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How we see the world shapes who we choose to be — and sharing compelling experiences can frame the way we treat each other, for the better. This is a powerful perspective.

We all know how just one night of bad sleep can put us in a total funk. When you struggle getting restorative rest night after night, the effects can be devastating.

I’ve spent much of my life lying awake in bed until the early morning, praying for sleep. With the help of a sleep specialist, I was finally able to connect my symptoms with a diagnosis: delayed sleep phase syndrome, a disorder in which your preferred sleep time is at least two hours later than conventional bedtimes.

In a perfect world, I’d fall asleep in the early morning hours and stay in bed until noon. But since this isn’t a perfect world, I have many sleep-deprived days.

According to the Centers for Disease Control and PreventionTrusted Source, adults like me who sleep less than the recommended seven hours per night are more likely than solid sleepers to report one of 10 chronic health conditions — including arthritis, depression, and diabetes.

That’s a significant connection, as roughly 50 to 70 million U.S. adults have some type of sleep issue, from insomnia to obstructive sleep apnea to chronic sleep deprivation.

Sleep deprivation is so potent that it can easily launch us into a downward spiral that, for many, can lead to depression or chronic pain.

It’s the classic chicken-and-egg scenario: Does disordered sleep cause depression and chronic pain or do depression and chronic pain cause disordered sleep?

“That can be hard to determine,” says Michelle Drerup, PsyD, director of behavioral sleep medicine at Cleveland Clinic. Drerup specializes in the psychological and behavioral treatment of sleep disorders.

There’s some evidence to suggest that sleep chronotype, or preferred sleep-wake times, can influence depression risk in particular. A large-scale study found that early risers had a 12 to 27 percent lower risk for developing depression and late risers had a 6 percent higher risk, compared with intermediate risers.

The cycle of sleep and depression

As a late riser, I’ve certainly dealt with my share of depression. When the rest of the world goes to bed and you’re the only one still awake, you feel isolated. And when you struggle to sleep according to society’s standards, you inevitably miss out on things because you’re too sleep-deprived to take part. It’s hardly surprising then, that many late risers — myself included — develop depression.

But no matter which comes first, the depression and chronic pain or the disordered sleep, both issues need to be resolved somehow.

You might assume that sleep improves once depression or chronic pain is resolved, but according to Drerup, this often isn’t the case.

“Out of all the symptoms of depression, insomnia or other sleep issues are the most residual despite improvement in mood or other symptoms of depression,” Drerup says.

I’ve used antidepressants for years and have noticed that I can be in a decent mood yet still struggle to sleep at night.

Similarly, people with chronic pain don’t necessarily see improvements in sleep once their pain is resolved. In fact, the pain often only continues to worsen until sleep is addressed. This may be related to the fact that some people with chronic pain may battle anxiety which in turn may cause stress chemicals such as adrenaline and cortisol to flood their systems. Over time, anxiety creates an overstimulation of the nervous system, which makes it difficult to sleep.

Because adrenaline increases the sensitivity of the nervous system, people with chronic pain will actually feel pain they wouldn’t ordinarily feel, says spinal surgeon and chronic pain expert Dr. David Hanscom.

“Eventually, the combination of sustained anxiety and lack of sleep will cause depression,” Hanscom adds.

The most effective way to resolve both chronic pain and depression is to calm the nervous system, and inducing sleep is an important first step.

Charley’s story of chronic pain and sleep problems

In 2006, Charley hit a rough patch in his personal and professional life. As a result, he became sleep-deprived, depressed, and experienced multiple panic attacks along with chronic back pain.

After seeing a variety of doctors and specialists — and making four visits to the ER in a month — Charley finally sought Hanscom’s help. “Instead of scheduling me for an MRI right away and talking about surgery options, [Hanscom] said, ‘I want to talk to you about your life,’” Charley recalls.

Hanscom has noticed that stress often creates or worsens chronic pain. By first recognizing the stressful life events contributing to his pain, Charley was better able to identify solutions.

First, Charley began by taking moderate amounts of anti-anxiety medication to help calm his system. For six months, he monitored his dosage carefully and then slowly weaned off the medication completely. He notes that the pills helped him transition back into a regular sleep pattern within a few months.

Charley also followed a consistent bedtime routine so his body could develop a regular sleep rhythm. The cornerstones of his routine included going to bed every night at 11, cutting down on TV, eating his last meal three hours before bed, and eating a clean diet. He now limits sugar and alcohol after learning that they could trigger an anxiety attack.

“All those things combined contributed to developing sleep habits that’ve been a lot healthier for me,” Charley says.

Once his sleep improved, the chronic pain resolved itself over the course of several months.

After finally getting a full night’s sleep, Charley recalls, “I was aware of the fact that I had a good night’s sleep and that gave me a little bit of confidence that things would get better.”

3 tips for breaking the sleep-depression-pain cycle

In order to break the cycle of depression-sleep or chronic pain-sleep, you need to start by getting your sleep habits under control.

Some of the methods you can use to help sleep, such as cognitive behavioral therapy (CBT), may also be used to address symptoms of depression or chronic pain.

