Jason Burtchell, PT, Cred. MDT
Don't wait to sleep until you're dead.
That’s right: this is a blog post by a physical therapist about sleep. Why? Shouldn’t I be talking about shoulders, backs, pain management and whatnot? Well, yes- and I assure you I will in future posts, but I find this subject so universally important regardless of body part, or whether or not you have experienced an injury at all, that it is worth my time and effort (and, frankly, your time and effort as well) to get this information out to as many people as possible.
It's hard to unplug, I get it. Between running a household, your job (looking at you, newly "work from home" people), the constant pull of our phones, the pull of streaming services allowing us to binge watch our favorite shows, disruption of routine: it's easy to put off going to bed. Then there is stress, thinking about what the next day brings, the election, COVID, and never mind the personal trials and tribulations that we all contend with that can keep our mind racing and our eyes open at night.
There's also pain. Many of us understand what it's like to lose sleep because we are hurting, a cycle that is all the more frustrating because sleep would be at least a temporary reprieve from hurting.
About 1/3 of adults in the United states get less than 7 hours of sleep per night1. There was a time when there was some bravado about this, the pride in working hard for incredibly long hours and sacrificing sleep- the “I’ll sleep when I’m dead” mantra. I certainly used to “live” by it.
Unfortunately, there is resounding evidence that lack of sleep will help us arrive at our final destination sooner than we may have otherwise.2 Long term sleep deprivation has been linked to: dementia/Alzheimer’s, obesity, heart disease, cancer, and a 12-15% increase in mortality when compared to those getting an average of about 8 hours of sleep.3,4
Short term, it will impact our memory, creativity, physical performance, testosterone production and mood. It can have scary effects on our immune system too: The flu vaccine effectiveness can be reduced up to 50% simply by receiving it when you are underslept.5
As a physical therapist, I have observed pain negatively impact sleep and conversely observed lack of sleep amplify pain symptoms. One patient whom I will never forget would sleep less than 4 hours per night most nights. I had been seeing her for some time and we were struggling to help her improve though we were providing the best interventions and she was very compliant with her home programming. Once I connected the dots (that she slept extraordinarily little), we changed her home program to include a non-negotiable 7-8 hours of sleep per night. Her symptoms reversed almost literally overnight. Not only that, but she sustained her improvements as she kept her sleep regular; when she did slip up and was under slept, she always felt worse.
As it turns out, the quality of our sleep matters a great deal as well. There are two main phases of sleep: non-REM sleep, and REM sleep. Both are important to our health, and both can be disrupted by poor sleep hygiene (more on that in a moment). Non-REM sleep is important for immune system function, energy restoration, cell regeneration, and healing to name a few things. REM sleep is critical for emotional regulation, learning, and creativity. We cycle through non-REM and REM phases of sleep throughout the night, thought the phases shift in duration as the night progresses: We have a bias toward deep sleep earlier in our sleep cycle, and have more REM sleep as we sleep longer. 6,7 We can, of course, impact our sleep quality in a number of ways besides just from a quantity standpoint.
So what can we do to improve our sleep quantity and quality? Check out these tips below. If you find that after trying these you are still struggling to get quality sleep, it’s important to follow up with your medical provider to discuss why you may be having trouble. There are a lot of types of sleep disorders out there, which means there are lots of treatments available too.
Tips to improve your sleep
1. Going to rip the band-aid off first here: put all electronics into “power off” mode at least an hour before bed, and preferably 2. The impact of our electronic devices on our ability to sleep is significant and multi-factorial: the light from the screens can impact our melatonin production (made by our bodies to help us sleep). Bright lights and blue light, specifically, can tell our biology that it’s “daytime” and therefore stimulate us to stay awake. Using a blue light filter (on your phone, computer, or tablet) can help reduce this, BUT: there is also a significant stimulating effect that will “rev us up” with electronics. Remember, all of our devices are designed to keep us on them. There’s a reason why you went to check your Facebook “real quick” and then looked up an hour later not quite sure where the time went.
2. Cool off a bit. We sleep better with our core temperature down. Ideally our room will be around 65-68 degrees. Some hacks? Well, in addition to keeping your bedroom cooler, you can take a hot bath right before bed. Why? The warm water will help bring blood to the surface and your extremities. When you get out of the bath, you can help dissipate that heat as you are getting into bed.
3. Keep your bed and wake time as consistent as you can. I certainly struggle with this. I tend to get up very early and try to go to bed early during the week. Then the weekend comes and I stay up later (to socialize or, admittedly, binge on The Umbrella Academy). By Sunday night I can’t fall asleep easily because now I’m already used to being up later. That Monday morning is that much worse as a result. The closer you can keep your sleep and wake times the same all days per week, the less disrupted your sleep cycle will be.
4. Get physical. Of course exercise helps regulate sleep. Even better: exercise outside and get some daylight, as this is the time we want that blue light exposure.
5. Do not drink alcohol before bed. I get it, many of us like to have a beverage of choice some nights, and you may even think that it helps you sleep. Here’s the thing: it really messes with your REM sleep a lot. In addition, alcohol is a sedative, meaning that while you are unconscious it is not the same as getting quality sleep. To put it another way: if Mike Tyson knocked you out, it would not be “restorative sleep” you were getting. It’s kind of like that.
6. Keep your room as dark as you can. Any light can disrupt your sleep. Try to keep your room as dark as possible.
7. If you can’t sleep, get out of bed. Your bed should be associated with, well, bed things (and the majority of them driven by, um, biology). If you are lying awake in bed, your brain will start to associate your bed with wakefulness. Instead of lying there, get up and go to a different room, do something quiet (reading, relaxing music, etc.) and then when you feel sleepy, go back to bed.8,9
8. If pain is keeping you awake, get it addressed. Again, be wary of medications to do this, especially if they make you drowsy (remember a sedative robs you of quality sleep). Talk to someone who can help you understand your pain and strategies to manage it so it’s not disrupting your ability to sleep (and heal!). Not sure who to talk to? Feel free to reach out. At minimum, we may be able to help you understand where to seek help if there’s not an easy fix; at best we may be able to help you with strategies to manage your symptoms and allow you to get that rest that you need.
For more information on sleep hygiene and health, a fantastic resource is Why We Sleep by Matthew Walker, PhD.
2. “The Drive” podcast with Dr. Peter Attia, episode 47-49 with Matthew Walker
5. “The Drive” podcast with Dr. Peter Attia, episode 47-49 and 126 with Matthew Walker
8. Ibid 2, 5