Painsomnia Steals 51.5 Minutes of Our Sleep Every Night. How Do We Cope?

“Chronic pain and insomnia go hand in hand, unless the pain is well-managed.”
— Dr. Medhat Mikhael
Spine Health Center at MemorialCare Orange Coast Medical Center

An ankle injury 10 years ago keeps JC Drake awake even today. It’s a condition loosely known as painsomnia, or insomnia from chronic pain, and it’s a regular reality for the 48-year-old resident of Germantown, Maryland. Daily pain makes a good night’s sleep challenging. And Drake is not alone.

According to a SleepFoundation.org June 2022 survey of 1,250 U.S. adults, 94.8% of people say they have lost at least an hour of sleep to pain in total in the past week. The vast majority, 85.1%, say that pain costs them at least two hours of sleep each night.

The brown fox quicks

-Raj

On average, respondents say they are losing six hours of sleep per week to pain. That means that pain is costing us nearly an hour of sleep, or 51.5 minutes, each night.

Adults who have pain average 6.7 hours of sleep per night, below the recommended❞seven to nine hours. This is also below or in line with prior sleep polls ❞, which found that people who experience pain sleep 6.7 to seven hours nightly, depending on pain severity.

Hours of sleep lost to pain

How many people experience chronic pain? In the United States, it’s 25.4% of adults, according to research❞ published in 2021. The Centers for Disease Control and Prevention❞ note a higher prevalence among women (21.4%) and white adults (23.6%) versus Black (19.3%), Latino (13%), and Asian adults (6.8%).

Diving deeper into these findings, we can get a greater sense of who is experiencing painsomnia, as well as the communities emerging online to help address it.

What Is Painsomnia?

Painsomnia is not a specific medical term. But researchers have long documented the connection between insomnia and pain

Insomnia is a diagnosed condition in which trouble falling or staying asleep leads to impairment during the day. Pain has a similar impairing effect.

“Chronic pain and insomnia go hand in hand, unless the pain is well-managed,” says Dr. Medhat Mikhael, pain management specialist and medical director of the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California.

That said, pain and insomnia may co-exist without a diagnosis of either. Among people who reported feeling pain that kept them up at least one night a week, 40.3% say they have not been diagnosed with a sleep disorder. About one-third, or 32.7%, have received an insomnia diagnosis, with 23.8% also saying they have received a diagnosis of sleep apnea and 21% having restless legs syndrome.

Sleeping through pain

What Type of Pain Is Keeping People up at Night?

Pain of all types can prevent people from sleeping. Among survey respondents, 56.2% of people who lost sleep pain experienced back pain, with 41.3% having neck pain, 32.2% having head pain, and 29.4% having knee pain.

— Dr. Medhat Mikhael
Spine Health Center at MemorialCare Orange Coast Medical Center

When asked to rate their pain on a scale of 0 (lowest pain) to 10 (most severe pain), 73.1% of people say their nightly pain was at level 5 or higher. According to the Mayo Clinic, this means most people surveyed are experiencing at least moderate pain7.

“Chronic pain and insomnia go hand in hand, unless the pain is well-managed. This is Test”

— Dr. Medhat Minal
Spine Health Center at MemorialCare Orange Coast Medical Center

What does this all mean?

“Pain does not have to be extreme to keep us awake,” says Dr. Alex Dimitriu, MD, founder of Menlo Park Psychiatry and Sleep Medicine and a SleepFoundation.org medical-review board member. “Even milder forms of pain can result in varying degrees of insomnia, resulting in trouble falling or staying asleep.”

Even when you do fall asleep, sleep may be less restorative when you’re in pain.

“Sleep is as much about quality as it is about quantity,” Dr. Dimitriu says.

How Has Pain Changed Sleep?

Sleep positions are important. And quite simply, pain in your back, neck, or anywhere else may change how you fall and stay asleep.

You may have to avoid sleeping on your back or side so you don’t put pressure on a certain body part, or you may move from position to position to avoid discomfort.

Drake says his ankle pain makes it difficult to fall asleep many nights.

The connection between sleep problems and pain6 is bidirectional, too. This means that pain causes insomnia, and insomnia causes further pain.

“When I have ankle swelling, it takes me two to three hours to get to sleep,” he says. “I often wake up with muscle cramps in the night.”

He’s not alone: Among survey participants, 57% of people who experience regular pain wake up at least three times during the night. In fact, it was the top pain-related effect on sleep, with 54.4% of people saying they also have difficulty falling back to sleep after waking. Another 40.9% say they wake up earlier than they’d like. And some people experience all of the above.

This adds up, Dr. Dimitriu explains.

“Falling asleep too late can push circadian rhythms into a delayed sleep-phase cycle,” he says. “And waking too early can result in an advanced sleep phase cycle, where you get tired too early in the evening.”

Irregular sleep patterns can also lead to heightened pain sensitivity, Dr. Dimitriu says, keeping the cycle going.

What Are People Doing To Cope?

Roughly half the surveyed adults, or 54.9%, sought care for their pain from a healthcare professional.

Either way, 69.8% of adults take some sort of medication for their pain, be it prescription drugs (58.9%), nonprescription (53.5%), or a combination of both.

As for the sleeping part: 55.8% of people surveyed who lose sleep to pain have taken sleep aids in the past month alone. Melatonin was the most popular by far, with 49.1% of those respondents choosing it over diphenhydramine/Benadryl (23.4%) and other options.

But sometimes, medication alone may not supply results. Support groups — primarily concentrated on social media such as Facebook, Twitter, and Instagram — have emerged to address pain and painsomnia in particular.

Although only 19.5% of people surveyed turned to pain-related support groups, 91.4% say those groups have been effective in helping them manage, understand, or improve their sleep. Many found these groups through simple online searches or via recommendations from health professionals, friends, and family members.

How helpful are support groups?

Tonya Coleman Henry, 46, of Central Texas, has turned to online groups for advice about her pain from gastroparesis and migraines, as well as for tips about dealing with insomnia.

“There are many people with many different conditions, but we are all alike in that we experience chronic pain,” she says. “The groups offer a listening ear, compassion, and friendship.”

Women are actually less likely than men to be a member of a support group, with 13.7% taking part versus 26% of men. Meanwhile, access to these groups may be an issue: Only 7.5% for people whose household income is $50,000 or less per year reported using a support group of any kind.

The advice in many of these groups centers on finding strategies for managing pain and sleep. It begins with a mindset that touches on your sleep hygiene, as well, says Ashley Allen, an orthopedic nurse practitioner and CEO of Allen Health & Wellness in Delaware. She recommends checking out Cognitive Behavioral Therapy for Insomnia (CBT-I).

“The idea is that you focus on changing thoughts and behaviors around sleep,” Allen says. “Letting go of the fear of not sleeping is a hugely important step in the process.”

Methodology

This survey was commissioned by SleepFoundation.org and conducted on the online survey platform Pollfish between June 8 and June 9, 2022. Results are from 1,250 survey participants who were ages 18 and older and lived in the United States at the time of the survey. All attested to answering the survey questions truthfully and accurately.

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