Does sleep really matter for chronic pelvic pain?

Guest post by Jessica Reale, PT, DPT, WCS

Did you know that most people will spend about 22 years of their lives sleeping? Sleep is one of the most basic human needs and is at the very base of Maslow’s Hierarchy of Human Needs right next to eating, sex and toileting. (Can I just say how unfair it is that chronic pelvic pain often influences all of these things!) Inadequate sleep has become a major health crisis and the Institute of Medicine (IOM) estimates that close to 50-70 million Americans chronically suffer from a disorder of sleep and wakefulness.

Inadequate sleep has been shown to negatively impact the body and is related to (IOM):

• Obesity in adults and children
• Diabetes and impaired glucose tolerance
• Cardiovascular disease and hypertension
• Anxiety symptoms
• Depressed mood
• Alcohol use

Sleep has incredible benefits for the body including promoting improved immune function and may even have pain-relieving (analgesic) effects. This is important for people suffering from chronic pain, especially since an estimated 66% of people with chronic pain experience poor or unrefreshing sleep (according to the Sleep Foundation) This has led many researchers to wonder, “Does chronic pain lead to sleep problems or do sleep problems lead to pain?”And, if sleep problems lead to pain, could we possibly decrease someone’s pain by improving sleep?

The answer ultimately is “Yes!” for all questions—but it’s a little more complicated than that. To understand this better, let’s take a look at some of the research related to sleep and chronic pain.

• A multi-level daily processing study by Tang and colleagues in 2012 examined the sleep patterns and pain presentation of 119 men and women (74% of them being women) with both chronic pain and sleep problems. Their results showed that pre-sleep pain was not a reliable predictor of subsequent sleep. Rather, pre-sleep cognitive arousal showed consistent impact on the quality of sleep. In addition, sleep quality consistently predicted pain in the first half of the day (but not so much in the second).
• A review by Kundermann and colleagues in 2004 came up with fairly similar conclusions. They found that pain disturbs sleep by increasing arousal and triggering the neurobiological consequences of stress leading to more disturbed sleep. They also suggested that a higher quality of sleep could lead to better pain regulation and that better pain regulation could lead to more restorative sleep.
• In 2013, Valrie and colleagues explored similar relationships between sleep and pain in a pediatric population. Their review recommended a bi-directional relationship of sleep and chronic pain mediated by physiological and biological factors as well as mood. They concluded that this relationship can influence function, quality of life and disability in children.

So, do interventions aimed at improving sleep actually work to reduce pain? Unfortunately, there still needs to be more research to better understand this. The results, however, are fairly promising:

• A study by Jungquist and colleagues in 2010 examined the effects of a cognitive-behavioral therapy program for 28 people with chronic pain and insomnia which included sleeprestriction, stimulus control, sleep hygiene, and one session of cognitive therapy devoted to catastrophic thoughts about the consequences of insomnia. Results showed improvements in sleep as well as the extent to which pain interfered with daily functioning.
• A review by Hasset and Gervetz in 2009 recommended sleep hygiene as an effective component of a multifactorial program for men and women with fibromyalgia.

So, what can you do today to sleep better and help improve your pain? Develop good sleep habits! (Bloom 2009)

• Develop a sleep ritual such as maintaining a 30 minute relaxation period before bedtime or taking a hot bath 90 minutes before bedtime
• Make sure the bedroom is restful and comfortable. Environmental factors such as the room being too warm, too noisy or too bright can make sleep more difficult.
• Avoid heavy exercise within 2 hours of bedtime. Rather, try to stay active during the earlier parts of the day.
• Try not to avoid eating a heavy dinner late at night.
• Avoid sleep-fragmenting substances such as caffeine, nicotine and alcohol
• Go to bed only if you feel sleepy
• Use the bedroom only for sleep and sex; do not watch television from bed or work in bed
• Sleep only in your bedroom
• If you cannot fall asleep, leave the bedroom and return only when sleepy
• Maintain stable bed times and rising times. Arise at the same time each morning regardless of the amount of sleep obtained that night.
• Avoid daytime napping. If you do nap during the day, limit it to 30 minutes and do not nap, if possible, after 2pm.

Developing good sleeping habits is so important for improving sleep patterns and can be a useful tool in recovering from chronic pain (pelvic pain included!). Please note: if you are struggling with insomnia—don’t hesitate to talk to your doctor! Sleep is a multifactorial process and is not just about having good habits—other factors such as breathing problems, medications, etc. can play a role. A good sleep specialist can help you determine the cause of your sleep problems and get you back to a healthy night’s sleep!

What other techniques have you used to help with your sleep? We’d love to hear from you in the comments below!

PROFESSIONAL SPOTLIGHT: 

Jessica Reale, PT, DPT, WCS

Jessica is a fantastic colleague and doing great things to spread education about pelvic PT. If you’d like to read more blog posts by Jessica, check out her blog at www.jessicarealept.com!

Jessica Reale, PT, DPT, WCS is a board-certified specialist in Women’s Health and treats pelvic floor disorders in men, women and children in Atlanta, GA. She received her doctorate in physical therapy (DPT) at Duke University School of Medicine and was the director of the largest pelvic floor rehabilitation program in South Carolina prior to relocating to Atlanta in 2015. Jessica is passionate about helping her patients achieve optimal health through individualized treatment plans integrating the most current research.  She is actively involved in educating the community and other professionals, and has lectured at support groups, conferences and universities.

References:

Bloom HG, Ahmed I, Alessi CA, Ancoli-Israel S. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc. 2009 May;57(5):761-89

Hassett AL, Gevirtz RN Nonpharmacological treatment for fibromyalgia: patient education, cognitive-behavioral therapy, relaxation techniques and complementary and alternative medicine. Rheum Dis Clin North Am. 2009 May;35(2):393-407

Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. Available from: http://www.ncbi.nlm.nih.gov/books/NBK19961/

Jungquist CR, O’Brien C, Matteson-Rusby S, Smith MT, et al. The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain. Sleep Med. 2010 Mar;11(3):302-9

Kundermann B, Krieg JC, Schreiber W, Lautenbacher S. The effect of sleep deprivation on pain. Pain Res Manag. 2004 Spring 9(1):25-32

Valrie CR, Bromberg MH, Palermo T, Schanberg LE. A systematic review of sleep in pediatric pain populations. J Dev Behav Pediatr 2013 Feb;34(2):120-8

Tang NK, Goodchild CE, Sanborn AN, Howard J et. al. Deciphering the temporal link between pain and sleep in a heterogenous chronic pain patient sample: a multilevel daily process study. Sleep. 2012 May 1:35(5):675-87A

For webinars and courses on pelvic pain, please check out our online platform Pelvic Global Academy.