Pain and Sleep: Understanding the Reciprocal Relationship

Understanding the complex relationship between pain and sleep and why it keeps us up at night.

By Ashley Little

Jun 9th, 2022

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Expert Insights from Dr. Kinjal Parikh, Doctor of Osteopathic Medicine in the OrthoCarolina network.

If your body is experiencing pain of any kind, you know that the likelihood of getting a good night’s sleep is pretty slim. Whether from a sprained ankle, sore throat or a dull ache in your lower back, pain makes falling asleep seemingly impossible.

Mattress Advisor set out to understand the complicated relationship between pain, sleep and the healing process. So we called on the expertise of Dr. Kinjal Parikh, Doctor of Osteopathic Medicine in the OrthoCarolina network. Read on to learn what we heard from Dr. Parikh about how lack of sleep impacts the level of pain we feel and why rest is so vital to recovery.

Pain and Inflammation

Before we can understand the relationship between pain and sleep, we have to understand what pain is and where it comes from.

Pain – “More Than a Feeling”

In the famous words of the great American rock band, Boston, pain is “more than a feeling” (and an uncomfortable feeling at that). In fact, the feeling of pain is the body’s way of communicating to you it is being harmed.

Pain takes place when there is tissue damage. When we get hurt, nerves called nociceptors communicate to the brain they sense damage. The brain then decides how to react and prevent further damage.

Enter inflammation.

Inflammation plays a role in bringing attention to the area of the body that needs healing.

Pain is often an effect of inflammation. The painful sensation of inflammation occurs because “the swelling [caused by inflammation] pushes against the sensitive nerve endings that send pain signals to the brain,” according to a post by Medical News Today.

Contrary to popular belief, inflammation is a good thing! Healing cannot occur without inflammation. Inflammation becomes a problem only when it goes untreated.

Take patients who have been treated for spine issue for example. Dr. Parikh says if things don’t get better within the first 3-6 months of treatment, the issues are more likely to become chronic.

One culprit of prolonged inflammation: sleep deprivation.

A Painful Relationship With Sleep

Pain and lack of sleep are inversely related. To fall asleep, your body must be relaxed. The problem? Discomfort from pain prevents you from relaxing, which makes it difficult to fall asleep.

To make matters worse, lack of sleep can increase pain. Dr, Parikh explains it this way:

“If you are not sleeping, that means you are moving around more and putting your muscles to work. This increases fatigue, soreness and achy-ness because your muscles don’t have a chance to rest and relax. Rest gives them the endurance they need for the next day.

When you are sleeping your muscles are in a more neutral position. Lying rather than standing puts significantly less pressure on the disks in the spine as well as the muscles. Chronic use [of the spine] can cause joints to become inflamed. Inflammation of other muscles and joints is the body’s way of compensating to offload pressure.”

The Impact of Pain on Sleep

In 2015, the National Sleep Foundation conducted a study with a sample of over 1,000 US adults on the impact of pain on sleep quality. Here’s what they found:

People with pain sleep less

People that experience pain sleep less and have worse sleep quality than people without pain. In fact, only 22% of people who have chronic pain reported getting a good quality of sleep.

People with pain have a greater sleep debt

Sleep debt is the gap between how much sleep people say they need and how much sleep they actually get. On average, individuals with chronic pain had an hour of sleep debt compared to no sleep debt in individuals not experiencing pain.

Sleeping difficulties that result from pain impact quality of life

People experiencing pain regularly reported feeling less in control of their sleep and worried about the effects of poor sleep on their health. Fifty-two percent of people with chronic pain said their sleeping issues interfere with their quality of life including work performance, relationships, mood, etc.

The study also found that individuals with chronic pain are three times more likely to be diagnosed with a sleep disorder.

The Importance of Rest in Recovery

It’s no secret sleep is important in recovery. When it comes to injury or ailment, the first order out of the doctor’s mouth is to rest.

The purpose of sleep is to restore. Sleep is critical to recovery because healing of our body’s tissue actually takes place during sleep.

“Sleep plays a big role in healing, whether from an injury or a chronic condition. The body needs to rest to maximize its body function. Without the proper rest, people can take much longer to heal,” Dr. Parikh explains.

Rest plays a different role in different types of healing. Someone healing from a short-term illness or twisted ankle is going to need much different care than someone who has just had extensive surgery.

Dr. Parikh told us: “From a physiological standpoint, there have been different studies that show people can heal better from wounds when they get more sleep. This shows that in the bigger picture, the body can recover from different ailments and reduce inflammation quicker when it gets adequate sleep. Lack of sleep can prolong inflammation which is the opposite of what sleep does – restores.”

Mattress tips for people experiencing pain

Dr. Parikh shares with us that patients often ask what type of mattress they should use. “The consensus from a physician’s standpoint is that it’s up to the patient’s preference. There is no one mattress that fits all.”

However, Dr. Parikh noted a study done in 2003 that looked at the firmness of mattresses for non-specific, low-back pain. Dr. Parikh reported that the results found medium-firm mattresses to be better than something that was extra-firm.

“This does not mean the medium-firm mattresses make pain go away. All this study found is that medium-firm mattresses helped people sleep better and improved their quality of life, function and perceived disability,” Dr. Parikh adds.

In terms of what’s comfortable, that’s very personal. The truth is, what good is a mattress if you can’t get comfortable enough to fall asleep?

Dr. Parikh says physicians typically recommend that people with chronic back pain try different mattresses and see what they prefer.  “For people that don’t have back pain and want to keep their back healthy, I would recommend a medium-firm mattress,” Dr. Parikh shares.

Take pressure off your spine while sleeping.

There are different ways to modify your sleeping position to take pressure off your spine. These, of course, ultimately depend on your comfort level and personal preference.

Our recommendations

Here are some of our recommendations for mattresses if you’re experiencing pain of some kind, all expert reviewed.

“If an individual feels better extended or upright they can typically sleep on their back. However, patients that have pain when they are upright or extended may also have pain when sleeping on their back. For those patients, I would recommend they try sleeping on their side in the fetal position or put a pillow between their knees,” Dr. Parikh explains.

Dr. Parikh’s number one goal is to keep patients in their bed, not recliners. “When you are in a recliner, the muscles in the spine are not in a neutral position and you are putting force on your neck and back which can lead to different muscular discomforts,” Dr. Parikh explains.

If your pain is keeping you from restful sleep, consult your physician about treatment options. Another night of disrupted sleep may make the problem worse.



Dr. Kinjal Parikh, DO, received his Doctorate in Osteopathic Medicine from Nova Southeastern University and completed his residency in physical medicine and rehabilitation at the University of Texas Southwestern. Dr. Parikh practices at OrthoCarolina in spine and physiatry.

OrthoCarolina is one of the nation’s leading practices of orthopedic care located in Charlotte, NC. They specialize in the areas of foot and ankle, hand, hip and knee, shoulder and elbow, spine, sports medicine and pediatrics.

Physiatry – Physical medicine and rehabilitation, also known as physiatry, is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. Learn more here.

Osteopathic medicine – Doctors of Osteopathic Medicine, or DOs, are fully licensed physicians who practice in all areas of medicine. Emphasizing a whole-person approach to treatment and care, DOs are trained to listen and partner with their patients to help them get healthy and stay well.