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We spend about a third of our lives doing it and we can’t survive without it.  Yet so many of us aren’t reaping all the health benefits that a good night’s sleep can provide.  How does getting quality sleep each night improve your overall health and wellness as well as help you recover more quickly from injury? 

Before we get started, take a minute to complete the sleep quiz below and see if there is room for improvement. 1 point for every “true” answer.

1. I don’t use my phone, tablet, or computer while in bed.
2. I don’t watch TV in bed
3. My mattress/sleeping surface is comfortable and has the right amount of firmness to help me rest without waking up stiff and sore
4. My bedroom is completely dark at night.  
5. The temperature in the room is set lower at nights between 60 and 67 degrees
6. The bedroom is completely quiet or there is soft “white noise”
7. There are no pets or children in bed with me.
8. My bedroom is organized, clean, and comfortable before I go to bed
9. I go to bed and wake up around the same time every day.

10. I consistently get between 7 and 9 hours of sleep every night.
11. I avoid alcohol, cigarettes, caffeine, and heavy or spicy meals 2-3 hours before bed.
12. I go to bed around 10 pm every night.

How’d you do?  

Here’s what your score means:

10-12 points: Good Morning!  You should be feeling refreshed and ready to face the day! Keep up the good work knowing you are maximizing your health and wellness.

7-9 points: A decent night’s’ rest is within your reach.  There is some room for improvement but overall you’re doing pretty good.

4-6 points: Feeling drowsy and worn out?  There are many things you can change to improve your sleep which will improve how you feel throughout the day.

0-3 points: You snooze, you lose! You’re at risk for many of the health consequences listed below.  Consider the short and long-term consequences of not getting the quantity and quality of sleep you need and deserve. It’s time to make some changes.

Let’s look at a few quick facts about the health consequences of not getting enough quality sleep:

• Lack of sleep has been shown to increase the risk of heart attack, stroke, diabetes, and obesity
• Lack of sleep increases the activation of genes linked to inflammation
• People who get seven hours of sleep a night or less are almost three times as likely to get sick as the people who got at least eight hours of sleep a night.
• Adolescents who average less than 7 hours of sleep per night are more likely to fail in school
• 63 percent of men who had a heart attack also had a sleep disorder
• Poor sleep quality leads to quicker cancer growth and more aggressive tumors
• A lack of sleep over time is associated with a decline in brain size
• Disruption of sleep cycles is linked to higher rates of breast, ovarian, and prostate cancers.
• Lack of sleep decreases pain tolerance
• Poor sleep quality also results in worse memory and a greater likelihood of developing Alzheimer’s.
• Children who get fewer than eight hours of sleep per night are 1.7 times more likely to get injured while playing their sport, compared with those who get eight or more hours of sleep.

With so many negative health consequences from skimping out on sleep, it could be one of the simplest things to alter in order to dramatically improve our health and wellness on many different levels.  From physical to psychological, the effects of how, when, and how much sleep we get impacts all areas of our lives.

One question I often get as a physical therapist is what can someone do to speed up their recovery and heal faster from an injury or from surgery.  In a previous blog ‘Nutrition for Injury Recovery’, Andrea Reynolds shared some insights to what type of diet can help us recover and repair injured tissues.  So how does sleep impact our recovery and can it make a difference in how quickly we get back to doing the things we love?

There are three key hormones released by the body that are affected by our sleep.  The first is human growth hormone or HGH. Throughout the day and especially at night your body releases HGH that is converted into growth factors by the liver. These growth factors work to rebuild muscles, joints, and other tissues.  Interestingly, when we choose to sleep has an effect on the secretion of HGH.  Some studies show that HGH has the highest levels of secretion between 10 pm and 2 am, but only if we are asleep.  Other reports cite that HGH levels top out about an hour after we fall asleep before we reach the rapid eye movement (REM), or dream stages, of sleep.  Either way, sleep deprivation suppresses the release of HGH and overall growth and healing.

Cortisol is another important hormone in the body that is secreted in response to stress.  As one of the “fight or flight” hormones, it is helpful to mobilize energy stores and prepare the body for activity to deal with the stressor.  While appropriate for short periods of time, high levels of cortisol for long periods of time has numerous negative health effects. Chronically high levels of cortisol suppress the immune system, delays bone and wound healing, and inhibits muscle growth. Less sleep at night causes secretion of cortisol. In addition to delayed healing and growth, increased cortisol has also been shown to increase visceral fat and to actually break down muscle in exchange for energy.   In one study comparing 2 groups on a calorie restricted diet, those who slept 5.5 hours a night lost 55% less body fat compared to those who slept 8.5 hours. Both sleep groups lost weight, but the sleep-deprived group lost more muscle mass than the group who slept more. In addition to finding ways to manage your stress level during the day, exposure to sunlight in the morning results in decreased levels of cortisol later on in the day. Resetting your biological clock happens when you get sunlight between 6 am and 8 am.

Melatonin is the last of the three hormones I’ll mention that plays a crucial role during our sleep/wake cycle. In addition to helping regulate our biological clock, it is a powerful anti-oxidant and has an anti-inflammatory effect on the body.  Its release is stimulated by darkness, and melatonin levels peak between the hours of midnight and 8 am. This release can be suppressed by the exposure of light, particularly blue light. Hence, the use of electronic devices that emit blue light can interfere with our ability to fall asleep and obtain the amount and quality of sleep that we need.

