Sleep Quality Affects Daily Pain Among Veterans

Daily pain scores are higher among veterans who have shorter sleep duration, worse sleep quality, and lower sleep efficiency, according to study findings published in Sleep Advances. Further, improved sleep quality significantly reduces pain the following day.

Previous research has demonstrated that military veterans report higher rates of chronic pain and sleep problems than the general population. Accordingly, many veterans are at high risk for alcohol misuse, as these individuals may self-medicate with alcohol to cope with their pain and/or disturbed sleep. Although previous studies have observed a bidirectional link between pain and sleep, relatively little is known about daily associations between pain and sleep among veterans who engage in heavy drinking.

To evaluate the relationship between sleep and daily pain among United States veterans with insomnia who have high levels of alcohol use, investigators conducted a secondary analysis of a study performed between 2019 and 2023. Military veterans (N=109) who served after November 9, 2001, reported 1 or more episode of drinking at least 4 or 5 drinks in the past 30 days, had a sleep-onset latency of 30 or more minutes or wake after sleep onset 3 or more times per week, and an Insomnia Severity Index (ISI) score of 10 or more were eligible for this study. The primary outcomes of interest were the relationships between pain intensity on a 0 to 100 scale and sleep quality on a 0 to 4 scale. Mild pain was defined as a pain score of 0 to 30, moderate pain as 31 to 60, and severe pain as 61 to 100.

Of the 109 veterans included in the study, 84.4% men, 78.9% were White, and 63.3% served in the Army. The participants had a mean (SD) age of 38.8 (9.6) years, were deployed 2.0 (2.1) times, and they reported having 2.4 (2.1) drinks per day.

The participants endorsed having mild (57%), moderate (31%), and severe (12%) daily pain. Additionally, the participants reported a mean (SD) sleep duration of 6.2 (1.3) hours per night, sleep quality of 1.8 (0.6), and a sleep efficiency of 72.4% (12.4%).

Veterans who reported better sleep quality than average had a 1-point decrease in pain the next day (P =.01). Individuals who reported longer sleep duration, better sleep quality, and higher sleep efficiency reported lower pain scores than individuals with shorter sleep duration (P =.01), worse sleep quality (P <.001), and lower sleep efficiency (P <.001), respectively.

Individuals who reported high daily pain scores had shorter sleep duration (P =.02), worse sleep quality (P <.001), and lower sleep efficiency (P <.001) than those reporting lower pain scores.

In the moderation analysis, no effect of alcohol use was observed on any sleep-pain or pain-sleep relationships.

Overall, these study results indicate that sleep is associated with daily pain measures among veterans. “These findings are particularly critical for heavy-drinking veterans with symptoms of insomnia, highlighting sleep optimization as a potential strategy for pain management,” the investigators concluded. “Future research should investigate the mechanisms underlying these associations. Such research is essential for developing targeted interventions to improve the quality of life and health outcomes for Veterans.”

The primary study limitation is the reliance on self-reported outcomes for all study endpoints.

This article originally appeared on Sleep Wake Advisor