When pain doesn’t let you sleep

Sarah waited until midnight before she turned off the TV, and then she slowly walked down the hallway to her bedroom. Why go to bed any earlier, she thought, when I won’t have a good night’s sleep anyway? With each step, Sarah tried to ignore the pain shooting through her feet. It felt like she was walking on sharp pieces of broken glass.


As Sarah slid onto the mattress, she re-arranged the sheets and blankets so that none of them would come in contact with her feet while she slept. Any extra pressure was agony. She turned off the light next to her bed and settled in for another long night. If she was lucky, she might get a few hours’ sleep before she had to get up and start another day.

Sleep and pain don’t mix

Sarah has been dealing with neuropathic pain in both of her feet for at least a year. Some days are worse than others, but every night is basically the same: It’s hard for her to get to sleep, and it’s even harder to stay asleep. Any movement makes her feet feel worse. And she never wakes up feeling refreshed.

Because Sarah’s neuropathic pain has lasted for more than three months, it’s considered to be chronic. It is estimated that 30 to 50 million Americans suffer from chronic pain, and experts say that up to 90% of people with chronic pain may have problems sleeping. That’s no surprise to Sarah – or to anyone else whose aches and pains prevent a good night’s rest. But it might be harder to figure out the answer to the following chicken-and-egg question about Sarah’s situation: Which came first – Sarah’s neuropathic pain, or her sleep problems? Don’t answer too quickly: It’s not as easy as you might think.


A circular problem

Healthcare providers know that there are several stages to a normal sleep cycle: People move from periods of light sleep, to deep sleep, and then to REM (rapid eye movement) “dreaming” sleep; this cycle repeats itself several times each night. But doctors also know that sleep and pain are tightly connected:

  • People who have chronic pain have more problems falling asleep and staying asleep.
  • A poor night’s sleep can make a person much more sensitive to pain the next day.
  • More pain during the day leads to more problems falling asleep at night and staying asleep.

See how that works? It’s a circular problem, and it can be tough to find a good solution.

Sorting through the options

Pain medication may seem like a good option, but experts say that many pain relievers actually make the problem worse: These medicines may give you less of the deep sleep that you need, and more periods of light sleep instead. Prescription opioid pain medicines, like morphine, can sometimes be offenders when it comes to getting deep sleep – and even over-the-counter pain relievers may cause problems. In fact, one research study found that acetaminophen was the only medication studied that can help relieve pain without increasing the likelihood of disturbing a person’s night’s sleep.

If pain medications don’t always help with sleep, then what other choices are there?

If you’re like Sarah and you suffer from chronic pain that keeps you from getting a good night’s sleep, talk it over with your health care provider. Sometimes prescription medications called benzodiazepines are used to help people who have problems falling and staying asleep, but could be very dangerous if you are also taking prescription pain medications. Other sleep medications such as zolpidem and eszopiclone are also available by prescription, and could be dangerous as well. For some people, there are safer prescription medications that may perform double-duty: they can help with sleep issues and cut down on pain. Examples include anti-depressant medications (such as trazadone) and anti-seizure medications (like gabapentin).

Sleep hygiene: It’s not what you think

When medication is mixed with good sleep hygiene, it’s possible to get back on the deep-sleep track. Good sleep hygiene means having good sleeping habits that can help you get to sleep, and stay asleep. Here are some examples:

  • Don’t drink alcohol or caffeine in the evening.
  • Use your bedroom only for sleeping or being intimate. If you can’t sleep, get up and leave the room until you feel tired.
  • Exercise in the morning or afternoon, not in the evening.
  • Put your body on a regular sleep schedule: Get up at the same time every day, no matter when you fell asleep the night before.


The bottom line is this: If you’re dealing with neuropathic pain and sleepless nights like Sarah, you don’t have to suffer in silence. Speak with your health care provider about getting proper treatment. A good night’s sleep is not a luxury: It’s vital for a good quality of life.


National Sleep Foundation
http://www.sleepfoundation.org   (Search on “sleep AND pain”)


http://www.webmd.com    (Search on “sleep AND pain”)


American Academy of Sleep Medicine
http://www.aasmnet.org (Search on “sleep AND pain”)


http://www.sleepnet.com (Search on “sleep AND pain”)


http://www.sleepeducation.com (Search on “sleep AND pain”)