The Sleep-Pain Connection: What You Need to Know

If you've been dealing with chronic pain, you've probably noticed that bad nights of sleep make your pain worse. What you might not realize is that this relationship goes both ways: not only does pain disrupt your sleep, but poor sleep actually makes you more sensitive to pain. Understanding this connection could be the missing piece in your recovery.

The Two-Way Street Between Sleep and Pain

Research shows that sleep and pain have a bidirectional relationship, meaning they influence each other in both directions. When you're in pain, it's harder to fall asleep and stay asleep. But here's the part many people don't talk about enough: when you don't get enough quality sleep, your body becomes more sensitive to pain, and you heal more slowly from injuries.

Studies have found that even one night of poor sleep can lower your pain threshold by up to 15%. For people with chronic conditions like low back pain, neck pain, or fibromyalgia, this creates a vicious cycle that can be hard to break without addressing both issues.

What Happens in Your Body During Poor Sleep

When you don't sleep well, several important changes happen in your nervous system and you body.

Your Pain System Gets Rewired

Your brain's ability to regulate pain signals becomes impaired. Normally, your brain has a "descending pain modulation" system that acts like a volume control for pain signals coming from your body. This system helps turn down pain when it's not helpful or dangerous.

Sleep deprivation disrupts this system, essentially turning up the volume on pain signals. Research published in the Journal of Neuroscience found that losing sleep for just one night reduced activity in the brain regions responsible for pain control while increasing activity in areas that sense pain.

Inflammation Increases

Sleep is when your body performs critical maintenance and repair work. During deep sleep, your body regulates inflammatory markers, which are substances in your blood that indicate inflammation levels.

The main inflammatory markers affected by poor sleep include:

• IL-6 (Interleukin-6): A protein that promotes inflammation

• TNF-alpha (Tumor Necrosis Factor-alpha): Another inflammation-promoting protein

• CRP (C-Reactive Protein): A general marker of inflammation in the body

  
  

Multiple studies have shown that people who consistently sleep less than 6-7 hours per night have significantly higher levels of these inflammatory markers. Since inflammation contributes to pain in conditions like arthritis, tendinitis, and muscle strains, this creates another pathway through which poor sleep worsens pain.

Your Stress Response Goes Haywire

Poor sleep also affects your HPA axis (hypothalamic-pituitary-adrenal axis), which is your body's main stress response system. Think of it as your internal stress control center. When this system isn't functioning properly due to sleep deprivation, you produce more cortisol (the stress hormone) at the wrong times, which can increase muscle tension, slow healing, and make you more sensitive to pain.

Tissue Healing Slows Down

Your body does most of its repair work while you sleep. During deep sleep stages, your body releases growth hormone, which is essential for repairing muscles, tendons, and other tissues. The glymphatic system, which is like a waste removal system for your brain and nervous system, also works primarily during sleep to clear out inflammatory byproducts and cellular debris.

When you don't get enough deep sleep, these repair and cleanup processes don't happen efficiently, meaning injuries heal more slowly and pain persists longer.

Practical Steps You Can Take

Understanding the sleep-pain connection is important, but what can you actually do about it? Here are evidence-based strategies:

Assess Your Sleep Quality

Start by honestly evaluating your sleep. Ask yourself:

• How many hours of sleep am I actually getting per night?

• How long does it take me to fall asleep?

• Do I wake up during the night? How often?

• Do I feel rested when I wake up?

• Am I relying on caffeine to get through the day?

If you're consistently getting less than 7 hours, having trouble falling or staying asleep, or waking up unrefreshed, your sleep is likely contributing to your pain.

Prioritize Sleep Hygiene

Sleep hygiene refers to the habits and environmental factors that promote good sleep. Evidence-based recommendations include:

Timing and consistency:

• Go to bed and wake up at the same time every day, even on weekends

• Aim for 7-9 hours of sleep opportunity (time in bed)

Environment:

• Keep your bedroom cool (around 65-68°F is optimal)

• Make your room as dark as possible

• Minimize noise or use white noise if needed

• Reserve your bed for sleep only (not work, eating, or watching TV)

Evening routine:

• Avoid caffeine after 2 PM

• Limit alcohol, especially close to bedtime (it disrupts sleep quality)

• Stop using screens (phones, tablets, computers) 1-2 hours before bed

• Try relaxation techniques like deep breathing or gentle stretching

Address Sleep Position and Support

Your sleeping position and mattress can affect both sleep quality and pain:

• For neck pain: Use a pillow that keeps your neck in neutral alignment. Side sleepers typically need a thicker pillow than back sleepers

• For low back pain: Research suggests a medium-firm mattress works best for most people. Side sleepers may benefit from a pillow between the knees

• For shoulder pain: Avoid sleeping on the painful shoulder and consider a body pillow for support

I will expand on this topic in a separate post in the future!

When to Seek Additional Help

Sometimes sleep problems require professional intervention. Consider talking to your primary healthcare provider if:

• You've tried improving sleep hygiene for 4-6 weeks without improvement

• You snore loudly or your partner notices you stop breathing during sleep (possible sleep apnea)

• You have restless legs or periodic limb movements

• You experience significant daytime sleepiness despite spending adequate time in bed

Your chiropractor can help coordinate care with sleep specialists if needed.

The Bottom Line

The relationship between sleep and pain is powerful and well-documented in scientific research. Poor sleep doesn't just make you tired; it fundamentally changes how your body processes pain, manages inflammation, and heals from injury. The good news is that improving your sleep can create positive momentum in your recovery.

If you're dealing with chronic musculoskeletal pain, addressing your sleep isn't optional—it's essential. Work with your healthcare providers to develop a comprehensive approach that includes both hands-on treatment and sleep optimization strategies.

Remember: healing happens during sleep. Give your body the rest it needs, and you'll give yourself the best chance at recovery.

References

1. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-1552.

2. Krause AJ, Prather AA, Wager TD, Lindquist MA, Walker MP. The pain of sleep loss: A brain characterization in humans. J Neurosci. 2019;39(12):2291-2300.

3. Irwin MR, Olmstead R, Carroll JE. Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation. Biol Psychiatry. 2016;80(1):40-52.

4. Haack M, Simpson N, Sethna N, Kaur S, Mullington J. Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology. 2020;45(1):205-216.

5. Xie L, Kang H, Xu Q, et al. Sleep drives metabolite clearance from the adult brain. Science. 2013;342(6156):373-377.

6. Alsaadi SM, McAuley JH, Hush JM, Maher CG. Prevalence of sleep disturbance in patients with low back pain. Eur Spine J. 2011;20(5):737-743.

7. Kovacs FM, Abraira V, Peña A, et al. Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial. Lancet. 2003;362(9396):1599-1604.