The Dichotomy: Chronic Pain and Sleep
- Dr. Howard A. Friedman MD, founder of HHOM LLC
- Oct 10
- 4 min read
10-06-2025
By Dr. Howard Friedman MD | Veteran | U.S. Army Medical Corps | Internal Medicine | HHOM LLC
Body cries in silence, the night becomes a weight.
Pain keeps the mind awake, sleep slips through the gate.
One needs the other to heal, yet each denies the door—
a cycle turning endlessly, until balance is restored.
----Dr. Howard Friedman, M.D.
Introduction
Chronic pain and sleep are locked in a two-way struggle. Poor sleep makes pain worse. Pain makes sleep harder to reach. Many veterans and patients describe it as a cycle they cannot escape long nights of tossing and turning followed by days of fatigue and heightened pain sensitivity. Science confirms what people living with this reality already know—the brain pathways that regulate pain and the brain pathways that regulate sleep are deeply intertwined.
Sleep: A Vital but Fragile State
Sleep is universal. Every species we know of has a version of it, yet no one fully understands why it is essential to life. Humans pass through distinct stages:
Stage 4 (deep sleep): The parasympathetic nervous system dominates here. Blood pressure falls, the heart slows, muscles relax. This is thought to be the body’s most restorative state.
Stage 5 (REM sleep): The sympathetic nervous system takes over. Dreams emerge, heart rate and blood pressure rise, and the brain is highly active.
The balance between these stages matters. Without enough deep sleep, the body cannot heal. Without enough REM sleep, the mind cannot reset.
Pain: More Than a Signal
Acute pain has a clear source—an injury, a burn, a broken bone. Chronic pain is different. It often outlives the original injury, sustained by rewired brain pathways that keep firing long after tissues should have healed. In this way, pain is less about what happens in your back or your knee, and more about what happens in your brain. These pathways keep the nervous system alert when it should be quieting down for sleep. The constant “noise” of pain interrupts the natural transition from wakefulness to unconsciousness.
The Cycle of Pain and Sleep
When pain flares, sleep is disrupted. When sleep is fragmented, the brain’s pain-processing pathways grow even more sensitive. Research shows that even modest sleep loss can amplify pain perception the next day. Over time, this becomes a cycle:
Pain prevents restorative sleep.
Poor sleep heightens pain sensitivity.
Heightened pain leads to further sleep loss.
Breaking this cycle is not simple. Medications can dull pain or promote sleep, but they rarely restore the natural rhythm. More promising are strategies that calm the nervous system—mind-body practices, consistent routines, and therapies that retrain both sleep and pain pathways.
Finding Hope: Breaking the Cycle
Though the link between pain and sleep can feel unbreakable, there are tools that help ease the loop. Healing doesn’t always mean eliminating pain, but rather finding ways to quiet its hold and reclaim restful nights.
Meditation and Mindfulness: Learning to calm the nervous system helps shift the brain’s attention away from pain signals and toward states of rest.
Music: Gentle, rhythmic music can lower heart rate, reduce stress hormones, and act as a bridge into sleep.
Hobbies and Creative Outlets: Engaging in art, writing, or simple crafts provides focus and joy, reminding the body that it can still feel pleasure beyond pain.
Routine: Going to bed and waking at consistent times trains the body’s circadian rhythm, making restorative sleep more accessible.
Connection: Sharing struggles with others—whether veterans, family, or support groups—breaks isolation and lightens the burden.
None of these erase pain. But together, they can soften its edges, invite sleep to return, and restore a sense of agency. With practice, patients often rediscover nights that heal instead of hurt.
Closing Reflection
At Howard’s House of Medicine (HHOM LLC), we understand how chronic pain and broken sleep weave together in a relentless pattern. Healing begins when the whole picture is seen—body, brain, and lived experience. That’s why we bring both medical insight and human understanding to the veterans, families, and patients we serve. Breaking the cycle is not easy, but it is possible. And you don’t have to walk that road alone.
In the hush of midnight hours, healing waits behind closed eyes.
But pain stands guard at every gate, restless, sharp, unwise.
When body and mind learn to yield, the cycle bends,
the pattern breaks. Rest returns, and with it—a gentler dawn awakes.
Dr. Howard Friedman, M.D.
—Dr. Howard Friedman, M.D.
Board-Certified | Internal Medicine | Veteran | U.S. Army Medical Corps
Founder of Howard’s House of Medicine (HHOM LLC)
Frequently Asked Questions:
Q: Can meditation really help with chronic pain and sleep?
A: Yes. Meditation and mindfulness practices calm the nervous system and reduce the brain’s focus on pain signals. Research shows they can lower stress hormones, ease muscle tension, and help the mind transition into deeper, more restorative sleep. Over time, meditation helps retrain the brain to separate pain from constant wakefulness
Q: How does music support sleep when you’re living with chronic pain?
A: Music works directly on both body and brain. Slow, rhythmic music can lower heart rate, reduce blood pressure, and decrease stress hormones—all of which create conditions for sleep. Beyond physiology, music can shift mood, provide comfort, and offer a gentle distraction from pain.
Q: What lifestyle changes make the biggest difference for pain and sleep?
A: Simple routines often make the greatest impact. Keeping a consistent bedtime and wake time helps regulate the circadian rhythm. Engaging in hobbies or creative outlets restores joy and reduces pain-centered thinking. Staying connected with supportive people—whether family, fellow veterans, or community groups—lightens the emotional load, which also improves sleep.
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