Trying to sleep when you’re in severe pain can feel impossible.
You’re exhausted, yet your body aches, and every position you try seems to make the discomfort worse. The hours stretch on while sleep stays just out of reach, and the frustration builds with each passing minute.
Pain and sleep have a complicated relationship. Pain can make sleep harder to come by, and poor sleep can increase how sensitive you are to pain, creating a cycle that is difficult to escape.
At DC Metro Therapy, we help people break this cycle using evidence-based approaches that address both sleep and pain at the level of the nervous system.
Sleep and Chronic Pain: How Are They Related?
Most people assume the relationship between sleep and pain is simple: pain makes it harder to sleep.
An estimated 50 million adults in the United States experience chronic pain, and in one study, 82% of people with chronic pain reported poor sleep quality.
Search for help, and you’ll find endless advice about mattress firmness, sleeping positions, pillow placement, and bedtime routines. These things can matter, and comfort is worth attending to. But there’s a deeper relationship between pain and sleep that has more to do with how your brain processes both.
Pain is influenced by signals from your body and by your brain’s interpretation of whether you’re safe or in danger. More pain doesn’t always mean more damage. Stress, fear, frustration, and the amount of attention you give to pain can all amplify the signals your brain produces.
The reverse is also true: safety, relaxation, and a calmer nervous system can decrease pain intensity.
This doesn’t mean your pain is imagined or “just in your head.” The pain you feel is real, and it comes from real changes in how your brain and nervous system process signals from your body.
But when you lie awake at night worrying about how pain will ruin your sleep and wreck your next day, that fear sends threat signals to your brain. Those threat signals can increase both pain and wakefulness, which is why the harder you try to sleep through pain, the more elusive sleep often becomes.
If you want to go deeper into how this works, our course Calm Your Brain, Heal the Pain walks you through the steps to retrain your brain’s response to pain.
How to Sleep When You’re in Severe Pain: 10+ Tips
The strategies below draw from three evidence-based therapy approaches:
- Cognitive Behavioral Therapy for Insomnia (CBT-i)
- Emotional Awareness and Expression Therapy (EAET)
- Pain Reprocessing Therapy (PRT)
They address sleep and pain at the level of the nervous system instead of as separate problems.
At DC Metro Therapy, when we work with clients who have both insomnia and chronic pain, we almost always treat the insomnia first. This is because improving sleep can have a positive ripple effect on pain.
In fact, research shows that CBT-i significantly improved sleep in people with chronic pain, with an 81% probability of better sleep after treatment.
1. Keep a consistent wake time
Waking up at the same time every day strengthens your circadian rhythm and helps your body settle into a more predictable sleep pattern.
After a rough night, the temptation is to sleep in and recover the lost hours, but this throws off your internal clock and often makes the next night harder.
A consistent sleep schedule, even when you slept poorly and even on weekends, reduces sleep disruption over time and gives your body a reliable anchor to build around.
2. Be mindful of spending too much time in bed
One of the most common sleep mistakes is that when sleep is difficult, many people extend their time in bed, hoping to capture more rest. Unfortunately, more time in bed usually leads to more time lying awake, which brings frustration and a heightened awareness of pain.
The longer you stay in bed without sleeping, the more your brain associates the bed with discomfort, restlessness, and wakefulness instead of rest. Matching your time in bed more closely to the sleep you’re getting can help strengthen the connection between bed and sleep.
Learn how to set up your bedroom for a good night’s sleep.
3. Reduce sleep effort
Trying harder to sleep almost always backfires because effort increases alertness. Thoughts like “I have to fall asleep now or tomorrow will be unbearable” send threat signals to your brain, which keeps your nervous system activated and makes it harder to fall asleep.
Instead of forcing sleep, you should create a sleep environment where it can happen on its own. Sleep is a passive process, and it happens more easily when you stop trying to force it.
4. Get out of bed if needed
If you’ve been lying awake for a while and frustration is building, get out of bed and do something quiet in another room until you feel sleepy.
Staying in bed while wide awake tends to increase frustration and racing thoughts. It also pulls your attention toward monitoring your symptoms. Taking a break from the attempt to sleep removes some of the pressure, and returning to bed only when you’re drowsy helps preserve the association between your bed and rest.
5. Reduce checking and monitoring
Repeatedly scanning your body to assess how much it hurts can amplify the pain signals your brain produces. The same goes for mentally tracking your sleep. Asking yourself, “How bad is it tonight? Will I be able to function tomorrow?” keeps your nervous system on alert.
Constant evaluation feeds the cycle of threat and wakefulness. Letting go of the need to assess and measure, even imperfectly, gives your nervous system room to settle and helps break the cycle between insomnia and chronic pain.
6. Change your relationship with pain
Pain is a protective signal from your brain. Its job is to alert you to potential danger and keep you safe. But sometimes, the brain becomes overly protective and continues producing pain even when your body is safe, and no real harm is present.
