Does pain make me sleep worse, and what can you do about it?

Pain and sleep influence each other in both directions. In one study conducted over 12 months, poor sleep increased the risk of developing neck pain by 76 percent. Conversely, older adults with pain in multiple locations scored considerably lower on their overall functioning, including sleep, than people without pain. The more locations that were painful, the greater the effect. This is observational research, so we cannot say with certainty what is cause and what is effect, but the association is clear and consistent.

Sleep quality itself carried more weight in that study of older adults than pain alone: poor sleep was more strongly associated with reduced functioning than single-site pain. The recommended sleep duration was around 7.5 hours; both sleeping too little and sleeping too long produced worse outcomes.

For specific pain complaints there is some evidence for what helps. With shoulder complaints caused by a tear in the muscles surrounding the joint, nearly everyone experienced night pain (in 91 to 93 percent of patients, with a mean pain score of 5.5 out of 10). After surgical treatment that score dropped to below 2 and sleep improved considerably. For jaw pain caused by teeth grinding, a small study (30 participants) showed that manual therapy improved sleep and pain more than home exercises alone after 8 weeks, although this remains preliminary due to the limited sample size.

In fibromyalgia, aquatic exercise measurably improves pain in the short term, but the effect on sleep was not statistically significant. A medium-firm mattress appears to promote comfort and sleep over a very soft or very hard mattress, although the research findings on this point are not consistent.

Non-pharmacological approaches such as relaxation exercises, cognitive behavioural therapy, massage, music, earplugs and an eye mask demonstrably improved sleep quality and reduced pain in research involving people recovering from heart surgery. Among these, cognitive behavioural therapy is the best-supported option for chronic pain combined with sleep problems, although effectiveness varies from person to person.