ANNOUNCER: It seems getting a good night's sleep isn't always as easy as it sounds. But it's particularly difficult when someone's in pain.
ELLEN MILLER, MD: Pain always feels worse at night. You may be able to relax at that time more when you go to sleep and then that's when you feel the pain the most.
JAMES O'BRIEN, MD: If someone is experiencing pain during the day, their body is under stress. And stress in individuals affects their sleep and activity during the course of the day by virtue of excessive amount of hormones, particularly adrenaline. So if you're going to sleep, experiencing some pain in the day and you're having adrenaline in your system, that could make it more difficult for you to get the sleep or to maintain a depth of sleep that you would benefit by.
ANNOUNCER: And of course pain comes in all shapes and sizes.
JAMES O'BRIEN, MD: Acute pain is the sudden development of discomfort. Whether it be surgically related, whether it be to deal with a tooth that needs repair, whether it be related to an accident that occurs. And oftentimes when you try to go to sleep at night, you are aware perceptually of these discomforts, which are unusual. Pain is clearly the nemesis of getting good sleep.
ANNOUNCER: While acute pain will often subside as the condition improves, chronic pain is a different story.
ELLEN MILLER, MD: Chronic pain, on the other hand, is not necessarily as sharp as the acute pain. It's more like a dull, constant pain and it just doesn't ever seem to go away. And we see this more with rheumatoid arthritis or osteoarthritis.
ANNOUNCER: Both types of pain can be the culprit, robbing you of a restful night in lots of different ways.
JAMES O'BRIEN, MD: It can make it more difficult for us to initiate sleep, making it longer for us to fall asleep and beginning to train us that falling asleep is not necessarily an easy thing for us to do, even though for years it's always been taken for granted.
The other problem that sleep is affected by in terms of pain is the interruption of sleep while we are asleep. So we may be waking up at night unaware that pain is the cause, but we just happen to roll on our wrist or elbow or shoulder before we rolled back and awakened, unaware of why we are awake. And that kind of habit literally affects and habituates an individual to expect that sleep will be disrupted.
ANNOUNCER: Adding to the problem of disturbed sleep may be the very medications that people take to relieve certain types of pain, such as codeine, demerol, morphine and steroids. Others may even contain caffeine.
ELLEN MILLER, MD: Sometimes medications for migraine headaches may contain caffeine, or sometimes some other pain medications are combination medications that have several things in it and one of the ingredients is caffeine, the caffeine can keep us awake.
ANNOUNCER: Whatever the reason for lost sleep, the lack of rest can even make the pain seem to feel worse in your waking hours.
ELLEN MILLER, MD: I think we can all agree that everybody feels worse when they don't sleep and every medical problem that they have is going to seem worse when they don't sleep. So the following day, when they're fatigued and they're recovering from lack of sleep, they also will feel worse in terms of any other medical condition, including their pain.
ANNOUNCER: So while sleep is important, pain may stand in its way. Pain medications can deal with the pain, but often the sleep problems persist. Luckily there are other ways to achieve a more restful night. One short-term solution may be the use of sleep aids.
JAMES O'BRIEN, MD: They generally come in two styles, the non-benzodiazepine medication and the benzodiazepine types medications Benzodiazepine medications work very, very well. The problem with them is that their half-lives can be very, very long and the side effect, hangover issue, is really in play. With the non-benzodiazepine medication, there's less likely to have any hangover effect. They are very short-acting medications; they're much cleaner medications
ANNOUNCER: Sometimes just changing bedtime behavior can help.
ELLEN MILLER, MD: What this is, is to get them to into a room that is as conducive for sleeping as possible. The right temperature, comfortable, dark room. They should use the bedroom just for sleeping; don't use it for all their other activities. Don't get into bed after dinner, turn on the television, bring all their work, sit there reading, doing what all of us do it in our bed and we're not supposed to.
Some of the other techniques that are useful for patients with sleep disorders are relaxation techniques and stress management.
ANNOUNCER: Although when you're in pain, you may feel like bed is the only place to be, experts urge that staying out of bed and awake may help you sleep better at night.
JAMES O'BRIEN, MD: Individuals who are in pain having sleep problems need to get the help that they need, because sleep is essential for the management of their pain, and if they're not able to solve it on their own, they need to talk to their doctor.
