No way to sleep when you suffer from pain

Endometriosis-related pain prevents proper sleeping

Key Points

Highlights:

• Severe endometriosis pain is related to insomnia and increases the risk of sleep disturbances up to 3 times.

Importance:

• It is important to question the sleep quality of women with "pain and endometriosis" while dealing with resistant symptoms.

What's done here:

• Women between 18-50 years diagnosed with endometriosis in a tertiary center have been included
• Pain assessments have been made by the Numeric Rating Scale (NRS), ranging from 0 to 10.
• The sleep assessment was made with a self-administered questionnaire, named "The Portuguese version of the Insomnia Severity Index".
• The women without pain and with mild pain were in “group 1” and women with moderate or severe pain were in “group 2”.
  

Key Results:

• A total of 234 women, 39 (17%) without pelvic pain, 66 (29%) with mild pain [Group 1]; 53 (23%) with moderate and 76 (32%) with severe pain [Group 2] were included.
• Insomnia frequency has been found parallel in women with moderate or severe pain.
• Three-fourths of pain-free or with mild pain revealed no insomnia-related symptoms.
• More than half of women with moderate pain and half of those with severe pain had insomnia.
• Moderate to severe pain increased insomnia 2.8 times and having severe pain increased insomnia risk up to 2 times.
• Being under-educated has also increased the insomnia rate by 2 times when compared to the educated population.

Limitations:

• Using self-reporting systems and also describing endometriosis by clinical imaging diagnosis and not histological assessment might mislead some results by overdiagnosis.

Lay Summary

Having chronic disease might alter the sleep quality and disturb sleeping periods. Besides insomnia, endometriosis itself changes the pain sensitivity and increases the body’s reaction to inflammatory and painful inputs. Thus, as a chronic and painful long-term situation, the relation between endometriosis and sleep disturbances is extremely important.

In the study conducted by Ricardo José de Souza et al, the researchers conducted a prospective self-report-based survey to outline the relation between endometriosis-related pain levels and insomnia. Women between 18-50 years diagnosed with endometriosis in a tertiary center have been included. Pain assessments have been made by the Numeric Rating Scale, and the sleep assessment was made with a self-administered questionnaire, namely "The Portuguese version of the Insomnia Severity Index".

The researchers gathered women without pain and mild pain and women with moderate or severe pain in the same groups. Insomnia frequency has been found in half of the women with moderate or severe pain. Three-fourths of women with mild pain or pain-free revealed no symptoms related to insomnia.

Moderate to severe pain increased insomnia 2.8 times.  Having severe pain increased the insomnia risk up to 2 times twice for every 10 years of pain duration. Furthermore, being under-educated has also increased the insomnia rate again by 2 times when compared to the educated population.  

The authors concluded that insomnia is a part of the life of women with endometriosis. Thus, it should be taken seriously by clinicians and should be questioned when dealing with resistant pain, thinking that insomnia might be the one making the problem even bigger.

Research Source: https://pubmed.ncbi.nlm.nih.gov/35478292/