“Humans spend roughly a third of their lives sleeping.”
Some people say that there will be time for sleeping when we die. Unfortunately, by having this attitude, one may get to test it sooner rather than later. There is no shame in sleeping. Some wear it as a badge of honor that only 4 hours of sleeping is needed, but as you’ll see later this is not a good idea. Here’s a list of power people that sleep less than the 6-8 hours per night recommended.
“…it has been recommended to consider sleep as another vital sign, as sleep can give insight into the functioning and health of the body.”
There have been multiple suggested vital signs such as pain, walking speed and now sleep. I am not saying that sleep isn’t important, but to call it a vital sign may be over-rated.
“…between 50 and 70 million adults in the US experience chronic sleep disturbances, and 62% experience a sleep problem several nights a week.”
Sleep is vital, but maybe not a “vital sign”. If you are having a problem with sleep, this could be a sign of something more serious, if not it could lead to something more serious.
For instance, my daughter has Down Syndrome. This is a genetic mutation of the 23rd chromosome, which leads to multiple physical changes. One of the changes is a larger than average tongue and smaller air passages. This is in combination with low muscular tone. The incidence of sleep apnea in kids with Down Syndrome is 50-100%. One of the side effects of sleep apnea is right sided heart failure, pulmonary hypertension, and delayed growth. These are some serious effects of a lack of sleep. I can speak for my daughter, but she will undergo a sleep study around the age of 3-4. I have some patients that have sleep issues and this is what I hear about doing a sleep study:
“It will be too inconvenient”
“I don’t want to know the results”
“I don’t want to have anyone watch me sleep”
In the grand scheme of things, I will not let ego override my daughter’s long term health. I don’t understand this belief system, but will always try to educate the patients in order to ensure that my patient’s health is as good I know that it has the potential to be.
“Costs associated with insomnia, which is the most prevalent sleep disorder, are over $100 billion per year due to health care costs, accidents, and decreased work.”
Difficulty falling asleep or staying asleep is termed insomnia. Think of how much money we spend in health care related costs. Add musculoskeletal pain costs to isomnia costs and the total is 340 billion.
If you could save $100,000/year, it would take you 3,400,000 years to save 340 billion dollars. If you could save $10,000 every single day, then it would only take you 93,151 years to save 340 billion.
As you can see, if we can start to improve national health, then we have the potential to save more money than I could count to in a lifetime.
“…proposed that knowledge about sleep and skills to screen sleep disorders and to promote quality sleep are important components for physical therapists to promote health and wellness.”
I’ll be honest. We don’t learn much about sleep in school. At least we didn’t 10 years ago. It’s hard to say if this has changed much in the previous decade, as I don’t hear many new graduates talking about sleep. Everything that I learned about sleep and health has come from a few podcasts from people like:
- Dr. Kirk Parsley
- Tim Ferriss
- Dave Asprey
It’s great that there is more research being published in the field of PT regarding sleep, but this is a population health issue and needs to be addressed by all health care professionals.
“Of the 43% who reported that they do not routinely assess their patient’s sleep habits or sleep quality, the most frequently reported reason was: ‘I do not know how to assess sleep habits or sleep quality.'”
I am not surprised by this number…actually I am. I am shocked that it is not higher. I am shocked that half of all therapists are actually assessing sleep habits or sleep quality. I think that most of us, in orthopedics ask whether or not sleep is disturbed, but I don’t know if this qualifies for asking about quality and sleep habits. Actually, I hope it doesn’t because this is a basic question that doesn’t assess much other than sleep or no sleep due to pain.
I ask my patients about urinating during the night, how many hours of sleep is achieved during the night, what the environment (room) is like regarding electronic devices and lights.
This is stuff that I had to learn on my own and wasn’t even mentioned in a Doctorate program.
“sleep is critical for immune function, tissue healing, pain modulation, cardiovascular health, cognitive function and learning and memory.”
We already talked about heart health and sleep quality in the personal story of my daughter.
There is some published research regarding a lack of sleep and an increase in Substance P.
Dr. Kirk Parsley speaks frequently of the effects of a lack of sleep on cognition.
“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.”
I don’t think that too many people will argue about the importance of sleep. We absolutely need it, but some can go days without sleep. Albeit, there will be some side effects.