When this happens, your goal shouldn’t be to eliminate every sensation but rather to change your relationship with pain. Approaching sensations with curiosity instead of fear can help teach your brain that you’re safe.
One way to practice this is through somatic tracking:
- Notice the sensations you feel without judging them as good or bad
- Observe the pain through a lens of safety rather than alarm
- Reduce the fear and urgency that can amplify your symptoms
This is one of the core practices in Pain Reprocessing Therapy, which helps retrain the brain to interpret pain signals as safe.
7. Express your emotions
Unprocessed emotions and accumulated stress can keep your nervous system in a state of activation, which contributes to both pain and sleeplessness. When you avoid difficult feelings, pushing down anger, grief, or frustration, your body can stay in a state of threat.
Learning to experience and express these emotions, rather than suppressing them, can reduce symptoms for some people. This is the foundation of Emotional Awareness and Expression Therapy, which helps you work through emotions that may be keeping your nervous system on high alert.
8. Move your body
Gentle movement during the day, when it feels appropriate for you, can support better sleep and signal to your brain that movement is safe. When pain leads you to avoid all activity, your world narrows, and your nervous system can become more sensitized over time.
You don’t need intense exercise. A short walk, light stretching, or any movement that feels manageable can release tension, improve mood, and help your body wind down more easily at night.
9. Engage in meaningful activities
When pain takes over, it’s common to drop the activities that bring you enjoyment and purpose. The problem is that withdrawing from everything you care about tends to increase isolation, low mood, and pain sensitivity.
Staying connected to meaningful activities, such as hobbies, relationships, creative pursuits, and time in nature, keeps your brain engaged with life beyond the pain and supports the reward systems that naturally help regulate it.
10. Try relaxation strategies
Relaxation techniques like deep breathing, progressive muscle relaxation, or visualization can help calm your nervous system and ease the activation that interferes with sleep.
The important distinction is that these strategies work best when used to create a sense of safety, not as another tool to force sleep. If you approach relaxation as a way to make sleep happen, it becomes another form of effort that adds pressure. But used gently, these practices help your body shift toward the calm state where sleep becomes possible.
11. Make your bed comfortable
Comfort matters, so you may benefit from setting up your bed with pillows and positioning that supports your body and eases pressure on painful areas.
At the same time, be careful not to fall into an endless search for the “perfect” position. Constantly adjusting and rearranging in pursuit of total comfort can become its own source of frustration and keep you alert. Find a setup that feels reasonably comfortable and let yourself settle.
When to See a Medical Provider
The strategies in this guide focus on the relationship between your brain, nervous system, and pain, but they’re not a substitute for medical care. New, severe, or changing pain should always be evaluated by a medical provider first.
That said, many people find the most relief by combining medical care with nervous system-based approaches like sleep therapy and chronic pain therapy.
FAQs
How can I fall asleep quickly when I’m in pain?
There’s no trick that forces sleep instantly, and chasing one usually makes things worse because effort increases alertness. The more useful approach is to lower the pressure around sleep rather than trying to speed it up. Give your body a comfortable setup, use a calming technique to settle your nervous system, and let go of the goal of falling asleep fast. If you’re lying awake and frustrated, getting out of bed for a bit and returning when you feel drowsy can be helpful.
Does pain go away when you sleep?
No. Your conscious experience of pain stops while you’re asleep because your brain isn’t processing sensations the same way it does when you’re awake. That said, pain can still affect your sleep quality, pulling you into lighter sleep stages or contributing to nighttime awakenings even when you’re not fully aware of it.
Is pain actually worse at night, or does it just seem that way?
Chronic pain often feels worse at night. During the day, work, conversations, and activity give your brain plenty to focus on, which naturally pulls attention away from pain. At night, those distractions disappear, and the quiet leaves more room to notice different sensations. Fatigue also tends to lower your tolerance for discomfort. So while the pain may not change a lot, the way your brain perceives and amplifies it can intensify when there’s nothing else competing for your attention.
How to Get a Good Night’s Rest with Chronic Pain
Many people with chronic pain get caught in this chain of thinking: “I have pain, so I won’t sleep, so tomorrow will be terrible.”
It feels logical, but fear increases the threat signals your brain produces, which can increase both pain and wakefulness. In other words, the very worry about not sleeping becomes part of what keeps you awake and amplifies the discomfort.
A shift in expectation can interrupt this cycle.
The goal isn’t to reach zero pain before you’re allowed to sleep. The goal is to help your brain and body feel safe enough that sleep can happen on its own, even with some pain still present.
At DC Metro Therapy, we help people break the cycle of pain and sleeplessness using evidence-based approaches like CBT-i, Pain Reprocessing Therapy, and Emotional Awareness and Expression Therapy.
Instead of focusing only on symptoms, we work with the brain and nervous system patterns that keep pain and insomnia going. If you’re tired of fighting your body every night, we can help you find a different way forward.
Learn more about chronic pain therapy and sleep therapy, or get started with our course Calm Your Brain, Heal the Pain to begin retraining how your brain responds to pain, symptoms, and sleep.
