones and tablets. Another problem is the blue light from laptops and tablets suppresses the hormone (melatonin) that makes us sleepy at night, so be sure to stop screen use at least one hour before bed.

Room temperature. To fall asleep, your body’s core temperature needs to drop a few degrees. So for your bedroom temperature it’s best to aim for cooler (but not cold), rather than warm. A helpful tip from the American Academy of Sleep Medicine is to think of your bedroom as a cave: it should be cool, quiet, and dark.

Use sleeping tablets sparingly and ONLY in times of acute stress and as a means of temporarily resetting better sleep patterns by having some additional time out. Always talk to your doctor before using any sleep aids that you’ve purchased over-the-counter.