“People with sleep disturbances report increased sensitivity to pain, but also those experiencing high pain intensity have reported significantly less total sleep time, delayed sleep onset, increased nighttime wakening, and decreased sleep efficiency.”
As a therapist, this part plays an important role in my care. I would estimate that about 90% of my patients are coming to me for some sort of pain complaint. Sometimes this pain can keep the patient awake. Knowing the role of Substance P regarding pain and sleep, I ask 100% of my patients about sleep. If sleep is disturbed, then I know that I have to attempt to understand the problems with sleep. If the problems go beyond sleep hygiene, then the patient is referred out to a doctor that specializes in sleep studies.
“providing interventions to improve sleep may impact pain and thus improve outcomes”
This is why it is so important for PT’s to ask about sleep! It may affect our outcomes!
We are all (I’m an optimist) trying to get patients better and we have to look at all of the variables that we can manipulate in order to achieve this goal.
“understanding the important relationship between sleep and pain could profoundly influence the treatment interventions targeted toward changing the patient’s experience of pain”
Just by improving sleep, we may be able to decrease a patient’s pain experience and improve function as a result.
“long duration of sleep (>8-9 h per night) was associated with an increased mortality due to cardiovascular disease and increased risk of developing coronary heart disease…short sleep duration (<5-6 h per night) was associated with an increased risk of developing or dying from coronary heart disease and weakly associated with developing other cardiovascular diseases.”
This is the paradox of sleep. Get too little and no bueno, but get too much and equally no bueno. Looks like 6-8 hours per night appears to be the right amount. Reading this paragraph makes me think of the three bears.
“Sleep apnea…increases the risk of developing cardiovascular disease…heart failure and stroke…breathing stops temporarily, which decreases the level of oxygen in the body alerting the brain to excite certain receptors.”
Fight or flight? When a person stops breathing, the body becomes excitable and stresses out. This stress can raise BP, increase heart rate and cause other neurological responses.
“About 75% of people with depression experience symptoms of insomnia…almost 20% of those with insomnia have clinically significant depression and anxiety.”
This is a quick question that we can ask when someone notes that they have anxiety or depression, which is typically asked on a history intake form.
“sleep may play an important role to the development of Alzheimer’s disease”
This has to do with neurofibrillar tangles in the brain. This is another topic of concern for me and my family.
We are doing a lot of studying in order to understand the ramifications of Down Syndrome and there is a high likelihood of developing Alzheimer’s disease.
We put some coconut oil in her cereal and oatmeal.
“…sleep hygiene has been associated with improved sleep quality in college students and in patients with low back pain…reduce pain and fatigue in people with fibromyalgia”
Sleep hygiene is ensuring that the environment and other factors surrounding the act of sleep are ideal for sleeping.
Sleep hygiene education
- “Go to sleep and wake up at the same time every day and exposure to bright natural light is helpful to set your natural biological clock”
- some people will use blue lights in the AM to try to help with waking or to prevent the “winter blues”
- Use your bed only for sleep and sex. Do not eat, work, or watch TV in bed.
- Getting a little graphic, but the bed needs to be a place meant for things done horizontal.
- Develop a relaxing bedtime routine
- Avoid moderate to vigorous activity at least 2-3 hours before bedtime
- Avoid caffeinated foods and drinks at least 4 hours before bedtime
- Refrain from drinking alcohol or smoking at least 3-4 hours before bedtime. It can cause you to wake up during the night and smoking can act as a stimulant
- Do not take un-prescribed or over the counter sleeping pills
- Avoid daytime napping so that you are tired at night and can fall asleep easily.
- Some people advocate for polyphasic sleep
- Make your sleeping environment comfortable and relaxing. Avoid light, wear earplugs and use a mask if needed
- Avoid eating a large meal or spicy food 2-3 hours before going to bed
- Talk to your doctor or health professional if you still have trouble sleeping.
Thanks for reading.
You can find me at movementthinker on Itunes and if you have questions can also send me a message at Goodliferehab.com.
Excerpts taken from:
Siengsukon CF, Al-dughmi M, Stevens S. Sleep Health Promotion: Practical Information for Physical Therapists. Phys Ther. 2017;97:826-836.