Abstract
ObjectivesPain can have a negative impact on sleep and emotional well-being. This study investigated whether this may be partly explained by maladaptive sleep-related cognitive and behavioural responses to pain, including heightened anxiety about sleep and suboptimal sleep hygiene.MethodsThis cross-sectional study used data from an online survey that collected information about pain (Brief Pain Inventory), sleep (Pittsburgh Sleep Quality Index; Sleep Hygiene Index; Anxiety and Preoccupation about Sleep Questionnaire) and emotional distress (PROMIS measures; Perceived Stress Scale). Structural equation modelling examined the tenability of a framework linking these factors.ResultsOf 468 survey respondents (mean age 39 years, 60% female), 29% reported pain (mean severity 1.12), most commonly in the spine or low back (28%). Pain severity correlated with poor sleep quality, poor sleep hygiene, anxiety about sleep and emotional distress. In the first structural equation model, indirect effects were identified between pain severity and sleep quality through anxiety about sleep (β = .08, p < .001) and sleep hygiene (β = .12, p < .001). In the second model, an indirect effect was identified between pain severity and emotional distress through sleep quality (β = .19, p < .01). Combining these models, indirect effects were identified between pain severity and emotional distress through anxiety about sleep, sleep hygiene and sleep quality.ConclusionsThis study provides data to support the tenability of a theoretically guided framework linking pain, sleep and emotional distress. If upheld by experimental and/or longitudinal study, this framework holds the potential to inform public health initiatives and more comprehensive pain assessment.
Highlights
Pain is a leading cause of disability worldwide and its prevalence is increasing in aging populations [1]
Pain severity correlated with poor sleep quality, poor sleep hygiene, anxiety about sleep and emotional distress
In the first structural equation model, indirect effects were identified between pain severity and sleep quality through anxiety about sleep (β = .08, p < .001) and sleep hygiene (β = .12, p < .001)
Summary
Pain is a leading cause of disability worldwide and its prevalence is increasing in aging populations [1]. Improved understanding of how pain impacts on sleep and mental health is important to ensure interventions that aim to reduce or prevent pain-related poor health outcomes target the most relevant contributing factors. Studies into the pain-sleep association have largely focused on the direction and the strength of the relationship [6]. Evidence indicates that sleep is a stronger driver of pain, a bidirectional association is accepted and studies of adult populations have shown that pain can have a negative, downstream impact on sleep quality and insomnia symptom onset [2, 7]. As understanding of the association has improved, attention has shifted to the role of biological, psychosocial, and behavioural factors on pathways between pain and sleep. Sleep-specific psychological and/or behavioural factors, including sleep-related anxiety and sleep hygiene behaviours, are yet to be examined as possible mediators
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