Chronic Pain & Sleep Apnea: Is There A Link?

July 18, 2011

Here’s a shocking statistic put out by the National Academy of Sciences—that 116 million Americans (37%) suffer from chronic pain. That’s more than diabetes, heart disease, and cancer combined. The article in the New York Times emphasizes the importance of more recognition of this condition by doctors. However, I doubt we’re ever going to make a significant dent in treating chronic pain unless we deal with their sleep issues.

It’s easy to argue that chronic pain can negatively affect your sleep quality. However, you can also argue that poor sleep can predispose you to chronic pain, once you experience a trigger (such as an accident, trauma, weight gain, or an operation). It’s been shown that poor sleep can lower your pain thresholds: Sleep deprived people were found to pull their fingers from a hot environment much quicker than people who had normal sleep. What this means is that the less quality or quantity of sleep you have, the more likely you’ll sense pain at very low levels.

If you think about the total number of people with obstructive sleep apnea (and even UARS), it’s probably about 1/4  to 1/3 of the population. Coincidence?

One general concept that Dr. Christian Guilleminault of Stanford describes is that sleep apnea patients have diminished nervous systems, whereas upper airway resistance syndrome (UARS) patients have intact nervous systems. In fact, I would argue that people with UARS have hypersensitive nervous systems. These are also the people who are overly sensitive to weather changes, chemicals, fumes, perfumes, odors and smoke. So perhaps people who are predisposed to chronic pain also have UARS.

Is it just coincidence that most of the patients that I see who have some sort of chronic pain also can’t sleep on their backs, have had excessive dental extractions, or have a parent that snores heavily? Most people with UARS can’t (or prefer not to) sleep on their backs, since that causes the tongue to fall back from gravity. Excessive dental extractions (usually from modern orthodontics) contracts the oral cavity space, leaving less room for the tongue, especially when in deep sleep, causing more frequent obstructions and arousals. As the person with UARS moves up the continuum, they’re more likely to progress into obstructive sleep apnea (like one or both parents).

If you’re truly committed to treating chronic pain patients, you have to simultaneously treat any underlying sleep-breathing problems. Giving sleeping pills just won’t cut it.

 

4 Responses to “Chronic Pain & Sleep Apnea: Is There A Link?”

  1. Sheri Conrad on September 28th, 2011 3:47 pm

    Hi Dr Park……I am 47 and just been diagnosed with sleep apnea after taking a sleep study. I didn’t really expect it and was just hoping to rule out OSA, but my doctor had suggested I do the sleep study. I am 5’6″, 154 lbs, neck circumference 13 in., walk daily at least 40 minutes, eat healthfully. My symptoms are daytime sleepiness (I can easily sleep 1 1/2 to 2 hrs on a day that I am not working), Irritability, mild depression, low energy and joint pain and stiffness mostly in my hips and occassional insomnia. My husband says I only rarely snore and he has never noticed an episode of breathing sessation while I am asleep. Regarding the hip pain, I was in a car accident 2 years ago and I had a bad fall from a horse a little over a year ago, neither of which resulted in any broken bones. I did not develop any hip pain until this past winter. i did go to a chiropractor for nearly 3 months with no improvement. I did need to take ambien in order to fall asleep for the sleep study. I guess I am just wondering if this all sounds like I could still have sleep apnia. I thought it would be more hormonal or thyroid problems causing my symptoms. I am especially wondering (and so is my husband) why he does not notice any snoring or any breathing sessations. He says I never “snort” during the night as if I am reawakened after breathing sessation. He says the study must be flawed in some way. The dr says my breathing stopped 22 times per hour. Is it possible also that having had to take a sleep aide could have caused this? Should I see about maybe doing an in-home study? I’d appreciate any input.
    Thanks,
    Sheri Conrad
    Danville, KY

  2. Steven Park on October 2nd, 2011 6:50 am

    Sheri,

    Your condition is not unusual. You don’t have to snore or snort at all to have significant sleep-breathing problems. It’s also likely that having the hip injury, it forced you to sleep on your back, when years of normally like to sleep on your side or stomach. This can aggravate breathing pauses due to the tongue falling back easier due to gravity. Also, you’re in pre-menopause, where progesterone levels are slowly decreasing. Progesterone is an upper airway muscle stimulant, increasing muscle tone in your tongue. So lowered progesterone levels will predispose you to more tongue muscle relaxation, especially if on your back. Home studies are not as accurate as in-lab studies. I would consider formally treating your sleep apnea.

  3. Kathleen Snyder on March 9th, 2012 12:49 pm

    Hi Dr. Park,

    My daughter (25) has had Reflex Sympathetic Dystrophy for ten years and has to take opioids to help with the pain. Her PA now wants her to have a sleep study done because she is afraid the medicine may be causing sleep apnea (the PA just came back from a conference where she must have heard something). Are you saying that most patients with chronic pain DO have sleep apnea? And if she does have sleep apnea, it is not necessarily from the medicine she takes?

    Thanks you so much for taking the time to answer my question.

  4. Dr. Arijit Roy on March 30th, 2013 1:08 pm

    dear Dr. Park,

    I wonder wether “Chronic Pain & Sleep Apnea” has been published in any clinical journal. Please let me know if there is any published report.

    Best Wishes,
    Dr. Roy.
    U of Calgary, Canada

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