STUDY:  Thoughts about Sleep May Cause Insomnia and Worsen Pain

STUDY: Thoughts about Sleep May Cause Insomnia and Worsen Pain

People with chronic pain who believe they won’t be able to sleep are more likely to suffer from insomnia, thus causing worse pain, says a study from the University of Warwick published in the Journal of Clinical Sleep Medicine.

Esther Afolalu and colleagues from the Sleep and Pain Lab in the Department of Psychology created a scale to measure beliefs about sleep and pain in chronic pain patients, alongside their quality of sleep.  According to the researchers, this is the first scale to combine both pain and sleep and explore the cycle between sleep and pain problems.

They say that conditions like back pain, fibromyalgia, and arthritis are linked with negative thoughts about insomnia and pain, and this may be managed by cognitive-behavioral therapy (CBT).

The study evaluated the psychometric and functional properties of a 10-item Pain-Related Beliefs and Attitudes about Sleep (PBAS) scale.  The PBAS scale was administered to four clinical samples of chronic pain patients who also had insomnia.  One examined the scale’s psychometric properties (n=137), one examined the test-retest reliability (n=26, one examined the sensitivity to treatment (n=20) and the fourth examined generalizability (n=62).  All study participants completed the PBAS with validated measures of pain interference, insomnia severity, and cognitive-behavioral processes hypothesized to underpin insomnia.

The results of their study show that people who believe they won’t be able to sleep as a result of their pain are more likely to suffer from insomnia, which results in more pain.  The scale they developed enabled researchers to predict patients’ level of insomnia and pain.  

The study has provided therapists the means with which to identify and monitor rigid thoughts about sleep and pain that are sleep-interfering, allowing the application of CBT for insomnia in people with chronic pain.

“Current psychological treatments for chronic pain have mostly focused on pain management and a lesser emphasis on sleep, but there is a recent interest in developing therapies to tackle both pain and sleep problems simultaneously. This scale provides a useful clinical tool to assess and monitor treatment progress during these therapies,” Esther Afolalu explained.

Dr. Nicole Tang, the study senior author, said, “Thoughts can have a direct and/or indirect impact on our emotion, behavior and even physiology.  The way how we think about sleep and its interaction with pain can influence the way how we cope with pain and manage sleeplessness. Based on clinical experience, whilst some of these beliefs are healthy and useful, others are rigid and misinformed. The new scale, PBAS, is developed to help us pick up those beliefs that have a potential role in worsening the insomnia and pain experience.”

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Authored by: Staff

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I wish these people who wrote this had pains like us. They wouldn’t be saying stupid things like this. I so angry 😠 as they are saying its all in the mind. It’s NOT

Jillian Drexler

“They say that conditions like back pain, fibromyalgia and arthritis are linked with negative thoughts about insomnia and pain, and this may be managed by cognitive behavior therapy (CBT)”. I have all three of these conditions and I didn’t start experiencing insomnia and pain and needing CBT until I developed these conditions. Who has positive thoughts about insomnia & pain? This article is rather annoying. It’s like the same old broken record “It’s all in your head” tune we as chronic pain patients hear over & over again. Time to flip the record over & play a new tune!

Elizabeth E. Chute, Ph.D

I have no trouble falling asleep as long as I can get in a comfortable position, which I usually can. But I wake up 5-6 hours later because that one comfortable position is now uncomfortable.

Tim Mason

If you have been waking up frequently with pain in your back or hip or where ever, it is only natural to ponder, I wonder if that ______ will bother me again tonight. I am not sure that those that conducted the study realized that people often move or change positions during the night without know it. Going from a standing position to a lying positions changes things that are not immediately evident. Discs “gel up” during the night. In my case with BHP my bladder may fill with 1000 to 1500ml of urine. Lying on my back that is about 1500 grams of weight bearing down on the structures directly in front of my back instrumentation. (I have actually measured my urine). I noticed that the pain decreased by a factor of 2 or more by just urinating.
Just like a man having BHP he is always going to wonder “How many times will I have to pee tonight?”
Not being able to fall asleep can depend on many enigmas.


Sounds very similar to “pain catastrophizing”, in that they believe we are making ourselves worse. Wonder what they say about when I go to sleep just fine, then am awakened at whatever hour of the night with severe pain? This happens quite often to me. Maybe I am responsible for it happening. (BTW, I suffer with severe head pain, not back or neck pain. So, a poor mattress or sleeping position isn’t a factor for me.)

That whole study was stupid. What makes them think that people with pain worry about sleep? People may awaken due to pain and not be able to go back to sleep, but worrying about sleep doesn’t cause pain. This article makes no sense to me. There’s always a reason for pain that people want to blame other than the underlying cause. Pain is always presumed to be caused by the patient. It gets tiresome just reading all the hypothesis of these researchers.


Once again, they have the cause and effect backwards!! What is wrong with these people??? What level of unreality do you have to indulge in, to believe that you’ll sleep just fine with pain searing through your back or arms, or that you can change your pain level with your mind?? If it were THAT easy, none of us would be in pain – do you think we WANT to be?? I’m so disgusted with these “researchers”… let’s just blame the victim, shall we?

Matthew J. Smith

Yeah, no sh!p, it’s like stressing about your anxiety !! I have sleep apnea anyway, which was REALLY agrevated when they tried switching me to Fentanyl. ….


Happens to me! I try to relax, do biofeedback, and never lay in bed awake, more than ten minutes. Being disabled from a spinal cord injury allows me to sleep whenever I feel like it!