How lack of sleep affects pain and recovery (and what to do about it)

Sleep is a basic human need and is critical to survival. It represents an essential period of recovery and has an important role in the proper functioning of most, if not all, body systems.

Sleep is important for immune function, tissue healing, pain modulation, cardiovascular health, cognitive function, learning and memory. Without adequate sleep, people can experience increased pain perception, reduced quality of life, depression and increased anxiety amongst other things  (ref)

According to the this well researched article , humans should spend roughly a third of their life sleeping. This amounts to between 7 to 9 hours of sleep a night. Despite this recommendation, millions of adults experience chronic sleep disturbances (also known as Insomnia). Insomnia is defined as taking more than 30 minutes to fall asleep at night (or back to sleep if woken in the middle of the night) for at least 3 days a week, ongoing for more than a 3 month period.


The relationship between sleep, pain and healing:

We have known for a long time that pain can affect sleep, but recently it has come to light that poor sleep can affect pain. A single night of total sleep deprivation has been shown to induce generalized hyperalgesia (increased pain response) and increased anxiety in healthy adults (ref). One reason for this is that poor sleep impairs our endogenous descending inhibitory pain pathways (our brains inherent ability to modulate or decrease pain) . Impaired sleep quality or quantity can also result in a low-grade inflammatory response, which can also lead to an increase in pain sensitivity, especially in those who have pain already (ref)

Ever noticed that you are much more prone to getting sick when you are lacking sleep? Sleep deprivation can lead to changes in the immune response including the over production of pro-inflammatory cytokines which can decrease the ability to fight off illnesses effectively. This decreased immune response can also alter the body’s tissue healing mechanism (ref). Something to think about if your injury is taking a long time to heal.

Its not just about quantity, sleep quality is also very important. Time in bed does not always adequate to time sleeping. According to the National sleep foundation high quality sleep includes

  • Sleeping at least 85 percent of the total time in bed (also know as sleep efficiency)
  • Falling asleep in 30 minutes or less
  • Waking no more than once per night
  • Remaining awake for no more than 20 minutes before falling back asleep


How do I improve my sleep quality:

If you are not sleeping well, the first thing to look into is your sleep environment. Minimal noise, comfortable mattress and pillows and the right room temperature are of the outmost importance. A dark room is also essential as light gives a stimulus to your brain that its time to be awake.

Avoiding nicotine, caffeine and alcohol especially before bed has been shown to improve sleep. Alcohol may help you fall asleep but it interferes with your ability to maintain a deep restorative sleep.

Bedrooms should be used for sleep (and sex) only. Watching tv or reading in bed is generally discouraged as we want our brains to associate the bedroom with sleep. As mentioned above we ideally want to spend 85% of the time spent in our bed, sleeping. Therefore if one wakes up at night and cannot return to sleep within 20-30 minutes, it is advised to leave the bedroom and do a non stimulating activity (reading for example ) elsewhere, until one feels sleepy again.



Exercising has generally been shown to improve sleep quality, but it should be conducted in the morning or early afternoon and not in the evening. This is because an increase in body temperature too close to bedtime interferes with the natural decline in body temperature that occurs in the evening as sleep mechanisms are initiated. ( Some people don’t find this a problem)

Sleep restriction/compression therapy is another well researched technique which can help improve insomnia. It is a method of behavior modification which restricts sleep to a specific window at night. It increases the drive to sleep, increasing the likelihood of falling asleep quickly and sleeping through the night( To learn more about this technique, read here.)

Changing a habit takes time and patience. Just changing one or 2 of the above elements may be enough to improve your sleep.  Whatever the case, improving sleep quality, and therefor physical and psychological wellbeing, is definitely worth the investment.



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