What is good sleep?
The recommended sleep for adults is between 7-9 hours of sleep per night.
Why is sleep so important?
Consistently getting less than 7 hours of sleep per night is associated with greater risk of:
- Developing a pain condition Finan, Goodin, & Smith 2013
- Heightened pain sensitivity Schuh-Hofer et al 2013
- Accidents and sporting injuries Copenhaver & Diamond 2017
- Reduced memory and learning Diekelmann & Born 2010
- Poorer cardiovascular health and disease Covassin and Singh 2016
- Mental health disorders such as depression and anxiety Freeman et al 2017
- Decreased immune system and increased susceptibility to infectious agents Asif et al 2017
- Dementia and Alzheimer’s disease Spira et al 2014
- Some cancers von Ruesten 2012
- Weight gain and obesity Kobayashi et al 2011
Conversely getting the recommended 7-9 hours’ sleep consistently will improve your mood, energy levels, productivity and reduce your risk of all the above health problems.
The sleep, pain, mental health vicious cycle and how to break it
- Poor sleep will heighten pain, delay healing and negatively impact on our mental health.
- Poor mental health (stress, depression and anxiety) will impact on our sleep and pain.
- Pain can negatively impact on our sleep quality and mental health.
The result of the interplay of poor sleep, mental health and pain that is not managed well can cause a vicious cycle that leads to a drastically reduced quality of life. Overcoming this is a vital part of improving your quality of life.
Breaking the cycle
Any strategies that target mental health, pain or sleep can be effective for breaking this cycle. Research shows that sleep impairments are a stronger, more reliable predictor of pain than pain is of sleep impairments. Therefore, targeting sleep impairments can be a more effective tool to breaking this cycle than targeting pain. The next section will give you tools you can use to do this.
Strategies for improving sleep quality
- Prioritise sleep as a vital part of your week and take practical steps to ensure it happens.
- Make a plan to improve your sleep.
- Set your body clock:
- Get regular with your wake time and bedtime even on the weekends no matter how poor your sleep was.
- If you need to catch up on sleep it is better to go to bed earlier rather than try to sleep in.
- Get out into natural light as soon as possible in the morning.
- Wind down pre-bedtime:
- Develop a relaxed bed routine that includes avoiding devices, work or other mentally stimulating activities in the hour before bed.
- Write down a ‘to-do’ list or a journal to get thoughts out of your head before bed (this can be done during the night if you wake and are struggling to get back to sleep).
- Ensure your bedroom is dark, cool and quiet (eye masks, earplugs, fans or air con if required).
- Bed is for sleeping- limit activities such as phones, laptops and TV’s in bed.
- If you can’t sleep after 20 minutes, get up and do something boring until you feel tired, then try again.
- too many caffeinated drinks during the day (but especially in the afternoon/evening).
- Alcohol- even if it helps you get to sleep alcoholic drinks at night impact on the quality of your sleep.
- Identify life stress that may be impacting on sleep and make a plan to manage this:
- Prioritising a good work life balance.
- Say ‘No’ to some things if you are over-committed.
- Prioritise stress reducing exercise during the day.
- Use relaxation techniques such as mindfulness and diaphragmatic breathing during the day and before bed.
- Take a twenty to thirty minute catch up nap during the day. Avoid longer than
thirty minutes during the day to limit impact on sleep quality at night.
- Get treatment for pain, depression, anxiety and low mood as these conditions
are shown to impact on sleep quality.
Useful resources on sleep
Two good websites to explore more info on sleep are:
For a review of various sleeping apps to help with sleep see:
For a simple breathing exercise or a guided imagery exercise see:
For a good blog site (by one of NZ’s best-known pain academic and clinician) with some good articles around sleep (as well as many other things pain related) see:
Asif, N., Iqbal, R., and Chaudhry, F. 2017 Human immune system during sleep. Am J Clin Exp Immunol.; 6(6): 92–96.
Copenhaver EA, Diamond AB. 2017. The Value of Sleep on Athletic Performance, Injury, and Recovery in the Young
Athlete. Pediatr Ann. Mar 1;46(3):e106-e111. doi: 10.3928/19382359-20170221-01.
Covassin and Singh 2016. Sleep Duration and Cardiovascular Disease Risk: Epidemiologic and Experimental Evidence
Sleep Med Clin. Mar; 11(1): 81–89.
Diekelmann, S. and J. Born (2010). The memory function of sleep. Nature Reviews Neuroscience 11: 114.
Finan, P., Goodin, B., & Smith, M. 2013. The association of sleep and pain: An update and a path forward. J Pain. 2013
December; 14(12): 1539–1552. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046588/pdf/nihms521705.pdf
Fox, J.L., Scanlan, A.T., Stanton, R. et al. 2020. Insufficient Sleep in Young Athletes? Causes, Consequences, and
Potential Treatments. Sports Med 50, 461–470. https://doi.org/10.1007/s40279-019-01220-8
Freeman et al 2017. The effects of improving sleep on mental health (OASIS): a randomised controlled trial with
mediation analysis. The Lancet VOLUME 4, ISSUE 10, P749-758, OCTOBER 01, 2017
Kobayashi, D., Takahashi, O., Deshpande, G.A. et al. (2012). Association between weight gain, obesity, and sleep duration: a large-scale 3-year cohort study. Sleep Breath 16, 829–833. https://doi.org/10.1007/s11325-011-0583-0
Schuh-Hofer S, Wodarski R, Pfau DB, et al. 2013. One night of total sleep deprivation promotes a state of generalized
hyperalgesia: A surrogate pain model to study the relationship of insomnia and pain. PAIN®. 154:1613-1621.
Spira, A1,2 Lenis P. Chen-Edinboro, 1 Mark N. Wu, 3 and Kristine Yaffe4 2014. Impact of Sleep on the Risk of Cognitive
Decline and Dementia. Curr Opin Psychiatry. Nov; 27(6): 478–483. doi: 10.1097/YCO.0000000000000106
Von Ruesten A, Weikert C, Fietze I, Boeing H. 2012. Association of Sleep Duration with Chronic Diseases in the
European Prospective Investigation into Cancer and Nutrition (EPIC). Potsdam Study, PLoS One, 2012, vol. 7 pg. e30972