Sleep and Chronic Pain: What To Do
The two-way relationship between persistent pain and disturbed sleep.
Last revised
Poor sleep lowers pain thresholds measurably, so treating sleep is treating pain rather than a separate problem.
Key takeaways
- Poor sleep: lowers pain threshold the following day
- First-line for insomnia: CBT for insomnia, not medication
- Most useful single change: Keep a fixed wake time every day.
- Commonest mistake: Alcohol as a sleep aid.
- See a doctor if any of the signs under "When to get help" below apply to you.
Do
- Keep a fixed wake time every day
- Ask about CBT for insomnia specifically
- Get out of bed after about twenty minutes awake
- Get daylight soon after waking
Do not
- Alcohol as a sleep aid
- Long daytime naps that reduce night-time sleep pressure
- Assuming sleep will improve once the pain does
The figures behind the list
Each item above follows from these, published in the guidance named at the foot of the page.
| Measure | Figure |
|---|---|
| Poor sleep | lowers pain threshold the following day |
| First-line for insomnia | CBT for insomnia, not medication |
| Fixed wake time | the most important anchor |
| Opioids and alcohol | both fragment sleep architecture |
Where to go next
- Sleep and Chronic Pain: A Beginner-Friendly Start
- Sleep and Chronic Pain: Common Questions Answered
- Sleep and Chronic Pain — the reference entry
- The Evidence on Exercise with Persistent Pain, Without the Hype
- Flare Management: What the Evidence Actually Says
When to get help
See a GP if insomnia has lasted three months or more, if you snore loudly and wake unrefreshed, or if you fall asleep involuntarily during the day. Seek assessment for pain that is new, changing, or wakes you consistently in the second half of the night.
Where this comes from
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarised or generalised beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.