Sleep and its link to pain

Sleep is essential for adequate functioning, health and good quality of life. Sleep and pain have a bidirectional relationship. Pain can interrupt the quality and quantity of sleep and sleep disturbance can exacerbate pain. Not only can sleep disturbance increase the perception of pain but also increase fatigue, negatively impact daytime functioning and impact emotional well-being. However, studies have shown that obtaining enough sleep each night is linked to decreasing the severity of pain (1).


What happens when we sleep?

While we are sleeping, our body undergoes a magnitude of restorative functions such as:

  • Tissue repair
  • Allowing our cells to divide and multiply
  • Release of hormones such as melatonin to help regulate our sleep/wake cycle.
  • Regeneration of bone, cartilage, skin and muscle.

A reduction in sleep can increase the amount of inflammation within our body which can enhance existing musculoskeletal pain and cause excess worry about pain. As a result, this increased stress can making falling and staying asleep more difficult (2).


How much sleep should we be getting?

Image result for sleep

We spend one third of our lives asleep and the need for sleep varies across different age groups. It is also important to listen to your body and assess how you feel on different amounts of sleep. Some people may feel productive and healthy on 7 hours of sleep while others may need 9 hours for adequate functioning (3).

The following sleep times are recommended by the National Sleep Foundation: 


6-13 years old 9-11 hours
14-17 years old 8-10 hours
18-64 years old 7-9 hours
65+ years old 7-8 hours

What can we do to improve our sleep?

In order to have good sleep hygiene you must practice behaviours that facilitate sleep and avoid behaviours that interfere with sleep.

Tips to ensure good sleep hygiene (3):

  1. Maintain a regular sleep schedule. Be consistent to ensure that you have a regular wake and bedtime even on weekends. Try not to sleep in for more than an hour or two on the weekends.

  3. Ensure a quiet, cool and dark bedroom environment. Aim for a cooler bedroom to help facilitate sleep.

  5. Avoid caffeine before sleep. Avoid caffeine about 6 hours before sleep. Remember some people are more sensitive to caffeine than others and it can stay in your system for up to 12 hours.

  7. Avoid light emitting technology before sleep. Artificial and blue light from our phones, TV’s or computers can disrupt our body’s circadian rhythm (sleep/wake cycle). By disrupting our circadian rhythm, it can lead to depression, obesity, certain types of cancers and cardiovascular disease. Try and avoid using these devices roughly an hour before bed and even use a blue light filter on your mobile device.

  9. Practice relaxation strategies before bed. Stress can make you irritable and cause difficulty sleeping and staying asleep. Deep breathing through your belly can help calm your nervous system.Practice mindfulness or meditation.

  11. Exercise every day. Exercising in the morning can result in a longer, deeper sleep at night. Exercising in the afternoon will allow your body temperature to rise, and then fall just when you are ready to sleep. Avoid exercising in the evening does not allow enough time for temperature change to occur and results in increased stimulation.


  1. Alsaadi, S.,
    McAuley, J., Hush, J., Lo, S., Lin, C., Williams, C., & Maher, C. (2014).
    Poor Sleep Quality Is Strongly Associated With Subsequent Pain Intensity in
    Patients With Acute Low Back Pain. Arthritis & Rheumatology66(5),
    1388-1394. doi: 10.1002/art.38329
  2. Fiedler, M.,
    Coryell, A., Hulla, R., & Gatchel, R. (2018). Sleep and Pain: A
    Biopsychosocial Perspective. EC Anaesthesia4(9),
  3. How Much Sleep Do
    We Really Need? – National Sleep Foundation. (2020). Retrieved 10 March 2020,
    from https://www.sleepfoundation.org/articles/how-much-sleep-do-we-really-need