Get some Zzzz's

When Barny asked me to write a blog for Be Prohuman I readily agreed in the vain hope that he might be more lenient in my PT sessions…..I think my optimism may be misplaced but it’s worth a try so here goes!!

The brief – talk about one thing you think makes a real difference from a Physiotherapy perspective.

My mind started to run through all the options…strength training, adequate mobility for a given task, recovery, periodisation of training load then, the eureka moment!

Bear with me, it’s a bit of a curve ball, but one issue I see time and time again in patients with injuries and persistent pain is lack of sleep and I feel it is something not particularly well addressed by the medical world or society as a whole.

Lack of sleep can limit training effects, impact on recovery, increase risk of injury and make you more susceptible to an array of medical conditions from diabetes to chronic pain. Our ever busy lives mean sleep is often viewed as an inconvenience that interrupts us doing stuff and is not prioritised for health.

My own interest in sleep came after a particularly stressful period of life which led to an 18 month bout of insomnia, I truly understood why sleep deprivation is used as a method of torture and the impacts this can have on physical and mental health. I started to research the issue and found that a significant proportion of the population are sleep deprived and many of my clients too.

So What is Sleep?

For an activity we spend on average 1/3 of our lives doing, most of us have very little understanding of what sleep is and why we need it.

Sleep is a state characterised by changes in brain wave activity, breathing, heart rate, body temperature and other physiological functions where we are less responsive to external stimuli, but able to rouse easily unlike other states of reduced consciousness. Many physiological functions reduce during sleep but others are increased such as release of growth hormone and cell repair, in fact some genes associated with repair are only activated at night suggesting that this is an important function of sleep.

The brain remains active throughout sleep and can be more active than when you are awake during certain phases which scientists believe may be related to memory formation but this is not fully understood.

2 internal biological mechanisms control sleep, your circadian rhythms and sleep-wake homeostasis. Circadian Rhythms direct a variety of functions from wakefulness, variation in body temperature, and metabolism and they control the timing of sleep along with our natural Cortisol cycle (and other mechanisms). They are controlled by your biological clock and synchronise with your environment but do continue in their absence which is why jetlag is so horrible! Your Sleep-Wake homeostasis internally tracks the need for sleep increasing deeper, longer sleep after a period of sleep deprivation.

There are 5 stages of sleep shown in the graphic below which repeat x4-5 per night on average. Slow wave sleep or deep sleep is most important for recovery which is why sleep quality is so important.

How Much Sleep Should I be getting?

The graphic below shows how much on average people should sleep according to age group. Of course everyone is different and some people need more or less than others. Teenagers are amongst some of the most sleep deprived with many only getting 5-6 hours per night. Statistics from 2013 show that 40% of people sleep less than 6 hours per night which can be detrimental to health and wellbeing.

What are the effects of too little sleep?

A few nights of reduced sleep due to life events or an acute period of stress will do no harm but with insomnia estimated to affect 1/3 of the UK population long term effects of sleep deprivation should be taken seriously.

The effects of chronic sleep deprivation are extensive and alarming. They include:

  • Impaired cognitive function – affecting our ability to learn, concentrate and remember things, creativity is enhanced x3 with a night’s sleep.

  • Impaired motor skills - resulting in increased risk of accidents. 31% of drivers are estimated to fall asleep at the wheel once in their life and 10,000 traffic accidents a year are reported in the USA as result of lack of sleep. Major incidents such as Chernobyl and Challenger Shuttle disaster are linked to fatigued shift workers and impaired decision making as a result.

  • Increased risk of injury – athletes who sleep less than 8 hours per night have a x1.7 higher chance of injury.

  • Increased incidents of depression, anxiety and other mental health issues.

  • Weakened immune system – increased frequency of illness resulting in time off work and training.

  • Increase in Chronic pain.

  • Increased risk of heart disease, stroke and raised blood pressure.

  • Increased risk of Alzheimers disease.

  • Increased risk of Obesity.

  • Increased risk of drug and alcohol dependency.

  • Shift workers are shown to have a reduced life expectancy compared to non-shift workers and have a higher incidence of certain cancers.

What Can I do to get a better night’s sleep?

  • The good news is there is plenty you can do to improve your sleep!

  • Prioritise sleep – view it as essential part of health.

  • Reduce your caffeine consumption – especially after lunch.

  • Make your bedroom a sleep haven!

  • Use light to your advantage – make your bedroom as dark as possible at night and use natural light to stimulate wakefulness in the day.

  • Switch off your mobile phones and keep them out of the bedroom.

  • Have a set sleep/rise routine.

  • Pay attention to diet – carbohydrate rich meals tend to promote sleepiness.

  • Exercise regularly but not too late.

  • Create a relaxing routine – warm bath, read a book or try meditation or yoga.

If you have disturbed sleep for more than a few nights then speak to your GP to ensure there is no underlying medical problem.

And finally a thought from Thomas Dekker, an Elizabethan writer who clearly knew a thing or two..

About the Author

Anna Curnow is a Chartered Sports Physiotherapist and Yoga Teacher in Worcestershire. Anna has worked in many sports from Rugby Union to Wheelchair Basketball and worked at both London 2012 and Rio 2016 Paralympic Games. She currently runs a private practice in Bromsgrove and works part time with British Judo.

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