The impact of pain on sleep
Pain pertains to the unpleasant sensation that is associated with a particular stimulus. This sensory condition may be caused by an injury or a medical condition and thus results in a combined physical and mental experience in an individual. In the field of medicine, the determination of pain a patient is generally subjective. The main reason behind this approach is that every individual has a certain threshold for pain, wherein what is painful to one person may not be painful to another. It is thus more acceptable to define pain is any kind of sensation that makes an individual go through an unpleasant or uncomfortable experience.
Pain is regarded as a common symptom in most medical disorders and its presence generally interferes with the daily activities of an individual. When pain persists for an extended period of time, it also affects the quality of life of a person, resulting in hardship and depression. Healthcare professionals often ask a patient upon presentation at the clinic to say if they are experiencing any kind of pain. If a positive response is received, the patient is asked to describe the pain in terms of intensity, location and duration. It is also important to determine whether the patient has taken any form of painkillers to augment his condition. Acute pain is technically determined by the duration of the sensation and that it could be easily treated by administration of simple painkillers. Chronic pain refers to the unpleasant condition that is generally intractable and that the underlying factors of the pain are usually much more complicated.
Pain is also considered as a defense mechanism of the human body towards a harmful stimulus. The adjustment of the body to that particular stimulus thus ensues soon after pain is present, as the body needs to regulate specific physiological activities in order to compensate for the change that has occurred within the body.
THE IMPACT OF PAIN ON SLEEP
Pain is an unpleasant experience of which, when observed at a higher frequency, could disturb the sleep activity of an individual. Its occurrence may result in the disruption of continuous sleep, as an individual is awakened by the persistence of the throbbing or stabbing pain from a particular pain of the body. It should be understood that a disruption in an individual’s sleeping patterns result in fatigue (Bardwell and Ancoli-Israel, 2008). This may be observed as an individual finds difficulty in completing a task that is often simply performed without any extra effort. In addition, an individual who goes through a marked loss in the number of hours or quality of sleep may be irritable. Interactions with other individuals may thus be of less quality, which in turn can affect an individual’s personal and professional relationships.
The immune system is also strongly correlated with the amount of sleep that an individual takes in a day. During sleep, the body is allowed to rest and to repair any damaged tissues that were used during the day. When the sleeping pattern of an individual is disrupted due to the intermittent occurrence of pain, then the individual’s immune system could weaken. It is thus often observed that individuals who do not receive at least 6 hours of sleep each day are more prone to infections and diseases.
The general well being of an individual experiencing chronic pain also deteriorates through time. The quality of life of an individual generally stems from how one feels about his current condition, hence the presence of pain can directly influence an individual to feel helpless and hopeless with regards to his life. In addition, an individual experiencing chronic pain may find difficulty in concentrating in common activities in his life, as well as find it uninteresting if he constantly feels discomfort and fatigue during the most part of each day. There are certain individuals who also develop depression as they find it hard to live through each day.
THE IMPACT OF PAIN ON WAKING FUNCTIONING
It has been reported that when an individual in chronic pain underwent an evening of poor sleep, the next day was generally characterized by more pain. It has been suggested that this individual has developed hypersensitivity to pain, as well as a modified mechanism for processing pain (Shaver, 2008). These changes in the body may also result in a significant decrease in blood flow, which in turn could decrease the amount of oxygen that is delivered to the rest of the body. The change in the reception and processing of pain is mainly controlled by the central nervous system. The constant and persistent pain induces the secretion of pain signals, which induces modification of the physiology of nerve cells. Aside from the continuous excitation of the neurons by pain, these cells attain a highly excitable condition that may involve only a small amount of stimulus to illicit a neural response. The activity of the neurons may be more spontaneous as the range of excitation of these cells is expanded. The conduction of nerve signals is thus faster, taking less time for transmission for the rest of the body to respond.
An individual’s actions during his waking hours may thus be modified by the pain he is experiencing. Since the individual is now more hypersensitive, it is possible that the individual is more irritable to negative interactions with his family or co-workers. The individual may be more sensitive to simple statements from people in his environment and may either develop crying bouts or fights with the source of the insult. The threshold for pain may also be lower, as the neurons of this individual have expanded in its range of stimulation. The individual may also be more jumpy with sudden loud noises and his excitability has been modified due to the persistent condition of pain. The individual will also feel stressed over simple things at home or at work, as he has to balance energy for his reaction to pain and for the daily activities he has to complete.
