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If you’re exhausted during the day yet find it hard to get to sleep at night, you might be miserable, but you’re not alone.

According to the the CDC, “More than one-quarter of the U.S. population report occasionally not getting enough sleep, while nearly 10% experience chronic insomnia.”

As a matter of fact, even those friends and family members you complain to about your sleeplessness may be nodding off. And you’ll be able to tell they’re wiped out from behaviors other than unstoppable yawning: Tired people show a distinct lack of empathy.

There are a multitude of reasons why we can’t sleep, and there are just as many reasons why we should get as much as nine hours a night. We’ll look at expert opinions on both the causes of insomnia — including the relationship between pain and sleep — and what you can do about it.


Who Is Affected By Sleep Issues?

Like misery, insomnia must love company. Sleep or the lack of it is an issue that a lot of people struggle with. Certain populations have more difficulty with insomnia than others, of course, and to varying degrees of severity.


Parents of Newborns

Parents of newborns usually have two conflicting emotions during their infant’s first few months: Immense pride and utter exhaustion. Dr. Alice Callahan, a research scientist and author of The Science of Mom, says a new mom’s “sleep debt actually begins in pregnancy,” although the period right after birth is usually the most sleepless.

“One study found that in the first week of the baby’s life (compared with late pregnancy), moms got 1.5 hours less sleep, fragmented into three times more sleep episodes per day,” she writes. “The early postpartum period is also characterized by lots of day-to-day variability in sleep. Sleeping with a new baby means unpredictability, with little to no control over whether tonight will be a good night or a bad one.”


People With Psychiatric Disorders

Chronic sleep issues are also common among people who have psychiatric disorders. The problems with sleeping range from being unable to sleep at all to being able to sleep initially, but then waking up and being unable to get back to sleep.

According to an article in the Harvard Medical School newsletter, more than half (and up to 80%) of patients in a typical psychiatric practice are affected: “Sleep problems are particularly common in patients with anxiety, depression, bipolar disorder, and attention deficit hyperactivity disorder.”

There is a chicken-and-egg relationship between mood disorders and insomnia, too. As Paul Ingraham of Pain Science points out, “40% of psychiatric mood disorders are preceded by insomnia, and insomnia sets in at the same time as another 20% of mood disorders.”



People With Chronic Pain

Then, there are people who struggle with chronic physical pain. More than any other medical condition, pain is the primary cause of insomnia — and it’s not just falling asleep in the first place that’s the problem. Many people with chronic pain tend to wake up during the night and wake up earlier than they would like to, clinical health psychologist William W. Deardorff writes at Spine Health.

“Research surveys of those with chronic pain problems have found that 65% report that they are awakened during the night due to pain, and 62% report waking too early due to pain,” he explains. “In addition, many patients with chronic back pain problems do not feel ‘refreshed’ in the morning when they awaken, a sleeping problem termed “non-restorative sleep.”

The underlying cause of the pain isn’t really at issue. Pain is pain. Whether you’ve got an aching back, migraine headaches or a condition such as fibromyalgia, sleep can be extremely elusive.

If you are able to nod off, sleep can protect you from certain painful experiences such as migraines. However, Ingraham cites a study that says insomnia itself can be the cause of migraine headaches.

He points out that insomnia can make you sick in other ways, too Statistics show a correlation between insomnia and increased absenteeism, but “the most consistent impact of insomnia is a high risk of depression,” he says.

People with rheumatoid arthritis, for example, have similar issues to those suffering from chronic back pain. “More than 75% of sufferers report not being able to get enough rest — and women are more likely to have trouble than men,” Prevention’s Karen Cicero writes.

Cicero also spoke with Sheeja Francis, MD, a fellow of the American College of Rheumatology, who sees patients suffer from insomnia every day. “Joint pain makes bedtime miserable for some of my patients.” Francis told her. “Inflammation can flare up in the middle of the night, causing swelling and stiffness.”



A Vicious Cycle

Studies have looked at the cycle created by pain and sleep issues, which gets worse the longer it continues. In a study published in the Sleep Medicine Reviews Journal [paid article], researchers examined how sleep deprivation and disturbances create a heightened sensitivity to pain and can actually cause pain. The cycle can start with either disturbed sleep or with pain, and “the two components maintain or even augment each other.”