1. Sleep hygiene

It may sound simplistic, but one thing I’ve found to be incredibly helpful for establishing a regular sleep schedule is creating good sleep habits, also known as sleep hygiene.

According to Drerup, one reason why many people may not see improvements in sleep once their depression is resolved may be due to bad sleep habits they’ve developed. For example, people with depression may stay in bed too long because they lack the energy and motivation to engage with others. As a result, they may struggle with falling asleep at a normal time.

Sleep hygiene tips

• Keep daytime naps to 30 minutes.
• Avoid caffeine, alcohol, and nicotine close to bedtime.
• Establish a relaxing bedtime routine. Think: a hot bath or a nightly reading ritual.
• Avoid screens — including your smartphone —30 minutes before bedtime.
• Make your bedroom a sleeping-only zone. That means no laptops, TV, or eating.

2. Expressive writing

Grab a piece of paper and pen and simply write down your thoughts — whether positive or negative — for a few minutes. Then immediately destroy them by tearing up the paper.

This technique has been shown to induce sleep by breaking up racing thoughts, which ultimately calms the nervous system.

This exercise also gives your brain the opportunity to create new neurological pathways that’ll process pain or depression in a healthier way. “What you’re doing is actually stimulating your brain to change structure,” Hanscom says.

3. Cognitive behavioral therapy

If you’re dealing with depression or chronic pain in addition to sleep issues, regular visits to a therapist may be in order.

Using CBT, a therapist can help you identify and replace problematic thoughts and behaviors affecting your well-being with healthy habits.

For example, your thoughts about sleep itself could be causing you anxiety, making it hard to fall asleep, thereby worsening your anxiety, Drerup says. CBT can be used to address sleep disorders, depression, or chronic pain.

To find a cognitive behavioral therapist in your area, check out the National Association of Cognitive-Behavioral Therapists.

Working with a sleep therapist or medical professional might be your best bet to get back on the path to a solid night’s sleep, as they may prescribe anti-anxiety medications or therapy and provide other solutions.

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Lauren Bedosky is a freelance fitness and health writer. She writes for a variety of national publications, including Men’s Health, Runner’s World, Shape, and Women’s Running. She lives in Brooklyn Park, Minnesota, with her husband and their three dogs. Read more at her website or on Twitter.

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According to the American Academy of Pain Medicine, chronic pain affects approximately 100 million U.S. adults and costs $560 to $635 billion per year in direct medical treatment costs and lost productivity. Talk about a painful pill to swallow.

Exercise is a common treatment for chronic pain. Depending on your current state of health, it may help decrease inflammation, increase mobility, and decrease overall pain levels, no additional medication required.

Try a combination of the cardio, relaxation, stretching, and strength exercises below and you may feel some of your pain ease away over time.

Cardio exercises

Cardiovascular exercise has several physical and mental benefits and can be particularly helpful for people with chronic pain. Cardio can be done any time of day and often requires little or no equipment. Try these two exercises.

Walking

Walking 30 minutes 3 to 5 times per week can help increase strength, endurance, and heart health. If walking is challenging for you, start slow and work your way up to longer walks as you get stronger. If you use a walker or a cane, make sure to take it with you.

Swimming and water aerobics

This is an excellent alternative to walking for people with mobility issues. This low-impact cardiovascular exercise can help keep you moving without putting added stress on your joints and muscles. Swimming can often be therapeutic, and it’s a great way to clear your mind.

Relaxation exercise

Relaxation exercises are important for many people who live with chronic pain. Visualization requires no equipment and can be done anywhere.

Deep breathing and visualization

1. Lie
   on your back or another comfortable position on the bed or floor.
2. Place
   your hands on your belly and relax your shoulders and feet.
3. Close
   your eyes and take a deep breath in through your nose. Exhale through your
   mouth, being sure to release all of the air.
4. Continue
   breathing in through your nose and out through your mouth, feeling your belly
   rise under your fingertips with each breath.
5. Continue
   this pattern and visualize pain leaving your body with every breath.
6. Repeat
   every evening before bed or throughout the day as needed.

Strengthening exercises

Building strength is important for stabilizing the joints and preventing future injuries.

For people living with chronic pain, adequate core strength is especially important. It helps you maintain proper posture and balance and reduces the risk of injuries that could lead to more pain.

Working the muscles of the abdomen, hips, and back can help improve core strength and stability. Try the exercises below.

Dead bug

1. Begin
   by lying on your back with your arms extended above you, like you’re reaching
   for the ceiling.
2. Lift
   your feet into the air and bend your knees to 90 degrees. Engage your core by
   relaxing your ribcage and drawing your bellybutton down towards the floor.
3. Exhale,
   then extend your left leg down towards the floor without letting it touch. At
   the same time, extend your right arm towards the floor above your head. Hold
   this position for 1 second. Return to starting position.
4. Repeat
   on the other side. Do 10 repetitions on each side.
5. Start
   by kneeling on all fours with your wrists under your shoulders and knees under
   your hips.
6. Create
   a flat back. Draw your shoulder blades down your back and engage your core by
   pulling your bellybutton up towards your spine. Do not let your back arch throughout
   this movement.
7. Extend
   one leg straight out behind you. Lower the leg, tapping your toe on the floor,
   then lift. Do not lift the leg above hip level. Repeat 10 times, keeping your
   core activated throughout the exercise and moving nothing but your leg.
8. Repeat
   on the other side.
9. You
   can increase the intensity of this exercise by kneeling on a small stability
   ball or foam roller.

