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Have you ever considered going to sleep with your Physical Therapist? ...She is an expert in sleep posture after all.  The National Sleep Foundation reports low back pain, chronic pain, and neurologic conditions like Parkinson’s as causes of insomnia. If you haven’t thought of talking to your physical therapist about sleep, maybe now is the time.

Why is Sleep Important?

We sleep for ⅓ of our lives. Sleep is a basic human need. Not just a period of inactivity, sleep is a critical period of recovery; it gives insight into the functioning and health of your whole body.  Disrupted sleep negative effects your quality of life, function, and well-being.  Without adequate sleep, you’re likely to experience increased pain perception, loss of function, depression, increased anxiety, attention deficits, impaired memory, and reduced ability to learn new motor skills. Disturbed sleep also increases your risk for accidents, injuries, and falls. With 50-70 million adults in the US experiencing chronic sleep disturbances, let’s considering how we are affected.

What does Sleep Impact?

• Immune Function and Tissue Healing- Many of the immune system functions occur during the body’s sleep-wake cycle. The number of fighting cells increase during the day when we are more likely to encounter more bacteria. During sleep our other immune cells and hormones are released and pro-inflammatory cell activity increases. This increases healing and decreases the body’s natural stress systems. Sleep deprivation limits our immune response and tissue healing.
• Pain Modulation and Perception- It is believed that sleep regulation and pain modulation are controlled by same nerves. There is a positive correlation between sleep quality and pain perception. People with sleep disturbance report increased sensitivity to pain, but also those experiencing high pain intensity have reported significantly less total sleep time, delayed sleep onset, increased night time wakening, and decreased sleep efficiency. Pain has been associated with poor sleep quality and shorter sleep time in patients with chronic pain, including those with fibromyalgia, osteoarthritis, low back pain, and painful diabetic peripheral neuropathy.
• Cardiovascular Health- Less than 6 hours of sleep at night is associated with an increased risk of heart disease. Sleep deprivation increases the sympathetic nervous system activation, which prevents your cardiovascular system from resting at night.
• Cognitive Function-While sleep impacts all cognitive functions, attention is most affected. Sleep deprivation results in slowed responses and increased mistakes on a test of maintained attention. Sleep disturbances may contribute to depression and anxiety through several mechanisms, including altered regulation of neurotransmitter activity and hyperarousal of brain brain related to emotional regulation. About 75% of people with depression experience symptoms of insomnia.
• Learning and Memory- Your working memory and attention are impacted by sleep. Your working memory helps you remember a new telephone number long enough to dial; or remember numbers to do mental math. You have to attend to information to put it in your working memory. Your auditory and visual-spatial attention allow you to respond to events around you. A lack of sleep reduces the speed you respond with. As part of this attention, sleep deprivation interferes with motor skill learning. A recent study showed that sleep deprived individuals performed worse on a reaching task compared with those who slept. If you’ve ever knocked over your morning coffee after a sleepless night, you know exactly what we mean.

Why does my Physical Therapist Care about my Sleep?

Most people come to their physical therapist for 1 of 2 reasons: to get out of pain, or to recover from injury. In order for your physical therapy to have the best impact, you need to be well rested.

• Immune Function and Tissue Healing- If your immune function is taking a hit, increasing blood flow and promoting healing is going to be slowed. This means your PT isn’t going to get its maximum effect. It means delayed recovery and possibly frustration from both you and your PT.
• Pain Modulation and Perception- So, you want to get out of pain, but PT isn’t helping. It could be in your head (but not the way you think… learn more about pain here). We know that pain perception is worse when we don’t get enough sleep, so your lack of sleep may be contributing to your ongoing pain.
• Cardiovascular Health- Exercise is a key component of your health and ability to feel well, but diminished heart health is going to make that much harder. Additionally, it is going to lead to quicker fatigue meaning you get less out of each physical therapy visit than you could.
• Cognitive Function- When your cognitive function is impaired, you’re likely to take bigger risks. If you’re coming off of surgery or a recent injury you may return to normal sooner than you’re ready. That means longer recovery, and often more painful procedures. Sleeping enough helps you make informed decisions that can help increase the speed of your recovery. When your PT tells you to rest, it’s a good idea to listen.
• Learning and Memory- When your motor skills are diminished your movements are not as crisp. When your movements aren’t as crisp, you don’t perform them correctly. This improper form can mean straining other body parts to get the same effect, or getting nearly no effect at all. Proper rest leads to proper form, and proper form leads to a better healthier you.

What can I do to sleep better?

When it comes to sleep your position is a bigger deal than you might know.

Your physical therapist can work with you to identify why sleep posture might be problematic for you, but there are a few common issues. Individuals with low back pain may benefit from side-lying with a pillow between their knees, or they may sleep on their back with pillows under the knees to decrease stress on the spine. Difficulty with bed mobility of moving in bed may also be affecting sleep. Adequate bed mobility is needed to change position while sleeping, and improved ease with changing position with sleep may reduce sleep disruptions. If you’re uncomfortable when lying in bed, you need to make a change. If you’re not sure what to do, it’s time to ask.

Anything Else?

Your physical therapist may be knowledgeable in sleep hygiene practices as well. Here are our top 7 sleep hygiene tips:

1. Go to sleep and wake up at the same time every day. This will naturally reset your biological clock and sleep cycles.
2. Limit screen time 30 minutes before bed. The blue light emitted decreases melatonin, increasing difficulty with falling and staying asleep.
3. Use your bed only for sleep. Avoid eating, working or watching TV in bed. By only sleeping in your bed, you train your body to sleep when you’re in bed, which will help you fall asleep faster.
4. Develop a relaxing bedtime routine. For example, reading, a warm bath, meditation, or stretching.
5. Avoid caffeine and spicy meals 4 hours prior to bedtime. Caffeine and spicy food can increase your brain activity making it harder to fall asleep.
6. Avoid moderate to vigorous exercise 2-3 hours before bed. Exercise stimulates your body and brain. Instead try exercising earlier in the day, vigorous exercise far enough in advance actually improves sleep at night.
7. Eliminate daytime napping, or limit napping to 20-30 minutes. Your body has natural sleep cycles. You might catch a little extra sleep here of there, but too long a nap will keep you up or lead you to night-time restlessness.

If you are experiencing difficulty sleeping, FYZICAL offers for a free evaluation of sleep positioning and possible treatment to decrease the negative effects of poor sleep.

https://www.sleepfoundation.org/insomnia/what-causes-insomnia