Sleep Well to Feel Well

When you think of physical therapy sleep probably isn’t the first thing that comes to mind.  Although hands-on therapy and exercise are often keys to a successful outcome, the body is more complex and other aspects of your overall health should be taken into consideration. In addition to diet and exercise, sleep is an important component of your well being.   The Centers for Disease Control & Prevention report that a third of US adults get less than the recommended amount of sleep. When lack of sleep becomes a long term issue it is associated with chronic diseases such as type 2 diabetes, heart disease, obesity, and depression.  The American Academy of Sleep Medicine recommends that you get 7 hours or more of sleep each night.

Effects of Sleep on Bodily Systems

In regards to your cardiovascular health, sleep deprivation can increase the activity of your sympathetic nervous system causing more variability in your heart rate and blood pressure.  Sleep apnea is associated with arrhythmias, ischemic heart disease, and stroke. Impaired cognitive function is also a result of sleep loss causing difficulty with memory and ability to learn.  Sleep has a large role to play with the immune system and tissue healing.  While we are at rest the immune system gets to work and helps to fight illness and heal tissues in the body.  Without the proper amount of sleep, the immune system cannot do its job properly which can delay healing.

Pain-Sleep Relationship

Lack of sleep can affect how we perceive pain.  Although not well understood, pain and sleep are in some ways controlled by similar mechanisms and those who lack sleep have heightened pain sensitivity.  According to the National Sleep Foundation nearly one in four people with chronic pain say they have been diagnosed with a sleep disorder. They also report less control over their sleep and worry more about it.  The pain-sleep relationship is a tricky one. If you have pain you have a harder time sleeping and if you are not sleeping you can have more pain. Don’t let this panic you.

If you are under the care of a physician or physical therapist for your pain continue the process however; don’t underestimate what a few good nights of sleep can do.  Some studies have shown that sleep hygiene and sleep education have been associated with improved sleep and pain in patients with low back conditions, fibromyalgia, and knee arthritis. These results are likely not limited to these populations as others may not have been studied yet.

Sleep Hygiene

Sleep is a behavior therefore; behavior or habit changes can improve your sleep.  Most people have a dental hygiene routine that they follow yet they have not considered having a sleep hygiene routine.  Practicing some of these simple habits can help:

  1. Go to sleep and wake up at the same time every day.
  2. Use your bed only for sleep.
  3. Develop a relaxing bedtime routine.
  4. Exercise to improve sleep at night but avoid vigorous exercise 2-3 hours before bedtime.
  5. Avoid caffeinated foods and drinks 4 hours before bedtime.
  6. Refrain from drinking alcohol or smoking 3 to 4 hours before bedtime.
  7. Do not take unprescribed or over-the-counter sleeping pills.
  8. Avoid daytime napping or limit naps to 30 minutes with no naps in the evening.
  9. Make your sleeping environment comfortable and relaxing.  Stop using light emitting electronics at least 30 minutes before bedtime and minimize noises.
  10. Avoid eating a large meal or spicy food 2-3 hours before bed.

If you implement these behaviors and feel you are still struggling with sleep please discuss this with your physician and/or physical therapist.  In addition, there are tools medical professionals use to screen for more serious sleep conditions to see if a referral to a sleep specialist is needed.


  1. Vitiello M et al.  Short-term Improvement in Insomnia Symptoms Predicts Long-term Improvement in Sleep, Pain and Fatigue in Older Adults with Co-morbid Osteoarthrits and Insomnia
  2. Cho S, Kim GS, Lee JH.  Psychometric evaluation of sleep hygiene index:  a sample of patients with chronic pain. Health qul Life Outcomes. 2013;11:213
  3. Orlandi AC, Ventura C, Gallinaro AL et al.  Improvement in pain, fatigue, and subjective sleep quality through sleep hygiene tips in patients with fibromyalgia.Rev Bras Reumatol. 2012;52:666-678.


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