A Painful Trifecta

In clinical practice, the treatment of sleep disturbance in the setting of chronic pain can be challenging. In the case presented, a patient with a longstanding history of insomnia, chronic pain, and psychiatric comorbidity was recently assessed and treated for mild obstructive sleep apnea. With treatment, there was substantial clinical improvement in several areas of functioning. This helps to illustrate that addressing coexisting sleep problems can help more refractory symptoms, such as chronic pain. While severe impairment persisted, this complex patient had a rapid change in symptoms. The dynamic interplay between sleep, pain, and psychiatric disorders is discussed, as well as the finding of alpha intrusions and alpha-delta sleep on the patient’s polysomnogram. Treatment implications are addressed.