How poor sleep affects your Lower Back pain, and 5 simple tips on how to sleep better tonight.
A good night’s sleep is the best medicine.
Sleep plays a vital role in most functions of the human body. Why else would our bodies force us to lie defenceless every night without good reason? This importance is pronounced when the body is trying to recover. Be it from a virus or infection, or recovering from an injury, a good night's sleep provides restorative benefits to the body.
But most people experiencing chronic low back pain (CLBP) will tell you a good night’s sleep is a hard thing to come by. It’s a well-established belief that pain and sleep are related. You’re in pain. You’re uncomfortable. You don’t sleep well. You feel worse the next day.
But in addition to this, recent research has pointed to a vicious cycle relationship between sleep and pain. Both increased pain and poor sleep negatively impact each other, resulting in a downward spiral of both.
How chronic low back pain can impair sleep
It is rare to find someone who is experiencing CLBP and is sleeping well.
The research into the impact of CLBP on sleep has been quite extensive. Multiple studies have found that more than 50% of people experiencing CLBP report sleep disturbances, but from my clinical experience I would say that number is much higher.
Being in pain can impair sleep in many ways. Pain makes it more difficult to find a comfortable position when in bed, making it more challenging to fall asleep. The irritability and sensitivity of someone with CLBP will mean they can experience a greater number of waking moments throughout the night. Just because of these two points alone, people experiencing CLBP will have a reduced overall duration of sleep. On top of this, multiple studies have also found that sleep quality is impacted by CLBP.
But is it purely just a one-way relationship between CLBP and sleep, or is there more than meets the eye?
A vicious cycle between poor sleep and chronic low back pain.
As sleep is becoming better understood, researchers are realising that the relationship between CLBP and sleep is far more complex than saying that being in pain disrupts sleep.
Think of CLBP causing sleep disturbances as one half of a vicious cycle. The other half is how poor sleep only makes CLBP worse.
Many studies have sought to test how reducing sleep will change how people experience pain. They have conducted studies on people without CLBP and found that if they experimentally reduce sleep these people experience heightened pain perception, reduced pain tolerance and pain thresholds, and the presence of generalised muscle tenderness. You can imagine that if these symptoms are the result of sleep disruption in people without CLBP, it can only be amplified in people who do have CLBP.
If that didn’t stress the point enough, it is a well-held belief that poor sleep is a cause of feelings of depression and anxiety. A large, and often misunderstood aspect of CLBP is having lower self-efficacy and higher levels of anxiety. For someone who already has these symptoms, adding poor sleep to the mix will only amplify them.
You can see that neither sleep or CLBP work in isolation, so why would it not make sense that if we can improve sleep we can improve symptoms of CLBP?
Are you getting the required amount of sleep?
Before we can talk about how you can improve your sleep, you must first understand how much sleep you should actually be getting.
The National Sleep Foundation Guidelines have set expected values for different age ranges, they are:
14-17 years old: 8-10 hours
18-25 years old: 7-9 hours
26-64 years old: 7-9 hours
65+ years old: 7-8 hours
If you see your age range and think you are getting the required amount of sleep, think again. Because most people get less sleep than they think. What is not well understood by a lot of people is that throughout the night it is normal to lose up to 1 hour of sleep through brief wake periods. And this average is for people without CLBP. It is likely that if you have CLBP you are waking up more frequently and for longer periods throughout the night. So when you think you’ve slept for 8 hours, you have more likely slept for only 7 or even less. I use a tool like Whoop 4.0 to track my sleep which allows me to see how much sleep I am actually getting.
So taking that into consideration, how much sleep are you really getting?
5 simple tips you can implement to improve your sleep.
There is a clear link between poor sleep and CLBP, so does it not make sense that if we improve sleep we improve symptoms of CLBP?
Here are 5 simple tips that you can use tonight to improve your sleep:
Keep the same waking and sleeping times each day, even on weekends. This helps to set your internal body clock. It will also help to improve your quality of sleep.
View direct sunlight within the first 30-60 minutes of waking. Direct sunlight will help to set your internal body clock, which will make it easier to wake up in the morning and make you more tired at night time. Exposure to sunlight will help you feel more alert during the day.
Reduce blue light exposure within 1-2 hours of going to bed. Blue light is emitted from most devices and even from ceiling lights. Blue light suppresses the body’s release of melatonin (a hormone that makes us feel tired)
Exercise throughout the day. Exercise helps to increase sleep pressure, which means you will be more tired when you are ready to sleep. But avoid vigorous exercise within 1-2 hours of going to bed.
Avoid caffeine within 8-10 hours of going to bed. The half-life of caffeine is 4-6 hours, so 4-6 hours after your last cup of coffee, there will still be half the concentration in your system.
It is easy to become overwhelmed by the complexity of chronic pain. Sometimes it can seem impossible to overcome.
From my experience, the key is to shift your focus from the big picture, and instead turn your focus to the things you can control. There is an observable relationship between CLBP and poor sleep, they feed off one another. And just as they can form a vicious cycle, they can also form a virtuous cycle. If we improve your sleep we will also have a positive impact on your chronic pain, both physically and psychologically.
As you can see from the 5 strategies I have provided, the changes you need to make to improve your sleep are small, but the results can be life-changing.
