How Chronic Pain Can Lead to Sleep Apnea

Many people living with chronic pain also suffer from serious sleep problems—including obstructive sleep apnea (OSA). Research has shown a strong two-way relationship between pain and poor sleep: pain makes it harder to sleep, and poor sleep can make pain feel worse.

The Vicious Cycle of Pain and Poor Sleep

Chronic pain affects how the brain handles sleep. It can:

• Cause frequent awakenings or “micro-arousals” during the night
• Prevent deep, restorative sleep (also known as slow-wave sleep)
• Lead to a lighter, more restless type of sleep known as alpha-delta sleep, which leaves people feeling unrefreshed

On the flip side, not getting enough quality sleep can:

• Lower your pain tolerance
• Slow down healing from injuries
• Make chronic pain feel more intense

How Common Is This?

• Over 28 million Americans report sleep problems due to chronic pain
• Between 50% and 88% of people with chronic pain also experience disrupted sleep
• The worse the sleep problems, the worse the pain tends to be

In a major study by Mysliwiec et al., researchers looked at active-duty military personnel and found a strong connection between pain conditions and insomnia. Nearly a quarter (24.7%) of the group studied were taking medication for pain, and many had trouble sleeping because of it.

Chronic Pain and Sleep Apnea

Pain may contribute to sleep apnea in ways similar to how PTSD affects sleep. The key problem is disrupted REM sleep, which is the sleep stage linked to dreaming and emotional processing.

When REM sleep becomes irregular—often due to pain signals or medications—the muscles that keep the throat open during sleep can relax too much, leading to airway collapse and breathing interruptions typical of sleep apnea.

Pain-related sleep issues can also lead to:

• Snoring, morning headaches, or migraines
• Muscle tension and fatigue
• Feeling unrested even after sleeping through the night

Conditions That Link Pain and Sleep Disturbance

Certain chronic pain conditions are especially tied to poor sleep and possible sleep apnea:

• Fibromyalgia
• Rheumatoid arthritis
• Osteoarthritis
• Chronic headaches or migraines
• Irritable bowel syndrome
• Chronic back pain or soft tissue injuries

Patients with these conditions often show abnormal brain wave patterns during sleep, such as frequent bursts of alpha waves that interfere with deep sleep. Some also experience sleep-related breathing disorders, periodic limb movements, or other disturbances that make their sleep unrefreshing and fragmented.

What This Means for Veterans and Others with Chronic Pain

If you have chronic pain from a service-connected injury or illness, and you’ve also been diagnosed with sleep apnea, there may be a direct medical connection. Pain may not just make it harder to sleep—it can contribute to the development or worsening of sleep apnea.

Understanding this link is crucial when applying for VA disability benefits, especially if you’re seeking a secondary service connection for sleep apnea.