How can sleep disturbances in patients with pain be managed?
The National Institutes of Health (NIH) has defined insomnia as complaints of disturbed sleep in the presence of adequate opportunity and circumstance for sleep. The disturbances may including one or more of the following: 1) difficulty initiating sleep; 2) difficulty maintaining sleep; or 3) waking up too early. Lack of restorative, REM sleep also is frequently associated with insomnia (NIH 2005). Patients with unresolved pain frequently have disturbed sleep, including nighttime awakenings, difficulty falling back to sleep after awakenings, and less time spent in restorative rapid eye movement (REM) sleep. Research has shown that losing as little as 4 hours of sleep in one night may result in a significant lowering of the pain threshold (Roehrs et al. 2006). In the patient with chronic pain, treating insomnia can present some challenges: 1) comorbid physical and psychiatric conditions may also be present (e.g., depression, anxiety), either as a cause of insomnia or a contributory fact
