In the Grips of ‘Painsomnia’

[Randall H. Duckett]

Thanks to my chronic pain, nighttime is a nightmare, but advice from an expert may save my sleep​

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My earliest memory of sleeplessness is from my boyhood.

On several late nights when I was in my early teenage years, I’d try, but fail, to sleep in my bedroom at the back of the family home in the Los Angeles suburbs. Then I heard the rumble of my father’s Mercedes coming up the alley.

Back then in the ’60s and ’70s, he worked as an attorney for a phone company. These were during the days when corporate life meant Mad Men style two-martini lunches and happy hours with buddies after work. I worried about him when he was out late drinking, the start of a lifetime of nights filled with anxiety and hypervigilance instead of slumber.

As soon as I heard his car, I’d run out of the house to our detached two-car garage. In the dark of the night, I’d arrived just as Dad was pulling up to the garage door. By the light of his headlights, I’d unlock it and hoist it up toward the roof, clearing the way for the car to enter. My father would pull in and be home safe.

Finally, only then, could I return to bed, relax, and go to sleep for whatever hours were left until morning.

Insomnia due to pain​

The roots of my insomnia run deep. Those boyhood nights with my dad started a lifetime of anxiety-related sleeplessness. Decades later, I have never shaken the dread I feel as I try to fall sleep. Add my chronic pain and slumber is all the harder.

I have a rare genetic disease that from early childhood caused my bones and joints to deform, grinding down as I aged. As a result, I’ve had eight joint replacement operations (both hips twice, both shoulders, both knees) plus had my ankles fused. Now that I am in my 60s, I hurt head to toe, day and night.

Chronic pain can be accompanied by several comorbidities, among them depression. One less-talked-about condition is what sufferers call “painsomnia.” It’s not a medical term; it’s just one that those of us with chronic insomnia use to capture the problem of sleeplessness when our bodies hurt.

“Like many aspects of health and wellness, the relationship between pain and sleep is bidirectional,” says Robert Roy Britt, author of Make Sleep Your Superpower: A Guide to Greater Health, Happiness & Productivity (and, as full disclosure, my editor at Wise & Well). “If you’re in pain, good sleep can be hard to come by, and poor sleep exacerbates pain. The reverse is true too: If you can find ways to sleep better, you can alleviate pain, and alleviating pain can improve sleep duration and quality.”

How widespread is this problem? A 2012 study put the rate of insomnia among people with chronic lower back pain at an astounding 78%, meaning that four out of five chronic pain sufferers may have trouble sleeping.

Another study published in the journal Pain Medicine and recently reported by clinicalpainadvisor.com, showed relative consistency in rates of insomnia among chronic pain sufferers. In a meta-analysis of 19,000 pain patients, the researchers found about 60% of Asian people in the study had pain-related insomnia. The rate for Black and for white people was around 50%. Data for Hispanic, Native American, and Pacific Islander people were not reported.

My sleepless life​

Most nights, I toss and turn despite taking sleeping pills. As I attempt to sleep, the pain gnaws at me. Unable to relax, I begin to wander from thought to thought about how my life and the world are going. This is generally accompanied by a gurgling gut reflecting the anxiety, echoed from childhood, I feel as I lie there.

I turn on my right side, then, after several minutes, on my left, wracked by stubborn consciousness. On good nights, I achieve something of a deep doze that gets me to morning. Weirdly, as dawn breaks, I often have cinematic dreams about my family or my former worklife.

I almost never feel rested during the day; indeed, most mornings I doze in my La-Z-Boy before the caffeine infusion of a couple of Diet Coke kicks in.

When I do sleep, I snore like a boar. I likely have sleep apnea. I did a sleep test once, staying overnight in a lab with electrodes hooked up to me, and hated the experience, making me reluctant to try again. I used a CPAP machine for a long time but didn’t see much result. I stopped because of the bulky hose and mask. I haven’t returned to a sleep doctor because the hassle outweighs my misery.

I admit I have lousy sleep hygiene. I usually stay up well into Colbert, Kimmel, and Fallon, a bit because of the terror of failing to sleep no matter how tired I get. I stay on devices too late: Reels is too addictive. I use a sleep mask to keep the room dark, but it ends up floating all over the bed as I flop and flip.

