Insomnia: Sleeping Disorders and Chronic Pain Conditions
Synopsis: Information relating to chronic pain as a cause of insomnia and why the perception of pain increases when trying to fall asleep.1
Author: Disabled World Contact: Disabled World
Main DigestPeople who experience chronic pain often times find their issues are compounded by the additional troubles that come with insomnia and sleeping disorders. Of the people who report experiencing chronic pain, approximately 15% of the overall population in America and half of seniors, around 65% report experiencing sleep disorders such as non-restorative or disrupted sleep. Back pain is the most common type of chronic pain issue and is the most prevalent medical disorder in industrialized societies. Perhaps not surprisingly, people with chronic back pain frequently report significant interference with sleep.
A sleep disorder in which there is an inability to fall asleep or to stay asleep as long as desired. Insomnia is most often thought of as both a medical sign and a symptom that can accompany several sleep, medical, and psychiatric disorders characterized by a persistent difficulty falling asleep and/or staying asleep or sleep of poor quality. Insomnia can be classified as transient, acute, or chronic.
- Transient insomnia lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences - sleepiness and impaired psychomotor performance, are similar to those of sleep deprivation.
- Acute insomnia is the inability to consistently sleep well for a period of less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is non-refreshing or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep and they must result in problems with daytime function. Acute insomnia is also known as short term insomnia or stress related insomnia.
- Chronic insomnia lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. People with high levels of stress hormones or shifts in the levels of cytokines are more likely to have chronic insomnia. Its effects can vary according to its causes. They might include muscular fatigue, hallucinations, and/or mental fatigue. Chronic insomnia can also cause double vision.
In a recent study it was discovered that around two-thirds of people with chronic back pain experienced a sleep disorder. Research has shown that disrupted sleep will then exacerbate the person's chronic back pain issue. A troublesome cycle develops in which the person's back pain disrupts their sleep and trouble with sleeping makes the person's pain worse - which in turn makes sleeping harder.
Pain Reduces Sleep Quality and Quantity
Chart showing sleep issues included in insomnia
The term, 'insomnia includes all types of sleeping issues. These issues can include:
- Difficulty falling asleep
- Difficulty staying asleep
- Awakening earlier than wanted
Of all medical conditions, pain is the #1 cause of insomnia. With chronic pain issues, difficulties with falling asleep is one of the most prevalent types of sleep disruption.
Awakening during the night and waking up earlier than wanted; however, are also frequent issues. Research surveys of people who experience chronic pain issues found that 65% report they are awakened during the night because of pain while 62% report waking up too early because of pain. Many people with chronic pain issues do not feel refreshed in the morning when they wake up - a sleep issue referred to as, 'non-restorative sleep.'
Trouble with Falling Asleep
Chronic pain may impact sleep in several ways. To understand how a pain issue might make it hard to fall asleep it helps to think about the process associated with going to sleep for the night. In getting ready for bed it is common to attempt to eliminate distractions or other influences in efforts to relax and start to fall asleep. Doing so might include making the room quiet, trying to get comfortable, turning off the lights, eliminating other noises, and then starting to try to fall asleep.
Unfortunately the, 'quieting,' of a person's environment might cause issues for people with chronic pain because the only thing left for their brain to concentrate on is the experience of pain. People will often times report that one of their primary pain management tools during the day is the ability to distract themselves from the pain they experience by staying busy with other tasks such as hobbies, crafts, watching television, reading, or interacting with other people. When they try to fall asleep; however, there are no other distractions available to them to concentrate on except for the pain they experience. In many instances, a person's perception of pain actually increases as they try to fall asleep. The longer attempts to fall asleep are delayed, the more stressful the situation is for the person.
Trouble Sleeping through the Night
Along with trouble falling asleep, people who experience chronic pain report waking up frequently during the night. Research has shown that people who experience chronic pain might also experience several intense, 'micro-arousals,' or a change in their sleep state to a lighter one, every hour they sleep. Micro-arousals lead to waking up in the night. The chronic pain issues may be a significant intrusion into a good night's sleep and disrupt the usual stages of sleep.
The issue is many times the cause of non-restorative sleep. People who experience chronic pain often experience less deep sleep, more arousals and awakenings during the night, as well as less efficient sleep. Due to this, their quality of sleep is often times light and not refreshing. The non-restorative sleep pattern might cause depressed mood, diminished energy, fatigue, and a worsening pain experience during the day.
Causes of Insomnia
Insomnia is often a symptom of another health condition. It is important for a health care provider to look for the underlying cause of a person's sleep issue and to treat the condition. The first task is usually to figure out the duration of the insomnia the person experiences. Short-term insomnia lasts less than 3 weeks, while long-term insomnia last longer. Then it is important to determine the cause of the person's insomnia and to treat the issue if possible.
Chart showing causes of long-term insomnia
If the issue remains, a non-pharmacologic treatment should be implemented. Short-term insomnia might be caused by pain, acute stress, medications, environmental changes, the withdrawal of sedatives, or stimulant use. If the cause cannot be resolved, a health care provider will usually treat insomnia with medication on a short-term basis. Long-term insomnia is more common and there are a number of causes, to include:
- Chronic pain
- Psychiatric disorders
- Alcohol and substance abuse
A number of medical disorders such as hyperthyroidism, congestive heart failure, dementia, rheumatologic diseases, asthma, chronic obstructive pulmonary disease and gastroesophageal reflux disease may also cause insomnia. People should be evaluated for these causes. Depression is a common cause of insomnia in seniors, many times resulting in early awakening, and is best treated with medications that have sedative side effects. Anxiety is the most common psychiatric cause of insomnia in seniors. Seniors with anxiety experience trouble with falling asleep.
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