Abstract
Noxious stimuli and painful disorders interfere with sleep, but disturbances
in sleep also contribute to the experience of pain.Chronic paroxysmal
hemicrania and possibly cluster headaches are related to REM sleep.
Whereas headache is associated with snoring and sleep apnea, morning
headaches are not specific for any primary sleep disorder. Nevertheless,
the management of the sleep disorder ameliorates both morning headache
and migraine.Noxious stimuli administered into muscles during slow-wave
sleep (SWS) result in decreases in delta and sigma but an increase
in alpha and beta EEGfrequencies during sleep. Noise stimuli that
disrupt SWS result in unrefreshing sleep, diffuse musculoskeletal
pain, tenderness, and fatigue in normal healthy subjects. Such symptoms
accompany alpha EEG sleep patterns that often occur in patients with
fibromyalgia. The alpha EEG patterns include phasic and tonic alpha
EEG sleep as well as periodic K alpha EEG sleep or frequent periodic
cyclical alternating pattern. Moreover, alpha EEG sleep, as well
as sleep-related breathing disorder and periodic limb movement disorder,
occur in some patients with fibromyalgia, rheumatoid arthritis and
osteoarthritis. Depression and not alpha EEG sleep are features of
somatoform pain disorder. Disturbances in sleep, pain behaviour and
psychological distress influence return to work in workers who have
suffered a soft tissue injury, e.g. low back pain. Patients with
irritable bowel disorder have disturbed sleep and have increased
REM sleep. In conclusion, there is a reciprocal relationship between
sleep quality and pain. The recognition of disturbed or unrefreshing
sleep influences the management of painful medical disorders.
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