(What’s the old joke? “I’ll do anything to lose weight except eat right and exercise.”)

Further, I “write” in my sleep, that is my mind becomes fixated on what I’m working on during the day and thoughts about phrases float into my head. I sometimes take notes on my phone to capture brilliant points, but in the morning they mostly turn out to be nonsense. Or I’ll get focused on a weird problem; last night it was how to coat my bones with silicon to protect them from disease.

(Huh? That doesn’t make sense now but it did in the haze of night. Told you it is weird).

Sleep is fundamental​

Because of my poor habits, I often miss out on one of the essentials of life, one that likely affects every other aspect of my health.

“Good sleep is one of the pillars of wellness, along with physical activity, healthy eating and strong relationships,” Britt says. “Sleep is foundational to all aspects of physical and mental health and longevity. As with air, water and food, we simply cannot function without sleep. And when sleep is good, all aspects of life get better.”

When we sleep well, he adds, “we can be more creative, more productive. We’ll get things done, which leaves more time and energy to do the fun things in life.” That makes for good days, which keeps stress and anxiety at bay. “Better days lead to better nights, and better nights fuel better days. It’s a powerful cycle.”

A recent article in the The Atlantic titled “Why Can’t Americans Sleep?” called insomnia a public-health emergency. Author Jennifer Senior detailed its terrors:

“I’ve already got a multivolume fright compendium in my head of all the terrible things that can happen when sleep eludes you or you elude it. You will die of a heart attack or a stroke. You will become cognitively compromised and possibly dement. Your weight will climb, your mood will collapse, the ramparts of your immune system will crumble. If you rely on medication for relief, you’re doing your disorder all wrong — you’re getting the wrong kind of sleep, an unnatural sleep, and addiction surely awaits; heaven help you and that horse of Xanax you rode in on.”

What to do about painsomnia​

Three things are crucial for improving sleep if you have chronic pain, according to Britt.

First, do everything you can to alleviate the pain. “I know that for many people, chronic pain is intractable, and you’ve tried everything,” Britt says. “But for others, it can be a problem that’s being ignored rather than properly treated. Get the pain resolved, and sleep will likely take care of itself.”

Above all, Britt advises, seek pain treatments involving physical activity. “Many modern ailments (including some types of chronic pain) can be traced back to inactivity. If you are able to exercise — any sort of activity — it’s well worth giving it a try, with advice from a physician of course, before turning to medications.”

If you’re on any prescription drugs, find out if sleep problems are a known side effect, and if so, discuss that with your physician. If insomnia persists, see a sleep specialist and do a sleep study (it’s really not that bad).

Second, if nothing resolves your chronic pain, work on sleep hygiene, which refers to the process of readying for bed: “Set and stick to a consistent bedtime, spend as much time outside as you can, especially early in the morning (natural daylight keeps your body clock well-timed), be physically active, eat a healthy diet, avoid alcohol, avoid caffeine after mid-day, and give yourself a good hour or so of low-stress wind-down time before bed,” says Britt.

Third, work on your mental health so that anxiety and stress from pain are minimized. “When we’re in pain, we worry that it’ll never end,” says Britt. “Such rumination is kryptonite defeating powerful sleep.”

Many are helped by mindfulness meditation, he adds.

“I used to sleep like a baby,” Britt reports. “But in my 50s, I developed pain-related trouble sleeping.” He would get pain in his hips and lower back that caused him to wake several times a night, stiff and sore and needing to roll over. The pain made it hard to go back to sleep. He tried multiple mattresses, and finally found a body pillow that helped.

“But I still could sleep comfortably only on one side. Then I discovered yoga. By strengthening my whole body — particularly the core — my pain was reduced to a minimum, and I sleep like a baby again. The lesson I learned, which contributed to my motivation to write my book: Never give up on good sleep.”

I’ve taken Britt’s advice to heart and I’m determined not to give up on slumber. But I also have a backup plan.

If all else fails, I’ll become a vampire.

Randall H. Duckett is writing a book on living in chronic pain. He invites fellow sufferers and pain experts to share their stories for it. Reach him at [email protected] or randallhduckett.com.

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In the Grips of ‘Painsomnia’ was originally published in Wise & Well on Medium, where people are continuing the conversation by highlighting and responding to this story.

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