How to Heal Pain By Sleeping: remedies and therapies to sleep better to decrease pain
Hi everyone, welcome to HIP’s Health Is PowHer episode #20! How to treat sleep and pain issues! I’m your host Dr. Anna, MD and we’re going to talk about how sleep affects pain. And how pain affects sleep.
Because pain is a bio-psycho-social phenomenon meaning there is a physical component and there is environmental and psychological and relationship component.
So really pain has to be managed holistically and take into account all domains of wellness, instead of just pharmaceuticals.
Insomnia is unfortunately one of the most common sleep disorders for individuals with chronic pain or chronic headaches.
Sleep and stress are the top triggers for pain flares for individuals dealing with fibromyalgia, joint pain, or migraines and headaches, for example.
But having pain also causes sleep to be disrupted.
So which one causes the other? Well, at this point they both have an influence on each other, but what has been found is that Sleep Disturbance magnifies pain more than pain magnifies sleep issues.
So why is sleep so important for decreasing pain or preventing pain?
Because sleep is essential in regulating our bodies, bringing us back into homeostasis and when we can’t sleep, the chaos of our bodies persist and continue.
One particular sleep function is to take out the trash in the brain and nervous system. This is accomplished through the GLYMPHATIC SYSTEM, but this brain lymphatic system only works when we’re sleeping!! If we don’t sleep, we can’t clean out the pain causing inflammatory substances in our nervous system and brain. So then these little guys just hang out and cause more pain in our bodies.
What kind of sleep issues cause worse pain?
Not getting enough sleep (for example, teens who need 9-10 hrs and adults who need 7-9 hrs).
Fragmented sleep (waking up in middle of night multiple times)
2. Not getting enough deep sleep or rem sleep (not feeling fully refreshed when waking up)
3. Sleep apnea (not being able to breathe well during sleep)
4. Restless sleep or restless leg syndrome (not having enough iron or neurotransmitters that prevent movement during sleep)
5. Narcolepsy (daytime sleepiness/falling asleep during hte day)
Only one of night sleep loss can increase pain. Or even too much sleep or changing your sleep routine can increase pain. The longer you suffer sleep problems, the longer it takes to decrease pain.
When do symptoms of pain develop after sleep problem?
Sleep problems in childhood increase risk of developing pain 2-3 years later!
What symptoms or disorders cause worsening sleep and pain issues?
Depression, poor stress coping, anxiety or mood disorders are known to worsen both sleep and pain issues. In fact, stress may itself cause insomnia not allowing you to go into deep sleep b/c your heart rate may be too revved up, the stress chemicals and your fight or flight nervous system is still on when it should be resting and relaxing!
What are some medications that are generally helpful for both sleep and pain?
Gabapentin - known to treat nerve pain but sometimes used off-label for fibromyalgia, headaches/migraines, is also very helpful to increase REM and deep sleep and increases the length of sleep as well as decreasing nighttime awakenings. It can cause drowsiness, vision issues, however so some individuals may not tolerate it.
Amitriptyline or Nortriptyline are tricyclic antidepressants that also help with sleep (more amitriptyline than nortriptyline), but may cause some leg movement issues at night (though rare) and constipation and significant hangover feeling for several weeks until one develops tolerance, and can affect your heart’s rhythm which can be potentially dangerous.
What supplements are generally beneficial for both sleep and pain?
Well, we all know Melatonin which helps us to fall asleep, but did you know it can also decrease inflammation and pain?
Melatonin is:
Anti-inflammatory
Stabilizes cell membranes
Blocks glutamate (a substance known to cause pain in nervous system)
Blocks CGRP release (another substance known to cause pain in nervous system)
Melatonin is usually used in higher doses, however, between 3-20 mg nightly and one usually has to titrate up otherwise it can cause significant drowsiness during the day, crazy dreams and for some, nighttime urination!
GABA and L-Theanine:
In animal studies, they found that GABA and L-theanine both prolong sleep and get you to sleep faster. L-theanine is generally well tolerated for most people, but sometimes GABA can make you flushed or feel tingly in the first week or two upon taking it.
Does my food, nutrition, diet or even my gut health make any difference in my sleep?
There isn’t that much research yet on this, but what they’re finding is that there is a relationship with food and sleep. Actually, food and pain as well!
For example, if someone has gluten sensitivity and they don’t know it, this may actually disrupt their sleep. If someone eats too late before bedtime, then this can cause “stealthy reflux or indigestion” which stops sleep. If someone eats too spicy or too difficult to digest food during the day, they still can develop sleep issues that night.
Iron is a big nutritional component that when unbalanced or deficient can cause headache pain and difficulty sleeping. If you have a healthcare practitioner that will check labs, make sure that ferritin and an iron panel and a CBC (complete blood cell count) is done. A CBC by itself does not tell you if you’re iron deficient. It has to be ferritin + iron panel + CBC. Ferritin is iron storage which is the first thing to decrease when someone has iron deficiency and it should always be between 50-70!!! Always review your labs b/c some practitioners unfortunately weren’t trained in iron and do not know this!
If ferritin is below 50, then starting off with a prescription for iron or iron over the counter (generally taken with Vitamin C) for 3 months under the care of a practitioner is the treatment. Sometimes, iron can cause constipation and stomach aches (but most often constipation), so some individuals have to titrate down. Usually more people tolerate it with food though it is easier absorbed on an empty stomach.
Vitamin D is also a big nutritional consideration because Vitamin D is found to be lower in individuals with insomnia, pain, and restless leg syndrome!
Vitamin D supplementation has been shown to help migraines and certain types of inflammatory pain!
Just a tip - most people become deficient in Vitamin D by February if they’re above or below equator and not supplementing. I take Vitamin D3 with K2 (it helps with cardiovascular disease and bone mineralization) 4000 IU daily from September through May every year as I live in Kansas City.
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