March 6, 2024

Sleep and Chronic Pain or “Painsomnia”

Photo by Sora Shimazaki

In the quest for better sleep, especially if you’re struggling with chronic pain, the journey can become nights filled with anxiety and frustration rather than rest. The more elusive sleep becomes, the more we crave it, inadvertently ramping up the pressure on ourselves to get it. This, paradoxically, makes sleep even more difficult.

The key to breaking this cycle might not lie in chasing sleep but in changing how we think about sleep and rest, particularly through Cognitive Behavioral Therapy (CBT).

Understanding the Cycle of Sleep Anxiety

When sleep doesn’t come easily, it’s an understandable reaction to want it even more. This desire can create an immense amount of pressure, feeding into anxiety that further complicates our ability to sleep and increases the likelihood of developing chronic insomnia.

It’s a self-fulfilling prophecy: the more we worry about sleep, the harder it becomes to get it. If you’re dealing with chronic pain or discomfort, this cycle is all too familiar. The anticipation of a pain-filled, sleepless night increases anxiety, which, in turn, heightens alertness and decreases the body’s ability to relax— one important element for sleep.

The CBT Approach to Managing Sleep Anxiety

Cognitive Behavioral Therapy (CBT) offers a structured method for addressing the unhelpful thought patterns that contribute to sleep anxiety. Through thought-challenging or cognitive restructuring, CBT teaches us to identify, question, and change the negative thoughts that hinder our ability to rest.

The Thought-Challenging Framework

The thought-challenging process involves several steps to help you shift from unhelpful to more balanced and constructive thinking.

Here’s how it can be applied to someone struggling with pain, physical discomfort and insomnia, with a focus on prioritizing rest:

  1. Identify the Situation or Trigger: Difficulty falling asleep due to chronic pain.
  2. Acknowledge Feelings and Emotions: Anxiety and frustration, rated at 80%.
  3. Notice Body Sensations: Pain sensations, tension, and restlessness.
  4. Pinpoint Unhelpful Thoughts or Images: “I’ll never sleep because of my pain,” or “I need sleep to function tomorrow.”
  5. Examine the Evidence: While pain is present, there have been nights where relaxation techniques have led to restfulness, despite limited sleep.
  6. Generate Alternative Perspectives: Focusing on relaxation, rather than sleep, may not eliminate pain but can reduce its impact on rest.
  7. Reflect on the Outcome: Implementing a relaxation-focused bedtime routine can offer a sense of peace and rest, which is beneficial in itself.
  8. Re-rate Emotion: After engaging in thought challenging, anxiety and frustration levels decrease, signaling a shift towards a more relaxed state conducive to rest.

Practical Examples

Example 1: Sarah has been dealing with chronic lower back pain. Every night, she worries about her ability to sleep, which only amplifies her pain. By applying the thought-challenging framework, Sarah learns to shift her focus from achieving sleep to engaging in relaxation exercises specifically designed for back pain. Over time, she finds that while her pain persists, her anxiety around sleep diminishes, leading to more restful nights.

Example 2: Alex struggles with insomnia exacerbated by rheumatoid arthritis. He often lies in bed, ruminating over the next day’s challenges, convinced he won’t cope without adequate sleep. Through thought challenging, Alex starts to question the helpfulness of his nighttime worries. He introduces a pre-sleep routine of gentle yoga and meditation, focusing on resting his mind and body. This shift in focus gradually leads to improved sleep quality.

Shifting the Focus: Prioritizing Rest Over Sleep

The examples above illustrate a crucial strategy in managing sleep anxiety due to chronic pain: shifting the focus from sleep attainment to prioritizing rest. By challenging unhelpful thoughts and adopting a more flexible approach to what rest can look like, individuals can create a more compassionate and accommodating space for themselves at night.

Trouble sleeping? Contact me today to schedule your free virtual consultation and begin your journey to good nights and better days.

Common Questions About Pain and Sleep

Photo by Engin Akyurt

How does sleep affect chronic pain?

Sleep and chronic pain have a bidirectional relationship, meaning each can significantly influence the other. Poor sleep can exacerbate chronic pain conditions, increasing sensitivity to pain by affecting pain perception pathways in the brain. Conversely, chronic pain can disrupt sleep patterns by making it harder to fall asleep and stay asleep due to physical discomfort and pain-related anxiety. This vicious cycle can lead to increased fatigue, mood disturbances, and decreased quality of life, emphasizing the importance of managing both sleep and pain effectively.

Why does pain sometimes go away when you sleep?

While asleep, the body’s perception of pain can decrease. During sleep, especially in deeper stages such as slow-wave sleep (NREM stage 3), the body undergoes various restorative processes, including muscle repair, growth, and the rebalancing of hormones that can influence pain perception, such as cortisol and growth hormone.

The distraction of consciousness away from pain signals due to the sleeping state can also contribute to temporary relief from pain. However, it’s essential to note that this relief can be short-lived, particularly if sleep quality is poor or disrupted by pain.

How else do you get restful sleep with chronic pain?

Getting restful sleep with chronic pain involves a combination of pain management strategies and sleep hygiene practices:

Pain Management: Consult with healthcare providers to effectively manage pain through medications, physical therapy, or alternative treatments.

Consistent Sleep Schedule: Go to bed when you’re sleepy and around the same time and wake up at the same time every day to regulate your body’s internal clock.

Create a Comfortable Sleep Environment: Use supportive pillows and mattresses and maintain a comfortable room temperature.

Limit Stimulants: Avoid caffeine, nicotine, and heavy meals before bedtime.

Relaxation Techniques: Practice mindfulness, meditation, or deep-breathing exercises to reduce pain-related anxiety and promote relaxation.

Limit Naps: Avoid long daytime naps that can interfere with nighttime sleep.

Physical Activity: Engage in gentle exercise or physical activity, as recommended by a healthcare provider, to improve sleep quality.

Seek Professional Help: Consider cognitive-behavioral therapy for pain (CBT-P) or CBT for insomnia (CBT-I) to address unhelpful thoughts and behaviors affecting sleep and pain.

Does sleep ease pain?

Getting quality sleep can ease the pain. Adequate sleep is essential for the body’s restorative processes, including the healing and repair of tissues and regulating pain-modulating hormones. Good sleep can strengthen the immune system, reduce inflammation, and decrease overall pain sensitivity. Furthermore, sleep can improve emotional well-being and resilience, providing better coping mechanisms for managing chronic pain. Improving sleep quality can, therefore, play a crucial role in comprehensive pain management strategies.


For those caught in the frustrating cycle of sleep anxiety and chronic pain, thought challenging presents a path forward.

By gently questioning and reframing unhelpful thoughts about sleep, it’s possible to reduce anxiety, prioritize rest, and, paradoxically, improve the chances of getting good quality sleep. The journey towards better sleep, then, begins not with a pursuit of sleep itself but with a change in how we think about rest and relaxation.

Trouble sleeping? Contact me today to schedule your free virtual consultation and begin your journey to good nights and better days.

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