When we see anyone for an initial visit, therapists want to know about sleep. Why should we care? We care because people who sleep poorly are more likely to develop pain, and having pain can lead to poor sleep. The associations are not equal however: sleep disturbance is a stronger predictor of pain than pain is of sleep issues. Getting your zzzz’s is vital. When you don’t, inflammation goes up, and sensitivity to pain increases. With increased pain, sleep gets even worse. Enter the vicious cycle. |
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Take John. John dreaded going to bed. His back pain got worse during those hours of fitful sleep. Tossing and turning in an effort to find a comfortable position made nights interminably long. And when morning came, getting out of bed was a challenge, both because he was tired and because the pain and stiffness were bad.
Let’s think about this a bit. Disc pressures and general stress on the spine are lowest when lying on your back (about 25kg disc pressure), and slightly higher in side lying (75kg) as compared with 185 kg - over 7 times as much stress - when seated and leaning forward. So, if stress on spinal structures is low at night, why do so many of us report more pain at night or first thing in the morning?
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Well, there’s stress (meaning tension or pressure exerted on a material object) and then there’s stress (emotional pressure or strain). Since we know that the physical pressure or tension on the spine is low when lying down, could emotional strain be contributing to pain at night?
Perhaps. Nighttime is when you are less distracted and it’s easy to focus on pain. Night time is when your brain starts to resolve all the problems of the day, the week, the month, heck, a lifetime. But not in the way you do when you’re awake. During sleep the “logical” frontal cortex is quiet, and the “emotional”, limbic brain activity is disinhibited. You tell your boss off in your dreams. You have nightmares of destitution from the comfort of your own bed. Fears you can talk yourself out of when you’re awake, become more vivid. And those things can interfere with a good night’s sleep.
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But it’s not all mental. As you rest, breathing slows and blood levels of carbon dioxide dilate blood vessels, making nerve endings more sensitive. And, with less movement, nutrition to cartilage diminishes and joint linings can become slightly congested, causing swelling and additional pain. Nighttime is also when cortisol, your body’s own anti-inflammatory, is at its lowest level.
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If we can agree that pain at night has many possible causes, what do we do?
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Practice Sleep Hygiene: You should consult a sleep specialist if sleep is a longstanding issue, but at a minimum, don’t eat or exercise for 1-2 hours before bed, keep your room dark and cool, and avoid using electronics an hour before you hit the hay.
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Medication: Talk to your doctor about medication or supplements that help with sleep.
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Exercise: Your PT can help you find the program to optimize exercise, given your specific muscle and joint problems. Exercise elevates endorphins to reduce overall pain. The right exercise prescription helps lubricate joints to make them feel better. And moderate exercise is a perfect antidote to stress, especially when practiced in nature.
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Positions for comfort: Your therapist can help discover positions or supports that will reduce discomfort and help you get to sleep.
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Mindfulness practices: If you have a meditation practice, keep it up. If not, PTs at ALTA are experts at changing breathing to increase relaxation. We have specific exercises to activate the rest and repair part of the nervous system.
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Remember John? He came to see us for back pain. With education, strengthening, relaxation training and practicing sleep hygiene, his back pain was gone. Not overnight and not every night at first, but with encouragement and support, John returned to doing what he loved, including sleeping soundly and waking up refreshed.
Sleep is vital to recovery. Rest is every bit as important as exercise to your overall health, and getting the right amount of each is critical. If you call today, a therapist at ALTA can look at your specific issues and help you find the right recipe to feel good again, day and night.
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In an effort to slow the spread of COVID 19, the state of Colorado is offering 2 free rapid tests for each resident. Just follow the directions on the link below. If you are concerned that you have been exposed to COVID, we encourage you to take a quick test before coming into the office. We want everyone to be safe. Thanks for doing your part to make that happen. |
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2955 Baseline Road,
Boulder, CO 80303
303.444.8707
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