In the recent blogs, we’ve explored the multi-faceted nature of pain and how it can be influenced by numerous things around us, in one way or another.
One such underrated and ignored contributing factor to pain is sleep.
Could there be a relationship between the popularity of the hustle culture that comes along with stress and insomnia and an increase in chronic pain cases over the years?
Studies have shown that Experimental induction of painful stimuli during sleep can induce microarousal and increase wakefulness in otherwise healthy,normal-sleeping subjects (e.g. Drewes et al., 1997; Lavigne et al., 2000).
Studies on specific complex persistent pain conditions such as fibromyalgia, arthritis, lower back pain, and headaches showed these individuals often have trouble falling asleep, trouble staying asleep, or wake up unrefreshed. In pain clinics, as many as 90% of patients reported at least one sleep disturbance (McCracken and Iverson, 2002; Menefee et al., 2000). The intensity of sleep disturbances has also been correlated with greater pain, depression, and disability (McCracken and Iver- son, 2002; Morin et al., 1998; Haythornthwaite et al., 1991; Wilson et al., 2002; Smith et al., 2001).
Getting more sleep enhances athletic performance and inadequate sleep impairs it, with sleep probably affecting injury rates and recovery.
On the other hand, evidence is also accumulating showing that sleep deprivation and selective sleep disruption (slow-wave sleep in particular) for no less than three consecutive nights can decrease pain threshold, amplify negative mood and produce somatic symptoms mimicking those of fibrositis (e.g. Haack and Mullington, 2005; Hakkio- nen et al., 2001; Lentz et al., 1999; Moldofsky and Scarisbrick, 1976).
Additionally, Sleep disturbance is linked with “a wide array of perturbations spanning from obesity, insulin resistance, type 2 diabetes, the metabolic syndrome, and cardiovascular disease risk and mortality in both adults and children.”
The relationship between pain and sleep is likely to be bi-directional.
Indeed, if the pain may cause difficulty initiating and/or maintaining sleep, pain intensity can be as well exacerbated by the lack of sleep. Affleck et al. (1996) asked 50 women with fibromyalgia syndrome to keep a diary about their sleep and pain for 30 days. They found that a poor night of sleep was followed by a day with greater pain and a painful day with a night of poorer sleep.
How can 8 hours in bed help you with your terrible back pain?
Well simply by allowing your body and brain the time to take action over a particular area.
Pain is an output of the nervous system in response to several factors. Sleep is one of the many factors like anxiety, depression, stress, fatigue, physical activity, social engagement, relationships, diet, immune health, etc contributing to the output i.e. pain. And it turns out sleep impacts the other contributing factors of pain as well forming a vicious cycle, for example, lack of sleep can make us feel low on energy affecting our physical activity, which further causes poor sleep(explained further in the blog), which can trigger anxiety again leading to troubled sleep.
However, just like lack of sleep negatively impacts pain and the other factors contributing to it, addressing and trying to improve your sleep quality and quantity can positively influence them as well.
The same can be explained using the famous cup analogy where the cup represents your ability to tolerate stress. Stressors are always being poured into the cup. We all have stress. If the amount of stress you pour into your cup exceeds the capacity of the cup and it overflows, the overflow is pain. We can either reduce the number of stressors or build a bigger cup to help the overflow i.e. pain.
One of the ways we can reduce the number of stressors is by getting more and better sleep.
How do we formally describe sleep and associated processes?
Sleep is described as, “a naturally recurring state of mind and body, characterized by altered consciousness, relatively inhibited sensory activity, reduced muscle activity and inhibition of nearly all voluntary muscles during rapid eye movement (REM) sleep, and reduced interactions with surroundings. It is distinguished from wakefulness by a decreased ability to react to stimuli, but more reactive than a coma or disorders of consciousness, with sleep displaying different, active brain patterns.”
In simpler words when you sleep your body temporarily disconnects from the outer world and focuses on the inside. During the day your brain is no more focused on protecting you and helping you navigate everything around you like making sure you don’t hurt yourself from the edge of the bed, safeguarding that bruise on your leg, and producing sweat to keep you cool, attending to all the annoyed clients, etc. In turn, while sleeping, the brain focuses on the inside of the body making repairs where needed and bringing all things back to the optimal range.
Going a little back-to-school grade science where we’ve studied the autonomic nervous system that regulates involuntary physiologic processes including heart rate, blood pressure, respiration, digestion, and sexual arousal, by transmitting impulses from the central nervous system (i.e. brain and spinal cord) to the involuntary organs and smooth muscles of the body.
The autonomic nervous system is further classified into the sympathetic and parasympathetic nervous systems.
The sympathetic nervous system is commonly known as the ‘fight or flight’ system, which is usually turned on during a stressful situation (providing you with a little bit of extra energy). (Note that stress, in this case, doesn’t necessarily mean psychological stress, it can also be emotional or physical.)
For instance, Like the flash flood of hormones, you get that boosts the body’s alertness and heart rate sending extra blood to the muscles when you need to reach work on time meanwhile getting your toddler ready for daycare. Rapid breaths deliver fresh oxygen to the brain, and an infusion of glucose is shot into the bloodstream for a quick energy boost right before your pitch ar work.
