I’m looking for evidence research and treatment opinions for a rise in sympathetic muscle tone during sleep (4am) and potential with irritated nervous tissue “lose” the adaptive potential that makes sleep “possible”.
I am interested in enabling pt to create their own strategy to allow good rest, whether asleep or not, and down regulating their sympathetic nervous system, often gives them the first deep sleep for a long time. Do you know of any studies using an intervention to address sleep impairment in people with chronic pain?
Recent studies indicate that sleep impairment is a predictor of future incidents of chronic pain and that sleep deficits are a stronger, more reliable predictor of pain than pain is of sleep deficits. Finan, Goodin and Smith (2013) suggest additional research into how different chronic pain conditions are affected by changes in sleep, which may give further insight into the mechanisms involved, for example, how chronic pain is affected by forced wakefulness or fragmented sleep. Dopaminergic signalling also may play an important role in contributing to sleep deficits seen in chronic pain sufferers. This suggests that chronic pain that also disturbs sleep, could further lead to dysregulation of the sleep-wake cycle.
From a day to day perspective, the temporal effect of sleep on pain may be stronger than that of pain on sleep. Experimental studies outlined in the review indicate that sleep disturbance has a substantial effect on pain perception as chronic sleep deprivation and was likely to correlate with increased pain sensitivity, and further, that extended sleep within the same population promoted reduced pain sensitivity. From a clinical standpoint, addressing sleep quality deficits may be worthwhile in the efforts to treat and prevent chronic pain. This view is further supported by findings that reduced sleep efficiency also reduces the efficacy of analgesics used in chronic pain patients, in particular, the use of endogenous opioid-mediated pain inhibition.
Research on the contribution of mood to the relationship between pain and sleep quality was also explored. Sleep, pain and the influence of positive or negative affect have been shown to be related; however various methodologies and the lack of any identifiable antecedent in the mood-sleep-pain pathway make the drawing of conclusions difficult.
http://www.ncbi.nlm.nih.gov/pubmed/24290442#
http://www.ncbi.nlm.nih.gov/pubmed/15033151#
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