5 Little-Known Tips for Sleeping With Chronic Pain

Sleep disturbance or insomnia is commonplace when you have chronic pain. Both these conditions are usually influenced by each other—while your pain can disrupt a restful night of sleep, lack of adequate sleep can exacerbate your pain symptoms. ¹ Harrison L, Wilson S, Heron J, Stannard C, Munafò MR. Exploring the associations shared by mood, pain-related attention and pain outcomes related to sleep disturbance in a chronic pain sample. Psychol Health. 2016;31(5):565–577. doi:10.1080/08870446.2015.1124106 ^{, 2} Tang NK. Insomnia Co-Occurring with Chronic Pain: Clinical Features, Interaction, Assessments and Possible Interventions. Rev Pain. 2008;2(1):2–7. doi:10.1177/204946370800200102

Sleep disturbance from chronic pain can occur in many ways; you may find it difficult to fall asleep, awaken frequently at night, wake up very early in the morning, and/or feel unrefreshed or tired after your night’s sleep.

See Chronic Pain and Insomnia: Breaking the Cycle

If you experience any of these insomnia symptoms, here are 5 little-known tips that may help you gain a healthy sleep routine:

1. Consume foods that may help promote sleep

Consuming certain foods in your evening meal may help increase the level of tryptophan in your body. Tryptophan is a type of protein that is essential for the production of the sleep-regulating hormone, serotonin. Increased tryptophan levels help reduce the time taken to fall asleep, promote more restful sleep, and improve alertness in the morning. ³ Frank S, Gonzalez K, Lee-Ang L, Young MC, Tamez M, Mattei J. Diet and Sleep Physiology: Public Health and Clinical Implications. Front Neurol. 2017;8:393. Published 2017 Aug 11. doi:10.3389/fneur.2017.00393 Examples of such sleep-promoting foods are ³ Frank S, Gonzalez K, Lee-Ang L, Young MC, Tamez M, Mattei J. Diet and Sleep Physiology: Public Health and Clinical Implications. Front Neurol. 2017;8:393. Published 2017 Aug 11. doi:10.3389/fneur.2017.00393 :

• Carbohydrates with a high glycemic index, such as rice.
• Fruits, such as cherries and kiwis.
• Whole foods, such as milk, pulses, fatty fish, and shellfish.

When you plan to make dietary changes, consult with your doctor to ensure that the new food or supplement that you try does not adversely affect any existing medical condition or medication that you may be taking. Also, consider abstaining from foods and drinks that may adversely affect your sleep, such as coffee, tea, and chocolates. These food contain caffeine and theobromine that may disrupt your sleep cycle. ³ Frank S, Gonzalez K, Lee-Ang L, Young MC, Tamez M, Mattei J. Diet and Sleep Physiology: Public Health and Clinical Implications. Front Neurol. 2017;8:393. Published 2017 Aug 11. doi:10.3389/fneur.2017.00393

See Food for Thought: Diet and Nutrition for a Healthy Back

2. Practice yoga daily

Yoga is a mind-body therapy and through the physical poses, rhythmic breathing, and meditation, yoga may help relieve chronic back pain and improve sleep. ⁴ Roseen EJ, Gerlovin H, Femia A, et al. Yoga, Physical Therapy, and Back Pain Education for Sleep Quality in Low-Income Racially Diverse Adults with Chronic Low Back Pain: a Secondary Analysis of a Randomized Controlled Trial. Journal of General Internal Medicine. 2019;35(1):167-176. doi:10.1007/s11606-019-05329-4

It is advised to learn yoga from a licensed instructor, who can tailor the poses according to your tolerance level and the underlying cause of your back pain. Once you learn the specific yogic poses, you can practice them at home according to your convenience. If you experience pain or discomfort while doing a pose, make sure to inform your yoga instructor.

3. Take a short walk in the evening

If you work at an office, get minimal exercise, have chronic lower back pain, and find it difficult to fall asleep at night, an evening walk may help relieve your pain and promote better sleep. ⁵ Hori H, Ikenouchi-Sugita A, Yoshimura R, Nakamura J. Does subjective sleep quality improve by a walking intervention? A real-world study in a Japanese workplace. BMJ Open. 2016;6(10):e011055. Published 2016 Oct 24. doi:10.1136/bmjopen-2016-011055 ^{, 6} Lee JS, Kang SJ. The effects of strength exercise and walking on lumbar function, pain level, and body composition in chronic back pain patients. J Exerc Rehabil. 2016;12(5):463–470. Published 2016 Oct 31. doi:10.12965/jer.1632650.325

When you walk, your core body temperature increases. This temperature then begins to drop due to the heat dissipation mechanisms of the body (such as increased blood flow to the skin). The resulting lower body temperature then helps trigger your sleep cycle. Walking may also reduce anxiety, promoting better sleep. ⁷ Varrasse M, Li J, Gooneratne N. Exercise and Sleep in Community-Dwelling Older Adults. Curr Sleep Med Rep. 2015;1(4):232–240. doi:10.1007/s40675-015-0028-6

