Lifestyle Hack #1: The importance of SLEEP in dealing with injury, chronic pain and inflammation

As a physiotherapist, I spend a good portion of my day talking about pain and the management of pain and inflammation to my patients.  If you haven't yet, check out Courtney's blog post about pain.  Sometimes, in the presence of time, the conversation strictly deals with the area of injury and the physical symptoms of pain.  There are however, quite a few things we can do, as lifestyle changes, to influence pain and inflammation in our body.  I was introduced to an article from a surgical colleague of mine that discusses lifestyle changes to deal with cognitive deficits, and more specifically Alzheimer's Disease.  However, when you look at the lifestyle "protocol" they introduce for people, the concepts also tackle whole body inflammation, which can help deal with chronic pain.  I was working with a patient last week recovering from extensive ankle surgery and excited to get back to an active lifestyle and I found our conversation quickly led to lifestyle changes she needed to implement to support her recovery, as she was experiencing significant pain with return to activity that was inhibiting her from exercising more then 2 times a week.

I decided to create a series of blog posts to deal with simple lifestyle changes to help tackle the pain and inflammation you might be experiencing on a daily basis. 

Although what we will talk about over the next few weeks will seem like common sense, sometimes knowing WHY we should do something makes it easier to help us actually DO IT.

So here we go.....Lifestyle Hack # 1:  Helping to take control of your pain, inflammation, injury and recover with SLEEP

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We can often think of sleep in a very narrow frame of mind: as we move throughout the day we are either tired, or we are not.  A lot of research has been done recently highlighting the MANY other effects lack of sleep can have on our body - many we might not even think about!

Almost 20% of our population is chronically sleep deprived.  Our busy work schedules and home responsibilities leave us with less time to get proper rest. 

This has now been linked as a major health issue because with sleeplessness comes:

  • Risk of heart attack, stroke
  • Risk of anxiety and depression
  • Risk of obesity
  • Risk of cognitive impairments: decision making, executive functioning and memory loss
  • Many more.....
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A recent study that included over one million Americans reported that sleep duration below 6 hours per night was associated with increased all-cause mortality (all-cause mortality is all of the deaths that occur in a population, regardless of the cause)

 

The biggest area I would like to highlight today is the relation of sleep with pain, inflammation and our body’s ability to repair/recovery from exercise and injury.

We might think of sleep as a passive process, but there is actually a lot going on in your body to recover, restore and rebuild while we sleep.  Sleep is actually a highly active metabolic process that helps optimize our brain structure, repair damaged cells in our body and restore energy levels.

Inflammation in the body can be linked to acute injury (example: rolling your ankle while stepping off the curb) or chronic injury (example: your shoulder that has been bothering you for the past 2 years).  Chronic inflammation is now also being linked to the development of asthma, arthritis, cancer, cardiovascular disease, type 2 diabetes and depression, many other health problems.  An increase in research involving decreasing inflammation has resulted in improvements in pain levels, cognitive functioning, memory improvement and improvement in the chemical markers of many chronic diseases.

So how can sleep help?

Poor sleep is associated with an increased risk of inflammatory diseases.  More specifically, research has shown that people who chronic sleep deprivation - 6 hours or fewer per night - had higher levels of three inflammatory markers: CRP, IL-6 and TNF-alpha.  With a increase in hours slept per night, comes a decrease in these chemical markers of inflammation and therefore a decrease in whole body inflammation.

Additionally, sleep can have an effect on pain tolerance.  One study found a single night of sleep deprivation (6 hours or less), led to an 8% decrease in pain tolerance.  Meaning you are experiencing pain easier and sooner then normal.  On the reverse side, in an individual with chronic pain and poor sleep habits (less then 6 hours a night), 4 consecutive nights of improved sleep (7 hours or more) resulted in an improvement in pain tolerance by 20% - WOW.  Imagine just increasing your sleep can help improve the amount of pain you are experiencing each day.

Maybe you are not dealing with chronic pain, but maybe you are feeling quite a bit of “post-workout pain” - sleep can help with this too!  It is when we sleep, particularly deep sleep that our muscles can respond, repair and rebuild (get stronger) from all the work we put them through, throughout the day.

A study looking at sleep and muscle recovery found that sleep debt (less then 6 hours a night) decreased the activity of protein synthesis (needed to repair muscle and build muscle) and increased the activity of protein degradation (muscle breakdown).  This would favour the loss of muscle mass and hinder recovery of muscle damage induced by injury and exercise.  Not seeing the gains you thought you might in the gym or dealing with an injury that seems to be lingering - sleep might be the answer!

 

Finally, looking at sleep and muscle performance:

Endurance Performance: Time to exhaustion in elite cyclists decreased 51 seconds following a poor night of sleep (less then 6 hours)

Accuracy/Reaction Time: Following a night of poor sleep in tennis players was associated with a decrease of serving accuracy of 53% and the same can be seen in basketball with free throw accuracy.  With improved sleep (greater then 7 hours) free throw accuracy increased by 9% and 3 point shooting accuracy increased by 9.2%

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So, you’ve made it this far, you’re convinced you could benefit from improved sleep - what changes can you make?

 

  1. Keep caffeine to the morning.  Difficult I know, but try to limit caffeine consumption to no later then 2pm in your day.  To start, even try switching up your caffeine choice - instead of going to a 2nd cup of coffee, try a green tea - which still has caffeine, but a smaller amount then coffee.  Or switch up your size, go for a smaller size instead of the Grande

  2. Prepare for sleep.  In the hour leading up to bedtime, try to limit screen time (eliminate if possible).  This is the time to limit cortisol (the stress hormone), which can definitely be elevated when checking your email one last time before bed or has been shown to stay elevated while we are staring at screens (TV show 'This Is US' on the iPad - anyone?).  Try swapping one more episode for a chapter in a book - this would be a great way to knock off a few books from your 2018 book goals

  3. Keep your room dark and cool.  60-67 degrees is the optimal temperature for sleeping.  In addition to sleeping in a dark room.  Think about hallway lights, alarm clock lights and night lights all as sources of unwanted light that could be interrupting your sleep.

  4. Sleep schedule.  Now that you know how long you need to sleep for (7 hours or more), now you need to schedule that, like you schedule your work out.  I personally like to get up between 5 - 5:30am (that is the only way these posts get written), therefore I plan to be in bed by 10pm.   This involves me starting my routine around 9pm and hoping to fall asleep by 10:30pm.  For best results, you want to try to keep this schedule throughout the weekend as well - which can be difficult! Therefore try to schedule early morning workouts, exercise classes or a golf game to try to keep you on your schedule over the weekend and holidays

  5. Exercise.  If you are someone that struggles with sleeping, try adding exercise to your day.  Exercise can help improve your body’s chemical balance to prepare the body for sleep at night, but will also help to physically exhaust you and relax your muscles to prepare for sleep.  That being said, try to avoid exercise within 2 hours of bedtime to decrease cortisol and adrenaline levels so you are able to sleep.

"Early to bed, early to rise, makes a (wo)man healthy, wealthy and wise" - Benjamin Franklin

Ok guys, I hope I have helped to shed some light on the importance of sleep.  As you can see - I am passionate about this topic.  If you have any questions related to anything sleep feel free to email us: thephysiospot@gmail.com