SLEEP is not only an important factor for good health and well-being, but it it is essential for recovery from injury. Often patients ask what they can do to speed up healing from an injury and sleep is the number one tool. Muscle, bone and tissue repair occurs overnight. Of course good quality nutrition also helps the synthesis of tissue healing and staying away from alcohol but let's focus today on sleep.
Most people when we ask about sleep in the clinic report they don't sleep well. (up to 45% of adults get inadequate sleep). Poor sleep can be caused from a number of reasons from medically diagnosed conditions such as sleep apnoea, restless leg syndrome or reflux to inflammatory musculoskeletal conditions or stress and anxiety.
As Physiotherapists we primarily ask about sleep when assessing your condition as it may give us information which will help with a diagnosis. For example, inflammatory conditions may cause pain and waking up typically at 3am. Alternatively trouble getting to sleep could indicate over doing it in the daytime. For example a swollen aching knee at bedtime was likely overworked during the day. So this may prompt us to tell you to rest more; stand and walk less while your injury is healing. Pain or stiffness in your neck or back in the morning can indicate a poor sleeping posture or problems with a pillow or mattress.
When you sleep your blood pressure drops, breathing slows and deepens. Blood flow
In your deep REM sleep cycle your pituitary gland releases growth hormones. The pituitary gland also releases prolactin which is your body's natural anti-inflammatory. This helps ease achy joints and muscles. So REM sleep is crucial for recovery and repair.
For athletes, sleep should be the most important recovery tool they get. Good quality sleep ensures hormones are released to build muscle and calm the central nervous system. This means they can reap the benefits of a gym work out more effectively.
Studies have shown that athletes who get less than 8 hrs of sleep a night are also 1.7 times more likely to get an injury. Sleep in important in recovery from tissue damage but also for athletes in maintaining mental alertness. Injury may e more likely due to lack of concentration.
Increased stress and anxiety can make falling to sleep difficult and cause waking up in the night. Prolonged states of stress result in increased cortisol in the blood. Increased pain from injuries also contributes to this increase of stress and cortisol. It's why patients in pain often say they feel so tired and feel more stressed when injured. Cortisol is vital for helping you wake up in the morning, but high levels at night can make you feel 'tired but wired.'
Studies show that mediation before bed can lower cortisol in the blood as it activates your parasympathetic or 'rest and digest' state. This aids a good nights sleep. Melatonin release in the brain is also necessary to fall asleep. Your brain releases melatonin at night when it is dark to induce sleep. The blue light of electronic devices suppresses the release of melatonin twice as much as green light (normal daytime light). Most smart phones have a blue light filter, but concentrating on a screen still keeps your brain active so it's best to keep phones away from you 2-3 hrs before bed. up.
If you find yourself tossing and turning in the night an inadequate mattress and pillow can be responsible. Often we'll talk through what you are using and how old it is. Sometimes we'll recommend postures to alleviate musculoskeletal pain and advise pillows as props to position you better. And sometimes we'll recommend a new pillow and or mattress. Please ask our recommendation before taking yourself to a bed store.
We all need good sleep, whether an athlete, weekend warrior or busy worker. So if you are injured, sorting out any poor sleep habits can also help you heal faster.
References: 2016 Sleep Health Survey of Australian Adults, The University of Adelaide, The Adelaide Institute for Sleep Health
Nedelec, The variability of sleep among elite athletes Sports Med Open, 2017
Halson SL. Stealing sleep: is sport or society to blame? Br J Sports Med 2016
Walters PH. Sleep, the athlete, and performance. Strength Cond J. 2002;24: 17–24.