See Exercise Walking for Better Back Health

Including an evening walk in your daily routine may also be beneficial in reducing chronic lower back pain by strengthening your back and abdominal muscles and increasing flexibility in your lower back. ⁸ Valdivieso P, Franchi MV, Gerber C, Flück M. Does a Better Perfusion of Deconditioned Muscle Tissue Release Chronic Low Back Pain?. Front Med (Lausanne). 2018;5:77. Published 2018 Mar 20. doi:10.3389/fmed.2018.00077 ^{, 9} Gordon R, Bloxham S. A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare (Basel). 2016;4(2):22. Published 2016 Apr 25. doi:10.3390/healthcare4020022

See Techniques for Effective Exercise Walking

4. Take slow, deep breaths to get to sleep and fall back asleep

Slow, rhythmic breathing has calming mind-body effects and may help alleviate pain and stress, promoting sleep. Research indicates that taking slow and deep breaths before bedtime can help you get to sleep faster and fall back asleep in case you wake up during the night. ¹⁰ Jerath R, Beveridge C, Barnes VA. Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia. Front Psychiatry. 2019;9:780. Published 2019 Jan 29. doi:10.3389/fpsyt.2018.00780

This type of breathing technique also helps synchronize your heart rate and breathing pattern, which may help promote deeper, restorative sleep. ¹⁰ Jerath R, Beveridge C, Barnes VA. Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia. Front Psychiatry. 2019;9:780. Published 2019 Jan 29. doi:10.3389/fpsyt.2018.00780

See 11 Chronic Pain Control Techniques

5. Consider taking a sleep aid

Several sleep-enhancing preparations are available over the counter to help promote better sleep. While some are available as tea bags for brewing, others can be taken orally in the form of tablets or capsules. Here are a few common examples:

• Herbal preparations: Valerian capsules and chamomile tea ¹¹ Valerian: Fact Sheet for Health Professionals. National Institutes of Health Office of Dietary Supplements. 15 March 2013. Available at https://ods.od.nih.gov/factsheets/Valerian-HealthProfessional/. Accessed 23 January 2020. ^{, 12} Adib-hajbaghery M, Mousavi SN. The effects of chamomile extract on sleep quality among elderly people: A clinical trial. Complement Ther Med. 2017;35:109-114. doi:10.1016/j.ctim.2017.09.010 ^{, 13} Miraj S, Alesaeidi S. A systematic review study of therapeutic effects of Matricaria recuitta chamomile (chamomile). Electron Physician. 2016;8(9):3024–3031. Published 2016 Sep 20. doi:10.19082/3024
• Fruit extracts: Cherry juice or capsules of tart cherry extract ¹⁴ Losso JN, Finley JW, Karki N, et al. Pilot Study of the Tart Cherry Juice for the Treatment of Insomnia and Investigation of Mechanisms. Am J Ther. 2018;25(2):e194–e201. doi:10.1097/MJT.0000000000000584
• Micronutrient supplements: Zinc and/or magnesium ¹⁵ Frank S, Gonzalez K, Lee-Ang L, Young MC, Tamez M, Mattei J. Diet and Sleep Physiology: Public Health and Clinical Implications. Front Neurol. 2017;8:393. Published 2017 Aug 11. doi:10.3389/fneur.2017.00393 ^{, 16} Rondanelli M, Opizzi A, Monteferrario F, Antoniello N, Manni R, Klersy C. The Effect of Melatonin, Magnesium, and Zinc on Primary Insomnia in Long-Term Care Facility Residents in Italy: A Double-Blind, Placebo-Controlled Clinical Trial. Journal of the American Geriatrics Society. 2011;59(1):82-90. doi:10.1111/j.1532-5415.2010.03232.x ^{, 17} Cherasse Y, Urade Y. Dietary Zinc Acts as a Sleep Modulator. Int J Mol Sci. 2017;18(11):2334. Published 2017 Nov 5. doi:10.3390/ijms18112334
• Synthetic preparations: Melatonin capsules or tablets ¹⁸ Xie Z, Chen F, Li WA, et al. A review of sleep disorders and melatonin. Neurological Research. 2017;39(6):559-565. doi:10.1080/01616412.2017.1315864

These supplements may help improve the onset, duration, and quality of sleep in some people.

When you are sleep deprived due to your chronic pain, it may be worth trying one or more of these little-known options to help you get more sleep. A process of trial and error will help you understand which option works best. If you’re not able to sleep well despite trying these tips, consult a doctor for prescription medications or other medical treatments.

Learn more:

Chronic Pain and Insomnia: Breaking the Cycle