So what can you do to improve the quality of your sleep and reap all the health benefits of a good night’s sleep?

1. Power Down the Electronics

We’ve all heard this before.  As mentioned above the blue light emitted from electronics stimulate cortisol production and decreases the melatonin release, which in turn messes up our sleep-wake cycle.  Try to stop looking at screens at least an hour before bed or there are programs/apps you can download (f.lux) which shift the color shades on your viewing screen to a redder hue.  If you are an iPhone user you can enable the “Night Shift” mode that blocks the blue light coming from the phone. When going to bed, I recommend not even having these devices in the same room with you.  If you do use your electronic device as an alarm clock, set it on the other side of the room so you won’t be tempted to check how many likes your facebook post received in the middle of the night.  Make sure the device is placed face down and on silent so that every notification and text message doesn’t illuminate the room.

1. Darkness Is Your Friend

Do as much as you can to reduce any other light sources in your bedroom. Use thick drapes or blackout curtains to block remaining cracks of light from the window.  Keep nightlights in the halls or bathroom, not in the bedroom. The darker the better.

3. The Sound of Silence.

If you live in a busy area of town with traffic or other constant noise you might consider using earplugs.  Turn off or silent appliances/devices to avoid interruptions at night. There are some basic machines which help create “white noise” to block out background noise and allow you to relax.

4. Turn down the thermostat.

Studies have shown that we sleep the best within a temperature range of 60-67 degrees Fahrenheit.  Warmer temperatures will cause night sweating and restlessness resulting in a lack of sleep. Installing a ceiling fan for the hot summer months can keep you cool as well as provide some white noise.

5.  No Pets in Bed

Avoid any furry distractions in bed. Not only do they raise the temperature but continual distractions can lead to less quality sleep.  Your cat shouldn’t be the morning wake up alarm at 4 am when it gets hungry or bored. Save yourself feeling tired in the morning and train your pets to not sleep in your bed.

6.  Keep the Room Clean

Your bedroom is your sleep sanctuary.  Keeping it clean, organized, and comfortable can allow you to relax and wind down as you prepare for bed.  Choose calming colors for the walls and decor that makes it a place where you can fall asleep easily without being distracted.

7.  What’s Your Bedtime?

Try to get into the habit of going to bed and waking up at the same time every day.  This helps keep your biological clock in rhythm and avoids huge swings in the sleep hormone levels.  Most people need between 7-9 hours a night. This need can change based on age, healing, and recovery needs.  If you are ill, the body needs to rest more. There is no magical time that everyone needs to sleep. If you are falling asleep in class or at work all the time and need stimulants to stay awake, you might need to sleep longer or look at the suggestions in this article to improve your quality of sleep.  Sleeping too much can be detrimental as well.

8.  Food and Drink

Avoid alcohol, cigarettes, caffeine, or heavy/spicy meals 2-3 hours before sleeping. They can keep you alert and awake, delaying how quickly you fall into a deeper sleep. Caffeine taken even 6 hours before bed can lead to the loss of up to 1 hour of sleep.

9.  Sleeping surfaces

There as many different mattresses body types as there are.  Some people need more firm surfaces while others find it easier to relax on a softer top.  When you choose a bed, lay down on one and plan to spend a few minutes there. Note how your body reacts to the surface.  If you find yourself relaxing and getting more comfortable, then that might be a good choice for you. Your mattress should be flipped and rotated every several months to avoid deformation and to break it in evenly.  If you roll to the center every time you get into bed because of the sagging it might be time for a new mattress.

10.  Pillow

Your pillow should be supportive enough to fill in the space between your head and mattress when you are on your side but not so much that your head is pushed forward when you are on your back.  One of the biggest mistakes I hear about is people sleeping with more than one pillow under their head. There are few worse things for your upper back and neck to be constantly forced into an awkward position for several hours at night.  As much as possible your pillow should help preserve the natural alignment of your head and spine. If you find yourself needing to place your hand or arm under your pillow, it might need to be a little thicker.

11.    Sleeping Position

This leads us to one final point about improving the quality of your sleep.  Your sleeping position! If you can’t find a position to get comfortable, your physical therapist might be able to help!   Some low back or hip conditions do well when a pillow is placed between the knees while you are on your side. Avoid sleeping on your stomach (prone) as much as possible. Laying prone places increased stress on your neck and lower back.  Don’t sleep with the arms overhead (Keep the elbows below your shoulders) to avoid placing more stress on the shoulders and use other pillows or towels to support injured areas. If you are still having trouble getting comfortable, make an appointment with your physical therapist who can problem solve with you based on your specific area of discomfort.

With a little effort and a few changes, you can turn restless nights into a time for your body to recover and repair itself.  Sleep your way to better healing and health!

Matthew Randall, PT, DPT, OCS, SCS, MTC, CSCS
Doctor of Physical Therapy

References

Pietrangelo A, et al. (2017)The Effects of Sleep Deprivation on Your Body 
healthline.com/health/sleep-deprivation/effects-on-body#1 sleepfoundation.org/sleep-topics
Wikipedia contributors. “Growth hormone.” Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 13 Dec. 2017. Web. 7 Feb. 2018.