CBT for Pain - Module 8 Summary

CBT for Pain: Sleep

Have you ever found that your aches and pains are worse after a bad night of sleep? Or, do you find it hard to sleep because of your pain?

The relationship between sleep and pain is complicated. Pain may make falling and staying asleep hard. And, not sleeping well can increase your pain. In this module, we will go over how sleep and pain are linked. We’ll also go through some ways to help you sleep better and lower your nighttime pain.

Pain-Sleep Relationship

Sleep allows your body to physically and mentally repair itself. Lack of sleep may make you more sensitive to pain. It also lowers your body’s ability to recover. On the other hand, sleeping well can help you better tolerate your pain. Good sleep also supports tissue growth, which helps you recover from injuries.

To improve your sleep, it’s important to check in with your sleep hygiene. Sleep hygiene refers to practices and habits that promote healthy sleep. It might involve doing more of something, like meditation or using earplugs, or doing less of something, like drinking caffeine in the evening. Let’s go through the following sleep hygiene methods and how they might affect your sleep.

Most people need 7 to 9 hours of sleep every night, but everyone is different. Think about when your sleep has felt the best. How many hours do you need to feel rested?


Improving your bedtime routine, including bedtime and wake-up times, can in turn improve your ability to sleep. Try to go to bed and wake up at about the same time every day of the week, including the days you don’t work. It’s best to do this even when you haven’t been sleeping well.


Napping may disrupt your sleep patterns. Research shows that those who nap more have less quality sleep. If you need extra rest during the day, a short nap is best.


Daily exercise or movement helps improve the quality of your sleep. Intense exercise close to bedtime might interfere with your sleep, but gentle stretching or slow walking may actually help you sleep better. You can make them part of your nighttime routine to help you de-stress and wind down.


Eating large amounts of food near bedtime can make it hard to sleep, but a snack is okay. It’s best to limit spicy foods, acidic foods like citrus and tomato, and alcohol. These foods can cause heartburn or reflux, especially when you’re lying down.

Stress and Mood

Your mental health affects your sleep, too. If you feel anxious, or your mind is racing before bed, it can keep you up. Having a relaxing nighttime routine can help. Doing some meditation or gentle stretching can help you wind down. You can ask your coach for extra support with this.

Substances - Stimulants

  • Caffeine: drinks, foods, and medicines with caffeine can make it harder to sleep, even if you have them several hours before bedtime. It’s best to avoid all caffeine after lunch.

  • Nicotine: The nicotine in tobacco products disrupts the normal sleep-wake cycle. If you  smoke, avoid smoking at least 2 hours before bedtime.

Substances - Depressants

  • Alcohol: Alcohol can cause drowsiness, so it might help you fall asleep. However, it affects the quality of your sleep, so you may not feel rested when you wake up. It’s best to avoid drinking alcohol close to bedtime.

  • Marijuana: Marijuana is similar to alcohol: even though it can make you drowsy, the Tetrahydrocannabinol (THC) in marijuana may affect your sleep quality.

More Sleep Hygiene Tips

  • If you’re in bed and can’t fall asleep after 20 minutes, do your best to get up and do something else until you feel sleepy - then try again.

  • Use your bed only for sleep and sex.

  • Keep your bedroom dark, quiet, and at a comfortable temperature. 

  • If there’s unavoidable light or sound in your bedroom, try using a sleep mask or earplugs.

  • If you need to use electronic devices like your phone or the TV close to bedtime, use blue light-blocking glasses to avoid their impact on your sleep.

What sleep hygiene tips would you like to start working on?

Help With Pain At Night

Sleep hygiene methods can help you improve your sleep, but your pain might be affecting your sleep as well. There are some habits you can work on to help reduce your pain at night.

The most comfortable and pain-free sleeping position for you depends on your pain location and any other conditions you may have.

  • Back and neck pain: avoid sleeping on your stomach: this puts extra pressure on your back and neck. Instead, try sleeping on your side with a pillow under your knees.

  • Shoulder pain: try not to sleep with your arms under or above your head. Instead, try sleeping on your back with a pillow under your elbows.

  • Hip pain: Sleeping on your back may help. You can also sleep on the side that doesn’t hurt with a pillow between your knees.

  • Knee pain: You can try sleeping on your back with a pillow under your knees. You can also sleep on your unaffected side with a pillow between your bent knees.


The sleeping position that feels best may make it harder to cover your body. To solve this, wear clothing that keeps you warm and comfortable while you sleep.


Your mattress should be medium-firm and allow your body to stay in good alignment. Regardless of your sleep position - your ears, shoulders, and hips should be in line with each other.

Remember from previous modules:

  • Being active during the day improves the quality of your sleep. Try to get some movement every day. 

  • Remember to pace yourself through activities that might make you sore.

  • Try some gentle stretches. Slowly move the painful area before you go to sleep or if you wake up during the night.

Relaxation Techniques

Deep breathing, guided imagery, journaling, and other relaxation methods can help you wind down before bedtime. You can also use them to get back to sleep if you wake up at night. They can help lower the anxiety and stress linked to your pain.

Pain Relief - Topical Relief

  • Applying heat or ice can help your pain. You can use either method throughout the day or if your pain wakes you up at night. Make sure you use heat or ice for only 15 minutes at a time. 

  • Pain relief patches, gels, and rubs can be used on the places where you feel pain, too. Using gentle massage alongside a gel or cream adds to the pain relief.

Pain Relief - Medications

  • Time your pain medicines and supplements so they give you the most relief close to bedtime. However, if your doctor has given you specific instructions about medication timing, please follow those guidelines.

    • Keep in mind: pain medicines can also interfere with sleep. Be sure to check with your doctor if you have concerns.


  • Pain may make falling and staying asleep hard. Not sleeping well can make your pain feel worse.

  • Sleep hygiene refers to practices and habits that promote healthy sleep. It might involve doing more or less of something.

  • Having a good sleeping position and appropriate mattress, regular exercise, using relaxation and pain relief methods can help lower nighttime pain.