Pain and Sleep: Managing Chronic Pain at Night

Pain can make it difficult to fall asleep, stay asleep or feel refreshed in the morning. Unfortunately, the relationship can work in both directions: pain may disturb sleep, while consistently poor sleep can make pain feel more difficult to manage.

This can create a frustrating cycle in which discomfort causes repeated awakenings, tiredness reduces your ability to cope and concern about the next night makes it even harder to relax.

Understanding how pain and sleep interact can help you identify practical changes and recognise when professional support may be appropriate.

Key points about pain and sleep

• Pain can delay sleep, cause repeated awakenings and make it difficult to return to sleep.
• Insufficient or fragmented sleep may increase sensitivity to pain.
• Pain and poor sleep can affect mood, concentration and daytime functioning.
• Improving an underlying sleep problem may form part of a broader pain-management plan.
• Relaxation, positioning and healthy sleep habits may improve comfort at night.
• Some pain medicines can cause drowsiness, restlessness or changes in breathing during sleep.
• Medicines should only be changed after speaking with a doctor or pharmacist.

Why can pain make sleeping difficult?

Falling asleep requires a gradual reduction in mental and physical alertness. Pain can interrupt this process by continually drawing your attention back to an uncomfortable part of your body.

Discomfort may also make it difficult to find a suitable sleeping position. Even after you fall asleep, changing position or placing pressure on a painful area can cause brief or extended awakenings.

People living with back pain, arthritis, nerve pain, migraines, pelvic pain, fibromyalgia and other persistent conditions frequently report disrupted sleep. However, the way pain affects sleep is different for every person.

Common experiences include:

• Taking longer than expected to fall asleep.
• Sleeping lightly because of discomfort.
• Waking when changing position.
• Finding it difficult to become comfortable again.
• Waking earlier than intended.
• Feeling physically unrefreshed in the morning.

Can poor sleep make pain feel worse?

Pain is influenced by more than the location or severity of an injury. The brain, nervous system, emotions, previous experiences and current circumstances can all affect how pain is experienced.

When you have not slept well, your capacity to manage uncomfortable sensations may be reduced. You may also feel more tense, irritable or emotionally overwhelmed, making pain feel harder to tolerate.

Poor sleep can affect motivation and energy as well. This may make it more difficult to exercise, prepare nutritious meals, attend appointments or use the self-management strategies that ordinarily help you cope.

A single bad night will not necessarily cause a lasting change in pain. The greater concern is an ongoing pattern of fragmented sleep, daytime exhaustion and increasing sensitivity.

How can pain and poor sleep form a cycle?

The relationship between pain and sleep can become self-reinforcing:

1. Pain makes it difficult to settle or remain asleep.
2. Broken sleep leads to tiredness and reduced resilience.
3. Pain feels more intrusive or difficult to manage the following day.
4. You begin worrying about whether pain will keep you awake again.
5. Increased tension and alertness make the next night more difficult.

Improving one part of this cycle may help another. Better pain management may support sleep, while addressing insomnia or another sleep disorder may improve your ability to manage pain during the day.

Could a separate sleep disorder be involved?

Pain may not be the only reason someone is sleeping poorly. Insomnia, obstructive sleep apnoea, restless legs syndrome, circadian rhythm disruption and medicine-related side effects can occur alongside a pain condition.

Possible signs of another sleep disorder include:

• Loud or persistent snoring.
• Choking, snorting or gasping during sleep.
• Morning headaches or a dry mouth.
• An uncomfortable need to move your legs at night.
• Severe daytime sleepiness despite spending enough time in bed.
• Falling asleep unintentionally during quiet activities.

If these symptoms are present, speak with a health practitioner. Treating an underlying sleep disorder may be an important part of your overall care.

Can treating sleep problems help with pain management?

Addressing a persistent sleep problem does not guarantee that pain will disappear. However, more restorative sleep may improve energy, concentration, mood and the ability to use other pain-management strategies.

People experiencing ongoing insomnia may benefit from cognitive behavioural therapy for insomnia, commonly called CBT-I. This structured treatment helps address the thoughts and behaviours that can keep insomnia going.

Depending on the cause, treatment might also involve managing another health condition, reviewing medicines, addressing sleep apnoea or changing habits that interfere with sleep.

How can I become more comfortable in bed?

Small adjustments to your sleeping environment may reduce pressure on uncomfortable areas. The most appropriate position will depend on the location and cause of your pain.

Strategies to discuss with your health practitioner or physiotherapist include:

• Using a pillow between the knees when sleeping on your side.
• Placing a pillow beneath the knees when sleeping on your back.
• Supporting a painful arm, shoulder or joint with an additional pillow.
• Checking whether your mattress and pillow provide suitable support.
• Using heat or cold therapy if recommended for your condition.
• Changing position carefully rather than waiting until discomfort becomes severe.

A position that helps one condition may aggravate another, so personalised advice is preferable when pain is persistent or severe.

What can I do before bedtime?

A predictable wind-down routine can help reduce physical and mental alertness before sleep. This is particularly useful when anticipating pain has itself become a source of tension.

You could try:

• A warm shower or bath if this is appropriate for your condition.
• Slow breathing or progressive muscle relaxation.
• A guided meditation or calming audio recording.
• Gentle movement recommended by your physiotherapist or doctor.
• Preparing pillows, heat packs or other approved supports before getting into bed.
• Writing down worries or unfinished tasks earlier in the evening.
• Reducing stimulating screen use before bedtime.

