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Connection Between Poor Sleep, Chronic Pain and Depression

The unfortunate fact is that both insomnia and depression are comorbidities of chronic pain. This means that a bad night of sleep can not only aggravate your depression, but also chronic pain. When this lack of sleep becomes more chronic, the effects also become more devastating for your health. At the same time, chronic pain also has a direct relationship with insomnia – prolonged sleep deprivation leads to a greater pain intensity the next day, making it more difficult to have a peaceful night’s sleep the next day as well. Read on to understand the connection between poor sleep, chronic pain, and depression.

Understanding the Cycle of Sleep and Depression

A constant lack of sleep can lead to depression over time. When you are unable to sleep night after night, sooner or later, some level of depression sets in. However, it is difficult to understand which comes first, the lack of sleep, depression, or chronic pain.

Regardless of whichever comes first, it is necessary to resolve all the issues. It is essential to first address the issue of sleep disorders. It has been found that out of the symptoms of depression, sleep issues are likely to be the most residual, even if there is an improvement in your mood and the other symptoms of depression.

Many patients of depression have found that even after they are in a decent mood, they still struggle to sleep at night. Similarly, people who suffer from chronic pain don’t necessarily notice a significant improvement in their sleep quality once the pain is resolved. In fact, until the sleep problem is addressed, the pain usually continues to worsen. This is believed to be associated with the fact that many people with chronic pain may also suffer from anxiety, which causes stress chemicals such as cortisol and adrenaline to be released throughout the body.(1,2) Over a period of time, this anxiety leads to an overstimulation of the nervous system, making it difficult to sleep in the night.

Adrenaline tends to increase the sensitivity of the nervous system, and due to this, people with chronic pain will start feeling more significant pain.

Over time, the combination of lack of sleep and sustained anxiety will lead to depression.

How to Break the Sleep-Depression-Pain Cycle

If you want to break this persistent cycle of depression, chronic pain, and lack of sleep cycle, then you need to begin with getting control over your sleeping habits.

Here are some methods you can try to help with sleep, including cognitive behavioral therapy (CBT), which may also help address the symptoms of chronic pain and depression.

Maintain Sleep Hygiene

Good sleeping habits are known as sleep hygiene. The best thing you can do for yourself to get a good night’s sleep and to establish a regular sleep schedule is to follow proper sleep hygiene.

One of the reasons why most people fail to see any improvements in their sleep even after their depression or pain is under control is due to bad sleeping habits. For example, people who have depression are likely to stay in bed for a long time because they simply lack the motivation and energy to get out of bed and start their day. Due to this, they are likely to struggle with falling asleep at a regular time.

Here are some tips to help develop better sleep habits:

  • Don’t go overboard on daytime naps. Limit them to no more than 30 minutes.
  • Avoid having alcohol, caffeine, and nicotine close to your bedtime.
  • Form a relaxing bedtime routine, such as a relaxing hot bath or reading for 10-15 minutes.
  • Avoid bringing in laptops, TV, or having food in your bedroom. Limit it strictly to sleeping only.

Cognitive Behavioral Therapy

If you suffer from chronic pain or depression, or even both, apart from sleep issues, then visiting a therapist may help. Using cognitive behavioral therapy, your therapist may help you identify and replace certain problematic or negative thoughts and behaviors that are affecting your health.

For example, if thinking about not sleeping is causing you to become anxious, thus worsening your anxiety further, then this type of therapy can help you push such thoughts out of your mind.

Cognitive behavioral therapy can help address sleep issues, chronic pain, and even depression.(3)


Relaxation is an important technique that can help treat insomnia and also depression. Many people with insomnia or other types of sleep disorders tend to suffer from hyperarousal, which is a type of fight or flight response that occurs when the body suddenly kicks into an alert or high action mode. However, since there is no real danger to fight or flee from, the body is continuously in a state of hyperarousal and not able to calm down.(4)

Different relaxation techniques will help increase the chance of people falling asleep. Progressive muscle relaxation has been found to benefit the most in such circumstances.(5) During progressive muscle relaxation, the patient is made to lie down and then slowly contract and relax their toes, calves, feet, knees, and all other body parts all the way up to their shoulders and then ending at the face.

A warm bath before bed, listening to soothing sounds or music, meditation, and other such techniques can also help.


It is essential to understand the difference between chronic pain, depression, and sleep disorders, and then to receive the treatment for sleep disorder first. Once you have your sleep cycle under control, you will automatically find that you will experience great benefit in the symptoms of chronic pain and depression.


  1. Hart, A., 1995. Adrenaline and stress. Thomas Nelson.
  2. Doig, R.J., Mummery, R.V., Wills, M.R. and Elkes, A., 1966. Plasma cortisol levels in depression. The British Journal of Psychiatry, 112(493), pp.1263-1267.
  3. Hofmann, S.G., Asnaani, A., Vonk, I.J., Sawyer, A.T. and Fang, A., 2012. The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5), pp.427-440.
  4. Kalmbach, D.A., Cuamatzi-Castelan, A.S., Tonnu, C.V., Tran, K.M., Anderson, J.R., Roth, T. and Drake, C.L., 2018. Hyperarousal and sleep reactivity in insomnia: current insights. Nature and science of sleep, 10, p.193.
  5. McCallie, M.S., Blum, C.M. and Hood, C.J., 2006. Progressive muscle relaxation. Journal of human behavior in the social environment, 13(3), pp.51-66.
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 28, 2020

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