Pain, inflammation, and sleep
We all want to wake up feeling rested and refreshed, mind and body ready to dive into the day. Unfortunately, for many people, that’s not how mornings begin. I see patients every day who are frustrated by waking with pain, stiffness, and fatigue. “Why do I feel so physically uncomfortable when I get out of bed?” is the question I hear again and again.
The truth is, there could be a number of sources of soreness, stiffness, and discomfort first thing in the morning. It may involve the sleep equipment you’re using—your bed and pillow. It also may be related to inflammation, coming from one source or another.
Let’s take a look at what can cause morning pain and fatigue—and what you can do to improve it.
Check in with your sleep gear
When you’re feeling sore, stiff, or pain upon waking, the first place to look for answers is your sleep equipment—specifically, your mattress and pillow. Remember: sleep is a performance activity. If you hiked a mountain in shoes that don’t fit, you’d probably finish the climb in some pain. The same idea applies to sleep. To do it well, you need the right equipment, and you need to replace that equipment when it’s worn out.
Your mattress needs to supply you with both support and comfort. A supportive mattress:
• holds your entire body, without sinking at the hips
• allows relief and comfort at pressure points, including the knees, hips, shoulders, and head
• lets your muscles relax throughout the body, especially at your back
Only you can be the judge of what is comfortable to you in a mattress. Keep in mind, your comfort preferences are likely to change with age. As people grow older, they often need a softer feeling bed, particularly to help address pain issues. Some say this has to do with less fat under your skin as a cushion.
The typical lifespan of a mattress is 7-8 years. But you can’t automatically count on getting that long out of your bed. Here are a couple things to keep in mind, when assessing the viability of your mattress:
Less expensive mattresses have shorter lives. Mattresses are expensive. They’re also an important investment in your sleep and health. It’s a good idea to spend as much as you can afford investing in a high-quality bed. If you went with a less-expensive mattress four or five years ago, it may no longer be able to provide you the support and comfort you need.
Needs for support and comfort change as we age. Throughout our lives, our bodies undergo changes that affect what we need from our mattresses. Weight loss and weight gain, changes to fitness levels, pregnancy, and conditions such as back pain or neck pain are all factors that can mean it is time for a new mattress. With age, many people need a supportive mattress that is softer, for comfort throughout the night.
It’s not just about your mattress, though. Your pillow is also important to your ability to sleep. The right pillow can make the difference between waking sore and stiff and waking relaxed and rested.
What does your pillow do for you? It aligns your cervical spine (that’s the part of the spine that’s in your neck), so there is no bend or muscle tightness in your neck while you sleep. A pillow that is too thick or too thin will put your cervical spine out of alignment. That’s likely to lead to neck pain and upper back pain.
The easiest way to tell if a pillow is providing you support is to lie down in your sleeping position, and have a friend or bed partner see if your head and neck are in alignment.
A pillow also needs to provide comfort, as well as support. The comfort of your pillow is a subjective measurement that is yours to determine. Your pillow needs to feel good. I recommend keeping a selection of pillows that provide you with support and are comfortable.
Pillows don’t last forever—far from it. I recommend replacing pillows every 18 months, to ensure you’re getting the most support and comfort. Memory foam pillows may last longer, up to 3 years.
Inflammation and sleep problems
You’re probably getting used to hearing about inflammation and health issues. There’s good reason for that. Chronic and excessive inflammation are recognized as a cause of illness and disease, diminished physical function, and accelerated aging. As a result of several possible factors, inflammation can be a reason for waking up feeling uncomfortable and unrested.
What is inflammation?
Inflammation is an important element of the body’s immune system. Inflammation is a response to the body’s perception of illness, injury, disease, and pathogens that might cause harm. Among the most common symptoms of inflammation are swelling, pain, and stiffness. Inflammation is part of the body’s healing process, it’s way of repairing damaged cells and tissues. So, not all inflammation is bad; there is some inflammation that is good and necessary for health. Chronic and systemic inflammation, however, is harmful to health over the long term. Both “good” and “bad” inflammation can lead to sleep problems.
