SleepApnea.org Webinar Featuring Daniel Hernandez, M.D.

By Eugena Brooks

Does Pain Impact Sleep

The problem with pain and sleep loss is that the two contribute to one other. Experiencing chronic pain can lead to sleep deprivation, but sleep deprivation can also make pain symptoms worse. It becomes a “chicken and egg” situation where it may be difficult to determine which is causing the other. 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.

Research reveals that two out of three people with chronic pain have trouble sleeping. Accreditation Association for Ambulatory Healthcare-certified facilities reported that nearly two-thirds of all adults living with back pain report having trouble sleeping because of discomfort or pains during the night. While back pain may cause insomnia, other researchers have found that insomnia only makes the symptoms of back pain worse.  Sleep issues are especially common for people with chronic pain, back pain, fibromyalgia or the pain of cancer. In addition, pain is one of the most common causes of insomnia. Up to two-thirds of patients with chronic pain conditions suffer from sleep disorders.

One of the SleepApnea.org webinars I attended recently, “Pain and Sleep: What You Can Do to Help,” gave me some new insight into the problem. The webinar was presented by Daniel Hernandez, M.D. who is the Medical Advocacy liaison for the Global Healthy Living Foundation (GHLF) ghlf.org which includes programs such as Creaky Joints creakyjoints.org, 50-State Network and Fail First Hurts.

Pain and Sleep Assessments:

Sleep Apnea, as we know, is usually accompanied with comorbid conditions of some type. The ones associated the most are hypertension, obesity, some auto-immune issues such as arthritis other chronic pain and fatigue. Some of the research findings Dr. Hernandez pointed out from research gathered by the GHLF programs was how only 20% of the general population reflected a mean score for pain greater than 60. In contrast to the mean score for patients with sleep apnea being 64.83 which is a 1.5 deviation worse than the mean indicating that only 5-10% of the population would test this high, showing patients much worse than the general population. The result being 50% of patients experience chronic pain that is worse than 80-99% of the general population. Sleep disturbances carries a mean score of 59.66 with 50% of the scores between 54.33 and 64.88 and a maximum score of 83.79. Fatigue carries a mean score of 64.20 with 50% between 59.12 and 69.49 with a maximum score at 84.68. 

With all that said, people with pain experience sleep disturbances that are 80% worse than the general population. 50% of sleep apnea patients experience sleep disturbances worse than 70-95% of the general population. On average 50% of patients suffer from fatigue that is 90-95% worse than the general public. Lastly, at least 50% of the patients experience fatigue that is no less than 80-99% worse than the general public. According to Patient Reported Outcomes Measurement Information System (PROMIS) a score of 60 means the symptoms are moderate and a score higher than 70 reveals that the symptoms are severe. What is important about these findings is that it’s all corelated. Like the chicken and the egg — one precipitates the other.

What We Can Do:

To be proactive in your treatments you should keep a log of your pain. This way when you see your doctor you can create a better understanding for your physician of what’s going on with you. Charting the following points are helpful:

• When did the pain start?
• How bad is the pain?
• How long does it last?
• Where is it located?
• What does it feel like?
• Is it constant or sporadic?
• Does it come on suddenly?
• Does it get worse or feel better with certain activities?
• How does it limit what you can do?
• Is the pain acute?
• Is the pain chronic which is has a much longer duration and constant?

The more information you can provide the more accurate the physician can diagnose and treat the issue. Use as many adjectives as you need. Record if the pain throbbing, stabbing, aching, burning, tender, cramping, heavy, fearful, tiring or exhausting, and so on.

Tools

For those with arthritis, there’s an app sponsored by CreakyJoints. It created a Patient-Powered Research Network (PPRN) called ArthritisPower™ in 2014 in partnership with the University of Alabama at Birmingham. According to Dr. Hernandez, ArthritisPower is part of 33 networks within the National Patient-Centered Clinical ResearchNetwork (PCORnet) that uses a downloadable app for enhanced individual health-tracking and user interface and data collection techniques for research. Also helpful is the website creakyjoints.org which is a go-to source for arthritis patients seeking education, support, advocacy and patient centered research.

My Personal Goal

What I came away from the webinar with is that I need to start a journal. I have been struggling with persistent tiredness. I do have treated sleep apnea as well as pain issues, however, at this point the pain is sporadic and the apnea is better controlled than it ever has been. None the less I am still always so tired. Obviously, there is more going on than I realize and I’m guessing that pin pointing it will require a running log of my symptoms.

So, Santa guess what I want for Christmas?

Speaking of which, Happy Holidays to all and a Healthy, Happy and Prosperous New Year!