Patrik Looft

Patrik is a physiotherapist and specialized in sports medicine, OMT and Functional Movement Screening.

Questions and answers on pain, injuries and sleep

Is there a connection between poor sleep and pain?
– Yes. Several studies have shown that deterioration in sleep quality and quantity leads to reduced tolerance for pain. There is also a clear link between poor sleep and long lasting pain (formerly called chronic pain), for example in the back and shoulders. Up to 88% of people with long-term pain suffer from sleep discomfort and one study has shown that 50% of patients with sleep problems also suffered from long-term pain.

What comes first, long lasting pain or bad sleep?
– This is a “hen or egg” situation where it is not always easy to determine if there is a bad sleep that results in prolonged pain or vice versa. It seems that influence can take place in both directions. However, the strongest effect seems to be the one that poor sleep has on long-term pain. Poor sleep also seems to be a better indicator of the risk of developing long-term pain than long-lasting pain to develop sleep disorders.

Why is it that bad sleep leads to an increased risk of prolonged pain?
– This is not entirely clear, but there are many theories and some evidence. For example, the degree of inflammation in the body increases with insufficient sleep. The increased inflammation goes hand in hand with an increased pain experience and thus appears to be the basis for the increased risk.

What type of long-term pain disorder is affected by sleep?
– There is currently no complete answer to this question but what we know is that bad sleep has a negative impact on muscle and joint disorder, headache / migraine, nerve pain and pain that has no known cause.

It has also been shown that sleep problems increase the risk of future long-term pain in painless persons. Poor sleep also degrades the prognosis of people with chronic headache / migraine and joint and muscular pain. Good sleep on the other hand seems to improve the prognosis of people with long-term headache / migraine and muscle and joint discomfort.

Can you have long lasting pain without sleep problems?
– Yes, but it is much more common with sleep problems among people who suffer from long-term pain compared to people who do not.

One study showed that 53% of people with long-term back pain suffered from sleep disorders. The corresponding figure for those without back pain was 3%.

Can you have sleep problems without prolonged pain?
– Absolutely, but more people who sleep badly have long-lasting pain compared to people who sleep well. Of people with insomnia, 50% also suffer from long-term pain. It has also been shown that people with long-term pain that sleep well have better predictions than those who sleep poorly.

If you have long-term pain and sleep discomfort, can the pain decrease if you improve your sleep?
– There are few studies that have investigated whether improved sleep in people with long-term pain leads to decreased inconvenience. However, there is evidence that people with long-term pain that sleep well have a greater chance of recovering compared to people who sleep poorly. This suggests that it can be effective to work to improve sleep in order to reduce the pain they suffer from long-term pain.

Do caregivers work to improve sleep in people with long-term pain?
– This is not so easy to answer because individual healthcare providers and pain clinics often work a little differently. There seems to be relatively few people working on this at the moment. The link between sleep disorder and pain is a relatively new research area that has developed a lot over the past 10 years. Hopefully, this is an area with which healthcare will work more in the future as research progresses.

How can you improve your sleep?
– There are several methods that can work if you want to improve your sleep, such as cardio training, such as cardiovascular training, CBS (cognitive behavioral science), weighted blankets, sleep hygiene and medication.

Both CBS and regular cardiovascular training have been found to be equally or more effective than drugs, but without side effects. Even the weighted blankets are an anti-drug method that many people experience improves sleep.

What does sleep hygiene mean?
– A common method of sleep disorder that has been used for a long time is called “sleep hygiene”. You learn different methods and tricks that can improve sleep. Examples of things that can be included are to only use the bed for sleep and sex, to get out of bed if you have not been able to sleep in 20 minutes, and to go to bed and go to bed at the same time each day. Another good trick is to stop using your computer / tv at least one hour before bedtime and to stop the intake of alcohol / nicotine at least 3 hours before bedtime. You should refrain from caffeine 6 hours before bedtime. Studies that have compared sleep hygiene and CBS have shown that CBS has a better effect on sleep.

