Sleep plays a fundamental role in physical recovery and nervous system function. However, many people living with chronic pain experience sleep disturbances. This reality is not insignificant: science now shows that the link between sleep and pain is bidirectional. In other words, poor sleep increases pain, and pain interferes with sleep.
When do we talk about insomnia?
Insomnia is defined as difficulty falling asleep or staying asleep at least three nights a week for three months or more, with an impact on daytime functioning. The Insomnia Severity Index (ISI) is used to measure the severity of insomnia: a score of 15 or higher indicates clinical insomnia and may warrant a specialist consultation.
Sleep and pain: a two-way relationship
Disturbed sleep increases sensitivity to stimuli interpreted as “harmful” by the nervous system, while persistent pain fragments sleep and reduces its quality. For example, a study conducted by Neilson and colleagues showed that 53% of people with spinal pain also had sleep disorders.
To better understand this relationship, here are some key concepts:
- Nociception: the process by which the nervous system detects a potentially dangerous stimulus.
- Hyperalgesia: an abnormal increase in sensitivity to pain.
- Central sensitization: a state in which the nervous system becomes overly reactive, amplifying pain signals.
Chronic sleep deprivation promotes hyperalgesia and central sensitization. In addition, it disrupts the natural pain inhibition mechanisms that are essential to the balance of the nervous system.
Sleep, pain, anxiety, and catastrophic thinking: a vicious cycle
In addition, poor sleep habits are associated with increased anxiety. This anxiety can fuel catastrophic thinking about both sleep (“I’ll never sleep”) and pain (“it won’t get better”), creating a vicious cycle that is difficult to break.
Be aware of other sleep disorders
Certain sleep disorders require special attention:
- Obstructive sleep apnea (OSA): This disorder causes breathing pauses during sleep, often accompanied by loud snoring and daytime sleepiness. The STOP-BANG questionnaire can help screen for this condition. Consult your doctor if necessary to confirm the diagnosis.
- Restless legs syndrome (RLS): characterized by an irresistible urge to move the legs, especially at rest. A doctor must confirm the diagnosis.
Is blue light really the problem?
For a long time, it was believed that blue light from screens was the reason for difficulty falling asleep. However, current data suggests that the content viewed is often more problematic than the light itself. Stressful news, emails, or social media increase mental alertness and delay sleep.
CBT-I: an effective and proven approach
Cognitive behavioral therapy for insomnia (CBT-I) is the first-line non-pharmacological treatment. It improves sleep quality over the long term, reduces the interference of pain, and promotes better daily functioning.
In fact, if you’re a fan, the popular Véronique Cloutier shares her positive experience with CBT-I in a blog post: https://veroniquecloutier.com/societe/sante/jai-teste-la-therapie-pour-insomnie-sommeil-haleo
Concrete solutions, starting now
Cognitive behavioral therapy for insomnia (CBT-I) is based on practical, scientifically validated interventions that aim to improve sleep while reducing the impact of chronic pain. These strategies are particularly relevant for people living with persistent pain, as they act directly on the nervous system and pain modulation mechanisms.
Here are four main areas on which CBT-I is based, presented in a concrete and applicable way for everyday use.
1. Reduce pre-sleep arousal
Relax to fall asleep more easily
The goal is to reduce mental and physiological arousal before bedtime.
- Reduce viewing of stimulating or stressful content in bed (e.g., social media, emails, news).
- Keep mobile devices out of immediate reach in bed whenever possible.
- Do not use your bed for activities that stimulate the brain (e.g., worrying, problem solving, working).
Incorporating relaxation techniques throughout the day, and especially before bedtime, can greatly facilitate falling asleep:
- Meditation or mindfulness
- Controlled breathing (e.g., 4-7-8 technique)
- Let your mind wander without digital stimulation
Finally, developing a relaxing and consistent bedtime routine helps the brain associate the bed with sleep: a warm bath or shower, reading or listening to a book, guided meditation, soft music.
2. Increase your “need” for sleep
Stay awake to sleep better
This approach aims to increase sleep pressure.
- If sleep does not come after 30 minutes or more, get out of bed and do a quiet activity in dim light, then return to bed only when drowsiness appears.
- Create a “cozy nest” and practice a relaxing, undemanding, and non-stimulating activity.
It is important to reassure yourself: a temporary increase in daytime sleepiness is part of the process and contributes to better sleep at night.
- Avoid naps whenever possible. If a nap is necessary, limit it to 15 to 60 minutes, ideally 20 to 30 minutes maximum. (Note: naps should not be avoided by individuals who do not suffer from insomnia. They can be very useful, for example for athletes).
- Exercise or engage in physical activity during waking hours.
- Exercise is beneficial at almost any time of day, but it is best to avoid vigorous activity in the hour before bedtime.
3. Train your circadian rhythm
Set your internal clock
A stable circadian rhythm promotes more restful sleep.
- Maintain a consistent sleep schedule.
- Wake up at the same time every day, with a maximum variation of ±1 hour.
Create a regular structure during waking hours:
- Consistent meal times
- Planned periods of physical activity
Light exposure strategies also play a key role:
- During waking hours: expose yourself to bright or natural light, especially when you wake up.
- As bedtime approaches: favor dim lighting and low light levels.
- Make the sleeping environment as dark as possible, while maintaining safety.
4. Optimize sleep hygiene
Prepare well to sleep well
Simple adjustments can significantly improve sleep quality:
- Make your sleeping environment comfortable, cool, quiet, and relaxing.
- Avoid heavy or very spicy meals 2 to 3 hours before bedtime.
- Avoid or limit alcohol consumption.
- Avoid caffeinated foods and beverages at least 4 hours before bedtime.
- Avoid excessive fluid intake 2 to 3 hours before bedtime.
- Do not go to bed until you feel sleepy.
- Reserve your bed for sleep and sex only.
Finally, it is essential to ensure a safe environment, especially for people living with pain:
- Accessible and safe bathroom
- Easily accessible lamp
- Soft lighting or motion-activated night light to prevent falls
A sleep diary, such as the one offered by https://consensussleepdiary.com/ or simply in a good old notebook, can help you better understand your habits, identify disruptive factors, and guide clinical interventions.
Take action
If you suffer from persistent pain and poor sleep quality, you don’t have to deal with this situation alone. Chiropractors and physical therapists are trained to assess factors contributing to pain, including sleep disorders, and to propose evidence-based strategies. In addition, our social workers can also help you develop concrete psychosocial tools to improve your sleep and well-being.
👉 Make an appointment now to address your pain with a comprehensive approach that takes into account sleep, movement, and nervous system optimization. Improving your sleep could be a decisive step toward lasting pain relief.
Reference:
Shepherd, M.H., Neilson, B.D., Siengsukon, C.F. (2025). The Pain of Poor Sleep: A Clinician’s Guide to Assessing
and Addressing Sleep Dysfunction in People With Musculoskeletal Pain Conditions. JOSPT Open. Advance
publication. https://doi.org/10.2519/josptopen.2025.0198
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Dr Charles Bélanger
Chiropractor and owner
