Sleep

What's the relationship between sleep and pain?

AUTHOR
Divya Rakesh, MD
REVIEWED BY
Kedar Angirus, MD
April 19, 2022

Kathy spends another night tossing and turning in bed.  Her arthritic pain seemed to have increased and keeps her up a couple of times in the night.  Her mornings are rushed and she often finds it difficult to reach work on time which has not gone unnoticed.  She feels overwhelmed with work and is unable to focus and complete her tasks on time.  Of late, she feels very tired and so her doctor had asked her to run some routine tests.  Her blood sugars are slightly high and she has been diagnosed with high blood pressure.

Why we need sleep: the importance of sleep

We all know that lack of sleep makes us feel tired and groggy the next day – but that’s not all, inadequate sleep can do more harm to our health than we think warn sleep experts.  

Sleep, diet and exercise have been long known to be the three pillars of good health. Yet, one in three adults do not get adequate sleep.  We are currently experiencing an epidemic of sleep disorders and insufficient sleep across all ages in our society.  Inadequate quantity and quality of sleep can affect our lives in many different ways.

Sleep fulfils the basic biological needs of our brain and body.  No, your body and brain do not shut down when you sleep, in fact, it continues to remain active and releases specific chemicals, hormones, required for growth and restoration of both brain and body.

The association between sleep and pain is bi-directional. Meaning, while it is a known fact that sleep quality can be influenced due pain, recent studies have shown that poor sleep quality can influence a person’s pain perception and thereby creating a vicious sleep-pain cycle.

Let us now dive a little deep to understand why sleep is so important and how it affects us.

Sleep and the brain

Sleep helps in learning, memory and mood.  Research links sleep with memory consolidation, perceptual learning, and maintaining focus, attention and alertness.  A famous quote “Sleep on a problem” holds well says sleep scientist Dr. Robert Stickgood, who in a Harvard study, observed that people who slept well after learning a task performed much better when tested than those who did not get sufficient sleep, thereby reiterating the importance of sleep in memory and learning.

Young children who are sleep deprived exhibit lack of focus and attention and become cranky and irritable, these symptoms may mimic symptoms of ADHD.  In adults, sleep deprivation can cause tiredness, poor judgment, impaired perception of events and slower reaction time.  It causes “tunnel-vision” effect where attention is restricted to centre of the field, overall slowing of reaction times and increased errors of omission which could, for e.g., lead to accidents while driving or using heavy machinery.

 

So why is our brain affected by sleep deprivation?

During the day, our brain consumes more energy than any part of the body and in the night when we sleep, the brain gets to replenish the energy used throughout the day. Sleep deprivation hence causes impairment in activities of the brain and in the long run can adversely affect the mood causing anxiety, depression and behavioural problems.  More recently, research has noted a link between sleep and repair and maintenance of brain cells.  Sleep plays a crucial role in removing toxic chemical buildup in the brain that can cause potential damage to brain cells, known as neurons, increasing the risk of developing Alzheimer’s disease and degenerative brain diseases in later life.  Therefore, a good sleep is vital for maintaining a healthy brain throughout our lives. Finally, recent large scale 11-year longitudinal study [Ma1] has also found a causal relationship between sleep deprivation and the likelihood of developing fibromyalgia later on in life.

Sleep and the body

Not just our brain, sleep is crucial for our body too.  It helps the heart recover during the night.  It lower blood pressure and heart rate allowing repair during this time.  Insufficient sleeps and sleep disorders such as sleep apnoea increase the risk of high blood pressure.  High blood pressure has also been noted in teenagers having disrupted sleep.

For all those who want to watch their weight, keep a check on hours you sleep.  Sleep regulates your hunger and appetite and if you are sleep deprived you are likely at risk of overeating and gaining weight. 

You probably have heard of “beauty sleep” and it’s time to believe it.  Research has backed the concept that sleep makes you look more attractive.  In the study, photographs taken of people when they were sleep deprived were perceived to be less attractive, less healthy and more tired compared to when they were taken after a normal eight-hour sleep.

Sleep improves our immune function.  Did you know that if you are sleeping less, you are three times more likely to catch a cold.  Yes, sleep deprivation suppresses our immune function making us susceptible to viral and bacterial infections.  Interestingly, several studies have observed that a good night’s sleep prior to and after vaccination is crucial for good antibody response.  A sleep study published in the International Journal of Behavioral Medicine supported this finding.  People who had a couple of good night’s sleep prior to receiving flu vaccines had good antibody response compared to people who had insufficient sleep.  Insufficient sleep critically impacts the immune function and disposes one to many infections, inflammatory diseases and cancer.  With the persistent high stress of our lives coupled with poor sleep practices and today’s pandemic situation, getting enough sleep is not just a luxury but a necessity.

Lack of sleep and weight gain

In a landmark study by Dr. Van Cauter at the University of Chicago, he was able to demonstrate that a lack of sleep or short sleep as he called it (sleeping fewer than 4-5 hrs a day) resulted in an increase in an individual’s body mass index (BMI). He showed that people who short slept, had an increased urge to consume more calories than their control counterparts who slept on an average of 8 hrs per day. The increase in appetite was seen in as little as two days into the study. The cumulative effect of deprived sleep can result as much as 10-15 lbs of weight gain in a year. Increased weight also causes excess strain on your joints which can in-turn reduce your ability to be active. Less sleep hours impairs metabolism allowing glucose levels to rise thus predisposing to development of obesity and diabetes. You see how this vicious cycle can have such a catastrophic effect?

Pain and sleep, sleep and pain

About 67-88% of people with chronic pain disorders suffer from poor sleep.  Unfortunately, this leads to lack of restorative sleep vital for the brain and body which in turn causes more inflammation and pain.  Sleep deprivation can in addition lower pain tolerance and elevate pain perception.  This was supported in an interesting study where subjects who were sleep deprived were asked to immerse their left hand, up to the wrist, in an ice water bath (~1°C), and perceived pain was recorded every 15 seconds.  It was noted that sleep deprivation significantly increased the person’s pain perception.  This means that if you had a bad night’s sleep, you are likely to notice that your chronic pain feels much worse the next day and because of the worsening pain, you may have another night of poor sleep leading to an endless self-perpetuating cycle of pain.  The concoction of chronic pain and poor sleep over a period of time can lead to additional health issues mentioned above– mental health issues such as anxiety, depression, suicidal tendencies; heart related issues; diabetes and obesity.

 

A good quality sleep can be the best, safe and cost-effective prescription for all suffering from chronic pain. It is hence vital to talk to your doctor if you experience chronic pain and are getting poor quality sleep.

 

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