How is your sleep? Do you get at least 7 hours? Do you wake up feeling rested? Does your pain feel worse if you don’t sleep well? Does your pain keep you from sleeping?

Sleep is one of the most important factors that Is addressed in my first visit with my patients. Countless patients who come to me for pain relate stories of sleepless nights, having trouble getting comfortable to fall asleep, or waking multiple times at night because of pain. Without addressing and improving sleep, healing is delayed and difficult.

According to the CDC, about a third of adults in the US report getting less than the recommended amount of sleep. While lack of sleep is associated with increased accidents, decreased performance, chronic disease, mental illness and decreased quality of life, it also influences the experience of pain.

Sleep Promotes Tissue Healing

When you sleep there is an increase in concentration of immune cells in your blood as well as growth hormone. This is primarily for tissue growth and repair. The manual therapy portion of physical therapy treatment helps to stimulate this process. When you go to sleep that night, your cells and body are busy at work making the physical changes that need to happen in order for you to heal.

Sleep Decreases Systemic Inflammation

Systemic inflammation means an inflammatory process that involves the entire body, not just certain regions in response to an injury. The concentration of immune cells involved in the inflammatory response in the blood is decreased with good sleep.

The reason is thought to be because sleep decreases the activation of the body’s two natural stress response systems:

• The sympathetic or “fight/flight” system: a subconscious part of the brain and some nerve roots that are involved in matters of survival and regulating the hormone functions of your body. The main control center is in the deep part of the brain (black circle).

• The adrenal system (blue circle): secretes cortisol, the “stress hormone.” It is well known that high levels of cortisol are correlated with high levels of systemic inflammation in the body.

When you don’t enough sleep, inflammation is allowed to persist for long periods of time. Good sleep promotes healing and the completion of the inflammatory process.

Sleep Decreases Pain Sensitivity

It has been well established in many studies that the amount of pain someone has and the amount of sleep someone gets both influence each other.

Getting enough sleep basically decreases the activation of the nerves involved that signal pain in the brain. It also influences the immune system (as described in the last section) in a way that decreases the sensitivity of nerves that signal pain in the brain as well.

4 Easy Ways to Improve Sleep Quality and Promote Healing

• Pain Reducers: It’s ok to use your pain medication as recommended by your primary care provider to get you through this rough spot so you can find a comfortable position and fall asleep. This is especially true if you have had surgery. You will not be on the pain medication forever. The better your sleep, the less pain you will have, and with the help of your physical therapist, you’ll recover more efficiently. Before long you will not need the pain medication any longer!

• Use supports to find a comfortable position: See this blog post for some strategies.

• Develop Better Pre-Bedtime Habits: Other ways to ensure you get good quality sleep include having a set bed time to make sure you get the recommended amount of sleep each night. Also avoid eating big meals or junk food/drink before bed and screens a 1-2 hours before bed.

• Deep Breathing Techniques: Deep breathing techniques help to turn off the “fight/flight” sympathetic nervous system and turn on the “rest/digest” parasympathetic nervous system. It also helps to decrease perceived pain. Try this technique in any comfortable position with a 4 second inhale and a 4-6 second exhale for at least 5 minutes once you get into bed.

Sleep tight everybody!

References:

1. Sleep and Sleep Disorders. CDC Website. https://www.cdc.gov/sleep/index.html. 15 April 2020.

2. Okifuji, A., Hare, B.D. Do Sleep Disorders Contribute to Pain Sensitivity?. Curr Rheumatol Rep 13, 528 (2011). https://doi.org/10.1007/s11926-011-0204-8

3. Guido Simonelli, Janna Mantua, Mary Gad, Maria St Pierre, Lonique Moore, Angela M. Yarnell, Phillip J. Quartana, Allen Braun, Thomas J. Balkin, Allison J. Brager, Vincent F. Capaldi. Sleep extension reduces pain sensitivity. Sleep Medicine. Volume 54, 2019, Pages 172-176, ISSN 1389-9457, https://doi.org/10.1016/j.sleep.2018.10.023.

4. https://journals.lww.com/pain/Abstract/2015/08000/Sleep_and_pain_sensitivity_in_adults.10.aspx

5. 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

6. The Health Impact of night time eating: old and new perspectives. Amber W Kinsey, Michael J Ormsbee. Nutrients 7 (4), 2648-2662, 2015

7. https://www.cdc.gov/niosh/emres/longhourstraining/tips.html

8. Cramer, H., Haller, H., Lauche, R. et al. Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complement Altern Med 12, 162 (2012). https://doi.org/10.1186/1472-6882-12-162