When it Hurts to Stay Awake

Further Thoughts on Sleep and Pain

The two most fundamental warning signals we encounter in our many days, through the long nights of our lives, are tiredness and pain. They remind us of our limits and encourage us to change our ways. Individually they’re manageable, at least in small doses. But together they can spiral us down into the depths of illness. When sleep deprivation and the infliction of pain are combined they have a single name – torture. This might seem a little melodramatic, but think about it from an everyday perspective. You work a long day, sweating at physical labour. At night you ache, you hurt, and rest returns you to something approaching normality the next day. But what if you can’t sleep properly?

More pointedly, what if your job doesn’t allow you to sleep properly?

In recent posts I’ve written about sleep and pain separately, but I’ve been thinking about their combined effect increasingly often. The disappearance and death of Vicky Flores here in Discovery Bay, Hong Kong has had a lot to do with that. For those who haven’t read my previous posts on Vicky, she was a domestic helper who fled her employer’s house for no established reason and drowned later that night. The police have commented that she was very stressed, but friends have also mentioned that she was suffering from various aches and pains before she died. Domestic helpers are often expected to work extremely long hours in Hong Kong, and Vicky died with mild pain killers still in her system, so I began to wonder whether there could be a link.

This line of inquiry certainly won’t solve the mystery of Vicky’s disappearance, but it could well illuminate one of the darker corners in the lives of lowly paid contract workers around the world.

Two recent studies offer a glimpse into the socio-economics of pain, fatigue and how they combine. The first, covered briefly in the July print edition of Scientific American, reports a survey of the extent to which Americans feel pain in their daily lives. A majority of the interviewees who were feeling pain were also dissatisfied with life. Hardly a surprise there – it’s what the Americans call a ‘no-brainer’. But hold that thought for the moment. Another two statistics that add something more specific to the scenario are the percentages of those in pain who were earning more than US$100,000 per year and less than US$30,000 per year.

The corresponding figures were 22.9% and 34.2%. In other words, and obviously leaving aside 42.9% of sufferers between these two income thresholds, there is an almost 50% increase when we move from people in pain who are well off to those in pain who are just scraping to get by. Add in dissatisfaction with life and you get hint of what low income, and more often than not physical labour, can do. But we still haven’t touched on sleep, and it turns out that interrupted sleep could well lower pain thresholds and make people suffer more. This in itself is worrisome, but the effect is particularly noticeable in women, especially those who need to wake frequently, like new mothers and – you guessed it – lowly paid domestic helpers.

Michael Smith, Robert Edwards, Una McCann and Jennifer Haythornthwaite published an article in the journal Sleep last year that highlighted a possible link in women between regular interruptions to sleep and tolerance for pain. More so than women who had their sleeping hours restricted, those who were forced to wake frequently reported pain more quickly when immersing a hand in ice water, even after a recovery sleep. The point is not that there’s a direct link between what you might call everyday fatigue and a greater likelihood of feeling pain, but that something allows the two to co-occur.

Why would a domestic helper have to wake frequently during the night? Not long after my wife arrived in Hong Kong she was given charge of a 3-day old baby, and for six years acted as his mother in all but name. That meant frequent awakening, long hours, working very hard to deal with two other children, and ultimately a great deal of physical discomfort. Her monthly income was around 4% of that earned by the woman who gave birth to the child.

The price of pain is far lower than you might presume.

We’ll probably never know what caused the aches and pains Vicky Flores carried in her final days, and she didn’t have to care for children. But like many domestic helpers she could have had other unreasonable demands on her time, various restrictions on her precious hours of sleep. She was, after all, compelled to live in her employer’s house by a standard contract that specified no set working hours.

There are over 200,000 foreign domestic helpers in Hong Kong, some underpaid, many more dragging through their days with little sleep. They’re living in a house of pain.

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