Written by Lolitaire Moyo-Healey. M.Ost DO, UKIHCA-RHC for BonVie Medical Aid scheme
Most of us know what it feels like to be sleep deprived for a few days, and the effects that can have on us. Things like low concentration and focus, less patience, increased irritability, changes in hunger hormones, low energy, and more.
The link between sleep and pain works in much the same way, but it is a two way relationship. Poor sleep increases pain sensitivity, and increased pain affects sleep and sleep quality.
How Sleep Affects Pain
Heightened pain sensitivity. Sleep deprivation lowers your pain threshold, meaning you feel pain more easily. Just one night of poor sleep can increase activity in your brain’s pain-processing regions and decrease activity in the areas responsible for natural pain relief (1).
Decreased neurochemicals. During sleep, your body produces hormones like endorphins and serotonin, which act as natural painkillers(2). Missing out on quality sleep deprives your body of this natural relief.
Increased inflammation. Lack of sleep is associated with higher levels of inflammatory markers like interleukin-6, which can activate the nerve pathways involved in pain (3), especially relevant if you’re managing arthritis or fibromyalgia.
Worsened mood and coping. Chronic sleep issues lead to fatigue, stress, and anxiety, making it harder to mentally cope with or manage pain.
How Pain Affects Sleep
Disrupted sleep patterns: Pain causes physical discomfort, making it difficult to fall asleep, and wakes you up repeatedly through the night. Every time you wake up, you lose ground on deep, restorative sleep. This is the stage where your body does most of its physical repair.
A body stuck “on alert”: Chronic pain keeps stress hormones and inflammatory markers elevated, pushing the brain into a state of heightened alertness that’s incompatible with sleep (4). This means with chronic pain your body is primed to stay awake and watchful, the same way it would be if you were anxious or under threat, which makes it much harder to relax into sleep.
Mental toll: The stress of managing ongoing pain contributes to anxiety and hyper-awareness, both of which feed into insomnia.
Tips for Better Rest
A combination of sleep hygiene and physical support.
Wind down before sleep – Do what you need to feel some slowing down before bedtime. Put your phone away 60 minutes before bed, a bath or shower, reading, journaling. Give your body and mind a chance to switch off.
Movement during the day improves sleep quality – This works two ways: using energy helps you go into deeper sleep, and exercise can produce a temporary reduction in pain sensitivity(5). Meaning better quality sleep, with less pain.
Use routine to signal to your brain that it’s time for rest – Repeating the same steps each night trains your subconscious to start winding down when it’s time. This could be as simple as brushing your teeth, dimming the lights, putting on pyjamas and then reading a page or two of a book.
Optimise your sleep position – Proper alignment reduces pressure on sensitive joints.
Low back pain: sleep on your side with a pillow between your knees, or on your back with a pillow under your knees, to maintain the natural curve in your lower back (6).
Neck pain: use a single flat pillow under your head if you’re mostly a back sleeper. If you sleep on your side, use a pillow high enough to support your head and neck. Avoid sleeping on your stomach as it forces your neck into a rotated position, which can aggravate joints.
Hip pain: sleep on your side with a pillow between your knees, and another under your side if needed.
Manage pain before bed
Heat or cold therapy: cold therapy can reduce inflammation and muscle spasm, while heat raises your pain threshold and relaxes muscles (7). Use heat for sore muscles and ice for joint swelling and stiffness, 15–20 minutes before sleep.
Warm bath: a warm bath or shower before bed helps trigger your body’s relaxation response.
Medication timing: if you’re on prescribed pain medication or anti-inflammatories, talk to your doctor about timing your dose to give you coverage through the night.
Consider your sleep hygiene – Simple consistencies make a big difference. Go to bed and wake up at the same time every day(8). A helpful way to think about it is 3-3-3: avoid intense exercise 3 hours before bed, have your last heavy meal 3 hours before bed, and cut off caffeine by 3pm.
Conclusion
Sleep and pain feed into each other constantly. Improving your sleep and getting better rest can really make a difference in pain management.
References
- Staffe AT, et al. Total sleep deprivation increases pain sensitivity… *PLOS ONE*. 2019.
- Better Sleep, Less Pain: Chronic Pain Management. Novus Spine Center. 2025.
- Rouhi S, et al. Chronic sleep deficiency and its impact on pain perception in healthy females. *Journal of Sleep Research*. 2025.
- A narrative review of the reciprocal relationship between sleep deprivation and chronic pain. *Journal of Pain Research*. 2024.
- Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations. *The Journal of Pain*. 2019.
- Sleeping positions that reduce back pain. Mayo Clinic.
- Cold versus heat for pain relief. Harvard Health Publishing. 2025.
- About Sleep. Centers for Disease Control and Prevention.
Author
Lolitaire Moyo-Healey
M.Ost DO, UKIHCA-RHC, Founder, Registered Osteopath, Mindfulness Practitioner, Accredited Health + Life Coach
