Poor sleep increases pain risk—especially as we age

For many people, getting older means contending with more frequent aches and pains. Musculoskeletal pain—pain in muscles, bones, and nerves—occurs with increasing frequency as we age. This age-related pain can take many forms. Sometimes it is acute and short-term, while other times it becomes chronic. Pain can occur, and re-occur, in specific sites around the body—the sore back, an aching knee, tension in the neck and shoulders—or pain can become more widespread and diffuse, affecting several areas of the body at once. Sometimes pain is associated with a specific illness or disease, and other times it exists independent of another diagnosed condition. Whatever the reason, the presence of pain can be difficult and debilitating, limiting physical activity and causing psychological distress.

Older adults are significantly more likely to experience all types of pain. Research suggests that adults over the age of 65 are twice as likely than their younger counterparts to experience pain in some form. Rates of chronic pain rise sharply among older adults. Aging also may make us feel pain more strongly: research indicates that increasing age brings about reduced tolerance to pain.

Sleep and pain exist in a complicated relationship to one another. Pain—both chronic and acute—can interfere with sleep, making it harder to fall asleep and to stay asleep. Poor quality and insufficient sleep contribute to pain in several ways, decreasing tolerance for pain, increasing its intensity and discomfort, and in some cases raising the risk for the development of chronic-pain conditions.

New research suggests that poor sleep plays a significant role in the risk for widespread pain among older adults. Researchers at the United Kingdom’s Keele University investigated the factors that contribute to widespread pain—pain that occurs in multiple places in the body at once—among adults age 50 and older. They found non-refreshing sleep—sleep that results in waking feeling tired—to be the single most likely predictor of the development of widespread pain. The study included 4,326 men and women age 50 and older. Among them, nearly 1/3 reported no pain at the study’s outset, while the remaining participants reported experiencing some degree of pain when the study began. Researchers gathered information on pain, sleep, and other aspects of physical health, as well as details about psychological health and lifestyle habits. Researchers followed up over a period of 3 years to monitor the development of new widespread pain. They then analyzed their data to identify the factors associated with increased risk for development of widespread pain. In their analysis, researchers adjusted for the presence of osteoarthritis, a condition common among older adults that can contribute to widespread and chronic pain. They found many participants developed new widespread pain during the 3-year study period, and that sleep proved to be a significant factor in pain’s development:

  • Among participants, 800 people—19%–reported developing new forms of widespread pain during the 3-year observation period.
  • People already experiencing pain were more likely to develop new pain. Among participants who reported some pain at the study’s outset, 25% developed new widespread pain over the next 3 years, compared to 8% of people who reported no pain at the start of the study.
  • Non-restorative sleep was the factor most strongly linked to the development of widespread pain.
  • Other factors that were associated with increased risk for pain were the presence of pain, anxiety, physical health related quality of life, and cognitive complaints.

Widespread pain in this study was not linked to specific conditions—it could have come from any number of sources. Not all adults who experience this diffuse pain have been diagnosed with a particular disease or illness. That said, there are a number of conditions—including arthritis and fibromyalgia—which are often accompanied by the presence of widespread pain. Poor sleep has been shown to increase the risk and severity of some of these conditions. The results from the current study suggest that with or without the presence of a chronic-pain-related disease, poor sleep may play a highly significant role in raising the risk of widespread pain as we age.

Other recent research also indicates the prominent role that sleep plays in the presence and severity of pain, and offers remedies that can help both pain problems and sleep problems:

A study conducted at Harvard University’s Center for Work, Health & Well-being explored the connection between sleep and pain among hospital care workers. Their results found that several types of poor sleep, including insufficient sleep, short sleep duration, and symptoms of insomnia, were strongly associated with pain, to the point of interfering with work and limiting the ability to perform daily tasks.

Sleep and chronic pain can interact negatively and exacerbate each other on a daily basis, according to research among women with several different types of chronic pain. Researchers found that a single night of poor sleep increased pain experienced the following day. And a spike in pain intensity during the day disrupted sleep that night. What’s more, negative mood appeared to further intensify the disruptive, escalating cycle of sleep and pain.

Recent research has offered some promising avenues for treatment to improve both poor sleep and chronic pain in people who suffer both. Regular, moderate exercise and cognitive-behavioral therapy have been shown effective in improving sleep and reducing pain, including among older adults.

We all want to age in good health and positive frame of mind, able to enjoy the full range of life’s opportunities. Pain associated with aging—and the disrupted sleep that accompanies it—can inhibit health and quality of life. Maintaining a routine of high-quality sleep in plentiful amounts may be one of the most important things you can do to reduce your risk of experiencing physical pain as you grow older.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor®

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