Behavioral Sleep Interventions for Chronic Pain: Mechanisms, Clinical Evidence, and Future Directions

Abstract

Chronic pain affects approximately one-quarter of adults in the United States, with 50–80% also reporting clinically significant insomnia. Given the limitations and risks associated with pharmacological treatments, there is a growing need for effective non-pharmacological approaches that address both pain and sleep disturbance. This review examines the role of behavioral sleep interventions in chronic pain management by synthesizing recent evidence, clarifying mechanisms linking sleep disruption and pain, evaluating the efficacy of interventions such as cognitive behavioral therapy for insomnia (CBT-I), and identifying gaps and future research directions. Chronic pain and sleep disturbance demonstrate a bidirectional relationship, with sleep disruption contributing to central sensitization. Neurobiological evidence suggests that behavioral sleep interventions, particularly CBT-I, can reduce neural pain activation and pain intensity. Despite promising digital delivery options, barriers related to access, cost, and routine insomnia screening persist. The evidence supports sleep as a modifiable and clinically meaningful treatment target, underscoring the need for broader implementation and mechanistic investigation of behavioral sleep interventions within chronic pain care.