More than a third of American adults fail to get enough sleep on a regular basis1, and, according to the National Sleep Foundation, two-thirds of people experiencing chronic pain have trouble sleeping.
If you’ve been injured, the resulting joint, muscle or nerve pain can stop you falling asleep and, even when you do drop off, staying asleep long enough to reach deep levels that help your body heal and restore itself can be difficult. This is because the same stimulation that activates your nerves during pain, also stimulates your brain and prevents you from sleeping.
Not only might the pain it is causing be distressing but you may also experience flashbacks to the incident that lead to you being injured. Concern about how well you are going to recover from your injury in the future can also result in a sleepless night.
The benefits of sleep for healing are extensive, so it is important to take advice on all the medication, therapies and pain relief devices available that will not only reduce your pain but also help you relax and improve your sleep patterns while recovering from injury.
Types of Injury and Pain
In the States, someone is accidentally injured every second.2 Single incidents like car accidents and falls cause acute injuries such as a break in the bone, dislocation, sprains or strains to muscles and ligaments.
On the other hand, repetitive actions, very common in sports, will result in injury from overuse. This is where minor trauma to the tendons, bones and joints is experienced over time, and can then lead to injuries such as tennis elbow or shin splints.
The 2 main categories for pain are acute and chronic.
Acute pain starts suddenly and, although shorter lived, may still affect your sleep for several weeks following injury. This could be in the form of a dull ache from a broken bone or a throbbing pain from a cut or wound while it is still healing.
Chronic pain, usually defined as pain that lasts for more than 12 weeks, is ongoing and can be more wearing, leading to psychological symptoms such as anxiety.
Although it may originally have been triggered by an injury such as a break or sprain, it can linger even after the initial injury has healed due to damaged nerves. If left untreated, both types of pain can be can be detrimental to your sleep patterns and, as a consequence, to your overall health.
Sleeping Aid Recovery
When you’re in pain, the recommended 7 to 8 hours of sleep can seem impossible to achieve, but, unfortunately, without enough sleep, pain can worsen. Your body doesn’t simply shut down when you are asleep but uses the time productively to deal with repairs, healing and regeneration of cells. This is one of the reasons why a good night’s sleep is so important to recovering successfully from an injury.
While you sleep, your body makes more white blood cells and these attack viruses and bacteria that can disrupt the healing process.3 As you fall into a deep sleep, the flow of this enriched blood is increased, taking oxygen and nutrients into the muscles and helping them to recover. Further growth and repair are stimulated by hormones such as prolactin which helps regulate inflammation, but these are only sufficiently released during deep sleep.
Pain Killing Drugs
For mild to moderate pain, over the counter, nonsteroidal anti-inflammatory drugs, or NSAIDs, such as aspirin or ibuprofen, can be effective to aid sleep. They block the production of the hormone prostaglandin that your body makes in response to an injury, reducing swelling and decreasing sensitivity to pain.
However, long-term use of these medications is not advisable as they can make you more anxious and disrupt your sleep routine. Aspirin and ibuprofen have both been shown to disturb sleep by causing patients to wake more frequently and keeping them awake for longer. Ibuprofen in particular also hampered the start of deeper sleep phases.4
A doctor should be consulted if you require pain relief for longer or need a stronger medication. For a more severe level of pain, you may be prescribed opioids. These work by binding to receptors in your brain, effectively telling your body that you are no longer in pain. They are very effective but can have serious side effects if not used correctly, and should only be used for a short period of time to avoid dependency.
Treatments for Insomnia
Prescription sleeping pills may be beneficial if pain is causing short-term disruption of your sleep patterns. Your body can quickly become used to the drugs, so they should only be taken temporarily in order to establish a better routine.
Standard over the counter sleeping aids usually contain antihistamines that can cause drowsiness. However, although they are not very effective at bringing on sleep, the feeling of drowsiness that they cause can sometimes still be felt the next day.
Barbiturates cause sedation by depressing the central nervous system and can be effective in managing sleep disorders but only over very short periods. They are rarely prescribed these days due to their adverse side effects, such as dependency and hallucinations, which can be experienced over longer periods of time.
