- Two-thirds of adults with back pain insomnia have sleep deficits of 42 minutes.
- Lost sleep leads to missed work, and physical and mental health conditions.
- Prescription sleep aids are the most common method to treat back pain insomnia.
Back pain sufferers sleep less than the average American with deficits as high as 42 minutes each night. According to The National Sleep Foundation, nearly two-thirds of all adults living with back pain report discomfort from pain as a reason for their insomnia.
“Pain worsens sleep patterns and sleep disturbances worsen pain—it’s a vicious cycle,” said Dr. Robert Bolash of the department of pain management at the Cleveland Clinic. “These problems can range from difficulty falling asleep to difficulty staying asleep; in turn causing heightened pain and worsening sleep.”
Sleeping allows the body time to rest and replenish. Insomnia disrupts sleep and can exaggerate back pain. This leads to poor physical and mental health, and missed work. An abstract by researchers T. Roth, et al. cited that “chronic insomnia is associated with absenteeism, frequent accidents, memory impairment, and greater health care utilization. The most consistent impact of insomnia is a high risk of depression.”
Treating Back Pain Insomnia
Treating insomnia caused by back pain requires the work of a medical team. Michelle Drerup, PsyD, of Cleveland Clinic’s Sleep Disorders Center treats hundreds of patients. They come to her with insomnia and other conditions. “Treating insomnia can help a patient’s chronic pain subside,” she said.
Several prescription medications improve sleep and treat chronic back pain. Some have side effects and the risk for addiction. Take these as part of a pain management plan.
Sedative-hypnotics induce sleep which helps with insomnia. These medications include:
The Top 9 Prescribed Sleeping Pills
Chart Caption: From Mayo Clinic
Side effects of these pills may include:
- Stomach problems, including diarrhea and nausea
- Prolonged drowsiness
- Severe allergic reactions
- Sleep behaviors
- Problems with memory and performance during waking hours
Talk to your doctor about side effect concerns.
If your back pain related insomnia causes depression or anxiety, your doctor may prescribe antidepressants. These drugs relieve symptoms using low doses and may improve both conditions. Examples include:
- Mirtazapine (Remeron)
- Trazodone (Oleptro)
- Aventyl, Pamelor (nortriptyline)
- Desyrel (trazodone)
- Elavil (amitriptyline)
- Serzone (nefazodone)
- Cymbalta (duloxetine) — approved for musculoskeletal pain
Possible side effects include:
- Physical Symptoms. Headache, joint pain, muscle aches, nausea, skin rashes, or diarrhea. These symptoms are mild and temporary.
- Sleep Disturbances. Your body may need time to get used to the treatment. Other symptoms common with antidepressants include nightmares and sleepwalking.
- Daytime Sleepiness. You may feel daytime sleepiness and nighttime wakefulness. Twenty-five percent of patients experience one or both of these side effects.
- Migraine Headaches. These are common in people with depression. Medications used to treat migraines, triptans, and SSRIs increase serotonin. Taken together, they may cause serotonin syndrome. These symptoms include flushing, rapid heart rate, or headaches.
If you’re taking medication for sleeping and back pain, ask your doctor about side effects.
Anti-anxiety medications increase drowsiness and promote sleep. Benzodiazepines—a class of anti-anxiety pills—are used to treat anxiety, but may be addictive. These can interfere with memory and attention if overused. Examples include:
- Ativan (lorazepam)
- Dalmane (flurazepam)
- Klonopin (clonazepam)
- Restoril (temazepam)
- Valium (diazepam)
Common side effects of benzodiazepines include:
- Poor balance or coordination
- Slurred speech
- Trouble concentrating
- Memory problems
- Upset stomach
- Blurred vision
Muscle relaxant relieve pain from muscle spasms to help you sleep. Though helpful, doctors advise against long-term use. Side effects can include drowsiness, dry mouth, constipation, and confusion. Examples of muscle relaxants include:
- Flexeril (cyclobenzaprine)
- Lioresal (baclofen)
- Skelaxin (metaxalone)
- Soma (carisoprodol)
Opioids treat acute to severe chronic back pain. In some cases, they promote sleep. In other cases, they disrupt natural sleep cycles. Other side effects include nausea, constipation, and risk of addiction. Examples include:
Opioids require a prescription. Alternatives medications—over-the-counter drugs—do not.
Over-the-counter sleep aids with pain relief properties
These drugs may help you sleep by including an antihistamine. The effectiveness of antihistamines as a sleep aid is unclear. Side effects include daytime drowsiness and decreased cognitive function. Use as directed and talk to your doctor prior to use. 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:
- Skin rash
- Daytime drowsiness
Use medication for as long as your doctor recommends. Long-term use risks addiction or dependence. Insomnia due to back pain is common and treatable. Talk to your doctor regarding your treatment options.