Christina Donnelly
Executive Director, Chronic Pain Ireland
Sleep disturbance is increasingly recognised as a key factor in chronic pain and other long-term health conditions.
Research consistently demonstrates a bidirectional relationship — poor sleep can heighten pain sensitivity, while chronic pain can disrupt sleep quality, continuity and restorative sleep stages.
How pain and sleep are connected
Evidence published in The Journal of Pain shows that insufficient or fragmented sleep can increase pain sensitivity the following day and impair endogenous pain inhibition systems that help regulate pain perception. This contributes to a self-reinforcing cycle wherein pain and sleep disturbance interact over time.
Systematic reviews, including research published in BMC Musculoskeletal Disorders, indicate that a substantial proportion of people living with chronic pain experience clinically significant sleep disturbance, including insomnia symptoms, frequent night waking and non-restorative sleep. These findings are consistent across long-term conditions, highlighting sleep as a cross-cutting issue in chronic illness.
Beyond pain conditions, population-based research, like The Irish Longitudinal Study on Ageing (TILDA), has shown that poor sleep is associated with reduced physical functioning, lower quality of life and increased multimorbidity. This reinforces the broader relevance of sleep across chronic disease management.
Evidence-based pain models highlight that thoughts, emotions and behavioural responses can influence symptom experience. Patterns such as worry about pain, fear of movement or reduced activity due to anticipation of symptoms, may contribute to pain persistence and sleep disturbance.
These patterns are frequently reflected by people living with chronic pain, including those engaging with Chronic Pain Ireland support services, where sleep disruption, fatigue and pain-related anxiety are commonly addressed, states Christina Donnelly, Executive Director, Chronic Pain Ireland.
poor sleep can heighten pain sensitivity,
while chronic pain can disrupt sleep quality,
continuity and restorative sleep stages
Interventions for sleep disturbances
Cognitive Behavioural Therapy for Insomnia (CBT-I) is recommended as a first-line treatment for chronic insomnia. Systematic reviews have shown that it can improve sleep outcomes in people with long-term conditions.
Non-pharmacological strategies, including consistent sleep routines and other behavioural approaches, are also supported in clinical guidance. Broader cognitive behavioural therapies are also used within chronic pain management to support coping and adjustment.
Improving sleep is an important component of chronic pain and chronic illness care, alongside physical and psychological approaches to support overall wellbeing.