The aim is not to force yourself to sleep. It is to create conditions that make sleep more likely while reducing the attention given to pain.

What should I do if pain wakes me during the night?

Try to avoid checking the time repeatedly or calculating how little sleep remains. This can increase frustration and make you more alert.

Begin with a calming strategy such as slow breathing, changing position or using a support recommended by your healthcare professional.

If you remain awake and become increasingly frustrated, consider leaving the bed for a quiet activity in a dimly lit space. Return when you feel sleepy again. This can help prevent the bed from becoming strongly associated with wakefulness and distress.

Do not take additional medicine unless it has been specifically prescribed or recommended for that purpose.

Can anxiety increase pain at night?

Anxiety can increase muscle tension and make it more difficult to direct your attention away from uncomfortable sensations. At night, when there are fewer distractions, pain and worry may feel more prominent.

You may begin thinking about how the pain will affect tomorrow, whether it will get worse or whether you will ever sleep normally again. These thoughts can increase alertness without helping resolve the immediate problem.

Relaxation exercises, mindfulness and CBT-based strategies may help reduce the distress associated with pain. This does not mean the pain is imaginary. It recognises that physical sensations, emotions, sleep and the nervous system interact with one another.

How can daytime habits support better sleep?

Night-time sleep is influenced by what happens throughout the day. Depending on your condition and clinical advice, helpful habits may include:

• Maintaining a consistent morning wake-up time.
• Getting daylight exposure earlier in the day.
• Remaining appropriately active rather than alternating between overactivity and prolonged rest.
• Using activity pacing to reduce pain flare-ups.
• Limiting daytime naps, particularly late in the afternoon.
• Reducing caffeine later in the day.
• Avoiding alcohol as a sleep aid.
• Keeping the bedroom dark, quiet and comfortably cool.

If physical activity consistently increases your pain, seek individual advice rather than abandoning movement entirely.

How can pain medicines affect sleep?

Effective pain relief may make sleeping easier, but different medicines can affect sleep in different ways. Some may cause drowsiness, while others may contribute to restlessness, unusual dreams, disrupted sleep or next-day fatigue.

Combining medicines that cause sedation can increase the risk of excessive drowsiness and breathing problems. Alcohol can increase these risks further.

Always take medicines according to their directions. Speak with your doctor or pharmacist if:

• Your medicine is no longer providing the expected benefit.
• You are regularly increasing the amount you take.
• You feel unusually drowsy or confused.
• Your sleep changed after beginning a medicine.
• You are experiencing side effects.
• You want to reduce or stop a prescribed medicine.

Do not suddenly stop a medicine that you have been taking regularly without obtaining clinical advice.

Why do opioids require particular care?

Opioids are strong prescription pain medicines that include codeine, oxycodone, morphine, fentanyl and others. They can cause sedation and slow or suppress normal breathing.

This risk may be greater when opioids are first started, after a dose increase, when combined with alcohol or other sedating medicines, or when someone has an existing respiratory condition or sleep-related breathing disorder.

People taking opioids should tell their prescriber if they have sleep apnoea, loud snoring, witnessed breathing pauses or unexplained daytime sleepiness. Opioids should only be taken exactly as prescribed and should never be shared with another person.

Slow or shallow breathing, blue lips or fingertips, unusual gurgling, severe drowsiness or being unable to wake someone may indicate an opioid overdose. Call 000 immediately and administer naloxone if it is available.

Are sleeping tablets the answer?

Sleeping medicines may sometimes be considered for short-term use, but they do not address every cause of disrupted sleep. Some can become less effective with repeated use and may cause dependence, falls, memory problems or next-day impairment.

Combining sleeping medicines with opioids, alcohol or other sedatives can be dangerous. A doctor should review your medical history, existing medicines and possible sleep disorders before recommending treatment.

For persistent insomnia, behavioural treatments such as CBT-I are generally considered before relying on sleeping tablets over the longer term.

When should I seek professional help?

Arrange a clinical assessment if pain or poor sleep is regularly affecting your mood, concentration, mobility, work, relationships or ability to complete daily activities.

You should also seek advice if:

• Pain is new, unexplained or becoming progressively worse.
• You regularly struggle to fall asleep or remain asleep.
• You have symptoms of sleep apnoea or another sleep disorder.
• Your medicines cause significant drowsiness or other side effects.
• You feel unsafe driving because of tiredness.
• You are relying on alcohol or taking more medicine than prescribed to sleep.
• Pain is accompanied by weakness, numbness, fever or other concerning symptoms.

Severe or sudden pain, difficulty breathing, loss of consciousness or symptoms of an opioid overdose require urgent medical assistance. Call 000.

Discussing persistent sleep problems with Herbly

If pain is repeatedly interrupting your sleep, an online insomnia consultation with Herbly provides an opportunity to discuss your sleep, medical history, current medicines and treatments you have previously tried.

A clinician will consider your individual circumstances and explain options that may be appropriate. Treatment and prescribing decisions are made independently following a clinical assessment, and no particular treatment or prescription can be guaranteed.

You can also meet Herbly’s doctors and clinical team before beginning the consultation process.