We routinely ask patients, "How is your sleep going? Do you sleep right through? Do you wake up refreshed?". Patients often look confused, but many answer, "Lousy, but I'm here about my low back, sore shoulder, neck ache etc." Poor sleep is a common problem, it has health risks associated with it and importantly can be contributing to your pain. So working on your sleep quality is an integral part of dealing with any sort of persistent pain you have. So what can I do.
Below we have adapted an article by the great researchers at examine.com to simplify what can help and hinder sleep.
What happens when we sleep?
It allows your body to recover
Important metabolic processes occur such as removal of toxic proteins in the brain,
During the REM phase (heavy sleep) your brain consolidates short-term memories into long-term memories.
What can happen when we have poor sleep?
It increases inflammation
It impairs focus
It impairs fat loss
It effects insulin signalling
It effects testosterone production and cardiovascular health
Getting enough quality sleep isn't just a health necessity. It can also improve you mentally ,physically and sexually. And studies show it just makes you happier!
So lets go through some tips for better sleep. starting with what can disrupt your sleep negatively.
Negative Factors For Sleep
Light. Light regulates your biological clock. Mostly through a hormone called melatonin. This hormone tells your body its time to sleep. The sun produces a light called Blue light which disrupts production of melatonin. Blue light is made by screens of Tv's, computers and phones. So avoid bright lights 2 hours before bedtime and if you are using a phone or computer install an app that reduces this. Iphones and Ipads have nightshift built into it to reduce blue light. Make sure your bedroom is dark as well!
Noise. It sounds obvious but some sounds are worse than others for affecting sleep. Generally sudden noises are more likely to wake you up rather than a constant noise like an air conditioner. Noises most likely to wake you up are noises that carry meaning to you. So for example you may sleep through traffic noise outside, but waken as soon as your baby cries. So noise can have a big impact on your sleep. If it's hard to make your bedroom quiet then use ear plugs. Some people may find soothing music at a low volume helpful.
Heat. If your core temperature becomes elevated it can contribute to insomnia. On the opposite side having a cooler bedroom can reduce the time it takes to fall asleep and you enter deeper stages of sleep quicker. Temperature is important as heat can impair your sleep more than noise!
Alcohol. It's no secret alcohol helps you unwind as it depresses the central nervous system. But it impairs the quality of your sleep. So don't use it as a sleep aid and generally its better to avoid alcohol after dinner.
Caffeine. Ok, lots of us love coffee! And there are some real benefits from it but it can mess up your sleep as well. Caffeine blocks different adenosine receptors in your brain. The A1 receptor promotes sleep, so when caffeine blocks this we feel more alert. It also blocks the A2 receptor caffeine can increase dopamine levels which stimulates and improves your mood. The problem with this is the A1 receptor gets sensitised to caffeine consumption while the A2 does not. So this means if you drink a lot of coffee you will get less stimulation the more you drink and think its not really effecting you anymore and you will feel tired. But! you will go to bed with caffeine flowing through you which will impair the quality of your sleep. So as a general rule don't have caffeine within 6 hours of going to bed.
What can help your sleep?
Exercise. Does exercising more lead to better sleep, or does good sleep lead to more exercise? Studies have found this hard to differentiate. But in general terms we know that exercising during the day leads to better sleep at night. Exercising at night is better than not exercising, but can disrupt the daily rhythm of some people.
Keep a consistent sleeping schedule. Your body really runs like a clock, a 24 hour clock. This is sometimes called your circadian rhythm. Most of this clock revolves around light and temperature. Your body functions better with routine. So the best advice is to have a "regular" bedtime. And to further consolidate this, cue your body that bedtime is coming. This might be by cleaning your teeth, having a shower, or reading.
Melatonin. We mentioned melatonin before, it's a hormone that when released signals sleep. So avoid blue lights 2 hours before bed. If you have done this and the other tips listed above and still have trouble falling asleep melatonin could be a useful supplement for you. It may improve your ability to fall asleep, and improve quality of sleep. It has become a popular "hack" for jet lag with international travellers.
Magnesium. If you are low in magnesium this can result in abnormal neuronal (nerve) excitations which can negatively effect sleep. This is more of an issue in the elderly as they tend to have a low magnesium intake. Its not uncommon in the young, particularly athletes who sweat a lot of magnesium out. However its easy to get a good intake of magnesium through food, so this should be your first strategy, diet. Then when it comes to supplements some are poorly absorbed by the body, eg magnesium oxide is poorly absorbed where as magnesium chelate is well absorbed.
So, work on your sleep and life can be a whole lot better!