Emotions, sleep and pain are interlinked; however, we understand little about how these aspects of our wellbeing are connected. Does a poor night’s sleep make us feel grumpy, which in turn makes our pain worse? Or does feeling sad in the first place make people less likely to recover from a poor night’s sleep and wake up with increased bodily pain? We set out to answer these questions in a cross-sectional study of 213 children and adolescents attending a specialist chronic pain clinic. The first question asks about mediation, or whether negative emotion explains the relationship between poor sleep and increased pain, while the second asks about moderation; that is, what amount of negative emotion is needed to make the relationship between poor sleep and pain even worse. This distinction is important, because if we know how feelings change sleep and pain then we can better tailor interventions to reduce pain. If negative emotion explains the general sleep-pain relationship, then modifying emotions should help most people’s pain. Alternatively, if only the grumpy feel the ill effects of poor sleep, then we might want to focus on interventions for people with high amounts of negative emotion.
In addition to examining the role of negative emotion, such as distress, irritability and poor concentration, we also included positive emotions, such as interest, joy, and alertness. Negative and positive emotions can happen at the same time. You might be feeling somewhat interested in this article, and slightly irritated at the same time (science is moving so slowly!) As such, positive and negative emotion uniquely contribute to wellbeing which is why it’s important to examine both.
Children and adolescents who presented to a chronic pain clinic in Los Angeles (aged 7-17 years) reported on their pain, sleep, disability (limitations in home, school, and social life) and positive and negative affect in the past 2-4 weeks. We focused on young people because it’s likely that the interconnections between sleep, pain and emotion begin early, and this age-group is ripe for making changes before established patterns are set. The most common pain complaint was head pain, followed by stomach, back and neck pain. Results indicated that 74% of children and adolescents self-reported that their sleep was poor (the measure included sleep duration, disturbance, latency, efficiency, quality, daytime dysfunction, and sleep medication use). Moreover, poor sleep quality was associated with increased pain, disability, negative affect, and decreased positive affect.
We found that negative emotion (but not reduced positive emotion) in part mediated, or explained, the relationship between poor sleep and increased pain; and both reduced positive emotion and increased negative emotion mediated the relationship between poor sleep and increased disability. There was no evidence for emotion as a moderator. These findings suggest that it’s not just grumpy people who feel increased pain after poor sleep; we probably all do! Poor sleep is likely to lead to feelings of distress and irritability, which contribute to increased pain and reduced functioning. This is the first time these relationships have been documented in young people.
Clearly, the majority of children with chronic pain are also dealing with sleep problems. The study was limited by a cross-sectional design, so we can’t conclude that poor sleep causes increased pain; however, the findings can give us some clues in thinking about how to help these kids. Reducing distress in children after a poor night’s sleep may ease pain; further, reducing distress and increasing joy may decrease disability and allow children to engage in important home, school and social activities, even when children have slept poorly. These ideas need to be further tested, but are potentially important interventions since many children with chronic pain withdraw from the very activities that keep them mentally and physically healthy including attending school.
One promising approach in reducing distress in young people with pain is yoga. Our recent exploratory work suggests that a 6-week yoga course may reduce distress and improve sleep in young adults experiencing chronic pain, including irritable bowel syndrome and rheumatoid arthritis. These studies are small, and require replication with large sample sizes and control groups that account for the effects of patient expectations and attention. Other mind-body approaches currently used in pediatric pain clinics that are worth testing in large trials include mindfulness, massage, biofeedback and hypnosis. Anecdotally, these approaches are helpful to many families, but whether they can improve sleep, increase joy and reduce distress in the face of chronic pain in children requires further scientific study.
About Subhadra Evans
Subhadra is a Developmental Psychologist and Lecturer at Deakin University, in Melbourne, Australia. She dabbles in yoga and mindfulness, and finds her daily dose of joy in a morning jog on the beach with her four children (two of whom are human).