POLYSOMNOGRAPHIC FEATURES OF PAIN
The features of pain have been comprehensively studies through polysomnography. One key feature is the presence of alpha electroencephalogram (EEG), which is characterized by low frequency brainwaves of approximately 7.5 to 11 Hertz (Hz). These alpha brain waves were reported to intrude into the non-rapid eye movement (REM) stage of sleep, which is simply regarded as deep sleep or technically the alpha-delta sleep (Lopes et al., 2008). The intrusion of alpha waves into this particular sleep stage results in fragmented sleep and in some cases, insomnia.
Alpha waves that are strongly associated with pain and affect sleeping patterns can be further subdivided according to the onset of the waves during sleep stages. Phasic alpha pertains to the type of alpha waves that occur simultaneously with the onset of the delta waves. On the other hand, the tonic alpha refers to the continuous production of alpha waves during the non-REM stage. Low alpha wave activity is that type which only develops alpha waves for 30% of the duration of sleep. It has been reported that phasic alpha waves are the most common type of brain activity in individuals experiencing pain during sleep.
Other polysomnography studies indicate that sleep apnea is often associated with pain (Tasali et al., 2008). It should be understood that sleep apnea has been positively correlated with medical conditions such as arthritis, fibromyalgia and chronic back pain, all of which generated excessive and persistent pain in an individual. Polysomnography studies show that the average number of episodes of apnea in an individual with chronic arthritis is 22 per hour, as the average frequency of awakening is 23 per hour. This report thus shows that sleep apnea and pain occur through some mechanism and control its occurrence in an individual.
BEHAVIOR AND/OR THERAPEUTIC RECOMMENDATIONS
It is important that a treatment regimen be designed for an individual who is positively diagnosed with chronic pain. Since pain is strongly associated with sleep disturbance and other indirect effects on the body, it is important to administer the appropriate painkiller to the individual that would alleviate the symptom of pain. In addition, it is also possible to provide anti-depressants, as depression is a general observation among patients with chronic or advanced medical conditions such as cancer or rheumatoid arthritis (Patel et al., 2008). There are also tranquilizers that induce a calming effect on the patient.
Other supportive therapies can also be provided to a patient experiencing chronic pain. Psychiatric counseling may facilitate the patient in accepting his condition medical condition, as well as cope with what he is currently capable of doing. Music therapy also decreases the chances of an individual to experience stress at home or in the hospital.
The occurrence of chronic pain is a medical condition that should be addressed in every patient, as this may influence the general physiological condition of the individual, as well as his quality of life. Pain may thus result in more complications in the patient, as it disrupts sleep and causes fatigue and emotional stress. On a personal note, it is important to treat a patient for any pain that he is experiencing, as it is unacceptable for an individual to further experience any suffering during his illness. It is thus important that pain be treated as soon as possible, in order to prevent the development of additional medical conditions in a patient.
Bardwell, W.A. and Ancoli-Israel, S. (2008). Breast cancer and fatigue. Sleep Medicine Clinics, 3, 61-71.
Lopes, M.C., Guilleminault, C., Rosa, A., Passarelli, C., Roizenblatt, S. and Tufik, S. (2008). Delta sleep instability in children with chronic arthritis. Brazilian Journal of Medical and Biological Research, 41, 938-943.
Patel, M., Chipman, J., Carlin, B.W. and Shade, D. (2008). Sleep in the intensive care unit setting. Critical Care Nursing Quarterly, 31, 309-318.
Shaver, J.L.F. (2008). Sleep disturbed by chronic pain in fibromyalgia, irritable bowel and chronic pelvic pain syndromes. Sleep Medicine Clinics, 3, 47-60.
Tasali, E., Cauter, E.V. and Ehrmann, D.A. (2008). Polycystic ovary syndrome and obstructive sleep apnea. Sleep Medicine Clinics, 3, 37-46.