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Insomnia and back pain really go hand in hand. In fact, in a recent study, it has been shown that approximately two thirds of people suffering from back pain also have disrupted sleep. It is also important to know that studies have also shown that disrupted sleep, in turn, actually exacerbates the back pain. Now, we also intuitively notice that if you don't get a good night sleep, then any aches and pains that you usually have are much more exacerbated and everything is more difficult without appropriate sleep - it is just more pronounced in people suffering from back pain. So, in treating back pain, it is very important to determine if the patients suffer from insomnia because it can definitely exacerbate the back pain itself and complicate the treatment.
Treatment should be aimed at treating the back pain as the underlying cause and insomnia as well. Treatments of insomnia really run the whole gamut of medications and behavioral alterations. For instance, the insomnia caused by back pain affects the quality of sleep and the duration of sleep, which means that we don't fall asleep as soon as we would otherwise and we wake up in the middle of the night, so overall we don't sleep as much. The pain itself also interrupts the progression of the sleep cycle, so we don't get enough deep sleep and REM sleep and we're not as rested as we would be otherwise. So, the restorative function of the body is not really utilized in actually treating the back pain if we don't treat the insomnia.
In treating insomnia, first and foremost, we have to control the pain. So, pain medications when appropriate should be utilized before going to sleep so that the pain doesn't interfere directly with the sleep. Also, muscle relaxants can be used because the muscle spasms at times accompany the low back pain. Sleep agents at times are appropriate, but should be used with caution because we know the source of the insomnia.
But it is very important not to overlook the behavioral aspect of what is called "sleep hygiene" and sleep hygiene really involves a number of different things. There are certain rituals that we always do before going to bed, such as turning off the lights, going to bed at a particular time, waking up at a particular time, brushing our teeth. It is very helpful psychologically to have a specific routine that right away gets us in the mode for sleeping. All of that helps us fall asleep and if we fall asleep sooner, it actually helps us stay asleep and progress through the normal sleep cycles. So, it's important to address the sleep as well as the back pain at the same time.