Sleep Health: The Science Behind a Good Nights' Sleep
When I am able to help a patient get a better nights’ sleep by offering sound advice based on evidence, it is nice to see that pain levels decrease, and function improves. It seems reasonable and I’m sure many of you are thinking this is quite obvious. However, research has shown that many of us do things that interrupt our sleeping without knowing its harmful consequences.
Sleep disturbances occur in one third of the US population, and the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control has deemed insufficient sleep to be a public health problem. In survey studies conducted by physical therapists, PT’s have overwhelmingly agreed that proper sleep is important for health and poor sleep impairs function. Sleep is critical for the proper functioning of the body, including immune function, tissue healing, pain modulation, cardiovascular health, cognitive function, learning and memory. Sleep disturbances occur in all age groups and in people with various conditions that are typically treated by physical therapists.
Humans spend approximately a third of our life sleeping and it is not a time of physiologic inactivity, rather, it is a time of recovery that supports cardiovascular, neurologic, and connective tissues. Sleep is a basic human need and if you try and cheat it, it can cause problems down the road.
Without adequate sleep, people can experience increased pain perception, loss of function, and reduced quality of life, depression, increased anxiety, attention deficits, information processing disruption, impaired memory, and reduced ability to learn new motor skills, and are at an increased risk for accidents, injuries, and falls. Holy cow, that’s a lot of problems to deal with if you’re not sleeping well. Let’s have a look at how poor sleep can affect pain, depression and anxiety, motor skill learning and rehabilitation outcomes and mortality.
A decrease in sleep seems to be responsible for an increased sensitivity to pain. People with sleep disturbance have an increase sensitivity to pain, but also those with high pain intensity have less total sleep time, delayed sleep onset, increased nighttime wakening, and decreased sleep efficiency.
Depression and anxiety
Sleep disturbances are very common in individuals with depression and anxiety. About 75% of people with depression experience symptoms of insomnia. There is evidence that insomnia is a risk factor for depression and anxiety.
Motor skill learning
Many different motor tasks have been shown to benefit from sleep to enhance learning so that individuals who sleep following practice of a task perform better on the task compared with individuals who stay awake for a similar period of time. Sleep deprivation also interferes with motor skill learning. A recent study showed that those who were sleep deprived performed worse on an arm coordination reaching task compared with those who slept. So, if your work duties, exercises routine or competitive sporting event occurs on the heels of no sleep, your performance can be less than optimal.
Current evidence suggests that poor sleep quality may also contribute to the development of neurologic conditions. A pivotal study in 2013 demonstrated that the protein, beta amyloid, gets cleared or broken down in the brain with a good night sleep. When sleep deprived, these proteins clump together and accumulate in the brain. In Alzheimer’s disease the beta amyloid proteins clump together, forming hard plaques which accumulate in the brain. Therefore, the amount of sleep contributes to the growing evidence that sleep may play a role in the development of Alzheimer’s disease.
Mortality and Sleep
Sleep reduction and reduced sleep quality are associated with rehabilitation outcomes and mortality. Healthy individuals from 30 – 70 years old who sleep less than 6 hours or more than 8 hours each night had a higher risk for mortality compared with those that slept the recommended 6-8 hours per night. Bottom line is that there is a sweet spot of 6-8 hours per night provides you with the most health benefits.
Sleep Hygiene Advice
1. Go to sleep and wake up at the same time every day.
2. Use your bed for sleep and sexual activity only. This will train your brain to recognize the bed for sleep.
3. Develop a relaxing bedtime routine.
4. Avoid caffeinated foods and drinks at least 4 hours before bedtime.
5. Avoid drinking alcohol or smoking at least 3 – 4 hours before bedtime.
6. Do not take unprescribed or over-the-counter sleeping pills.
7. Avoid taking daytime naps so that you can fall asleep quickly at night.
8. Make your sleep environment relaxing and comfortable. Use lots of pillows for various body parts as needed and instructed by your PT.
9. Avoid eating large meals or spicy foods 2 – 3 hours before bedtime.
10. Talk to your doctor if you still have trouble sleeping.
This person is using a body pillow for comfort. Body pillows allow one to keep the pelvis, hips, knees and shoulders in a more neutral position. Sleep postures are not static. In a good nights’ sleep the body changes position more than 100 times.