The Intersection of Sleep Disorders and Postoperative Pain: A Narrative Review of a Bidirectional and Understudied Relationship

Abstract

Background: The relationship between pain and sleep represents one of the most significant yet insufficiently researched interactions between physiological systems during the perioperative period. Evidence indicates that pre-existing sleep disturbances, such as insomnia or sleep-disordered breathing, are strong predictors of postoperative pain intensity, higher opioid consumption, and increased risk of chronic postoperative pain.

Objective: This review aims to examine the bidirectional interaction between sleep and postoperative pain, highlighting its impact on rehabilitation and recovery, while proposing strategies for improved perioperative care.

Methods: Relevant literature was reviewed to evaluate the effects of postoperative pain on sleep architecture, including changes in sleep continuity, slow-wave sleep, and rapid eye movement (REM) sleep. Clinical and mechanistic findings on the reciprocal relationship between sleep disturbance and pain were also analyzed.

Results: Postoperative pain was found to fragment sleep, reduce restorative sleep stages, and impair overall sleep quality. Poor sleep, in turn, heightened pain sensitivity, interfered with rehabilitation, and delayed recovery. This cyclical relationship is rarely addressed in standard perioperative care despite its clear impact on patient outcomes.

Conclusion: A paradigm shift is required in perioperative medicine to incorporate preoperative sleep screening and targeted multidisciplinary interventions for sleep and pain management.

Implications: Future studies should focus on mechanistic and clinical investigations to break the cycle between pain and poor sleep. Integrating sleep-focused assessments and interventions into perioperative care pathways could reduce opioid use, improve recovery, and enhance overall patient well-being.