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Sleep Quality and Pain

Published: August 7, 2020

Research suggests that poor sleep can increase pain sensitivity. Pain during the day can affect the quality of your sleep that night and poor sleep quality can increase your pain levels the next day. It’s a vicious cycle!

Sleep is broken up into 2 main phases; REM and Non-REM. This stands for “Rapid Eye Movement”. We move through both of these phases throughout our sleep cycle.

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The cycle can be broken down into these stages:

  1. We begin with stages 1 and 2, which are lighter stages of sleep.
  2. Next, we then go into deeper sleep in stages 3 and 4, which is sometimes called slow wave sleep.
  3. We then move back up to lighter sleep and then into REM sleep. This is where we dream.
  4. This cycle gets repeated a number of times throughout the night, with more time spent in deep sleep at the beginning of the night and more time spent in lighter stages and dreaming towards the morning.
  5. It is normal for us to wake up several times a night but we should fall back to sleep immediately. Unfortunately, when we have pain; we wake up and notice the pain which causes our nervous system to be alerted and our sleep is disturbed.

It is a cycle, sleep can be disturbed by pain and by food, and pain and food can disturb sleep. Sleep can assist with our mood and energy, which can lead to a better workout and exercise session, a happier mood and hence a greater sleep. So where do we start?

If pain is impacting your ability to sleep, start with some pain strategies with your Physiotherapist (exercise, treatment, pain management strategies, bed sleep postures or assistance devices). So, if we can manage this then with less pain, more sleep occurs which will further reduce pain and we start to win back the battle of pain and sleep. If needed the Physiotherapist can then refer on to other assessment and professions as needed.

We also know the positive effect of exercise on mood and that racing mind when we try to sleep. We are also aware that when our bucket is full, our worries, emotions and pain can get out of hand; which often leads to no sleep. Try an exercise plan from your physio as well as some relaxation strategies through the day or prior to bed.

Here are some additional recommendations to follow to help improve sleep quality:

  • Routine
    Going to sleep and getting up at the same time each day is important for your circadian rhythm. This can improve hormone production, cell regeneration and brain wave activity.
  • Relaxation
    The nervous system needs to calm down prior to us being able to fall asleep. We’ve all had nights were our minds just won’t stop racing and as result we wake up feeling grumpy and tired. The key to effective relaxation is to practice it regularly. The following apps can be a great way to start: Headspace, Calm, Smiling Mind and Simple Habit.
  • Diet
    Avoid foods high in trans fats, sugar and caffeine four hours before bed. Click here to read more about the link between Nutrition and Sleep.
  • Exercise
    Avoid exercising within two hours before going to bed, as it will increase your heart rate and body temperature, therefore making it a lot harder to fall asleep.
  • Light
    The greater the difference between day time light and evening darkness, the more “melatonin” the body produces, this is a hormone that promotes sleep. This can be done by reducing light in the bedroom (blackout curtains) and increasing sun light exposure during the day. 
    - Minimise blue light (supresses the production of melatonin) one to two hours before bed. Use blue light filters on devices or blue light filter glasses.

If you have any questions or would like more information, please feel free to contact me on 9439 6776, or email to

Article written by Cameron Ramlu, Physiotherapist at Back In Motion Eltham.