Pain and Sleep
Pain and Sleep Connection
Pain and Sleep are interconnected. When we are in pain, we often have disturbed sleep, we may wake more often during sleep, or not be able to get into a deep sleep cycle. A disturbed night of sleep, especially a disturbed deep sleep cycle, leaves us tired and predisposes us to experience an increase in pain in our bodies muscles and joints.
Researchers have found that one night of sleep disturbance can lead to a reduction in our pain threshold of about 15%.
In a separate research experiment, it was found that small variations in the average amount of sleep we get from one day to the next can predict the level of overall pain we may feel the very next day.
Ref: Modern Pain Care
When we experience disturbed sleep there are varying responses in certain parts of our brain. Our frontal lobe activity is decreased leaving us with a decrease in the ability to make effective decisions or to solve problems.
Another study used brain imaging on people who had pulled an all-nighter ie got no decent sleep at all. For each participant, activity spiked in the pain perception parts of the brain and plunged in regions thought to help manage or reduce pain. The biggest peak areas were in the somatosensory cortex part of the brain.
After sleep distrubances, the area called the somatosensory cortex, which is responsible for reacting to stimuli, including painful stimuli is heightened, meaning we can become more highly reactive to pain in a shorter space of time. We sometimes refer to this as a lower pain threshold or an increase in sensitivity to stimuli that we experience as pain.
The Amygdala, a deeper brain area, also experienced increased activity. This is the area of the brain that controls our fears and other emotions. The amygdala is also the part of the brain that plays a major part in our emotional responses and affective states and disorders. Some of the more common affective states related to pain are learned fear, anxiety, and depression.
Often when we feel pain or pain has become chronic, our brain’s perception is that we will be harmed by things like movement, exercise, treatment, anything that creates a stressful emotion. We can become so fearful that we then avoid certain activities or movements. This fear-avoidance or learned fear is not necessarily based on the reality that something is actually harmful to us, however, our brain may interpret it in that way.
What can City Physio Physiotherapist’s do to help Pain and Sleep disturbances?
Part of our job as physiotherapists is to help our patients overcome fear avoidance behaviour (learned fear), by using not only hands-on treatment, dry needling or exercises, to target your injury or pain, but to talk to, explain and assist our patients understanding the way that pain and our brain works and how we can help them to overcome or negate some of these brain sensitivities and their consequential ways of thinking. Other treatments used at City Physiotherapy might be mindfulness training exercises, relaxation exercises, positive self talk and focus about what we can do, diaphragmatic breathing exercises to name a few.
It is imperative that a part of your treatment from your Physiotherapist when you have chronic pain and sleep issues is through talking to you not only about your injury but about a variety of aspects of your life that all impact on your pain and sleep. We can help you minimise your pain and can help you to learn to adapt and dampen down your pain sensitised brain. Of course, each individual person is unique and we all come with our own history and life story that also plays a major part in how we experience pain and how we as therapists target your particular treatment. The way we think about our pain and ourselves, how we act and what kind of self-talk we undertake can all play a major role in the way that our Physiotherapists work with patients who suffer from injury, pain, chronic pain, pain sensitivity, learned fear, anxiety, and depression.
Ref: Why it hurts to Lose Sleep, Benedict Carey, The NY Times, Jan 28, 2019.
