How Sleep Affects Your Injuries

One of the first questions we ask all of our clients during their initial evaluation is how they are sleeping. We want to know if their injury is affecting their sleep but we also want to know about the quantity and the quality of their sleep in general. Why? Because we know sleep can have a massive impact on injury risk and recovery. 1

During the busy times in your life it’s easy to sacrifice sleep in an effort to get more done. Many of us think that a week’s worth of poor sleep (4-5 hours a night) can be remedied by sleeping in on the weekend. Unfortunately, research shows that it can take up to 9 days to eliminate “sleep debt.” 2

What is the relationship between sleep and pain/injury? Multiple studies have shown an inverse correlation between sleep quantity and injury risk/pain experience. This means the less sleep you get, the more likely you are to get injured and the more sensitive you will be to the same “pain inputs”. The inflammatory state of chronic sleep deprivation leads to abnormal pain processing so we should aim to get as much quality sleep as possible.

Some actionable ways to work on improving your sleep quality and quantity are outlined in a 2017 paper by Siengsukon, et. al.3 These are 10 sleep related behavior changes that you should try to implement in your life if you want to increase your recovery from training and reduce your risk of future injury. If doing all of these things is not possible for you right now, don’t worry–doing some of them is always better than none of them.

1. Go to sleep and wake up at the same time every day.

2. Use your bed only for sleep and sex.

3. Come up with a relaxing bedtime routine.

4. Avoid moderate-vigorous exercise at least 2-3 hours before bed.

5. Avoid caffeinated foods and drinks at least 4 hours before bed.

6. Refrain from drinking alcohol at least 3-4 hours before bedtime.

7. Don’t take non prescribed or over-the-counter sleeping pills.

8. Avoid daytime napping.

9. Stop using light emitting electronics at least 30 minutes before bedtime (blue light suppresses melatonin) and keep the room cold and dark.

10. Avoid eating a large meal, spicy food, or liquids 2-3 hours before going to bed.

It’s also worth mentioning that if you haven’t had a good night of sleep, it is always okay (and encouraged) to modify your workout plan for the day. You’ve probably noticed that when you don’t get as much sleep as you’re used to, weights feel heavier and cardio feels harder. In this case, use rating of perceived exertion (see RPE blog) instead of percentages for lifts or intensities for your standard programming. You could also consider lowering your target RPE for the day. If your intention for your workout is to move and feel good, focus on that instead of trying to perform.

Sleep well my friends!

Simpson NS, Scott-Sutherland J, Gautam S, Sethna N, Haack M. Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain. 2018 Jan;159(1):33-40.

Siengsukon CF, Al-Dughmi M, Stevens S. Sleep Health Promotion: Practical Information for Physical Therapists. Phys Ther. 2017 Aug 1;97(8):826-836.

Kovacs FM, Seco J, Royuela A, Betegon JN, Sánchez-Herráez S, Meli M, Martínez Rodríguez ME, Núñez M, Álvarez-Galovich L, Moyá J, Sánchez C, Luna S, Borrego P, Moix J, Rodríguez-Pérez V, Torres-Unda J, Burgos-Alonso N, Gago-Fernández I, González-Rubio Y, Abraira V. The association between sleep quality, low back pain and disability: A prospective study in routine practice. Eur J Pain. 2018 Jan;22(1):114-126.

Shaver JL, Iacovides S. Sleep in Women with Chronic Pain and Autoimmune Conditions: A Narrative Review. Sleep Med Clin. 2018 Sep;13(3):375-394.

Simpson NS, Scott-Sutherland J, Gautam S, Sethna N, Haack M. Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain. 2018 Jan;159(1):33-40.