Sleep, stress and environmental factors for chronic pain
Chronic pain can vary from day to day and can sometimes flare-up dramatically (see also 'Coping with flare-up'). Those we talked to explained how pain could affect their sleep patterns. They also discussed the impact that fatigue and everyday stresses had on their pain. Pain could also be affected by other illnesses and environmental factors such as temperature.
Living with pain and coping with daily life can be tiring and many people that we talked to complained of fatigue. Getting to sleep and being disturbed at night were big issues for most people. Lack of sleep could often lead to increased pain.
Pain disturbs her during the night and if she doesn't get enough sleep the pain will be bad the...
Yes, it varies. Yes, I mentioned this earlier like today, maybe it's my best day, I feel that I don't have a headache. Every three, four days, once a week at least, I get very, very bad headache, which will last like twenty four hours until I take the heavy medication, it will not go.
Then, if I feel sleepy like at night and I don't go to sleep at that time, then I develop headache and it will continue the whole day. So I have to sleep like eleven o'clock, twelve o'clock, if I keep awake for one hour extra, for some interest I have, then I get the headache, yes.
Does the pain often disturb your sleep?
Of course, especially at night, I feel it more. When I lie down, I have to sleep on my right side, the shoulders gives me very bad pain. So I try different types of positions and the pillow and try to adjust myself until I sleep and I sleep with pain sometimes.
Do you ever have to get up in the night because of the pain?
Oh yes, yes. Two times like, sometimes, even if I go to sleep late, I wake up early morning. Like last night I took a sleeping pill, two milligrams, I slept about two o'clock after midnight, after I rubbed the ointment and things. I went to sleep at one, I couldn't, then I got up from bed about two o'clock, I took the medication, I did the requirement and I took the sleeping pill, ibuprofen also, and I went to sleep. Then I wake up at six o'clock because the pain again started.
Some found that taking sleeping tablets or pain medication at night was helpful while others preferred to use relaxation techniques (see also 'Pain management' relaxation and distraction'). Having a good bed was important and several people said that their electric blankets were “indispensable”.
A woman who found it painful to get up at night said that she avoided drinking anything after 8 o'clock so that she wouldn't need to use the toilet until morning.
Some people said that if their pain disturbed them at night, they found it was better to get up and find something to distract them. A woman said this was the time she felt most isolated and wished there was someone she could phone.
Is often disturbed by pain at night and finds it a lonely time and wishes there was someone to...
But most of the other people within the support group, they're all awake as well, but you don't like to ring them 'cos it might be that one night when they're sleeping. But we were going to have, sort of, you know, try and do some sort of help line but we couldn't really sort it out how it would work, but it would be great, you know, if you knew that somebody else was awake in the same situation as you and you could ring them up and have a chat with them, because it is a very long, lonely night.
You know, three, four, five o'clock in the morning is just awful and then you're always thinking, you know, I really ought to get back to bed and try and get to sleep because soon it's going to be light and it's going to be time to get up and then we've gotta start this all over again. But the night is probably the worst I think. 'Cos you've also got to be quiet, you can't go, you know, thumping around doing things in case you wake, you know, other people up or disturb the dog or whatever. Don't like the night.
Another person recorded TV programmes and watched them during the night, others found it better to read. Some people rested or slept in the afternoon, although one man found that this could disturb his sleep pattern.
Often wakes with pain in the night so tapes programmes to watch at night.
But, one thing I haven't really mentioned, is that I'm often awake at night and I end up getting up and walking around the house and sitting down by the fire downstairs and I tape a lot of stuff on the television during the day so that I can watch it at night through my headphones.
Because the pain seems to be worse at night. I don't know whether it is because you're lying down or whatever.
Says pain and fatigue go hand in glove but feels that it is better not sleep during the day.
Yeah, I think pain and fatigue, they go hand in glove. It's very common, people with pain, we get very tired, 'cos see even when we're asleep, you know, it doesn't mean to say that we're not in pain, we're just unaware of the pain and like me in the morning, I get up at half five anyway, but I'm normally awake earlier than that anyway because my back sort of, it becomes tight and stiff and it sort of wakes me up and says 'Time to move now [name]'.
So, even if I wasn't working I'd be still, I always wake up early anyway. But that means that I get up, do my stuff, go to work, come home, but the thing is I get very tired as well, you know. Like most people probably get up at six, seven o'clock, go to work and come home and that's it and they might want to go out.
But pain does make you feel very tired, it makes, does give you a lot of fatigue and the one thing you try and avoid doing, in the early days what I used to do is have a nap in the afternoon. No, you can't do that. When you have a nap in the afternoon, it disrupts your sleep pattern so it's like a viscous circle.
You... 'cos you have that nap in the afternoon, it disrupts your sleep pattern and you don't want to sleep at night. So, even if you are tired in the afternoon, try and do something, keep yourself awake, keep active then, when you do go to bed at night, you, you try and get a fuller night's sleep. Sometimes as lot of people think 'Oh, I haven't got, I don't get me eight hours sleep' well, they tell me, a lot of people don't need eight hours sleep anyway.