Leg lifts on all fours

Warnings

Always consult your doctor before starting an exercise program. Specific exercises may vary depending on the origin of your chronic pain. It’s always best to consult a physical therapist for a personalized exercise routine. Certain conditions, such as fibromyalgia, may lead to increased pain with exercise, so start slow and monitor your symptoms.

Takeaway

Inactivity leads to stiff muscles, decreased mobility, and decreased strength. These effects can worsen the symptoms of chronic pain. Engaging in a regular exercise routine can help you manage your symptoms and improve your overall health.

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Natasha is the owner of Fit Mama Santa Barbara and is a licensed and registered Occupational Therapist and Wellness Coach. She has been working with clients of all ages and fitness levels for the past ten years in a variety of settings.She is an avid blogger and freelance writer and enjoys spending time at the beach, working out, taking her dog on hikes, and playing with her family.

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• A new study found that short-term use of anti-inflammatory medications may contribute to chronic pain.
• In the United States, there are about 50 million adults with chronic pain, with injury being a common cause.
• Research has shown that while anti-inflammatory medications like NSAIDs may resolve pain in the short term, they can also lead to long-term pain for some people.

Using anti-inflammatory medications like steroids or ibuprofen may relieve pain in the short-term setting, but a new study suggests this may lead to chronic pain.

Research published in the journal Science Translational Medicine led by clinicians at McGill University in Canada suggests that it may be time to re-examine how pain is treated in the short term and how that translates to long-term pain.

There are about 50 million adults with chronic pain in the United States. According to the Centers for Disease Control and Prevention (CDC), injury is the most common cause of chronic pain, and 25% of U.S. adults report having lower back pain in the last three months.

Inflammation is a natural response

After an injury, inflammation starts to increase throughout the body. This is the body’s natural response to infection or injury, and as inflammation increases, the person may feel pain in stronger amounts. However, blocking these natural inflammation pathways may result in possible long-term and chronic consequences.

Jeffrey Mogil, PhD, an author of the study and the Canada Research Chair in Genetics of Pain at McGill University, tells Healthline that the inflammation is intentional and necessary.

“It’s possible that that inflammation that the body naturally makes might be there for a reason,” Dr. Mogil explained.

“There is already evidence that if you block the body’s inflammation that it disrupts wound healing, so it’s possible that you shouldn’t be blocking something that the body is trying to do for a reason,” he said.

Research findings

The researchers examined patients and mice with lower back pain for three months on a physical and cellular level.

Many people who experience pain take anti-inflammatory medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids to help resolve their pain. However, while some people will fully resolve their pain, others will translate this into chronic pain.

The researchers examined 98 patients over three months and found that a particular cell in the body called neutrophils was a key player in the pain response pathway.

They discovered that while blocking these neutrophils may help reduce pain in the short term, in mice, blocking them can prolong the pain for up to 10 times longer. Similarly, patients who had elevated levels of neutrophils — those without having these cells reduced by medications — had protective findings against translating acute into chronic pain.

The researchers also said that other studies had supported their findings as well. An analysis in the United Kingdom that included about 500,000 individuals found that people who took anti-inflammatory medications experienced long-term chronic pain for the next two to 10 years.

“There are multiple studies of evidence that are pointing in the same direction, each of them compensating for the flaws of the other, and this is all part of a bigger story in understanding chronic pain,” Mogil told Healthline.

“In patients with chronic back pain, the association between NSAID use and the persistence of pain is a little more than suggestive, but it is significant and means that it is worth our time to better controlled studies to see if this is truly the case,” said David Edwards, MD, PhD, Chief of the Division of Pain Medicine and Associate Professor of Anesthesiology & Neurological Surgery at Vanderbilt University Medical Center in Nashville, Tennessee.

Guidelines from the American Academy of Family Physicians suggest that instead of initially turning to medications to treat pain, using heat, massages, or physical therapy should be the first step. If those don’t work, medications like anti-inflammatories or other analgesics like acetaminophen can assist.

Dr. Edwards suggests that you should ask your doctor two important questions before starting any pain medications, even common ones like NSAIDs or acetaminophen. “What are the side effects of this medication if I use too much? And how long is it safe to use this medication, and when should I stop?”

More research needed

Scientists continue to investigate and answer questions about pain both at acute and chronic levels. Pain affects almost everyone and understanding how it works and how to treat it is important.

While this data is compelling, both Edwards and Mogil agree that more randomized and controlled studies need to be performed before there is a complete shift in how to treat pain.

“This research points us in the right direction and makes us reconsider how we treat pain, and the next step is to test this in a prospective way, in the clinic,” Edwards told Healthline.

Mogil tells Healthline that while his teams are already discussing and evaluating how they’re going to investigate this further, he believes that others will use this evidence to further understand the pain process in other areas.

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