Sleep and chronic pain: how they affect each other and what science says

Anyone living with chronic pain knows nights can be the hardest part. The NIH note that chronic pain may be accompanied by disturbed sleep, along with anxiety, depression and difficulty moving around.^[1] But the link also runs the other way: poor sleep can change how the brain processes pain.

What we know: poor sleep amplifies pain

A University of California, Berkeley study published in 2019 in the Journal of Neuroscience compared healthy adults’ response to pain after a normal night and after a night without sleep. It found that sleep deprivation:^[2]

• Increased activity in the brain areas that sense pain (the somatosensory cortex).
• Reduced activity in regions that help regulate it.
• Lowered the pain threshold: a heat stimulus started to hurt at lower temperatures.

What is still unclear

The evidence in healthy people is stronger than in people with chronic pain. A 2022 systematic review of 31 studies found moderate-to-limited evidence that fragmented sleep increases pain sensitivity in healthy people, but only very limited evidence that short sleep worsens spontaneous pain in people who already have chronic pain. The authors concluded that the effect in this group remains uncertain.^[3]

In other words: sleeping well probably helps, but it is not a cure for pain on its own.

A therapy with evidence behind it: CBT for insomnia

The NIH define chronic insomnia as sleep problems 3 or more nights a week lasting more than 3 months, and list a regular sleep schedule, cognitive behavioral therapy for insomnia (CBT-I) and medicines among the treatments.^[5]

Does CBT-I work when chronic pain is also present? A 2021 meta-analysis of 12 clinical trials (762 participants) with chronic pain found:^[4]

Probability of improvement after CBT for insomnia in people with chronic pain

End of treatmentFollow-up

Better sleep

81%71%

Less pain

58%57%

In short: CBT-I clearly improves sleep, with a small effect on pain, and it also improved depressive symptoms at the end of treatment. It had no significant effect on anxiety or fatigue.^[4] That’s why it works best as part of a plan, not as the only treatment.

Habits the CDC recommends

The CDC recommends that adults aged 18 to 60 get 7 or more hours of sleep, and offers these tips:^[6]

1. Go to bed and get up at the same time every day.
2. Keep your bedroom quiet, relaxing and cool.
3. Turn off electronic devices at least 30 minutes before bed.
4. Avoid large meals and alcohol before bedtime.
5. Avoid caffeine in the afternoon or evening.
6. Exercise regularly and eat a healthy diet.

If pain keeps you up at night and fatigue makes the pain worse, an assessment can help you address both at the same time.