You should not take sleeping tablets if you are already taking opioid medication to deal with the pain from your injury as this can lead to a greater risk of overdose. Of the 91 Americans who die every day from an opioid overdose, nearly a third were found to have also been taking benzodiazepines, drugs prescribed to help overcome anxiety and problems sleeping.5
Pain Relief Devices
If you are worried about the side effects of pain relief drugs and other prescribed pills, there are alternative methods available to relieve pain effectively and safely without medication. These are especially valuable in dealing with chronic pain that is ongoing even when the original injury has been treated.
An EMS machine (or Electrical Muscle Stimulator) can help with relieving muscle pain and the swelling and inflammation that it can cause. It can also encourage healing by stimulating blood flow and improving mobility.
A TENS (transcutaneous electrical nerve stimulation) machine uses electrical impulses to reduce pain signals to the spinal cord and brain. Pads positioned on the site of pain can relax and relieve sore muscles, limit discomfort from painful joints and alleviate nerve pain. The impulses can also stimulate the production of endorphins which act as natural painkillers in the body.
Because they are programmable, TENS machines can be used to alleviate pain as you try to get to sleep. The pads should ideally only be used in one place for a limited amount of time. However, setting the timer for 20 minutes will allow relief from pain to help you to drift off, but because the machine will then switch off, the impulses passed through the pads will stop before irritating the skin.
Coping with Psychological Trauma
It’s common to experience significant damage to your tissues and bones after severe physical trauma such as a car accident or serious fall. This damage will most likely cause considerable pain that will affect your sleep.
However, even when the pain starts to subside, the psychological after-effects of a traumatic event could continue to disrupt your sleep patterns. Neurochemicals in the brain such as adrenaline can make it very difficult to relax and, coupled with nightmares and flashbacks, may lead to insomnia.6
Once the physical pain is managed with drugs or other therapies, an effective treatment for insomnia is cognitive behavioural therapy. Through this treatment you can learn strategies for reducing stress and anxiety, aiding relaxation and managing your sleeping patterns better. It can be helpful to talk through the worries that are preventing you from sleeping and you will learn methods to overcome these negative thoughts that keep you awake at night.
Exercising with Injury
Although it might seem counterintuitive to exercise when in pain, moderate exercise during the day can help you relax to sleep better at night. The chemical endorphins produced in the brain during exercise act as natural painkillers and mood enhancers, leading to improved sleep and a reduction in levels of stress. A short gentle walk or even just 5 minutes of aerobic exercise can reduce levels of anxiety7.
Of course, the type of pain, its level of severity, and the nature and location of your injury must be considered before undertaking exercise. Some injuries such as broken bones will require immobilisation in a sling or cast in order to prevent further damage and reduce pain. However, if you only have a sprain, some gentle movement as soon as significant pain has subsided, is recommended.
You should take advice from your doctor or physical therapist, but it may be possible to adapt a routine or modify movements to avoid injured areas while still giving you all the benefits of exercising.
Alcohol may temporarily numb pain and bring on sleep quicker, but it also acts as a stimulant, waking you up and causing you a more restless night. For this reason, it should be avoided.
Even if your mobility is limited by pain, try to get outside during the day just to sit in sunlight. This will trigger production of serotonin to boost your mood and help produce sufficient melatonin, the hormone responsible for helping you sleep, when the lights go out at night.
Sleep is vital for a healthy body and mind. It provides time for the brain to recharge, and for cells to regenerate, allowing the body to optimize the chance to heal itself. When it is disrupted by pain caused by injury, and the anxiety that follows, the ability to heal is diminished and so a cycle of sleep deprivation and poor body function begins.
To break that cycle, finding relief from chronic pain is essential. This can allow the body to relax and shut down long enough for sufficient levels of repair to take place, and so further ease the source of the pain and any inflammation and infection associated with it.
By exploring all the different ways to deal with pain, you will find a method that suits you. Combined with techniques to help you relax, this will then lead to a comfortable, restorative night’s sleep and a quicker recovery from your injury.