💤 Why Sleep Matters When You're Living with Chronic Pain(and how it fits into DBT's "PLEASE" skills)
If you live with chronic pain, you’ve probably had nights where sleep just doesn’t come — and days where the lack of sleep makes everything worse. This isn't a coincidence. Sleep and pain are closely connected, and understanding that connection can help you take real steps toward feeling better.
One place we talk about this in DBT (Dialectical Behavior Therapy) is through the PLEASE skills — a set of strategies to care for your body so your mind can function at its best. One of those key strategies? Sleep.
🧠 The Pain–Sleep Cycle: A Tough Feedback Loop
When you’re in pain, it’s harder to fall asleep and stay asleep. But when you’re not sleeping well, your pain feels worse the next day. This creates a feedback loop where:
Poor sleep increases pain sensitivity
More pain leads to more sleep problems
And round and round it goes
It’s not just about physical discomfort — sleep deprivation also affects your mood, makes it harder to regulate emotions, and can increase feelings of hopelessness or irritability.
🛠 Enter the DBT "PLEASE" Skill
In DBT, PLEASE is an acronym that helps you reduce emotional vulnerability by caring for your physical body. It stands for:
PL – treat PhysicaL illness
E – balanced Eating
A – avoid mood-Altering substances
S – balanced Sleep
E – get Exercise
Taking care of your physical needs, like sleep, makes it easier to access your wise mind, tolerate distress, and stay in control — even when pain flares up.
😴 How Sleep Helps with Pain Management
Here’s what happens when you start improving your sleep:
Your pain threshold increases – You’re less sensitive to the same pain.
Your emotions stabilize – Less anxiety, fewer emotional outbursts.
You handle stress better – Which can reduce pain flare-ups triggered by tension.
You feel more in control – This builds confidence, which is a key part of healing.
It’s not magic. It’s biology.
🌙 Tips to Improve Sleep with Chronic Pain
Stick to a sleep schedule – Go to bed and wake up at the same time each day.
Create a wind-down routine – Dim the lights, avoid screens, and do something calming.
Limit naps – Especially in the late afternoon.
Get out of bed if you can’t sleep – Do something quiet and restful, then try again.
Stretch gently before bed – This can reduce body tension and pain.
Practice a DBT mindfulness exercise – Like breathing with willingness or half-smiling in bed.
🧩 You Don’t Need Perfect Sleep — Just Better Sleep
Chronic pain might make sleep difficult, but small improvements in your sleep habits can make a big difference in how you feel, think, and cope. It’s not about perfection — it’s about practicing willingness and making your body a little more ready to heal.
🌿 If you’re interested in learning more DBT skills to support your journey with chronic pain, I offer structured groups that explore tools like PLEASE in depth. Find out more here or reach out if you'd like to join the next round.
By Dr Michelle Beukes-King
