Sleep Problems Predict Later Pain Problems for Young Adults

Sleep Problems Predict Later Pain Problems for Young Adults

Sleep problems are a predictor of chronic pain and worsening pain severity over time in young adults, according to a study in PAIN.

Interestingly, researchers found that the presence of pain generally doesn’t predict worsening sleep during the transition between adolescence and young adulthood.  They believe that early identification and treatment of sleep problems might help reduce later problems with pain.

Drs. Bonvanie and colleagues of University of Groningen, the Netherlands analyzed “bidirectional” relationships between sleep problems and pain in their study of young adults, ages 19 – 22.  The study focused on overall chronic pain as well as specific types of pain, including musculoskeletal, headache, and abdominal pain.  It included approximately 1,750 young Dutch men and women who were followed for three years.

About half of participants who had sleep problems at the initial evaluation still had them three years later.  At baseline, subjects with sleep problems were more likely to have chronic pain and had more severe musculoskeletal, headache, and abdominal pain.

After three years, those with sleep problems were more likely to have new or persistent chronic pain.  Overall, 38 % of participants with severe sleep problems at initial evaluation had chronic pain at follow-up, compared with 14 % of those without initial sleep problems.  The relationship between sleep problems and pain was stronger in women than it was in men.

“Emerging adulthood is characterized by psychosocial and behavioral changes, such as altered sleep patterns,” Drs. Bonvanie and coauthors wrote.  “Chronic pain is also common in this age group, especially among women.  Sleep problems might be an important risk factor for increased pain, acting through altered pain thresholds, emotional disturbances, or behavioral changes.”

“Our findings indicate the sleep problems are not only a precursor for pain, but actually predict the persistence of chronic pain and an increase in pain levels,” the researchers said.

They concluded, “Our findings suggest that sleep problems may be an additional target for treatment and prevention strategies in female emerging adults with chronic pain and musculoskeletal pain.”

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Jean Price

I’m wondering if this is a “which came first, the chicken or the egg” scenario! It makes sense that sleep patterns effect pain, since deep sleep is necessary for repair and so many other body functions regarding wellness and balance. It also makes sense to say pain impacts sleep…the duration, the depth, the additional stimulus of interruptions, and the general functions of sleep also. Yet, sleep issues causing pain or chronic pain is a little more nebulous to me. Especially severe chronic pain, although I’m sure sleep disorders would heighten the impact of the chronic conditions that cause pain and therefore might be seen in this light. I think it’s important to carefully differentiate which is the cause and which is the result for a number of reasons. More effective treatment, less bias, and more understanding of the medical conditions, along with more understanding of the biological impacts of pain would be among the most important factors to separate out. Less activity, medications, stressors, disease progress….all my of these things can alter sleep and yet they can both lessen and increase pain. If we are going to bring this to the table, as I believe we should, careful scientific evaluation is needed…not just assumptions, and not just for the goal of adding false credence to “altered pain thresholds from emotional disturbances and behavioral changes” in women! (I think overall women are more likely to have caregiving factors which can interfere with sleep….I know this was true in my household when the children were small! And although there have been some changes, women who work outside the home also carry the majority of the care of the children and the home in addition!). Since there are multiple sleep disturbances, even more than one type of sleep apnea, and more than one type of treatment/therapy, besides more than one type of machine to help treat it, it would also be important to asses those factors. Obstructive sleep apnea usually responds to a CPap machine, however central or clear airway apnea often does not. That’s where a BiPap comes in for treatment. Sleep is a necessary part of our lives, pain or no pain. And poor sleep or poor restorative sleep can affect an otherwise healthy person…everything from personality characteristics to alertness to relationships to coping skills to emotional, spiritual and physical health. To correctly asses its impact on pain, we must also have a clear picture of the impacts on those without pain. Otherwise the information is likely to be useless, or even damaging.


Took me several years to get diagnosed with sleep apnea even though I asked my doctor for a sleep study. She argued with me that I was not “tired” or “exhausted.” She insisted that I was “depressed.” She shoved an anti-depressant script at me and left the room while I was still talking. My appointment was less than 5 minutes long.

About seven more years of sleep pills, a fibromyalgia diagnosis that the above doctor knew about because she had been copied on a letter from a rheumatologist who also failed to tell me my diagnosis (I found out from requesting my records after seeing an out of town doctor following a car accident. The doctor had been treating my mother and knew her history.)

Now that I have a CPAP machine, I take no sleep medicine. I take Mobic and tramadol at night for osteoarthritis and a muscle relaxant (baclofen) at 12pm and 4pm for cervical spondylosis. I react paradoxically to the muscle relaxant by having more energy (less pain to tire me out?) The fibromyalgia pain that roamed my body randomly is not present unless I become sleep deprived. The osteoarthritis pain is localized and much more predictable.

I feared losing my ability to work when doctors were turning their backs on me. I had memory problems and cognitive issues (forgetting words, losing concentration) and lots more pain and crushing fatigue.

Sleep problems are dismissed. Psychological diagnoses are favored. Problem is that sleep does impact mood. Take a look at cranky toddlers… Nap time, right? It is commonsense that doctors lack. They are often judgemental and biased. They disregard the patient’s self-reported experience. You cannot “doctor” properly without allowing the patient input. It is like some doctors wish the patient were not a conscious, speaking being… Just an object.

I have much better treatment now, but I could have lost my job, my livelihood… And it would have been personally devastating beyond words.


I wish they had known that decades ago.. I’ve had chronic insomnia since childhood, and I’m not at all surprised it might be connected to my chronic pain (which I have had in some form since childhood also). But here’s the caveat – insomnia is ALSO ignored or dismissed with recommendations for “sleep hygiene”. As if there is no such thing as primary insomnia (some doctors still persist in saying insomnia is a symptom of something else like anxiety and depression, rather than a cause of it.) The first 32 years of my life, before they created Ambien, were a total torture to me – insomnia makes life unlivable! But even today, insomnia seems to have the same problems as chronic pain – so where are the solutions to insomnia?? I can’t even get my sleep medicine covered by insurance, and every time I go to my sleep doctor, my anxiety shoots up that he will suddenly decide “it’s been long enough, you need to stop”. Just like pain meds. Why can’t doctors work with responsible patients like me, who have found a way to work with chronic conditions such that we have a somewhat functional life?? Why do they insist we be like everyone else (I would LOVE to not have these problems, thanks!) and why do they remove the only solution that is currently available, without having anything else but platitudes to offer?