Sleep and Pain: Why Your Nights Matter More Than You Think

The role of sleep in pain is often underestimated. A short or restless night can be enough to make the body more sensitive, reduce exercise tolerance, and make everything feel more “stiff” the next day¹. Conversely, gradually improving sleep quality can, for many people, help make pain more manageable on a daily basis¹.

Sleep doesn’t just affect fatigue. When nights are too short, irregular, or fragmented, several systems involved in pain become disrupted: the nervous system becomes more sensitive, the body’s natural pain-inhibiting mechanisms function less effectively, and certain hormonal and inflammatory balances may be disrupted¹,³. As a result, for the same level of exertion or the same posture, sensations may be perceived as more painful than during a period of more restorative sleep².

The relationship works the other way around, too. When we’re in pain, we often sleep less well, wake up more frequently, and our sleep becomes less restorative¹. Over time, many people feel that their poor sleep and their pain reinforce each other, to the point where they’re no longer sure which came first¹.

Why Sleep Affects Pain

During sleep, the body does not “shut down”: it constantly regulates systems involved in recovery, mood, attention, and pain modulation¹. When sleep is lacking, this regulation becomes less effective, which can lower the pain tolerance threshold and increase fatigue the next day².

From a biological perspective, several mechanisms are likely involved. Research suggests, in particular, an alteration in the descending pain control systems—that is, the brain mechanisms that normally help to suppress some pain signals³. Sleep deprivation may also be accompanied by changes in hormonal and inflammatory balance, which also contribute to making the body more reactive¹,³.

This does not mean that pain is “all in the head.” It means that it also depends on the overall state of the nervous system, recovery, and the biological context in which the body functions¹,³. Better sleep doesn’t solve everything, but it’s often a useful tool for making pain more bearable and putting the body in a slightly less alert state¹.

When Pain Disturbs Your Sleep

Sleep disturbances are common in cases of persistent pain. Difficulty falling asleep, waking up during the night, and the feeling of having “light” or non-restorative sleep are very common complaints among people who have been in pain for several weeks or months¹.

It’s not just because a painful area causes physical discomfort at night. Pain can also sometimes increase alertness, anxiety, and rumination, which makes it harder to fall asleep and perpetuates the problem¹,³. Over time, it’s common to feel like you’re caught in a cycle of nights that don’t provide much rest and days when the pain takes over¹.

What You Can Already Adjust

The goal isn’t to change everything all at once. In practice, it’s often a few simple adjustments, made over time, that are the most helpful.

Getting some sunlight in the morning and maintaining a relatively regular schedule often helps stabilize your sleep-wake cycle.

Limiting caffeine late in the day, cutting back on screen time in the late evening, and avoiding heavy meals right before bed can make it easier to fall asleep and help you sleep more soundly.

Exercising regularly throughout the week often helps you sleep better, as long as the intensity is appropriate for your current fitness level.

A quiet, dark, and slightly cool bedroom often promotes a more restful sleep.

The idea isn’t to follow a perfect sleep hygiene routine. Rather, it’s about identifying a few realistic strategies that fit into your daily life and seeing if they improve your sleep a little over the course of several weeks.

The Role of Osteopathy

In this context, osteopathy isn’t limited to treating a painful area. It can also help you take a step back and look at the bigger picture: the pain itself, sleep, fatigue levels, stress, movement patterns, and the demands of daily life.

In counseling, the goal isn’t to give everyone the same list of advice. Rather, it’s about analyzing what seems most relevant to your situation and then identifying a few concrete, realistic options that fit your lifestyle.

In other words, there are often several possible approaches, but their effectiveness depends on the individual, their pain, their sleep, and their circumstances. The goal is to develop a case-by-case approach, rather than applying a one-size-fits-all solution.

References

Finan PH, Goodin BR, Smith MT. The association between sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-1552.

Schrimpf M, Liegl G, Boeckle M, et al. The effect of sleep deprivation on pain perception in healthy subjects: a meta-analysis. Sleep Med. 2015;16(11):1313-1320.

Kourbanova K, Alexandre C, Latremoliere A. Effect of sleep loss on pain—New conceptual and mechanistic avenues. Front Neurosci. 2022;16:1009902.