7 Ways To Sleep Better Despite Chronic Pain

Pain is one of the most common reasons people lie awake at night; ask any of our Sleep Experts®. But for those with chronic pain conditions such as arthritis, back pain and fibromyalgia, 88% experience insomnia versus 33% of those without a pain condition, says Luis F. Buenaver, Ph.D., assistant professor of psychiatry and behavioral sciences at Johns Hopkins University and director of the Johns Hopkins Behavioral Sleep Medicine Program, in Baltimore.

"If you suffer from chronic pain, your sleep is typically going to be shallow and restless, and you won't get as much deep sleep as someone without chronic pain would get," he says. That's because the "activity to the brain from the pain signals prevents the brain from entering or staying in the sleep cycle," explains Dr. Padma Gulur, a board-certified pain management specialist in Durham, North Carolina.

When you sleep poorly, it impacts your "body's natural ability to manage and cope with pain and makes you more sensitive to pain," which then affects your ability to sleep well, Buenaver adds. "It's a vicious cycle." But here's the good news: You can break it. While some people need pain meds to help manage their condition due to the severity of their symptoms, there is powerful proof that certain behaviors can help you cope with chronic pain (and even minimize it) so you can sleep better. "It's amazing how effective and powerful non-pharmacological treatments are for insomnia," confirms Buenaver. Read on for science-backed ways to sleep better at night despite your chronic pain condition.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Cognitive Behavioral Therapy for Insomnia (CBT-I) is where a specially trained psychologist or therapist will help you restructure negative thoughts, feelings and behaviors. It's the gold standard for treating insomnia, explains Buenaver, who estimates that 40% of his practice involves people with chronic pain conditions. CBT-I has also been scientifically proven to help reduce the severity of chronic pain and, therefore, make it more manageable for people living with it, per a 2022 study. It can help alleviate depression and anxiety as well, both common conditions in those with chronic pain, he adds.

Relaxation techniques

Buenaver uses progressive muscle relaxation as a part of his CBT-I protocol, in which you slowly tense and release muscles from your toes to your face; diaphragmatic breathing, where you breathe in slowly, imagining your belly filling with air and then breathe out slowly through pursed lips; and guided imagery, which involves imagining a peaceful setting to help you relax. These techniques help minimize stress, which "can activate or engage your central nervous system, specifically your flight or fight system," and leave you sleepless at night, he explains. Furthermore, stress increases muscle tension, which can make chronic pain worse.

Try out an exercise routine

Research shows that regular exercise improves the quality of your sleep and your ability to fall asleep at night. It also helps relieve stress, which contributes to the cycle of insomnia and chronic pain. Even if you don't exercise at all right now, start by going outside and walking for five minutes, and then slowly add a few minutes to each walk, suggests Michelle Drerup, a doctor at the Sleep Disorders Center at the Cleveland Clinic. If you're looking for something low impact, yoga or tai-chi are both sleep-promoting exercises that help loosen the joints and stretch the muscles, says Buenaver.

Stretch it out

Stretch as often as possible, particularly if you "experience muscle tension or tightness, or muscle spasms," recommends Stephanie Ho, a board-certified psychiatrist with a specialty in chronic pain, in New York City. The act of stretching can relieve muscle tightness and help eliminate or minimize spasms, she explains. In fact, a 2022 study shows that stretching can significantly help relieve low back pain, a condition that the American College of Physicians estimates will affect 80% of all people living in the United States at some point in their lives.

Get out of bed during the day

If you endure restless nights in bed and spend time during the day in pain in your bed without sleeping, you may start to associate your bed with pain instead of sleep, says Drerup. To help break this connection, she suggests choosing another place in your home to rest during the day, such as a recliner or sofa that isn't in your bedroom, ideally. Reserve your bed for nighttime sleeping.

Eat regular meals

Instead of waiting to do most of your eating later in the day or at night, eat regular meals throughout the day, says Drerup. In addition to putting yourself at risk for heartburn by eating at night, "digestion is a pretty stimulating process," she explains, and eating late is linked with higher rates of obesity, per a 2020 study. Obesity, in turn, can make many types of chronic pain worse, she adds, including back pain, headaches, fibromyalgia and nerve pain.

Practice good sleep hygiene

Wake up at the same time every morning and go to bed at the same time every night. Avoid exercising about three hours before bed, and don't drink caffeine or alcohol late in the day, says Buenaver. Wind down about an hour before bed with a consistent routine, such as taking a shower and reading a book. When it's time for bed, "Make sure the room is quiet and dark," says Gulur. "Do not watch TV or read books in bed" because these activities "train us to stay awake." Lastly, don't stay in bed tossing and turning if you can't sleep. Get up and do a task you are not fond of, such as reading a boring book or cleaning out a cabinet. "As soon as you feel sleepy, go back to bed and sleep," Gulur adds.

The bottom line: Nobody wants to live with chronic pain, but there are ways to thrive even if you experience it-starting with getting a better night's sleep. By following our expert sleep strategies, whether you take pain-reducing medication or not, you can rest better at night and help minimize the chronic pain you're experiencing.

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