Sleeping better when you have pain

Approximately 50 million adults — that’s about one in five — experience some amount of daily pain. While these people usually encounter flare-ups during the day, in many cases, the pain worsens at night.

Why might pain go up when the sun goes down? Some research has suggested that pain may follow a circadian rhythm, like the body’s 24-hour clock that regulates our sleep-wake cycle. This helps explain why some people regularly have higher pain levels at certain times, such as during the night. Another possibility is that even if pain levels are similar during the day and at night, the lack of daytime activities and distractions can make pain at night more noticeable and bothersome.

Nighttime flare-ups are especially problematic, as they can disrupt sleep. In fact, at least 50% of individuals with insomnia — the most often diagnosed sleep disorder — suffer from regular pain. Nighttime pain also is associated with obstructive sleep apnea and restless legs syndrome. These issues can lead to sleep deprivation, which increases cytokines (proteins involved in the body’s inflammatory response) and makes people even more sensitive to pain.

No matter the cause of your pain, where it strikes in the body, or its severity, there are many ways to prevent and manage nighttime flare-ups so you can get your rest. Here are some strategies.

Adopt a regular pre-bedtime relaxation routine

A smooth transition from a hectic day can help the body and mind prepare for sleep. Spend at least 20 minutes before bedtime focused on relaxation, which helps slow the heart and breathing rate, decrease levels of cortisol (the stress hormone), and lower the chance of flare-ups. For example:

• Take a warm or cool shower.
• Perform a series of gentle stretches or yoga poses.
• Do several minutes of meditation or deep breathing exercises.

Create a healthy environment

Make the bedroom as dark and cool as possible. (The ideal temperature is 65° to 68° F.) Consider light-blocking curtains or shades to minimize outside light. Upgrade your mattress, pillow, sheets, and pajamas. Use a sound machine that plays soothing white noise or relaxing nature sounds like falling rain.

Reframe your thoughts

People who regularly have nighttime pain often worry about whether it will occur, which can further increase stress and anxiety and make flare-ups more likely. If you fear that pain will keep you up, remind yourself that you can and will fall asleep. Changing this mindset is difficult, but engaging in more positive thinking is important in helping to mitigate pain.

Getting back to sleep

If pain wakes you up, allow your body time to recover so you can fall back asleep. Listen to soft music or read. (However, avoid electronic devices, like computers, tablets, and smartphones, that emit blue light, which is known to interfere with sleep by suppressing the secretion of the hormone melatonin, which controls the body’s sleep cycle.)

Another option is to count breaths. Close your eyes, inhale and count to one, exhale and count to two, and continue until you reach 10. Repeat as necessary until you are relaxed and the pain has subsided.

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