Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Too Much Sleep

Among chronic pain patients, dependent upon the research study, between 50% and 90% of the patients report sleep problems, sleep deprivation, insomnia, restlessness, nightmares and other complaints. Some of this is naturally emerging due to the impact of pain upon the sleep cycle.

Equally as often, the use of narcotics for pain creates poor sleep architecture, and the sleep is not restful. Also, some patients must sleep in a recliner, on the sofa to avoid disturbing others and some even report being propped up in bed, making sleep quite difficult.

However, there is also a body of research that indicates that excessive sleep also results in increased pain. Chronic pain patients report up to 80% increase in pain when receiving less than 3 hours sleep, but those who sleep more than 11 hours report an even more substantial increase in pain. This is due to the probable nature of those 11 hours of sleep which are most often disrupted, disturbed, fragmented or overly light in nature.

Logically, patients who use narcotics to promote sleep may also arrange their bodies in unnatural positions during sleep, such that pain from poor positioning disturbs their rest.

Thus, asking a patient if s/he gets enough sleep will not tell you the extent of the interplay between their sleep and their pain. It is crucial to obtain details of duration and precise nature of sleep. Also, the concept of napping is quite problematic since sleep deprived patients will supplement with multiple naps during the day. This decreases the need for sleep the following evening, complicating their capacity to normalize their sleep.

For our chronic pain patients, therefore, it is important to both gain complete sleep data and be prepared to explain to the patient the role of sleep and aspects of effective sleep hygiene. Few patients have appropriate sleep hygiene and will watch television, read and even snack in bed, rather than using the bed for the targeted purpose of sleep.

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