How should you exercise to sleep better?
– Both cardio training and weight training can improve sleep but cardio training seems to be more effective. If you are an elderly person with chronic insomnia, it is important to start relatively easily and then gradually increase the exercise. If you are young or have less severe sleep problems you may start a bit tougher.

A training program with cardiovascular training that proved to be effective in treating sleep disorders is described below (the program was performed 4 times / week by stationary bike, walking or jogging on treadmill):

  • Week 1: 10-15 min, 55 % of maximum pulse
  • Week 2: 15-20 min, 60 % of maximum pulse
  • Week 3: 20-25 min, 65 % of maximum pulse
  • Week 4: 25-30 min, 70 % of maximum pulse
  • Week 5-6: try to reach 30-40 min, 75 % of maximum pulse
  • Week 7-16: 30-40 min, 75 % of maximum pulse

This program lead to increased quality of sleep, duration of sleep, and quality of life.

Will the positive effect on sleep increase the more you train?
– There seems to be a so-called “dose-response relationship” (ie, more training gives a greater effect) between exercise and improved sleep. But it seems to only apply to a certain limit. Exceeding the limit, the exercise may instead lead to impaired sleep. This has been measured by elite riders who seem to sleep worse when they train the hardest. For this reason, exercise should be performed at a “moderate” and progressively increased level if the purpose is to improve sleep.

Is it bad for your sleep to exercise close to bedtime?
– No, this seems to be a tenacious myth. Several studies show that sleep is not impaired by exercise close to bedtime as long as the bedtime is not postponed due to exercise. On the contrary, it has been found that people who exercise between 0-2 hours before going to bed feel that they sleep better than otherwise, and this is also supported by some studies.

For example, in a study where the participants were allowed to exercise only 30 minutes before bedtime, one could not find any negative effects of the exercise being performed late in the evening. Finally, even tough physical exercise late in the evening does not seem to impair sleep. As with everything else, of course, there are certain individuals who actually have difficulty sleeping if they work out late in the evening, but these are exceptions.

How does poor sleep affect recovery?
– Poor sleep has proven to have adverse effects on recovery after training. For example, it has been observed that the body’s carbohydrate supply in the muscles decreases in cases of sleep deprivation. For an athlete, this means that they are not optimally recovered when it is time for competition or for the next training session. This may eventually lead to overtraining.

How does insufficient sleep affect sport performances?
– Sport performances are generally not affected that much after only a day or two with poor sleep, but after a long period of sleep depritvation, performance in both power sports and sustainability sports is clearly affected negatively. In a study where the participants slept less for 3 nights in a row, reduced strength was observed when testing bench press, leg press and marklift after the second night.

How are the muscles affected by sleep?

Studies have shown that insufficient sleep leads to increased levels of stress- and growth hormone in the blood, which contribute to a degradative environment in the body. This causes the muscles to break down. So if the purpose of exercising is to build muscles, you should sleep properly. Sleep deficiency also seems to lead to an increased risk of muscle injury in athletes. This occurs because the recovery capacity is reduced, which means that the muscles do not recover right after the breakdown that occurs during the exercise.

Is the risk for injuries affected by bad sleep?
– Yes. It has been found that the risk of suffering from certain acute injuries increases if you sleep poorly. An example of such damage is ankle sprains. This occurs because the body’s proprioceptive ability (ability to determine the position of the body’s own limbs) is impaired by sleep deprivation.

How many hours should you sleep per night?
– The general advice is that an adult needs to sleep 7-9 hours / night. Children need to sleep gradually more than this, the younger they are.

In addition to the negative effects of too little sleep mentioned above, what other negative effects can occur?

– Regularly sleeping for less than 7 hours / night is associated with weight gain, obesity, diabetes, hypertension, heart disease, stroke and depression. Too much sleep also leads to a weakened immune system, increased risk of colds, increased number of mistakes and increased risk of accidents.

Can you sleep too much?
– Regularly sleeping for more than 9 hours / night may be suitable for children and adolescents, if you are ill, or if you´re trying to recover from sleeping too little. For the rest of the population, too much sleep may cause health risks, but this is not entirely clear at this time. Even when it comes to sleep, it seems moderation is the best.