The Pain of Poor Sleep: A Clinician’s Guide to Assessing and Addressing Sleep Dysfunction in People With Musculoskeletal Pain Conditions

BACKGROUND: Poor sleep is highly prevalent among individuals with pain conditions and contributes to increased sensitivity, emotional dysregulation, and impaired recovery. Despite the strong evidence linking sleep disturbances with pain and disability, sleep is rarely addressed systematically. Physical therapists have the opportunity to screen for sleep dysfunction, provide behavioral education, and refer patients to sleep medicine specialists when necessary. CLINICAL QUESTION: How can physical therapists effectively integrate sleep health assessment and behavioral strategies into the management of individuals with musculoskeletal pain conditions? KEY RESULTS: This commentary provides a pragmatic framework for addressing sleep dysfunction in physical therapy. A stepped approach to sleep screening is recommended, focusing on key questions and validated tools to identify insomnia, obstructive sleep apnea, and restless legs syndrome. The role of cognitive behavioral therapy for insomnia (CBT-I) is highlighted, with an emphasis on 4 domains: reducing presleep arousal, increasing sleep drive, entraining circadian rhythm, and promoting sleep hygiene. Sleep hygiene alone has limited impact, but when integrated with other strategies, it supports broader behavioral change. CLINICAL APPLICATION: Physical therapists should routinely assess sleep as part of a comprehensive pain management strategy. Integrating sleep health promotion, screening tools, and appropriate referral pathways into practice supports person-centered pain care. Enhanced training in sleep health for physical therapists will support the delivery of evidence-informed sleep support. JOSPT Open 2026;4(1):12-22. Epub 11 November 2025. doi:10.2519/josptopen.2025.0198