26 Aug Chronic Pain and Sleep
Sleep Disturbance – An article from the Institute for Chronic Pain (USA)
Original article: http://www.instituteforchronicpain.org/understanding-chronic-pain/complications/sleep-disturbance
The most common forms of sleep disturbances and recommended treatments in patients with chronic pain include following:
- the most effective long-term treatment for insomnia is cognitive behavioural therapy
- Common medications for patient with pain and sleep (these may only be mildly effective) may include the following: hypnotics (zolpidem and eszopliclone), benzodiazepines (diazepam, clonazepam, or lorazepam), tricyclic antidepressants (trazadone or amitriptyline). Note patients using opioid medication for chronic pain are more likely to suffer from insomnia.
- cases of hypersomnia may be caused by one of the following: Depression, over-medication
- Chronic pain rehabilitation programs are a treatment option for individuals with chronic pain and hypersomnia.
- Sleep apnoea (obstructive and central)
- Sedative and pain medications may add to the complexity of sleep apnoea
- Treatments may include; CPAP, Mandibular advancement splint, ASV, BiLevel
- Restless leg syndrome (RLS)
- RLS is generally the urge to move the legs when attempting sleep
- RLS may be treated with medication (eg: Dopamine agonists, Dopaminergic agents)
Pain and Sleep – An article from The National Sleep Foundation (USA)
Original article: https://www.sleepfoundation.org/articles/pain-and-sleep
Pain is a key factor in the gap between the amount of sleep people say they need and the amount they’re getting – an average 42 minute sleep debt for those with chronic pain and 14 minutes for those who’ve suffered from acute pain in the past week. By contrast, there’s no overall sleep debt for those without pain. 45% of those with acute pain and 37% of those with chronic pain reported good or very good sleep quality. More than half of those with chronic pain say sleep difficulties in the past week have interfered with their work. 23% of those with chronic pain say they’ve been diagnosed with a sleep disorder by a doctor, compared with just 6% of all others.
Some tips for people with chronic pain are:
- Stop or limit caffeine consumption.
- Limit alcohol intake.
- Use of pain killers and/or sedatives are effective, but should be used under the supervision of a physician.
- Practice relaxation techniques.
Assessment of Obstructive Sleep Apnoea (OSA) in Patients with Chronic Pain Syndrome: How does Portable Respiratory Recording Compare to Polysomnography (PSG)?
CP Collazo, K Calero, S Sanders, N Kaur, W Anderson, 0608 ASSESSMENT OF OBSTRUCTIVE SLEEP APNEA IN PATIENTS WITHCHRONIC PAIN SYNDROME: HOW DOES PORTABLE RESPIRATORY RECORDING COMPARE TOPOLYSOMNOGRAPHY?, Sleep, Volume 40, Issue suppl_1, 28 April 2017, Pages A225–A226, https://doi.org/10.1093/sleepj/zsx050.607
In this article, Collazo et al. look to assess the validity of a type 3 and/or 4 sleep study on patients with chronic pain syndrome. They found the sensitivity and severity characterisation of these is suboptimal when compared to the PSG gold standard with chronic pain. Oximetry and positional measurements were similar between PRT and PSG.
There are four types of sleep studies (PSG), type 1-4, with type 1 being performed in the laboratory, and type 2-4 being performed in the home. Type 1 & 2 sleep studies are used to diagnose OSA as a medicare funded sleep investigation in Australia. Type one studies have the most recorded parameters (EEG, ECG, respiratory effort, oximetry etc), with type 4 having the least physiological parameters recorded (eg nasal flow & oximetry only in some cases).
Sex differences in measures of central sensitization and pain sensitivity to experimental sleep disruption: implications for sex differences in chronic pain
Michael T Smith, Bethany Remeniuk, Patrick H Finan, Traci J Speed, D Andrew Tompkins, Mercedes Robinson, Kaylin Gonzalez, Martin F Bjurstrom, Michael R Irwin, Sex differences in measures of central sensitization and pain sensitivity to experimental sleep disruption: implications for sex differences in chronic pain, Sleep, Volume 42, Issue 2, February 2019, zsy209, https://doi.org/10.1093/sleep/zsy209
Chronic pain disorders are costly, often intractable, and differentially affect females. Elucidation of mechanisms and modifiable risk factors is needed. Sleep disruption is one promising risk factor; cross-sectional studies suggest that sleep disturbance is associated with central sensitisation, a process that amplifies pain. Females demonstrate heightened central sensitization (CS), a risk factor for chronic pain characterised by enhanced responsivity of central nervous system nociceptors to normal or subthreshold input. Sleep disruption increases pain sensitivity, but sex has rarely been evaluated as a moderator and few experiments have measured CS.
Findings from this study suggest that sleep disruption may augment central sensitisation in males and females differently. In males, sleep disruption induced secondary hyperalgesia, a feature commonly associated with neuropathic pain. In females, it increased temporal summation, a phenomenon common in many chronic pain disorders. These data link sleep disruption to central pain–processing alterations associated with chronic pain risk and support studies targeting sleep to prevent chronic pain.