ELLEN MILLER, MD: Pain always feels worse at night. You may be able to relax at that time more when you go to sleep and then that's when you feel the pain the most.
JAMES O'BRIEN, MD: If someone is experiencing pain during the day, their body is under stress. And stress in individuals affects their sleep and activity during the course of the day by virtue of excessive amount of hormones, particularly adrenaline. So if you're going to sleep, experiencing some pain in the day and you're having adrenaline in your system, that could make it more difficult for you to get the sleep or to maintain a depth of sleep that you would benefit by.
ANNOUNCER: And of course pain comes in all shapes and sizes.
JAMES O'BRIEN, MD: Acute pain is the sudden development of discomfort. Whether it be surgically related, whether it be to deal with a tooth that needs repair, whether it be related to an accident that occurs. And oftentimes when you try to go to sleep at night, you are aware perceptually of these discomforts, which are unusual. Pain is clearly the nemesis of getting good sleep.
ANNOUNCER: While acute pain will often subside as the condition improves, chronic pain is a different story.
ELLEN MILLER, MD: Chronic pain, on the other hand, is not necessarily as sharp as the acute pain. It's more like a dull, constant pain and it just doesn't ever seem to go away. And we see this more with rheumatoid arthritis or osteoarthritis.
ANNOUNCER: Both types of pain can be the culprit, robbing you of a restful night in lots of different ways.
JAMES O'BRIEN, MD: It can make it more difficult for us to initiate sleep, making it longer for us to fall asleep and beginning to train us that falling asleep is not necessarily an easy thing for us to do, even though for years it's always been taken for granted.
The other problem that sleep is affected by in terms of pain is the interruption of sleep while we are asleep. So we may be waking up at night unaware that pain is the cause, but we just happen to roll on our wrist or elbow or shoulder before we rolled back and awakened, unaware of why we are awake. And that kind of habit literally affects and habituates an individual to expect that sleep will be disrupted.
ANNOUNCER: Adding to the problem of disturbed sleep may be the very medications that people take to relieve certain types of pain, such as codeine, demerol, morphine and steroids. Others may even contain caffeine.
ELLEN MILLER, MD: Sometimes medications for migraine headaches may contain caffeine, or sometimes some other pain medications are combination medications that have several things in it and one of the ingredients is caffeine, the caffeine can keep us awake.
ANNOUNCER: Whatever the reason for lost sleep, the lack of rest can even make the pain seem to feel worse in your waking hours.
ELLEN MILLER, MD: I think we can all agree that everybody feels worse when they don't sleep and every medical problem that they have is going to seem worse when they don't sleep. So the following day, when they're fatigued and they're recovering from lack of sleep, they also will feel worse in terms of any other medical condition, including their pain.
ANNOUNCER: So while sleep is important, pain may stand in its way. Pain medications can deal with the pain, but often the sleep problems persist. Luckily there are other ways to achieve a more restful night. One short-term solution may be the use of sleep aids.
JAMES O'BRIEN, MD: They generally come in two styles, the non-benzodiazepine medication and the benzodiazepine types medications Benzodiazepine medications work very, very well. The problem with them is that their half-lives can be very, very long and the side effect, hangover issue, is really in play. With the non-benzodiazepine medication, there's less likely to have any hangover effect. They are very short-acting medications; they're much cleaner medications
ANNOUNCER: Sometimes just changing bedtime behavior can help.
ELLEN MILLER, MD: What this is, is to get them to into a room that is as conducive for sleeping as possible. The right temperature, comfortable, dark room. They should use the bedroom just for sleeping; don't use it for all their other activities. Don't get into bed after dinner, turn on the television, bring all their work, sit there reading, doing what all of us do it in our bed and we're not supposed to.
Some of the other techniques that are useful for patients with sleep disorders are relaxation techniques and stress management.
ANNOUNCER: Although when you're in pain, you may feel like bed is the only place to be, experts urge that staying out of bed and awake may help you sleep better at night.
JAMES O'BRIEN, MD: Individuals who are in pain having sleep problems need to get the help that they need, because sleep is essential for the management of their pain, and if they're not able to solve it on their own, they need to talk to their doctor.