Pain points

Physical pain can make it difficult to find a restful sleep position. But the presence of pain in the waking day, and its potential restrictions on movement and exercise, can also impact sleep quality. That’s how a pattern can emerge: disrupted sleep by night, and inhibited sleep-promoting activities by day.

Whether the pain is from an injury, headaches, arthritis, or a chronic medical condition, this vicious cycle can make restful sleep impossible, making you ever more tired and, consequently, more sensitive to pain. Let’s take a deep dive into the world of pain and sleep, and find what can help.

Beginning with the basics

What is pain, anyway? Jill Bodak, Toronto-based osteopath and anatomy educator, breaks down what many of us feel. Pain is:

• the body’s mechanism for recognizing physical harm or damage
• a feedback loop wired into the body that provides sensory information on how various body tissues are faring
• an individualizing experience that could be fast, reflexive, and acute or slow, calculated, and chronic

Bodak describes how pain is felt through sensory nerves, and these map and report on just about every part of our bodies, including muscles, bones, organs, and vessels. These, in turn, feed information back along pathways in the spinal cord to be processed in the brain.

Further foundations

Just as elemental, what is sleep? (And what does pain have to do with it?) Sleep, says Bodak, is one of the many rhythms the human body relies on to be well. “Digestion, circulation, menstruation, and respiration are all rhythmic cycles our body needs to function,” Bodak says. And each requires sleep.

Putting things together

Pain interrupts our sleep cycles by making those core processes more difficult. When we experience pain, Bodak says, “the body releases chemicals associated with sympathetic ‘fight or flight’ responses, and these chemicals work against the calm and sleepiness we need to drop into deep sleep.”

“Pain stresses the body out and keeps the body up,” as Bodak puts it. And, from there, a cycle reinforces itself: losing sleep ups pain and gets in the way of healing, and both of these add stress to the body, which, in turn, can keep the body awake.

Bringing in breath

From mattresses to specialized mats and from lightbulbs to light therapy, there are products and protocols galore that, in principle, nourish better sleep. But the most impactful interventions for pain and sleep might be closer, and cheaper, than you think.

“Breathwork is the term used to describe consciously engaging with the way you breathe as a means to alter the way you feel,” Bodak explains. “Conscious attention to breath and a variety of breathing techniques have been used to decrease pain, manage chronic symptoms, and combat the challenges of both pain and sleep loss.”

Put simply, breath is “an ancient form of medicine” as Bodak sees it. And breathwork practices help with awareness and changing habits, and can also have a significant impact on stress, pain, and sleep.

Five stories

Breathwork works by altering the pattern of how we breathe, in turn transforming our posture. In osteopathic medicine, there are is more than just one diaphragm in the body, including the pelvic floor, and through breath and posture changes, there can be a “redistribution of high to low pressure that can accumulate when our breathing is tense or shallow, or our pain or our posture lock us into a limited range of motion.”

Bodak describes how the five diaphragms of the body “must move and work well together in order to feel and sleep well” Diaphragms are areas of transition in the body, the separate zones, and have different pressure gradients; for example, the respiratory diaphragm separates the abdominal and chest cavities.

As Bodak says, “When any of these diaphragms stop doing rhythmic pressure redistribution, our nervous system gets wound up [and] our physiology tenses,” making good-quality and -quantity sleep to support pain relief a real challenge.

Diaphragmatic breathing

Deeper, more intentional breathing with the diaphragm in mind enables a slowed heart rate, stabilized blood pressure, decreased levels of cortisol, and activation of the vagus nerve. Chronic pain symptoms, along with those of irritable bowel syndrome, low mood, anxiety, and sleep disorders can be supported through intentional breathing.

Bodak suggests using a daily activity, like washing dishes, taking out trash, walking to your car, or getting out of bed in the morning, and turning it into a meditation by noticing how you breathe while you do it. Consider whether you’re distracted or multitasking and get curious about what’s happening in the soles of your feet, your pelvic floor, the bottom and top of your lungs, and the hood of your mouth. Says Bodak, “These invite our breathing to slow down and awareness to increase.”

A sigh of relief

As Bodak points out, when we “feel into and appropriately mobilize the body’s diaphragms that make up our structural health, through attentive breathing, mindful mapping, and down-regulating movement, [we] can learn how to sense [our] own internal operating systems in ways that decrease pain and, in turn, stress, which allows for the possibility of better sleep.”

This article was originally published in the November 2024 issue of alive magazine.