With up to two-thirds of patients with chronic pain conditions also experiencing sleep disorders, two experts from a top U.S. hospital, Cleveland Clinic, suggest cognitive behavioural therapy for insomnia as a potential solution.
For people with chronic pain – whether from back pain, fibromyalgia or the pain of cancer treatment – sleep issues are especially common, and pain is one of the most common causes of insomnia.
“Pain worsens sleep patterns and sleep disturbances worsen the pain. It’s a vicious cycle,” said pain specialist Robert Bolash, MD. These problems can range from difficulty falling asleep to difficulty staying asleep, and lack of good sleep can lead to heightened pain and worsening sleep.
His colleague, behavioural sleep medicine specialist Michelle Drerup, PsyD., added that treating insomnia can help chronic pain subside, but before treating insomnia, it is important to rule out other issues that could be causing sleep problems.
“Sometimes, after receiving a new diagnosis, it is common for people to struggle with other disorders that can affect sleep, like depression or post-traumatic stress disorder,” she said.
If people struggle with insomnia, it can also be caused by a sleep-related medical condition, such as sleep apnea. When sleep quality is poor, pain levels are exacerbated. “At times, we see patients with pain diagnoses who really have a medical condition such as sleep apnea. When their sleep apnea is treated, their pain diminishes as well,” Dr Bolash explained.
A three-pronged approach to address insomnia
The two experts recommend the following three-pronged approach that could help people to address their insomnia: Understanding insomnia, understanding good sleep habits and understanding the therapy.
When it comes to therapies, cognitive behavioural therapy for insomnia (CBT-I) includes a number of strategies designed to improve sleep quality and help change thoughts and behaviours that interfere with sleep. This type of therapy is often preferred over medications because it has no side effects and is a more effective long-term solution.
Another strategy to help with insomnia is relaxation training, which reduces or eliminates muscle tension and distracts from racing thoughts. Techniques include specific muscle group relaxation, guided imagery and meditation.
Dr Drerup explained: “Relaxation is a process that decreases the effects of stress on your body and mind by activating your body’s natural relaxation response – the parasympathetic nervous system. Relaxation strategies help by slowing down your breathing and heart rate and can reduce the release of stress hormones.
“In general, relaxation techniques involve refocusing your attention onto something calming and increasing awareness of your body. Guided imagery or visualisation is one type of relaxation technique in which one focuses on mental images of a peaceful, calming place or situation. Incorporating as many of the senses as possible, including smell, sound, touch and sight is encouraged.”
For example, if you enjoy relaxing at the ocean, you can picture yourself on your favourite beach, thinking about the sound of the crashing waves, the feeling of the sand under your toes and the warmth of the sun on your skin.
“Learning basic relaxation techniques takes practise, but anybody can do it. Numerous apps and resources are available to help guide someone who is interested in developing these skills,” she added.