When addressing insomnia associated with chronic pain, it is important that the patient receives the best possible treatment for pain using a multidisciplinary approach.
As with any symptom of a chronic pain syndrome, one should not attempt to treat the sleep disruption in isolation without taking into account treatments for the pain problem that is part of the cause.
Sleep Apnea, Restless Legs Syndrome May Be Factors
Investigating and treating any medical problems that could be affecting sleep is typically a priority. Some of the common medical problems associated with poor sleep include:
- Sleep apnea. A person with this condition stops breathing for about 10 seconds or has reduced airflow hundreds of times during the night. The brain wakes the person in order to resume breathing, causing severely fragmented sleep and daytime sleepiness. Opioid pain medications, which many people with chronic pain take, have been linked to sleep apnea.4
- Restless legs syndrome. An extreme urge to move the legs, usually caused by uncomfortable sensations in the legs, is typical with this syndrome. The person may also experience involuntary jerking of the limbs during sleep and sometimes when awake. The symptoms may cause difficulty in falling or remaining asleep, causing daytime tiredness or fatigue.
Treatments are available for both these conditions, and may bring significant relief of symptoms.
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Behavior and Psychological Strategies for Better Sleep
Behavioral approaches can help improve the quality of one's sleep when they are practiced on a consistent basis. The skills acquired in learning cognitive behavior therapy for chronic pain, for example, may also be useful in improving sleep quality.
Drawing on one of more of these approaches may be considered:
- Sleep hygiene. The term “sleep hygiene” describes a series of everyday strategies to develop a regular sleeping/waking cycle that gradually helps people relax and get the sleep they need.
- Psychological techniques. Meditation, cognitive behavior therapy, and deep breathing exercises are some of the more common practices.
- Sleep medications. Specifically designed to help with sleep, these medications may be considered by themselves or along with other strategies in certain circumstances.
Approaches that do not require medication should be attempted first, since they are safe and without adverse side effects. If these methods are not completely effective, it may be appropriate to consult with a physician about medications as well.
- Guilleminault C, Cao M, Yue HJ, Chawla P. Obstructive sleep apnea and chronic opioid use. Lung. 2010;188:459-468.