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Chronic back pain and sleep

Long-term chronic back pain can stop a person from getting a good night's sleep.

A lack of restful sleep can also make a person wake up feeling more tired and sore.

Causes of sleep problems

The back pain itself may cause a sleep problem. Here are some other causes:

  • Anxiety and depression can result in the inability to fall asleep or stay asleep, which will aggravate pain. Anxiety and depression increase a person’s sensitivity and awareness of pain, and the lack of proper sleep aggravates both the pain and any depression with anxiety.
  • Breathing-related sleep disorders associated with obesity - such as obstructive sleep apnoea - can further aggravate pain by causing you to wake frequently throughout the night and by interfering with normal sleep patterns. 
  • Limb movement disorders - such as restless leg syndrome - may further disrupt the normal sleep pattern. These conditions may be related to anxiety and depression as well as stress.
  • Self-medicating with alcohol may help you fall asleep, but you'll probably wake up tired, grumpy and in pain.
  • Some prescription medications can impair the quality of your sleep.

Medications that improve sleep and reduce chronic back pain

Some medications can help you sleep while helping with your chronic back pain. However some of these medicines have side effects and the potential for addiction. They should be used as part of a more comprehensive and widespread programme of pain management.

  • Newer sedatives may not have a negative effect on your sleep.
  • Over-the-counter pain relievers such as aspirin, paracetamol or ibuprofen can be effective for short-term use. Use them only as directed and let your doctor know what you are taking.
  • Prescription medicines for severe back pain include antidepressants such as doxepin and amitriptyline or a muscle relaxant such as diazepam and baclofen.

Medication should only be used for as long as is recommended. Long-term use can result in dependence on some drugs. The goal of medication should be to help you develop a more normal sleep pattern.

Lifestyle changes for chronic back pain and sleep problems

Here are some tips for getting a good night's sleep with chronic back pain:

Avoid stress. Stress is the major cause of insomnia. It is also associated with chronic back pain.

Limit or eliminate caffeine. Even moderate caffeine use can cause insomnia and sleep disturbances.

Avoid eating heavily before bedtime. A heavy meal can cause acid reflux ( heartburn) and keep you awake. However, though there are no studies to show that it can induce sleep, have a mug of warm milk if it comforts you. The placebo effect can be very powerful.

Don't self-medicate with alcohol. It's worth restating that alcohol impairs the quality of sleep.

Do some soothing exercises. Do these three exercises for several minutes while lying in bed unless it hurts to do them:

  • Bring both knees towards your chest (as if doing a bomb in a swimming pool).
  • Alternate bringing first one knee, then the other, towards your chest.
  • Bring both knees to your chest and twist from one side to the other.
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