Millions of people lie awake at night, caught between physical discomfort and exhaustion, wondering why pain seems worse when they're tired and why sleep becomes impossible when they hurt. What most don't realize is they're trapped in a neurobiological cycle that goes far deeper than simple cause and effect.

In this comprehensive exploration, we uncover the fascinating science behind the pain-insomnia connection—from the specific brain circuits that link these experiences to the stress hormones that amplify both conditions. You'll discover why your nervous system becomes hypersensitive when sleep-deprived, how catastrophic thinking creates self-fulfilling prophecies, and why traditional treatments often miss the mark.

More importantly, you'll learn about the evidence-based approaches that actually work to break this cycle. Cognitive Behavioral Therapy for Insomnia emerges as surprisingly effective for people with chronic pain, while common medications often fall short of their promises. We explore why addressing sleep might be your most powerful tool for pain management, and how changing specific beliefs and behaviors can rewire your brain's response to both pain and sleep challenges.

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Important Disclaimer:

The content presented in this episode of “Strides to Solutions with Esther Adams” is for educational and informational purposes only. This podcast discusses psychological concepts and personal development strategies but is not a substitute for professional mental health treatment, therapy, or medical advice.

The information shared should not be used to diagnose or treat any psychological, emotional, or medical condition. If you are experiencing mental health challenges, relationship difficulties, or symptoms of codependency, please consult with a qualified mental health professional who can provide personalized assessment and treatment.

This episode contains discussions of childhood emotional neglect, family dysfunction, relationship challenges, and trauma that some listeners may find emotionally activating. Please prioritize your wellbeing and consider whether you’re in an appropriate emotional space to engage with this content. If you find yourself becoming distressed while listening, please pause and seek support from a trusted friend, counselor, or mental health professional.

The patterns and experiences described are general in nature and may not apply to your specific situation. Recovery from codependency is a complex, individual process that often requires professional support. What works for one person may not work for another, and attempting to address deep-rooted patterns without appropriate support can sometimes be overwhelming.

If you are in crisis or having thoughts of self-harm, please reach out for immediate help:

* National Suicide Prevention Lifeline: 988

* Crisis Text Line: Text HOME to 741741

* International Association for Suicide Prevention: https://www.iasp.info/resources/Crisis_Centres/

Remember, seeking professional help is a sign of strength, not weakness, and everyone deserves support in their journey toward healthier relationships and personal wellbeing.

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References

Afolalu, E. F., Moore, C., Ramlee, F., Goodchild, C. E., & Tang, N. K. (2016). Development of the Pain-Related Beliefs and Attitudes about Sleep (PBAS) Scale for the assessment and treatment of insomnia comorbid with chronic pain. Journal of Clinical Sleep Medicine, 12(9), 1269-1277. https://doi.org/10.5664/jcsm.6130

Bean, D. J., Horne, J. K., Lee, A. C., & Johnson, M. H. (2021). Pre-sleep cognitive arousal exacerbates sleep disturbance in chronic pain: An exploratory daily diary and actigraphy study. Scandinavian Journal of Pain, 21(4), 724-731. https://doi.org/10.1515/sjpain-2020-0185

Dressle, R. J., Feige, B., Spiegelhalder, K., Schmucker, C., Benz, F., Mey, N. C., & Riemann, D. (2022). HPA axis activity in patients with chronic insomnia: A systematic review and meta-analysis of case-control studies. Sleep Medicine Reviews, 62, 101588. https://doi.org/10.1016/j.smrv.2022.101588

Generaal, E., Vogelzangs, N., Penninx, B. W., & Dekker, J. (2017). Insomnia, sleep duration, depressive symptoms, and the onset of chronic multisite musculoskeletal pain. Sleep, 40(1), zsw030. https://doi.org/10.1093/sleep/zsw030

Gerdle, B., Dragioti, E., Fischer, M., Dong, H. J., & Ringqvist, Å. (2023). Catastrophizing and acceptance are mediators between insomnia and pain intensity—An SQRP study of more than 6,400 patients with non-malignant chronic pain conditions. Frontiers in Pain Research, 4, 1244606. https://doi.org/10.3389/fpain.2023.1244606

Goossens, Z., Bilterys, T., Van Looveren, E., Malfliet, A., Meeus, M., Danneels, L., Ickmans, K., Cagnie, B., Roland, A., Moens, M., Nijs, J., De Baets, L., & Mairesse, O. (2024). The role of anxiety and depression in shaping the sleep–pain connection in patients with nonspecific chronic spinal pain and comorbid insomnia: A cross-sectional analysis. Journal of Clinical Medicine, 13(5), 1452. https://doi.org/10.3390/jcm13051452

Li, Y., Luo, Y., Su, W., Ge, J., Crowther, A., Chen, Z., Wang, L., Lazarus, M., Liu, Z., Qu, W., & Huang, Z. (2024). Anterior cingulate cortex projections to the dorsal medial striatum underlie insomnia associated with chronic pain. Neuron, 112(9), 1328-1341.e4. https://doi.org/10.1016/j.neuron.2024.01.014

Selvanathan, J., Pham, C., Nagappa, M., Peng, P. W., Englesakis, M., Espie, C. A., Morin, C. M., & Chung, F. (2021). Cognitive behavioral therapy for insomnia in patients with chronic pain—A systematic review and meta-analysis of randomized controlled trials. Sleep Medicine Reviews, 60, 101460. https://doi.org/10.1016/j.smrv.2021.101460

Simpson, N. S., Scott-Sutherland, J., Gautam, S., Sethna, N., & Haack, M. (2018). Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain, 159(1), 33-40. https://doi.org/10.1097/j.pain.0000000000001053

Sun, H., Li, Z., Qiu, Z., Shen, Y., Guo, Q., Hu, S., Ding, H., An, S., & Cao, J. (2023). A common neuronal ensemble in nucleus accumbens regulates pain-like behaviour and sleep. Nature Communications, 14(1), 4472. https://doi.org/10.1038/s41467-023-40450-3

This isn't about pushing through or thinking positive thoughts—it's about understanding the complex interplay of neurobiology, psychology, and behavior that creates these problems, and using that knowledge to find real solutions. Whether you're struggling personally or supporting someone who is, this deep dive provides both validation for the complexity of these challenges and hope for meaningful improvement.

Based on cutting-edge research from leading neuroscience and pain psychology journals, synthesized for practical understanding and application.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit esthernava.substack.com