Peer Reviewed

The bidirectional relationship between sleep and pain

David Hillman

Although it is well understood that uncontrolled pain is a source of sleep disturbance, disturbed sleep can also aggravate pain. Assessment of patients with pain should include consideration of this bidirectional relationship, including treatment of both the pain, with appropriate caution around the use of opioid analgesics, and the disturbed sleep.

Key Points
  • Pain and sleep have a bidirectional relationship: pain disturbs sleep, and disturbed sleep exacerbates pain.
  • Treating sleep disorders has positive effects on pain symptoms, while treatment of pain with opioid analgesics can have positive and negative effects on sleep.
  • Chronic opioid use is often associated with disordered breathing during sleep.
  • Continuous positive airway pressure therapy may be indicated when disordered breathing during sleep is obstructive, whereas adaptive servo-ventilation therapy may have a role if central sleep apnoea is present.
  • Some common mechanisms are involved, with central sensitisation known to have a role in both the pathogenesis of pain and disturbed sleep in patients with fibromyalgia.

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