Using a Multifaceted Approach to Break the Sleep-Pain Cycle

Optum Workers' Comp
| Nov 24, 2015

We’ve all experienced those times when much-needed sleep was elusive or have been woken up in the middle of the night only to find you just can’t get back to sleep. Whether caused by stresses from social obligations, work, or home responsibilities, an occasional bout of insomnia, while frustrating, is relatively harmless. However, for those suffering from chronic pain caused by a workplace injury, a lack of sleep can lead to a sleep-pain cycle where pain causes insomnia and a lack of sleep exacerbates pain.

It is estimated that 5-15% of the U.S. population suffers from insomnia. Of those that suffer from insomnia, a projected 80% is the result of a psychiatric, psychological, or medical condition, such as chronic pain. These statistics might be the reason for the influx of television commercials advertising new sleep medications, such as Belsomra®. The cyclical nature of pain making sleep difficult and a lack of sleep exacerbating the pain is one of the reasons proper treatments of pain and insomnia are so important to recovery from a workplace injury or illness.

A number of diagnostic tools can be used to determine if a person is suffering from insomnia versus a temporary period of disrupted sleep. Once a diagnosis of insomnia is confirmed, any contributing underlying medical conditions should be assessed. In the case of insomnia related to chronic pain, adequate treatment of pain and any pain-related psychological issues, such as anxiety, depression, or stress should be optimized, as often appropriate treatment of the underlying medical condition alleviates insomnia and enables the injured person to obtain adequate sleep. In situations where insomnia persists despite a safe and efficacious therapy regimen for the underlying condition, there are two methods of intervention, non-pharmacological and pharmacological.

  • Non-pharmacological Intervention – Includes stimulus control, behavioral intervention, sleep hygiene, and relaxation therapy, such as deep breathing exercises, and yoga and meditation.
  • Pharmacological Intervention – Includes benzodiazepines, non-benzodiazepine hypnotics, melatonin-receptor agonists, and over-the-counter products.

Treatment guidelines suggest the optimal approach to therapy is a short-term prescription sleep aid in conjunction with long(er) term non-pharmacological therapy. The key is to ensure that the therapy regimen accurately addresses and treats the underlying condition and not just the resulting insomnia. In cases of insomnia caused by chronic pain, this means that pain must be controlled as effectively as possible to allow not only for treatment of the sleep disorder, but to advance the person’s recovery and ultimately achieve a better outcome.

For more information, click here to read our white paper, “The Effect of Sleep on Chronic Pain: Enhancing Sleep Can Lead to Less Pain and Better Outcomes.”

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