How to Sleep Better When You're in Pain: Physical Therapist Tips
Struggling to sleep because of pain? Learn practical, physical therapist-approved strategies to improve sleep, reduce nighttime discomfort, and support your body's recovery.
If pain keeps you awake or leaves you feeling stiff and sore every morning, you're not alone. Quality sleep is one of the most important parts of your body's recovery process, yet chronic pain, poor posture, muscle tension, and stress can all interfere with restful sleep. The good news is that improving how your body moves during the day—and how you support it at night—can help you wake up feeling more rested and comfortable.
According to the CDC, about a third of adults in the US report getting less than the recommended amount of sleep. While lack of sleep is associated with increased accidents, decreased performance, chronic disease, mental illness and decreased quality of life, it also influences the experience of pain.
Sleep Is Part of Your Movement System
Sleep isn't separate from how your body moves—it's part of the same system. During sleep, your nervous system regulates muscle tone, your tissues recover from daily stress, and your brain reinforces the movement patterns you've practiced throughout the day. If your body spends the day relying on compensations, excessive tension, or poor posture, those patterns don't disappear at bedtime. They can continue to create unnecessary stress on your joints and muscles throughout the night. That's why lasting improvements often require more than changing your pillow or sleeping position. They require improving how your whole body moves.
Learning to breathe efficiently can reduce unnecessary muscle tension and help your body relax before sleep.
Your sleeping position matters, but the way you move during the day has an even greater impact on how your body feels at night.
Sleep Promotes Tissue Healing
When you sleep there is an increase in concentration of immune cells in your blood as well as growth hormone. This is primarily for tissue growth and repair. The manual therapy portion of physical therapy treatment helps to stimulate this process. When you go to sleep that night, your cells and body are busy at work making the physical changes that need to happen in order for you to heal.
Sleep Decreases Systemic Inflammation
Systemic inflammation means an inflammatory process that involves the entire body, not just certain regions in response to an injury. The concentration of immune cells involved in the inflammatory response in the blood is decreased with good sleep.
The reason is thought to be because sleep decreases the activation of the body’s two natural stress response systems:
The sympathetic or “fight/flight” system: a subconscious part of the brain and some nerve roots that are involved in matters of survival and regulating the hormone functions of your body. The main control center is in the deep part of the brain (black circle).
The adrenal system (blue circle): secretes cortisol, the “stress hormone.” It is well known that high levels of cortisol are correlated with high levels of systemic inflammation in the body.
When you don’t enough sleep, inflammation is allowed to persist for long periods of time. Good sleep promotes healing and the completion of the inflammatory process.
Sleep Decreases Pain Sensitivity
It has been well established in many studies that the amount of pain someone has and the amount of sleep someone gets both influence each other.
Getting enough sleep basically decreases the activation of the nerves involved that signal pain in the brain. It also influences the immune system (as described in the last section) in a way that decreases the sensitivity of nerves that signal pain in the brain as well.
With good sleep, the critical level of excitement is raised, which means it takes more stimulation for the nerve to produce a sensory signal.
4 Easy Ways to Improve Sleep Quality and Promote Healing
Pain Reducers: It’s ok to use your pain medication as recommended by your primary care provider to get you through this rough spot so you can find a comfortable position and fall asleep. This is especially true if you have had surgery. You will not be on the pain medication forever. The better your sleep, the less pain you will have, and with the help of your physical therapist, you’ll recover more efficiently. Before long you will not need the pain medication any longer!
Use supports to find a comfortable position: See this blog post for some strategies.
Develop Better Pre-Bedtime Habits: Other ways to ensure you get good quality sleep include having a set bed time to make sure you get the recommended amount of sleep each night. Also avoid eating big meals or junk food/drink before bed and screens a 1-2 hours before bed.
Deep Breathing Techniques: Deep breathing techniques help to turn off the “fight/flight” sympathetic nervous system and turn on the “rest/digest” parasympathetic nervous system. It also helps to decrease perceived pain. Try this technique in any comfortable position with a 4 second inhale and a 4-6 second exhale for at least 5 minutes once you get into bed.
Sleeping Better Starts Before Bedtime
The quality of your sleep isn't determined only by your mattress or pillow. It's influenced by how your body moves, the tension you carry throughout the day, and how efficiently your muscles support your joints.
If you've tried sleep tips without lasting relief, it may be time to address the bigger picture.
The Healthy Movement Reboot teaches you how to improve posture, build better movement habits, and reduce unnecessary strain throughout your body—so you can feel better both day and night.
Sleep tight everybody!
References:
Sleep and Sleep Disorders. CDC Website.https://www.cdc.gov/sleep/index.html. 15 April 2020.
Okifuji, A., Hare, B.D. Do Sleep Disorders Contribute to Pain Sensitivity?. Curr Rheumatol Rep 13,528 (2011). https://doi.org/10.1007/s11926-011-0204-8
Guido Simonelli, Janna Mantua, Mary Gad, Maria St Pierre, Lonique Moore, Angela M. Yarnell, Phillip J. Quartana, Allen Braun, Thomas J. Balkin, Allison J. Brager, Vincent F. Capaldi. Sleep extension reduces pain sensitivity. Sleep Medicine. Volume 54, 2019, Pages 172-176, ISSN 1389-9457, https://doi.org/10.1016/j.sleep.2018.10.023.
https://journals.lww.com/pain/Abstract/2015/08000/Sleep_and_pain_sensitivity_in_adults.10.aspx
Sleep Health Promotion: Practical Information for Physical Therapists. Physical Therapy, Volume 97, Issue 8, August 2017, Pages 826–836, https://doi.org/10.1093/ptj/pzx057
The Health Impact of night time eating: old and new perspectives. Amber W Kinsey, Michael J Ormsbee. Nutrients 7 (4), 2648-2662, 2015
https://www.cdc.gov/niosh/emres/longhourstraining/tips.html
Cramer, H., Haller, H., Lauche, R. et al. Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complement Altern Med 12,162 (2012). https://doi.org/10.1186/1472-6882-12-162
