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Fight Insomnia and Your Back Pain with the Help of a Sleep Aid

December 26, 2017
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According to the Cleveland Clinic, “Up to two-thirds of patients with chronic pain conditions suffer from sleep disorders.”


If you have chronic back pain and consider yourself an insomniac — guess what — you’re not alone. You need to be comfortable to fall asleep and “comfort” has been removed from your vocabulary since you received your back or spine diagnosis, but numerous products are on the market that can help you catch some Z’s in spite of the pain. There are risks and side effects associated with all sleep-aiding drugs, so it’s essential to understand the details prior to starting any regimen. 

“Pain worsens sleep patterns and sleep disturbances worsen pain — it’s a vicious cycle,” Dr. Robert Bolash, of the department of pain management at the Cleveland Clinic, said. 

“These problems can range from difficulty falling asleep to difficulty staying asleep; in turn causing heightened pain and worsening sleep.”

Michelle Drerup, PsyD, of the Cleveland Clinic’s Sleep Disorders Center treats hundreds of patients each year who come to her with insomnia and a variety of painful medical conditions. 

“Treating insomnia can help a patient’s chronic pain subside,” she said. Yet, sometimes other factors besides chronic pain can cause a patient’s insomnia. Prior to treating a patient for pain-related insomnia, doctors must eliminate other sleep and psychiatric disorders and determine whether other medication is causing the issue.

“At times, we see patients with pain diagnoses who really have a medical condition such as sleep apnea and when their sleep apnea is treated, their pain diminishes as well,” Dr. Bolash said. “Those are the simple cases.”

How about the not-so-simple cases? 


Treating back pain and insomnia often requires the work of a medical team composed of specialists from multiple disciplines.

“We know that certain pain medications can improve sleep, and we prescribe these for patients who have both a sleep disorder and a specific pain disorder,” Dr. Bolash said.

While medications can help patients fall asleep, certain opioids can disrupt sleep, prevent the deep sleep that is essential to feeling rested, and cause breathing disturbances during sleep. As with anything back pain-related, there is no cure-all that works for everyone.  



Prescription Medications for Back Pain and Sleep



Several prescription medications were created to improve sleep while relieving chronic back pain, however, some have side effects and the potential for addiction. They should be used as part of a more comprehensive and widespread program of pain management.


Sleeping Pills


Most sleeping pills are classified as 'sedative hypnotics,' which is a specific class of drugs used to induce or maintain sleep.

Sedative hypnotics include:

  • Benzodiazepines
  • Barbiturates
  • Hypnotics

The 9 Most Frequently Prescribed Sleeping Pills


Sleep medication

Helps you fall asleep

Helps you stay asleep

Can lead to dependence

Doxepin (Silenor)


*

Estazolam
*
*
*
Eszopiclone (Lunesta)

*
*
*
Ramelteon (Rozerem)

*


Temazepam (Restoril)

***
Triazolam (Halcion)

*
*
Zaleplon (Sonata)

*
*
Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist)

*
*
Zolpidem extended-release (Ambien CR)

***

Chart Caption: From Mayo Clinic


Depending on the type, people taking prescription sleeping pills may exhibit side effects, including:

  • Dizziness or lightheadedness
  • Headache
  • Gastrointestinal problems, including diarrhea and nausea
  • Prolonged drowsiness
  • Severe allergic reactions
  • Sleep behaviors
  • Problems with memory and performance during waking hours


Always speak with your doctor about the potential side effects before starting a sleeping pill regimen.


Antidepressants

Prescription medicines for severe back pain include antidepressants. Sometimes prescription drugs used primarily to treat depression may ease insomnia when taken in low doses. Although widely used, these are not approved by the Food and Drug Administration (FDA) for insomnia only. When insomnia is secondary to depression or anxiety, antidepressants may work to relieve both conditions simultaneously. 

Examples of prescription drugs that may reduce your back pain, headaches, nerve pain and fibromyalgia include:

  • Amitriptyline
  • Doxepin
  • Mirtazapine (Remeron)
  • Trazodone (Oleptro)
  • Aventyl, Pamelor (nortriptyline)
  • Desyrel (trazodone)
  • Elavil (amitriptyline)
  • Serzone (nefazodone)
  • Amitriptyline
  • Cymbalta (duloxetine) — approved for musculoskeletal pain


Taking antidepressants can cause several possible side effects, including:

  • Physical Symptoms. When you initiate an antidepressant treatment, depression medication, side effects may include physical symptoms such as a headache, joint pain, muscle aches, nausea, skin rashes, or diarrhea. These symptoms are usually mild and temporary.
  • Sleep Disturbances. You may notice that you still have trouble sleeping when you first start taking an antidepressant. This is because your body may need time to get used to the effects it has on your brain. Other symptoms common with selective serotonin reuptake inhibitor (SSRIs) include nightmares and sleepwalking.
  • Daytime Sleepiness. SSRI medication side effects may include daytime sleepiness and nighttime wakefulness. An estimated 25 percent of patients on SSRI drugs will experience one or both of these side effects.
  • Migraines. Unfortunately, migraines tend to be more common in people with depression, so be extra careful when taking SSRIs. Medications used to treat migraines, triptans,  and SSRIs increase the brain chemical serotonin. If taken together, these medications may cause serotonin syndrome, the symptoms of which may include flushing, rapid heart rate, or headaches.


