By in Osteopathy

Sleep Problems & Back Pain

sleep back pain

Sleep problems are prevalent in the global population with main factors that affect the quality of rest being prolonged sleep onset latency (can’t get to sleep), excessive wake after sleep onset (can’t get back to sleep if you wake up in the night), short total sleep time, low sleep efficiency, or poor sleep quality.

Somewhere between 30 and 55% of individuals in the developed world have complained of deprived sleep patterns at some point in their lifetime yet despite the potential widespread benefit for sleep promotion and established behavioural treatments, there is limited access to such treatments.

Sleep hygiene clinics offer education and support to those seeking help and who qualify for these treatments, however, research identifying factors of poor sleep should be available to all in order to help reduce the risk of developing illnesses where sleep deprivation has potentially contributed.

Medical research in this area focuses on patients already symptomatic because of their sleep habits, therefore there is little data on the normal population habits and as such, risk factors in normal individuals have not been specifically identified. There is general information out there but due to the growth in knowledge within medicine regarding the link with poor sleep and risk of many systemic diseases and conditions.

Current evidence supports one area that is specifically of interest to me and that is that poor sleep (both in quantity and quality) can be predictive of developing and worsening low back pain.

Medical research has identified that sleep patterns influence our emotional well-being and mood which can further sensitise back pain and reduce the ability to not only tolerate pain but also affects motivation and energy levels required to rehabilitate back pain. A secondary factor is that anxiety and concerns over our backs can negatively impact sleep. Fear over back pain results in increased tension patterns in the muscles around the low back which only contributes to enhance pain and sensitivity and negatively impact sleep quality.

Society often blames back pain on physical factors such as poor posture, weak core or spinal asymmetries and although there are multiple factors identified that contribute to the development and maintenance of low back pain, research has been able to demonstrate that physical factors play a very limited role in contributing to either the development or maintenance of lower back pain.

Evidence has identified active strategies that encourage self-confidence in moving, regular exercise and stress management as the most appropriate treatment for lower back pain. Also, developing appropriate and healthy attitudes about our backs through education is one of the most important aspects of treating and managing low back pain.

Rather than worrying about a new or long term back issue, you should be seeking effective, evidence-based treatment and advice to help you manage and overcome your back pain and limit time lost to pain and suffering.

Strategies to improve sleep when suffering from pain include, establishing a routine where behaviours both during the day and evening are more conducive to sleep (see list below). Help your body to relax using breathing regulation and mindfulness techniques that aid sleep and when your sleep is disturbed by pain when certain postures and movement in bed aggravate, it is important to remember that the pain is not suggestive of damage and moving in a more relaxed manner will be less provocative of pain.

Below are some of the most common sleep hygiene interactions/recommendations including limiting caffeine consumption, smoking and alcohol, the timing of exercise, stress and noise reduction, sleep timing and reducing daytime napping.

Evidence points to the reasons below as contributors to poor sleep quality and quantity.

Remember that the reasons listed have only been identified in people already suffering from poor sleep that have sought help. Research has not looked at populations without sleep disturbance so the list is just a guide for the general population.

Caffeine

Caffeine has been demonstrated to disrupt sleep when consumed too close to bedtime. There is a dose-response relationship, so the more consumed the greater the disruption. The effects may be limited to caffeine-sensitive individuals so it may not affect everyone. Also, there has been little or no data on caffeine consumed in the morning or afternoon so that has identified an area of future research along with how to identify caffeine-sensitive individuals.

Nicotine

Both short and long term nicotine use, as well as nicotine withdrawal, has been shown to disrupt sleep. There is some limited evidence to suggest that sleep disruption can be resolved following cessation and withdrawal. An area in need of research is how passive smoking affects sleep patterns.

Alcohol

Although alcohol can decrease the time it takes to fall asleep, it has been shown to increase arousal in the second half of the night. It is dose-dependent so the more consumed the larger the effect. Like nicotine, withdrawal of alcohol will also affect sleep patterns of alcohol-dependent individuals and can continue long term, even after cessation with only moderate improvement in sleep.

Exercise

Although different types and intensity of exercise have not been rigorously studied, regular exercise has been demonstrated to improve sleep habits and despite a popular belief, research does not support the claim that late-night exercise can negatively affect sleep.

Stress

Psychological stress is associated with heightened pre-bedtime arousal and therefore impaired sleep. Various stress management strategies have been shown to reduce pre-sleep arousal and improve sleep, although no one strategy has been proven more effective than any other.

Noise

Nighttime noise can be disruptive even if the individual has got used to the regularity of the sound. EEG studies have demonstrated a sustained increase in heart rate despite seemingly sound sleep patterns.

Daytime Napping and Sleep Timing

Avoiding daytime naps will help you get a more sound sleep at night. Although some sleep treatments include both regularity in sleep time and waking time evidence does not appear to support both. However, irregular sleep/wake patterns have been demonstrated to negatively affect the restfulness of sleep.

If you are interested in having your back assessed then please contact The Body Matters, and ask to see Matthew Oliver. You can find out more about our services on our osteopathy and physiotherapy pages.

Louise
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