Sleep, a topic that thanks to the stress of the COVID-19 pandemic, has become all the more relevant. We have had an increasing number of clients in the practice reporting feelings of anxiety and being overwhelmed by many of the knock-on effects that this global pandemic has brought into our lives. While we can’t control the external factors of our environment, we are able to make an impact on our internal factors, such as the quality of our sleep. Even prior to COVID-19, sleep has been a key consideration in the management of pain and injuries. If you think that your sleep, or lack thereof, could be feeding your levels of anxiety or vice versa then read on…
As always knowledge is power and we hope to empower you by bringing awareness to this topic and giving you tools for you to help yourself, to match your own unique needs. We promise to keep the scientific jargon to a minimum (bit challenging with research articles- but for you we will do our best) and to peak your curiosity. This is such a rich topic that to write a blog is to merely scratch the surface. Our content has largely been drawn from Matthew Walker’s book, an international bestseller (it’s not just us that are obsessed with these nerdy books), “Why We Sleep”.
His novel starts off with the below:
“Do you think you got enough sleep this past week? Can you recall the last time you woke up without an alarm clock feeling refreshed, not needing caffeine? If the answer to either of these questions is “no,” you are not alone. Two-thirds of adults throughout all developed nations fail to obtain the recommended eight hours of nightly sleep.” YIKES! If this doesn’t ring alarm bells for you, then keep reading to see what the consequences are of not obtaining enough sleep.
The very simple question “why we sleep?” used to be accompanied by a very simple answer – we sleep to cure sleepiness. As you can imagine with the growing interest in sleep being linked to our health and well-being, we now have a far more detailed response. To keep this relatively surface level – we sleep to aid the mind and to assist the vast processes in the body to function optimally. This is essential for us to function (even at a sub-optimal level) on a daily basis. Sleep is our life support system, its mother nature’s best effort at immortality and it has been referred to as the swiss army knife of our health. With that in mind, who wouldn’t want to prioritise sleep.
Now let’s talk about the sleep cycles and different stages of our sleep. Human beings have two types of sleep – we have REM (rapid eye movement sleep) and non-REM sleep. REM sleep is our dream state of sleep, while non-REM sleep has four different stages to it. With each stage, the depth of sleep increases and the final third and fourth stages are our most restorative stages of sleep. This concept becomes increasingly important as we dive into lifestyle factors associated with sleep.
To make this knowledge more practical, let’s discuss these stages in terms of when your head hits the pillow. Once you’ve jumped into bed, lights out and head on the pillow, you’ll start off with light non-REM (stages one and two) sleep and continue down the stages. About 60 – 70 minutes later you’ll pop up into a short REM sleep period. Every 90 minutes or so you’ll cycle back between going down into non-REM and up into REM sleep, with the time spent in non-REM sleep decreasing and the time spent in REM sleep increasing as you shift into the second half of the night. So essentially, the first half of the night you’ll have deep dreamless sleep (as the ratio of non-REM dominates) and the second half of the night you’ll have REM dream sleep. Each of these stages has a hugely beneficial function.
Even though we need this type of pattern fully engaged to sleep properly, over the last 100 years it has been recorded that we sleep less than we need. In the U.K. it has been recorded that an adult gets on average 6 hours and 49 minutes of sleep each night. This total has shifted significantly, decreasing 15-20% from what was previously recorded. There is also research linking this lack of sleep with cancer and Alzheimer’s disease. Sleeping works closely with the brain and is effectively working as a “sewage system” to clear out metabolic toxic proteins. So alarmingly if you aren’t managing to get enough shut eye each night, you’re not giving your brain a chance to recover from any build up and this increases your risk of disease.
You may be wondering, if 6 hours and 49 minutes is not enough, then what is a good amount of sleep? The range is between 7 – 9 hours with a “sweet spot” of 8 hours. However, if there are any additional stressors placed on your mind or body you may need more. This shift will continue as you go through life and encounter changes. To figure out if you’re getting enough sleep, Matthew Walker suggests noting if you could sleep past your alarm clock going off. If yes, then you’re probably not getting enough sleep.
All of this plays a pivotal role in your ability to heal. So you decide to come to Physiotherapy after your knee surgery, or you’ve been experiencing lower back pain and we ask you how you’re sleeping. The initial link may not seem very obvious, but if you’re not giving your body a chance to heal and recover, the next steps of physical rehabilitation could be lost or reduce your potential progress. To get into some of the science around this – your body has Natural Killer Cells. These are our immune cells and are needed to assist with keeping us healthy. They are also referred to as the secret service agents of our immune system. If you’re not getting enough sleep, you could be experiencing a 70% drop in cell function. Which means you could be doing all the right exercises but with a lack of sleep, you’re not able to recover optimally. There are a number of other processes that would also not be fully supporting your recovery and ability to heal.
Some of the other topics we could chat through during our sessions include your stress levels, what your diet is like, and what exercise you’re incorporating. All of these lifestyle factors play a part in your ability to acquire your necessary amount of sleep. To start off, let’s think about physical activity. Regular exercise has been proven to help get you into the deep restorative sleep stages. It has also been proven to assist with better quality of sleep. And we know from the research that if you’ve had a good night of sleep, you’ll feel more motivated to exercise, you’ll be able to exercise more intensely and you’ll reduce the risk of injury. So exercise is good for sleep and sleep is good for exercise. It has also been said to be the greatest legal performance enhancing drug (why not give it a try…). Having said that, if you feel tired and know your body needs to prioritise rest, the research suggests not waking up to exercise but rather sleeping in.
Technology (specifically in the bedroom and before sleep) is another factor you have to control to ensure you’re best set up for a good night’s rest. This is linked with your body’s need to produce Melatonin. The light from your tablet directly impacts your body’s ability to produce this hormone and therefore your ability to feel sleepy building up to bedtime. There is a whole whack of information on this and some really great advice on how to manage this. I can highly recommend reading the book or even googling (but not in bed tonight) some of the best ways to promote healthy interaction with technology and sleep hygiene.
Sleep has a direct impact on mental health and we cannot dissociate our mental health from our physical health. Specifically, dream sleep has been said to be our emotional first aid and the best “nocturnal soothing balm.” If you don’t manage to get a good night’s rest, your anxiety levels may be heightened the next day. Due to your anxiety being heightened, you may struggle to fall asleep the following evening. And so the vicious cycle continues.
So as we’ve learnt, sleep is the single most effective thing we can do to reset our brain and body health each day. Below are some tips to get your best sleep yet:
- Regularity (make sure you’re in bed at night and out of bed in the morning at a similar time each day).
- Darkness (switch off bright lights one hour before bedtime).
- Keep it cool (18-18.5 Celsius for your room temperature).
- Walk it out (If you can’t fall asleep after 20 minutes, take a walk around or go to another room).
- Alcohol and Caffeine (monitor your intake and times you’re consuming).
We hope you’re feeling more equipped to get longer, deeper sleep.
Sleep well!