Are you Sleeping?
This article is part 1 of a series about the Hidden Symptoms that are impacting your physical therapy. Be sure to check out the other hidden symptoms!
How often are you waking up? Do you wake feeling rested? Are your sleeping hours fairly consistent? How long does it take for you to fall asleep? Have you found a pre-sleep routine that prepares you for a restful night?
If you are not asking yourself these questions, I would suggest that now is a good time to start. The importance of sleep is not news to you. If I conducted an informal poll, I am willing to bet that a majority of you would know that "6-8 hours" of sleep is recommended and that most of you don't get enough. You know that a lack of sleep is interfering with your health.
What you might not have considered, however, how poor sleep is wasting your time and effort.
Let's start with the thing that drove you into a medical clinic:
PAIN
There is a lot more to pain than you think. In future articles, I hope to share with you some of the principles of pain neuroscience. For now, know that pain might have a source- such as a knife jabbing into your forearm- or it might not (think fibromyalgia); either way, it is the BRAIN that processes the information and turns it into the sensation that you experience. The brain and Central Nervous System have the capacity to turn the pain sensation up or down. Research is revealing that sleep and pain regulation operate along similar neural pathways. Furthermore, there is a relationship between poor sleep and those who experience chronic pain. As a patient experiences less deep sleep ("slow-wave sleep"), they report increased pain sensitivity and intensity. In a study of patients with fibromyalgia, the patients that were taught about sleep hygiene soon reported less pain and fatigue than those who were not given instructions. In essence, good sleep may have positive impacts on pain just as much as treating pain can improve sleep.
What you need to know:
When you get good sleep, you may experience less pain before therapy even begins. With less pain, you can more fully participate and make the most out of your PT session. Improved outcomes in less time while building better sleep habits? Yes, please!
IMMUNITY
Your Sympathetic Nervous System (SNS) is responsible for your body’s responses to heightened situations. You may have heard of it as the “fight or flight” system. Ideally, the SNS is at its “loudest” for short periods of time before the Parasympathetic Nervous System (PNS) takes over, keeping us in a calm, cool, collected state. During deep sleep, the SNS is turned waaaay down, allowing specialized immune cells to roam the body and clean up the inflammatory cells we accumulated during those SNS periods. When your loved ones are ill, what is the first thing you advise them to do? “Go to bed. REST.” We understand, even if we don’t heed, the healing powers of sleep. Maybe it’s time we internalize sleep’s preventative power.
What you need to know:
Deep, slow-wave, sleep gives your stress a break and allows the immune system to do its job.
MOTOR SKILLS
Have you ever struggled through a difficult skill- say a tricky guitar sequence, or that new TIk Tok move- only to find that you can suddenly do it after a good night’s sleep? You’re not imagining it. Multiple studies have demonstrated that something happens during sleep that turns novel motor tasks into ingrained skills. Individuals who sleep will often perform better on a novel task than those who stayed awake for the same period of time. Just as good sleep seems to enhance motor learning, poor sleep seems to interfere. Any one of us could tell a story about the time we had a bad game or race after a bad night of sleep? It’s not just fatigue that’s kicking your butt, it’s the sleep-deprived neuromotor processing that is bogging you down.
What you need to know:
A good night’s rest empowers you to perform better with new physical skills!
COGNITIVE FUNCTION
The keystones of cognitive function include Attention, Memory, and Learning. Anyone who has been a new parent can speak to the toll that disrupted sleep takes on your ability to function in any of those categories. I recall being a new parent and looking at a long-time client dead in the face while struggling to remember her name. We probably all have similar stories about being a grad student, new parent, insomniac, etc, and found that we couldn’t do the mental tasks that were required of us.
We often exercise in stimulating environments: A busy clinic, a bike lane, a living room crawling with kids and pets… It’s only simple on the surface. Your brain is quietly humming along, making decisions about what noises are important, which sensations should be created/avoided, and how to move the arm so that it does what your PT asked you to do. Imagine your brain trying to hum along as smoothly on 5 hours of interrupted sleep. When you lose sleep you lose your ability to efficiently attend, process, and learn. THIS MATTERS, EVEN (especially) IN EXERCISE.
What you need to know:
Your exercise/rehab session is an opportunity to learn and perform. Set yourself up for success with 6-8 hours of Z’s.
Now what?
This article was inspired by:
PT Pintcast: What Physical Therapists Have To Know About Sleep Health
Reference:
Catherine F. Siengsukon, Mayis Al-dughmi, Suzanne Stevens, Sleep Health Promotion: Practical Information for Physical Therapists, Physical Therapy, Volume 97, Issue 8, August 2017, Pages 826–836, https://doi.org/10.1093/ptj/pzx057
