Chronic Low Back Pain and Insomnia: Tips for Breaking the Cycle

My cat, Goober, seen here can fall asleep at any time of the day in any part of the house. But of you have chronic back pain, your chances of having sleep problems are greater than 50% (Pinheiro, Ho et al., 2016). In fact, a person’s likelihood for experiencing low back pain and insomnia is heritable. A condition known as central sensitization, that central nervous system (brain and spinal cord) is hypersensitive to pain, also plays a role in insomnia.

For the purposes of this article, chronic pain is defined as pain lasting three months or more. Clinical insomnia is considered if a person has 30 minutes of sleep latency or minutes awake after sleep onset for more than 3 days per week, lasting more than three months. If you experience both symptoms habitually, chances are that the two are related.

Chronic pain and poor sleep quality have a bidirectional relationship, meaning that chronic pain makes it more difficult to initiate sleep and stay asleep, and sleeplessness exacerbates the experience of pain. Both conditions reflect a dysfunction of neurotransmitters in the brain. Neurotransmitters are chemicals that cells within the brain use to communicate. In this case, the neurotransmitters affected are dopamine and serotonin, both involved in the body’s innate analgesic systems and control of circadian rhythms: the 24-hour cycle of sleep and awake states.

Other factors can make both conditions worse. These include stress, anxiety and depression, and low-grade inflammation of the nervous system (Nijs, Mairesse, et al., 2018). Your bedroom environment may contribute to insomnia. This includes an uncomfortable or unsupportive mattress, blue light sources, high ambient temperature, and noise. Finally, you may become overanxious about your ability to fall asleep, a condition psychologists describe as catastrophizing.

Research studies indicate that medication therapy may not be the most effective approach to this problem (Nijs, Mairesse, et al, 2018). A group of physical therapists in Belgium (Nijs, Mairesse et al., 2018) suggest a combination of cognitive behavioral therapy, relaxation techniques, sleep hygiene and exercise therapy may be the best way to start sleeping better. You may also want to fill out the Insomnia Severity Index to share with your primary care provider, to see if it would be beneficial to seek treatment from a sleep specialist.

Cognitive Behavioral Therapy or CBT is a method of identifying and changing maladaptive thought patterns such as all-or-nothing thinking, fortune telling and catastrophizing. Chapter 2 of the back pain workbook contains additional information. The book also contains information about relaxation techniques (chapter 6) that can help to reduce your stress levels after a busy day.

Evaluate your bedroom environment. A lot of us use the bedroom for activities other than sleeping such as tablet surfing and watching television, which can interfere with your ability to initiate sleep. If you have started going to bed early in the hope of getting adequate sleep despite awakenings throughout the night, consider the opposite strategy: go to bed only after you feel tired, even if this is very late. This will help your body’s natural homeostatic mechanisms to kick in so you can begin sleeping shortly after going to bed.

Finally, consider some nutritional and exercise strategies. Try not to drink caffeine after mid-afternoon. Instead, consider herbal, non-caffeinated teas. While a small amount of alcohol may make it easier to fall asleep, larger quantities can interfere with sleep quality. If you currently exercise regularly, do so in the morning or afternoon. Avoid exercising within three hours of bedtime. If you do not exercise regularly, beginning some moderate physical activity may help with sleeping.

 

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