From Our Experts

What’s the Connection Between Insomnia and Back and Neck Pain?

Originally published May 9, 2017

Last updated May 25, 2023

Reading Time: 4 minutes

Christopher Ornelas, MD, a physiatrist who specializes in spinal disorders at Keck Medicine of USC, shares tips on how to relieve chronic back pain and get a good night’s sleep.

If you have chronic back or neck pain and struggle with sleep, you might assume it’s the pain keeping you from sound slumber. Seems obvious, right? But the connection between chronic pain and insomnia is more complex than you may think. As many as two-thirds of people with chronic pain have sleep disorders, and researchers are finding that pain and insomnia have a reciprocal relationship and may coexist.

Managing chronic spine pain is hard enough, and adding poor sleep to the mix can truly affect your quality of life. Below, we will explore the close relationship between chronic pain and insomnia, along with strategies on how you can get your much-needed rest while managing your pain.

Insomnia: the top sleep complaint

Insomnia is the most common sleep problem, but it’s easily misunderstood. First, insomnia isn’t just about difficulty falling asleep. It’s also characterized by waking up in the middle of the night and causing troubled sleep. Second, insomnia is not an isolated disorder but rather a symptom.

To combat insomnia, you need to understand its root cause. In about half of cases, insomnia is a result of a mental or emotional condition, such as anxiety or depression (both of which are common in people with chronic back or neck pain).

Insomnia comes at a hefty cost — both to sleep quality and to the United States health care system. Lost work productivity linked to insomnia in the U.S. is estimated at $63.2 billion per year, as reported by the journal Sleep. Insomnia also contributes to about $31 billion per year in work accidents, according to research in the Archives of General Psychiatry.

Insomnia and chronic pain: a glimpse into the research
When exploring the relationship between chronic pain and insomnia, researchers have found it’s not as simple as pain causing insomnia — though pain certainly plays a big role. Below are findings from three studies to help illustrate the connection between chronic spine pain and insomnia.

  1. Chronic pain and insomnia are close companions. Addressing your back pain early has benefits beyond your spine. A 2013 study published in the Journal of Orthopaedic Surgery (Hong Kong) found that nearly half of its study subjects had both chronic back pain and insomnia. As part of the research team’s conclusions, they recommended back pain be treated early to avoid serious complications from insomnia.
  2. Poor sleep equals more pain? Not so much more pain but more feelings of pain. A 2012 study in the journal Sleep found that insomnia can heighten your perception of pain the next day. While poor sleep doesn’t cause additional pain, it can make you extra sensitive to the sensation of pain.
  3. Is cognitive behavioral therapy for insomnia the answer? A study published in 2010 in Sleep Medicine reviewed three previous studies that followed patients who had chronic pain and underwent cognitive behavioral therapy for insomnia. The results of the previous studies showed that cognitive behavioral therapy for insomnia can effectively treat sleep problems in patients with chronic pain. You can learn more about cognitive behavioral therapy for insomnia below.

Sleeping easy with chronic pain
Insomnia treatments are generally divided into two groups: behavioral therapy and prescription medications. Behavioral therapy is the preferred treatment, as it provides a longer-term solution with no harmful side effects. If your doctor recommends prescription drug treatment for insomnia, it will likely be to treat occasional bouts of insomnia.

For those struggling to get a good night’s rest with chronic back or neck pain, cognitive behavioral therapy for insomnia is a common first-line treatment, because it addresses the thoughts and feelings that act as barriers to restorative sleep. People with chronic pain can be kept awake by pain, anxiety and other worries that those without chronic pain don’t experience. This therapeutic approach can improve sleep by changing the behaviors and negative thoughts that interfere with quality sleep.

Chronic behavioral therapy for insomnia has shown promising results, with reports of success in as many as 80% of patients who pursued the treatment. Also, a 2014 review in Annals of Internal Medicine reported that, on average, people who underwent chronic behavioral therapy for insomnia fell asleep nearly 20 minutes faster and spent 30 fewer minutes awake during the night compared with those who didn’t use the therapy.

Another approach that may help ease insomnia is called relaxation training. In relaxation training, a professional teaches you how to progressively relax your muscles and meditate to distract you from sleep-stealing thoughts.

Other tips for warding off insomnia with chronic spine-related pain:

  • Use your bedroom for sleeping and sexual intercourse only. Watch television, read, work and do other activities in other areas of your house.
  • Wait until you’re feeling sleepy before going to bed. If you can’t fall asleep within 20 minutes, go into another room until you feel drowsy again.
  • Stick to a set wake-up time regardless of when you fall asleep.
  • Kick your napping habit.

Having chronic pain and sleeping well is possible.

As anyone with chronic back or neck pain will tell you, pain isn’t just physical — it’s mental and emotional, too. It’s all those layers of pain that can prevent people with chronic pain from sleeping well. The relationship between chronic pain and sleep is complex — as one gets worse, it affects the other. Fortunately, behavioral therapies exist to help you break the cycle of negative thoughts and feelings that keep you from the sleep you need. If you struggle with chronic pain and sleeping through the night, talk to your doctor about the options available to you.

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Christopher Ornelas, MD
Christopher C. Ornelas, MD, is a physiatrist at the USC Spine Center and specializes in the treatment of nonoperative spinal disorders.