In order to make it easier to sleep at night, it is often recommended that people with pain avoid stimulants later in the evenings and try to minimise the naps they take during the day. During the night it is best to avoid stimulants like coffee or tea and things like the television or computer games as these are tiring rather than restful.
People were at their best at different times of day. Several people found getting up in morning particularly painful because they had stiffened up overnight, and found it helpful to have a bath or hot shower in the morning. Many said that they went to bed earlier because coping with pain tired them out.
Everyday stresses and strains of life had an impact on people's pain. Some said that they were now less able to cope with stressful situations. Examples given included family arguments, bereavement, dealing with difficult tradesmen, Christmas or other family events, being late for an appointment, being stuck in traffic, the car breaking down or being let down by other people.
Some people noticed that their pain increased when they were stressed, upset or angry, and many felt they did not have enough energy left to deal with their pain which effectively lowered their pain 'tolerance'.
Finds that her pain tolerance is lower if she has to deal with other stressful events.
So it just shows you how much mind and body are inter-related really, because, if you're having a good day, you can cope with much more than a bad day. So I think, you know, there's definitely, your mind does play a part in it as well. But, you know, if it's just if each day comes along and it's what I expected it normally to be, you know, you just get on with it.
Explains that stressful events like Christmas, bereavement and dealing with young children can...
So Christmas can be quite stressful and I'm sure everybody, you know, goes through these kind of difficult times. Be it, you know, illnesses within the family or bereavements or whatever it might be, and stress can have a huge affect on your pain levels and on your mood and I think, when you are in kind of low moods, your pain actually feels worse. Whether it is or not, I think it actually feels worse. It's more difficult to cope with.
It's like when, you know, my children were younger and not sort of sleeping maybe terribly well and you would sort of get up in the morning and, because you were tired, it seemed to be worse, your pain seemed to be worse and you didn't cope with things in the same way because you were tired. But certainly you know, yes, stress, lack of sleep, low mood, it does definitely affect your pain levels.
Sometimes it was not until after an event that people realised how much their pain had increased. Pain itself could cause anxiety and frustration and some recognised it was important to break the cycle of stress and pain. (See also 'Coping with the emotional impact of pain').
Describes how dealing with his first wife's illness and death resulted in increased pain.
My wife was diagnosed, my first wife was diagnosed with breast cancer. And I came back from the States feeling as fit and as well as I had done for a long time and I was really feeling my pain was under control. But I came back to my wife, who was deteriorating very rapidly, she'd been diagnosed round about February and by May she was in a very bad way.
She wasn't really responding to chemotherapy and emotionally she was at a very low ebb because she was busy, she'd been a busy teacher and mum and doing various things. And she was absolutely, I think, terrified at the cancer. One of the things that happened is that emotionally I think she froze. We had quite a difficult time getting her to get any signs of being positive and this was extremely difficult for me.
At the same time the burden of looking after her fell on to me, running the house, doing the shopping. And these were things that I had not done for a long, long time and I found it extremely difficult. And of course the pain levels absolutely shot up. I was really struggling. And then, at the end of July, she went into a decline, was taken into hospital and by the end of August she'd died. And this was absolutely devastating. It was one of those things where you, you come to a sudden full stop. And it's where do you go from here?
One of the things I very soon learned that I needed to do was to get back to basics and I went back to starting all the activities that I used to do when I first went on the Pain Management Course. I got back, because I'd neglected them, to doing the basic physiotherapy exercises. I went back to going through the basics of learning relaxation techniques. I learned' I went back to targeting. You know, these were the things that I held on to. And I think these helped me to get through that period.
Realises that the anger and frustration he feels with his pain and limitations can make his pain...
And I think, when you're angry, your pain comes up more and my anger comes from my frustration of not being able to do things or if I get stuck or my ankle gives way and then my pain is there. You know, it stares you right in the face because that's... and you can't get away from it and I think that's when it hits you more. But certainly stress levels yes, it's there quite a bit and...
How do you deal with that?
Not very well sometimes, you sometimes just have to let time take it's course and things ease away. But again if I, it depends, I mean, if you're by yourself then some of the ways I mentioned earlier, you know, just about, 'Right, that's it, it's come, I've got to stop what I'm doing'
I'll go off in the car and I'll go and do something else and get away from the issue, you know, and if that means going up by the river or something like that, great. I'll go and sit by the railway line and put my anorak on or something like that, you know, and get away from it. But that's quite useful. If it's with your family, it's a bit more difficult because you can't suddenly whiz off, you know.
If I'm looking after my son, because my wife's at work, something like that, you can't whiz off, you have to stick in there. And again, you try and let time whiz it through. Sometimes that doesn't work and I'm probably not a very good playmate then but that's it, there's not a lot you can do about that it's just something that's there. I defy anybody who says they'd cope with their stress completely with pain, I don't believe them.
Coping with another illness such as flu or a cold could make pain more difficult to manage, particularly when people took to bed and stopped their usual stretching and exercises.
A few people reflected that their pain got worse during cold weather which was something they had thought only older people experienced. Several people commented on the need to keep themselves and their houses warm.
Last reviewed August 2018.