The way to break the cycle has two approaches:

  • “sufficient management of disturbed sleep, which might then alleviate pain,” or
  • “better pain relief which may promote more restorative sleep, which then further assists in long-term pain relief”


The Importance of Sleep

The more researchers study sleep, the more they understand how crucial it is for everything from brain function to overall health and wellness to your emotional state. If you are seriously sleep-deprived, which means you’re getting less than five hours a night, Ann Pietrangelo at Healthline writes that your risk of death from all causes increases by about 15 percent.

“Sleep deprivation is dangerous to your mental and physical health,” she adds, “and can dramatically lower your quality of life.”

You’ve probably heard that not getting enough sleep makes you gain weight, too, which in turn leads to obesity-related health problems. Pietrangelo explains that sleep deprivation causes four physical changes in your body to create a “perfect storm” for weight gain:

  • It increases production of the stress hormone cortisol.
  • It lowers levels of the hormone that tells your brain that you’ve had enough to eat.
  • It raises levels of the biochemical ghrelin, which is an appetite stimulant.
  • It prompts your body to release higher levels of insulin after you eat, promoting fat storage and increasing your risk of developing type 2 diabetes.

In 2010, researcher Lia Steakley examined research pertaining to youth, ages 16 to 19. The results shows that girls who don’t get enough sleep are more affected in the long term than boys with respect to weight gain. The increased weight is due to changes in eating patterns that “cumulatively alter energy balance,” and the gender slant may be because of “the increased propensity for female teens to engage in emotional eating,” she writes in Stanford Medicine’s Scope.



What You Can Do to Get Some Shut-Eye

The tried and true pointers, which include turning off your smartphone and computer at least an hour before you turn in, are known as “sleep hygiene.” Here are a few more sleep hygiene tips, courtesy of the folks at Beyond Tired:

  • Do a relaxing activity before bed such as taking a bath, meditation or yoga.
  • Avoid alcohol, caffeine or heavy meals close to bedtime.
  • Make sure your bedroom is dark, quiet and cool.

Also, you can try listening to classical music as part of your sleep hygiene routine. The Arthritis Foundation recommends it for pain relief, writing on its blog that studies found pain and stress levels were measurably decreased when research participants listened to slow-tempo classical music.

“Music therapists have also found that heart muscles synchronize to the beat of music, as does breathing,” they write. “When classical music rhythms mimic the average resting heart — approximately 70 beats per minute — the soothing sounds actually helped to slow fast-beating hearts.”


Adjust Your Sleeping Position

If it’s specifically your back that’s keeping you up, try some simple sleeping position fixes before popping pain killers. Earle at the Muscles and Joints blog has a few sleeping positions that open up the spine, helping to relieve strain on the back and pelvis.

“Don’t think that the position you choose must be strictly adhered to all night long though,” he adds. “You’ll toss and turn anyway and remaining in one position too long will cause joints to stiffen up.”

Jonathan Fitzgordon of Core Walking agrees. “If you sleep for any number of hours in one position it is likely to have an effect on the way you feel when you wake up.” He advises that you at least start out with a neutral position that doesn’t throw off the natural alignment of the body; otherwise, you might wake up with an aching back, sore neck or even numb arms.

One more sleeping position tip, from Carrie DeVries at Sports Health: “If you sleep on your side every night — on the same side — you may be at risk for an injured shoulder.”

This is an easy fix. Just alternate the side you usually sleep on so you don’t continually put pressure on the tendons in your shoulder. You’ll know if you’re sleeping too much on one side (which can cause rotator cuff tendinitis) because the inflamed tendons will complain with some mild pain, and you’ll also experience some stiffness in that shoulder.


Drink More Water

Don’t forget to hydrate, the team at Advanced Pain Management writes. While you don’t want to drink so much before bed that your bladder wakes you up in the middle of the night, you don’t want to retire completely dry, either. “Water can … help keep your spine healthy, since it’s an important component of spinal discs.”


images by:
Irina Gavrilonoka, Gerd Altmann, Joan Greenman, Momir Kostic

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