Sleep may not be the first topic you think about when recovering from an injury. Truthfully, I didn’t start to truly appreciate the role of sleep has in the recovery process until after I had my twin’s. I began to notice that the less sleep I got, the more my body ached throughout the day. The achy knee from my weekend run began to linger into mid-week, my sore shoulder from rocking my daughter to sleep seemed to nag well into my work shift. This is when the light bulb came on… Maybe I should start paying more attention to the role of sleep in the rehab process. Sleep may not be directly addressed through physical therapy treatments, but there should be some consideration of the negative effects poor sleep will have on the rehabilitation process.
Everybody has a bad night of sleep once in a while. The occasional sleepless night won’t make or break you. However, continuous nights of poor sleep will have multiple negative physiologic and psychological effects. While we sleep our body is busy at work, repairing and refueling for the next day. A proper nights rest will help maintain your cardiac health, manage blood pressure, balance hormone levels, promote immune system health, and improve your cognitive function (attention, processing, and memory) for the next day (1).
How Does Non-Restorative Sleep Play a Role in Rehab?
When you are sick, everyone knows to rest and get plenty of sleep to get better. We can take that same principle and apply it to your rehab process. Especially during the acute phase of your injury or after surgery, your body is busy fighting to heal the injury, so it will need extra rest to help the process along. This is why many patients report excessive fatigue following surgery, despite getting enough rest throughout the evening.
From a chronic standpoint, poor sleep habits may be related to chronic health conditions such as diabetes, cardiovascular disease, obesity, and depression (2). Research conducted on patients with chronic pain revealed that “86% were poor sleepers and 56% reached the cutoff for a diagnosis of clinical depression” (3). While we do not know what causes the relationship, the evidence is clear. Lack of sleep effects how we perceive pain, our mood, and our ability to recover from an injury.
If you struggle with sleep, don’t panic. One study showed that in patients with chronic pain, just one restful night sleep increased the amount of physical activity during the following day (4). As Physical Therapists, increased physical activity is music to our ears. If you are able to move more throughout the day, you will be more successful during your rehabilitation process.
Sleep Hygiene
Everyone’s sleep habits vary. The key to having restorative and restful sleep is determining how much sleep you need and at what hours of the night you sleep best. The America Academy of Sleep Medicine states the recommended amount of sleep varies depending on the age of the person, but individuals eighteen and older should sleep for seven to eight hours per night (5). Some of us are night owls, while others are up at the crack of dawn. You will want to tailor your schedule (if work and family allows) to cater toward your natural rhythm.
Lastly, if you find yourself in a constant cycle of fatigue and waking up each morning feeling foggy and unrested, you should work on your sleep hygiene. Sleep hygiene is a pretty straight forward concept; however, many of us continue to ignore it. The CDC refers to sleep hygiene as “practicing good sleep habits.” Start implementing these tips to practice good sleep habits.
Good Sleep Hygiene
1. Go to bed and wake up around the same time each day.
2. Avoid eating or drinking before bed (especially alcohol or caffeine).
3. Keep a quiet and calm sleeping space.
4. Put down your smartphone, tablet, or computer thirty minutes before bed.
5. Avoid napping during the day.
6. Exercise during the day, but immediately before bed.
A few simple changes to your evening routine may be just what you need to restore your function. Restorative sleep is such a simple and overlooked part of our lives that can lead to chronic health conditions, but by practicing sleep hygiene techniques we can all be healthier and more productive. Happy sleeping!
References
1. Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. J Clin Sleep Med2015;11(8):931–952.
2. Sleep and chronic disease. Centers for Disease Control and Prevention website. https://www.cdc.gov/sleep/about_sleep/chronic_disease.html. Updated July 1, 2013. Accessed October 7, 2017.
3. Harrison L, Wilson S, Heron J, Stannard C, Munafo MR. Exploring the associations shared by mood, pain-related attention and pain outcomes related to sleep disturbance in a chronic pain sample. Psychol Health. 2016;31(5):565-577.
4. Tang NK, Sanborn AN. Better quality sleep promotes daytime physical activity in patients with chronic pain? A multilevel analysis of the within-person relationship. PLoS One. 2014;9(3):e92158.
5. Matsumoto T, Tabara Y, Murase K, et al. Combined association of clinical and lifestyle factors with non-restorative sleep: The Nagahama Study. PLoS One. 2017;12(3):e0171849..
