This commentary puts forward a simple paradigm: “poor sleep” causes or worsens pain. A lot of content is technical about biochemical pain pathways as it relates to what are known as pro-inflammatory states, because pain is one form of inflammation. Even if you skim through this section, you’ll see the gist is the paradigm stated above.
The researchers point out everybody seems to agree pain disrupts sleep and therefore leads to “poor sleep.” So, their goal is ask how to explain the converse, that is, how does poor sleep cause pain?
My frustration with the work is not about inaccuracies. Rather, virtually all sleep doctors already know poor sleep causes pain, because they’ve treated people with poor sleep who subsequently declared “my headaches vanished,” “no more fibromyalgia,” “no more aches and pains when I get up in the morning.” In other words, on the clinical level, any professional in the field of sleep medicine who works even part-time with patients has heard these kinds of results and so much more.
So, why would researchers need to write a piece of this sort when it’s common knowledge? The answer may or may not surprise, but it’s about the nexus between gaining funding for research and proving something scientifically.
I as well as many other sleep doctors can tell you about all the people who suffered headaches that vanished after treatment for sleep apnea, but that’s not the same as someone doing a scientific experiment to “prove” it. In such research one group gets treated with real PAP devices (appropriate pressure for each patient) and the other group would get a fake PAP (i.e. very low, non-therapeutic pressure). Once proven that PAP decreased headaches more so than fake PAP, we would then have scientific knowledge to be published in a journal. And, then of course, this new information could lead to more ideas about sleep and pain, and then you have a longitudinal plan in place to regularly gain funding to continue down this pathway of research…and dollars.
Scientifically, it makes a certain sense, but my frustration is the transfer of knowledge say to primary care doctors treating patients with headaches is delayed for years if not decades, because the information has not been validated in the scientific literature. When not in the scientific literature, the primary physician has an excellent chance of never hearing of these connections. What’s more likely is the primary refers a patient to a sleep center, and when the patient returns to the primary and exclaims how the sleep apnea treatment cured the headaches, eventually enough exposure to such examples leads the primary to change the way medicine is practiced.
This organic transfer of knowledge happens irrespective of the scientific literature, and considerable harms come to a great many headache sufferers who never interact with a doctor who knows the connections between their condition and the sleep apnea causing the poor sleep.
If you’d like to know more about morning headaches and sleep apnea, check out the 3:47 mark of this 8 minute video. By the way, in my clinical experience, albeit anecdotal, I have encountered patients with migraines who reported a radical decrease once they started using PAP.