On the other hand, the parasympathetic nervous system is described as the ‘rest and digest’ system which helps you slow down and replenish energy and helps digestion, storing of energy, and cellular replenishment supporting the maintenance of the body at rest. Blood pressure, breathing rate, and hormone flow return to normal levels as the body settles into homeostasis or equilibrium.
During sleep, the brain, and body focus on the maintenance and repairing of the guys who were hard at work during the day like the muscles of the leg if you moved around a lot, the lungs which were hard at work taking rapid breaths, the painful back that had to sit through long office hours, the gut which had to put in extra hours to digest all the spicy Indian food. No wonder we sleep better after a heavy meal!
Lack of sleep or reduced quality of sleep is a common problem in people suffering from chronic pain and sometimes in people with no pain, which holds the potential to make them more prone to aches and pain. Disturbed quantity and quality of sleep can lead to disturbed ongoing repair in the body and altered homeostasis ultimately leading to reduced healing and insufficient energy to go through the worldliness of the next day eventually leading to accumulated fatigue.
So how can you sleep better?
1. Start by setting a routine.
The suprachiasmatic nucleus in the hypothalamus of the brain is the central pacemaker of the circadian timing system and regulates most circadian rhythms in the body hence it thrives on routine.
Imagine going to bed every day at 10 pm and waking up at 6 am, over a while your body gets used to it and starts releasing certain hormones like melatonin around 10 am which makes you sleepy and cortisol around 6 am, which wakes you up.
Now one day you sleep at 2 am or you get to bed at varied times for a few consecutive days. This leads to the brain assuming that you are in a state of stress or some form of danger, that is keeping you up. And like always, your brain tries to protect you by releasing cortisol (stress hormone) because who would want to sleep in a state of danger, resulting in disturbing quality and quantity of sleep?
Additionally, try spending some time in the sun. Aim for at least 30-60 minutes, preferably in the morning, it helps stimulates the circadian rhythm and its routine
Therefore, start with sticking to a time, whatever works best for you according to your schedule.
2. Get moving!
Isn’t it always a struggle to sleep after a day of sitting around or a long nap during the day instead haven’t we all slept like a baby after a very hectic day that involved a lot of moving around?
This could be because during sleep when the brain and the body focus on “repair”, there is always more to repair and recover in the body after an active day contrary to a relatively restful day where the body hasn’t been used much and there is less need for repairing and recovery.
So logically if you’ve done nothing physical during the day then there’s nothing for recovery physiology to do and in turn, no need to switch on the sleep physiology with much enthusiasm.
All physical activity counts. You can start with getting up at regular intervals during the day, going out for walks or a bike ride, or you can put together an exercise routine that you enjoy whether it is yoga, cardio, pilates, or weight lifting.
3. Slow down before bed
By now we already know how the parasympathetic system is more active during rest. A little slowing down before bed can help stimulate the parasympathetic system and hence can aid in sleeping.
Soft lights and music along with having a comfortable room temperature and some light reading before bed can help stimulate the parasympathetic system as opposed to loud music, harsh lights, and watching tik tok videos before bed.
Avoid large meals and excess fluid intake 2-3 hours before, restrict caffeine for 8 hours before bed, along with steering clear of alcohol and cigarettes, even though they might help you sleep, they negatively impact sleep quality.
Moreover, relaxation or meditation at any time of the day can allow the parasympathetic system a chance to assist in tissue replenishment and growth.
4. Sleep the way you feel comfortable
The only way to do something consistently and optimally is to find the things that work the best for you. Anything that requires constant effort turns into work and sleep is not ‘work’, you shouldn’t be worried about your posture while sleeping because if it doesn’t matter during the day then it also doesn’t matter during the night.
How can someone turn off their brain when they are constantly worried about the placement of ten pillows around them or are fearful of getting into the wrong posture while sleeping even though they do not really have any control over it.
The best way to sleep is the way you feel the most comfortable. Whether it is with a thick or thin pillow under your neck, two pillows or none, or on a soft mattress or no mattress. There is no evidence that one specific sleeping posture or pillow placement is superior to the others.
Sleeping when a part of your body hurts can be tricky, hence it’s ideal to try out different positions and pillow placements, no matter how odd they might seem to you. For example, two pillows or a thick pillow under the neck can work when neck flexion is a relieving position for someone with neck pain, or a pillow under the knee or ankle can help in cases of knee or heel pain.
In fact, different positions or pillow placements can feel good on different days for the same person, we move 2-5 times per hour or 32-33 times per night while adopting 7-8 different sleeping postures because there are a great many options for us to choose from. Going to bed shouldn’t be a hefty task.
Rome wasn’t built in a day, likewise, you wouldn’t be able to sleep well instantly right after trying to modify your schedule and habits. The Centre for disease control and Prevention recommends a minimum of 7 hours of sleep per night for an adult aged 18-60 years. Keep at it and prioritize your sleep, it will help you build a bigger cup.
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