Ask your doctor about potential side effects if you’re taking prescription medications for both sleep and back pain conditions.


Anti-Anxiety Medications

Anti-anxiety medications can increase drowsiness and promote sleep. While these drugs may be useful short-term, all benzodiazepines — a class of anti-anxiety pills — are potentially addictive and may cause problems with memory and attention if used over an extended period of time. They are usually not recommended for long-term treatment of sleeping problems. Examples of Benzodiazepines include:

  • Xanax
  • Valium
  • Ativan
  • Librium
  • Ativan (lorazepam)
  • Dalmane (flurazepam)
  • Klonopin (clonazepam)
  • Restoril (temazepam)
  • Valium (diazepam)


Halcion (triazolom) is an older benzodiazepine sedative-hypnotic medicine that has largely been replaced by newer medications like the ones above. Common side effects of benzodiazepines include:

  • Drowsiness
  • Dizziness
  • Poor balance or coordination
  • Slurred speech
  • Trouble concentrating
  • Memory problems
  • Confusion
  • Upset stomach
  • Headache
  • Blurred vision


Muscle Relaxants

A muscle relaxant helps to relieve pain stemming from muscle spasms while helping you sleep. Medical professionals do not advise their use for long-term pain relief. Side effects can include drowsiness, dry mouth, constipation, and confusion. Examples of muscle relaxants include:

  • Flexeril (cyclobenzaprine)
  • Lioresal (baclofen)
  • Skelaxin (metaloxalone)
  • Soma (carisoprodol)


Opioid Pain Kilers


Opioids help to treat acute to severe chronic back pain and may promote sleep. Some of these medicines can disrupt the natural sleep cycle, reducing the amount of deep sleep you get. You may feel tired and ready for bed. You may also fall asleep more easily, but the medication may prevent you from entering deep rapid eye movement (REM) sleep. Other side effects of opioids include nausea, constipation, and risk of addiction.

Examples of opioids include:

  • Codeine
  • Morphine
  • OxyContin (oxycodone)
  • Percocet (oxycodone with acetaminophen)
  • Vicodin (hydrocodone with acetaminophen


While opioids require a prescription, other drugs that can be used to manage back pain and insomnia do not. 


Over-the-Counter Medications


Non-Steroidal Anti-Inflammatory Drugs (NSAID)

These products may be effective for short-term use to relieve your back pain. They may also cause liver toxicity in high doses, so be careful when taking them long-term. While there is no exact match for Ambien in over-the-counter form, several other sleep aids are available without a prescription. 

Most sleep aids include antihistamines, an ingredient found in cold medicines that may also work as a sedative. One powerful antihistamine is Benadryl, an allergy medication. Others include:

  • Tylenol
  • Aleve
  • Aspirin
  • Panadol
  • Paracetamol
  • Ibuprofen


Over-the-Counter Sleep Aids with Pain Relief Properties

Like the NSAIDs, these drugs may help you sleep by including an antihistamine. However, according to the National Institutes of Health, the effectiveness of antihistamines as a sleep aid is not well established and they can have side effects like daytime drowsiness and decreased cognitive function.

Use these drugs only as directed and let your doctor know what you are taking so they may approve before you consume. Examples include:

  • Advil PM (ibuprofen and diphenhydramine)
  • Tylenol PM (acetaminophen and diphenhydramine)
  • Aleve PM (naproxen sodium and diphenhydramine HCl)


According to the Mayo Clinic, “Tolerance to the sedative effects of antihistamines can develop quickly — so the longer you take them, the less likely they are to make you sleepy.” Side effects of over-the-counter medications include:

  • Nausea
  • Vomiting
  • Constipation
  • Headaches
  • Skin rash
  • Hypotension
  • Daytime drowsiness


Medications should only be used for as long as your medical team recommends. Long-term use can result in dependence on the various drugs discussed above and can eventually throw your body's natural alarm clock more out of whack than it already is. The goal is to help you develop a more normal sleeping pattern. 

Try to fall asleep at around the same time each night. This will help instill that normal sleep pattern, which positively affects your attitude for the next day.

BackerNation wishes falling asleep with back pain was as easy as counting sheep, but getting a good night’s sleep is much more complicated than that. It’s our mission to provide you the accurate information that you need to make an informed decision regarding your health.

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