a woman sitting on a bed

Why We Need to Talk About Sleep

November 30, 2020

I recently completed the Therapeutic Pain Specialist (TPS) certification, discovering that pain is a complex topic. Recent research indicates that pain is an output by the brain. Pain is based on information coming in from the peripheral nerves, information from the environment and information based on past experiences or beliefs. The brain analyzes this information and decides on a course of action depending on what you need for survival in your current situation.

Pain may or may not be an initial outcome.

Think about running along and you twist your ankle. Does it hurt? Of course it does. Now you are running across the road and you twist your ankle with a car rapidly approaching. Do you have pain now? No, your brain analyzes the environment, your knowledge of fast moving cars and tells you to keep moving to safety. This is just one example of how our brain processes information.

There are 4 core aspects in the treatment of pain:

  • Pain Neuroscience Education

  • Goal Setting

  • Aerobic Exercise

  • Sleep Hygiene

There is much we could cover on pain neuroscience education but we will leave that for another day. As therapists, we are familiar with the benefits of aerobic exercise and we are used to goal setting with our patients. As a hand therapist, sleep was not something I was used to addressing with my patients. Although sleep hygiene can be beneficial for many of our patients and for ourselves, patients with chronic pain often have trouble sleeping. Their body is in a state of hypervigilance, their sympathetic nervous system is active.

Patients are often on Opioids which alter sleep with just one dose. Opioids contribute to sleep apnea. Faulty sleep prior to surgery leads to increased opioid use and decreased sleep post surgery. Discussing sleep hygiene with patients pre-surgically may contribute to better surgical outcomes and decreased pain.

There are (4) stages of sleep with (2) of them, REM and deep sleep, being considered restorative sleep. We need between 7-9 hours to get enough restorative sleep for health and healing. In deep sleep we get physical and emotional restoration, growth hormone is released for cell repair and our immune system is strengthened and renewed. REM sleep is important for memory and emotional processing. It helps with learning. Lack of sleep is linked to cardiovascular disease, stroke, type II diabetes, anxiety, depression, obesity and problems with memory and information processing.

Every hour of sleep you get before midnight is equivalent to 2 hours after midnight. You want to start getting ready for bed by at least 11 pm so you can start to calm your nervous system down by turning off the computer and TV and do something relaxing. If you nap more than 20 mins it alters your sleep cycle, you start to move into your second phase of sleep and can be left feeling groggy. Below is a checklist I use to introduce people to sleep hygiene. I encourage patients to pick one and work on it, hold them accountable. I encourage you to pick one and work on it. Next time I see you I may ask if you are getting enough sleep!

Louw A, Puntedura E, Schmidt S, Zimney K. Pain Neuroscience Education,vol2. Minneapolis, MN:OYP; 2018


About The Author

About the Author

Karen Clark, OT, CHT