Let’s take a look at several factors that can trigger inflammation and may contribute to stiffness, soreness, and pain at the end of a night’s sleep:
Injury and illness.When sick or injured, the body responds with inflammation. This can lead to pain and discomfort that may interfere with how well you sleep and create physical pain and stiffness upon waking. This is the case if you are fighting off a cold, or if you’ve twisted your ankle running around with your kids on the playground. It’s also the case with more serious illnesses and chronic conditions, including arthritis. For many conditions, symptoms tend to be worse at night, which can lead to feeling a lot of discomfort in the morning. What’s more, pain and sleep have a bi-directional relationship: they each influence the other. Poor sleep makes us more sensitive to pain, and the presence of pain makes it harder to sleep.
What you can do: Treating your condition, and managing pain as a part of treatment, can help you sleep better and feel less uncomfortable and tired when you wake.
Aging.Aging appears to be both a result of inflammation and a contributor to it. Systemic, low-grade inflammation becomes more common with age. So do morning stiffness, soreness, pain, and unrefreshing sleep. Levels of C-reactive protein, a key inflammatory marker, tend to rise with age in many people.
What you can do: Take care of yourself, physically and mentally. Manage stress, maintain a healthy weight, and be physically active. Stay on top of your health with regular visits to your physician, including blood work that screens C-reactive protein and other inflammatory markers.
Autoimmune disease.Autoimmune diseases occur when the immune system mistakes the body’s own healthy cells for harmful invader cells. The immune system mounts an attack on those healthy cells, and that includes an inflammatory response. We don’t know how many people have autoimmune conditions—the National Institutes of Health estimates 23.5 million, while the American Autoimmune Related Diseases Association estimates that number at 50 million. The prevalence of autoimmune diseases has been rising in the U.S. and in other Western countries for decades. There are more than 80 autoimmune disorders identified, including rheumatoid arthritis, lupus, Crohn’s disease, psoriasis, inflammatory bowel disease, and celiac disease. Inflammation, and with it physical pain and poor sleep that can extend through the night to early morning, are common symptoms among these disorders.
What you can do: If you’ve been diagnosed with an autoimmune disorder, follow your treatment protocol. If you’re experiencing chronic or unusual fatigue, stiffness, or pain first thing in the morning or at any time of day, see your doctor for a check in—and be sure to talk about your sleep issues while you’re there.
Diet.The foods we eat can contribute to escalating inflammation—or they can help reduce and control it. Foods that trigger inflammation include ones laden with unhealthful fats and sugar, including fried foods, red and processed meats, refined carbohydrates like white bread, cookies, and cakes, and soda. An anti-inflammatory diet is full of vegetables, fruits, nuts fiber-rich whole grains, and wild-caught fish. The Mediterranean diet is a model for eating to limit inflammation.
What you can do: If you’re experiencing unrefreshing sleep, pain, stiffness and discomfort in the morning, take a fresh look at your diet. Swap out pro-inflammatory foods for anti-inflammatory ones, and keep your intake of processed foods and sweets to a minimum.
Too little—or too much—exercise.We still have a lot to learn about the relationship between physical activity and inflammation. Regular exercise appears to limit inflammation, especially as we age. A sedentary lifestyle can result in more pain and stiffness in the morning, and throughout the day. Research shows exercise improves sleep quality across the adult lifetime, as well as reducing some physical pain during sleep and lowering levels of daytime fatigue.
Over-training is an increasingly common problem I see among my patients who exercise—a problem that can lead to sleep issues and discomfort. Insomnia is one of the first symptoms of overtraining, according to research. Exercising too much or too intensely can lead to injury—and inflammation and pain that interfere with sleep. Over-use injuries related to exercise become more common with age. Exercise is great for the body, great for health, and great for sleep—but if you work out too hard or too often, you’re likely to feel some negative effects, including sleep and pain in the morning, and during the day.
What you can do: The National Institutes of Health and the American Heart Association recommend at least 150 minutes of exercise a week for healthy adults—that’s 30 minutes a day, five days a week. To improve sleep, research suggests a consistent exercise routine has the greatest benefits, especially for people who experience difficulty sleeping.
Don’t resign yourself to uncomfortable, stiff-limbed mornings of rising from bed feeling tired and sore. Use the right sleep equipment, pay attention to your daily habits and routines, and seek medical help for symptoms that are interfering with your rest.
Michael J. Breus, PhD, FAASM
The Sleep Doctor™