In short
Pain disrupts sleep, and poor sleep makes the nervous system more sensitive to pain. Research suggests poor sleep predicts worse pain more strongly than the other way round. Improving sleep, often with CBT for insomnia, is one of the most useful things people with chronic pain can do.
On this page
Pain and sleep: a two-way street
Most people with chronic pain have trouble sleeping. Pain makes it harder to get comfortable, wakes you at night and leaves you less refreshed. The reverse is also true: a short or broken night’s sleep makes the nervous system more sensitive to pain the next day.
A review of the research in the Journal of Pain found that sleep problems were a stronger and more consistent predictor of later pain than pain was of later sleep problems. In other words, sleep may be one of the best places to intervene.
Why poor sleep makes pain worse
- It lowers pain thresholds, so the same signal hurts more
- It affects mood, stress and the ability to cope
- It reduces energy for activity and exercise
- It can increase inflammation
Living with pain that hasn’t settled?
Talk it through with an Australian doctor online. No referral needed.
Breaking the cycle
Treat insomnia directly
Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first treatment for long-term insomnia, including in people with chronic pain. It focuses on resetting the sleep pattern and changing the habits and thoughts that keep insomnia going. See CBT for insomnia.
Practical steps
- Keep the same wake-up time every day, including weekends
- Get out of bed if you’ve been awake for a long time and do something calm in dim light until you feel sleepy
- Avoid long daytime naps
- Get morning daylight and some activity during the day
- Plan your evening pain relief and comfort: pillows to support painful joints, a warm shower, gentle stretches
- Cut back on caffeine after midday and alcohol in the evening
See also our sleep hygiene checklist.
Check for other sleep problems
Snoring with pauses in breathing, gasping or very heavy daytime sleepiness can be signs of sleep apnoea, which is worth checking. Some medicines can also affect sleep and breathing at night.
What about sleeping tablets?
Medicines for sleep can be helpful for short periods in some situations, but they don’t fix the underlying pattern and can cause problems with longer use. CBT-I has longer-lasting benefits. Talk to your GP about what’s right for you.
When to see a GP
See a GP if pain is regularly keeping you awake, or poor sleep is affecting your mood, work or safety. A GP can look at pain and sleep together and arrange CBT-I, a sleep study or other help.
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-52.
- Riemann D, Espie CA, Altena E, et al. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. J Sleep Res. 2023;32(6):e14035.
- Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(2):255-262.
- Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet. 2021;397(10289):2082-2097.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.