Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Insomnia & Recovery

A patient who does not sleep well is unlikely to fully participate in rehabilitation efforts, and the patient will be irritable, forgetful and unlikely to learn effective pain tolerance.

Be aware that medications (called “hypnotics”) typically used for the treatment of sleep disorder are not truly “addictive”. They can be habit forming in the sense that a person can begin to rely upon them rather than permit normal sleep patterns to be restored. But there are more risks from their pain medication than their sleep medication.

Concerns for the impact of insomnia are appreciable, and the data from a recently published three year sleep study revealed that:

Almost half of patients with insomnia have suffered from sleep problems for 3 years or more; three-fourths report at least 1 year of insomnia symptoms; insomnia is unlikely to remit spontaneously, and recurrence is common.

Chronic insomnia increases the risk for other problems, including depression, anxiety disorders, and substance abuse.

The take-away message is that we must consider insomnia as a serious aspect of injury. Treat it sooner rather than later. The patient with true insomnia will report sleep problems and various daytime difficulties, but not necessarily daytime sleepiness. With regard to sleep, the questions posed to the patient need to be quite precise or insomnia may be overlooked.

I had a patient recently who was very slow to recover from a knee injury. It was revealed that he simply was obtaining very little effective sleep. Once this was addressed, the patient began to show for physical therapy, reduce his pain medication and look for work alternatives.”

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