It's a spiral. Lack of sleep causes pain to feel worse. Pain causes lack of sleep. Meds may be affecting your normal sleep pattern. That's something else to discuss with your doc--or maybe a nurse practitioner if one works with your doc. NPs are sometimes better listeners and if one has worked with several docs, an NP may be less locked into one way of medicating patients. I think some docs get into a rut of prescribing the same thing, while and NP may have seen a variety of doctors try different things. I'm hoping for less pain and more sleep for you, starting now!