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Nocturnal Back Pain

Hey Everyone,

So I know I’m not the only person with back pain who struggles to sleep at night, because I have spoken to so many people who have experienced the same issue. In fact according to the US National Sleep Foundation, it’s not just people with back pain, two out of three people with chronic pain have trouble sleeping. But why?

 

“An individual simply cannot get comfortable to fall asleep due to the discomfort of pain,” says Frank. J. Falco, MD, who specialises in pain and sleep problems in the USA. He goes on to say that, “pain causes anxiety,which disrupts sleep even more”.

“In addition to preventing a person from falling asleep, pain also results in difficulty staying asleep. And once pain keeps you awake one night, it is likely to do the same thing again and again. Pain-related insomnia gets worse over time”.

 

But what causes back pain to be more prevalent at night for some people?

 

A study was carried out by researchers from the University of Manchester and was funded by grants from organisations including the Medical Research Council, Arthritis Research UK and the Welcome Trust. It looked into the changes of invertebral discs in a 24 hour period.

 

On the NHS Website it states:

 

“Back pain is a very common condition, likely to affect as many as 8 in 10 people. Damage to intervertebral discs – the cushions of fluid and cartilage that separate the bones of the spine – is thought to be a major cause of back pain. The researchers say that these discs thin out during the day, with the weight of our bodies, then expand again at night when we rest, with fluids regenerating the tissue.”

So we can see that there are changes in the spine during the night, could this be contributing to the extra pain we as Cauda Equina Syndrome patients feel? I know personally that I am hypersensitive in and around the area where I had my Cauda Equina compression and use Lidocaine patches because even touch sets off an exaggerated response. So could this lengthening of the spine due to the inverterbral disc expansion be a reason for that extra pain? It seems possible.

 

Additionally, periods of inactivity can cause muscles to become stiff even just from laying in bed for a few hours. That stiffness makes it difficult for me to adjust position and often wakes me up. It is hard for me to move to a sitting position or get out of bed when I first wake.

 

As a Cauda Equina Syndrome patient I still have shooting electrical pain into my buttocks, saddle region and parts of my legs. This is exacerbated by twisting in bed and can often be one of the most painful reasons why I wake and consequently cannot fall back off to sleep. Is this due to nerve damage, is it chronic pain or due to the nerve root compression, I don’t know, but I know that it’s becoming a big problem in relation to my sleep patterns. I had a sleep study performed which showed me holding my breath several times before waking up due to the pain. This pattern is repeated several times a night.

 

Lack of sleep is hard for anyone, let alone a person living with a condition such as ours.
“You need a certain amount of each stage of sleep to feel rested and for proper memory,”Tracey Marks, MD, an Atlanta-based psychiatrist says. These stages include light sleep, deep sleep, and REM (rapid eye movement).

 

“We normally go through four to six cycles of these stages per night. But if pain wakes you up, you spend too much time in light sleep,” she explains. “This reduced sleep – in particular, shortened REM – may increase sensitivity to pain”.

 

 

The University of Manchester study that I mentioned previously say their results, “support the notion that disruptions to circadian rhythms during ageing or in shift workers may be a contributing factor for the increased susceptibility to degenerative IVD (intervertebral disc) diseases and low back pain”.

 

So therefore disruptions in sleep patterns could be affecting the way in which our intervertabral discs expand during the night and thus contributing to future pain.

 

Ultimately, all the science is suggesting just how important sleep is.

 

So what can we do to try to help ourselves get a better night sleep?

 

First of all practical solutions that would help anyone with back pain:

 

* Supportive mattress In a Journal of Applied Ergonomics study nearly 63% reported significant improvements in low back pain after switching to a new sleep system ie. new mattress and/or bad frame. Web MD suggests for those unable to afford a new sleep system, to try adding plywood supports between the mattress and its base. Or as a temporary solution, have someone move your mattress onto the floor. 

* Try cushioning between the knees when laying on your side to aide in the better alignment of the spine. Similarly using cushions under the knees when laying on your back can relieve some of the stress on the lower spine.

 

* To maintain support in the bottom curve of your lumbar spine a small rolled up towel can be helpful.

 

General tips for sleep:

 

* Lavender essential oil is known as a good way to relax the mind and prepare you for sleep.

 

* Limiting caffeine intake in the evening to prevent being kept awake.

 

* Night time rituals such as reading before bed can distract you from pain and signal to the brain that you are getting ready for sleep.

 

* Making sure not to eat too much before bed

 

* Exercise during the day helps promote good sleep patterns

 

* Melatonin supplements are known to help promote sleep. Melatonin is the sleep inducing hormone that is created in the pineal gland, using a supplement can aid falling to sleep quicker.

 

Things that help me:

 

* I use apps or YouTube videos of meditation to distract myself from the pain. My favourite types of exercises are the muscle relaxing meditations. The app I use is Calm App but Headspace is great too.

 

* Heat, I use hot water bottles frequently to soothe sore aching muscles.

 

* I have a specific pillow that supports my neck while I sleep and it has really helped.

 

* I have started using the Hempen CBD 550mg balm which has proven very helpful in relaxing muscle spasms and aiding in the pain I get from tension. I use it on my back and shoulders before I go to sleep and I don’t think I could be without it now! 

 

* My most recent purchase was a Calming Blanket that is weighted. The blanket is supposed to give your body feedback about where it is in space and allows the mind to calm. This is called the proprioceptive input. I bought it because of the muscle spasms and jumps that occur in my legs during the night that also wake me up. The weighted blanket prevents large movements from happening and seems to be a great purchase thus far.

 

 

I hope this has been helpful for you and please let us know if you have found anything that helps you sleep at night so we can share it with others.

 

Until the next time,

 

Catrina

 

 

Sources: NHS Website, Web MD, National Sleep Foundation, British Medical Journal paper: The intervertebral disc contains intrinsic circadian clocks that are regulated by age and cytokines and linked to degeneration.

 

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