Are Pain And Sleep Connected?

By Jen DeLorenzo, PT, CFMT, TPS, NBC-HWC*

Ahhh, I slept like a baby last night. How would you describe a baby sleeping?….Peaceful, quiet, tranquil.

How many nights does this reflect your slumber? In Virginia, the rate of insufficient sleep (<7 hours per night) is higher than the US average. 50-70 million Americans have sleep disorders. One in four Americans experience chronic pain. Coincidence?

Sleep Disordered Breathing

Sleep Disordered Breathing is a major contributor to insufficient sleep and can interfere with quality of sleep. Sleep apnea is on the severe end of the spectrum. If you answer “yes" to these important statements about sleep, reference this comprehensive list.

I wake: • …during the night and/or use the bathroom one or multiple times • …to an alarm • …up tired/grumpy/groggy • …with messy sheets in the morning • …and I am told I snore, sleep talk, sleep walk, or grind my teeth

Sleep is work!

Most of us think of sleep as pleasurable and peaceful. But sleep is work! This is when children grow, where learning and memory take place, and where we repair ourselves. We understand sleep restores our energy but how amazing that it facilitates our bodies to heal and repair themselves! Proper sleep is also essential for assisting with the relief of pain. Indeed research shows that sleep affects multiple body systems and functions including immune function, pain response and tissue healing. Your best efforts during the day may be lost without proper sleep.

While quantity is important, read on to see why quality is more important. There are five stages of sleep. The deep phase is where the “work” and magic of sleep happens. Slow wave and REM sleep are the two stages of deep sleep. Here we are “paralyzed” as described by neurologist Dr. Stasha Gominak. We are most paralyzed in REM sleep. Ideally we should have 2 ½-3 hours of REM sleep each night. But wait, if we are paralyzed, how is it we keep breathing? Our systems are so intricate and amazing that our brain can shut down everything but the essentials to do the repair work. Our diaphragm and heart thankfully do not get paralyzed.

The body repairs itself during deep sleep

So what happens in deep sleep that is so important to our health and assisting with pain? As we enter deep sleep, our brain wave pattern slows. The pattern becomes steady and releases growth hormone which is essential for growth in kids and repair in adults. Dr. Gominak believes the growth hormone is the “boss hormone” that calls other hormones into action as needed. If this crucial phase is interrupted with movement, sleep can’t do its job. This can lead to unpleasant symptoms. Night after night no opportunity to repair or calm the nervous system, symptoms or issues may linger or progress. Proper sleep serves as a piece of healing, growth, and restoration.

Let’s imagine a Beltway construction project. VDOT is doing night repairs and shuts down all lanes from 10PM-6AM. The site is prepared (sleep hygiene and nutrition) and they start working. Uh oh, it’s 11:30 and an ambulance needs to get through (snoring spouse). The work is interrupted to let the ambulance through. Back to work. 2AM, what now? A hazmat truck needs to get through (teenager just came home). More construction delays! Now imagine this happens every night multiple times. When and how will this project be completed? Night delays will lead to daytime delays with traffic issues. You wake sore and achy, snap at the kids, or feel groggy at your morning meeting. This is what it is like for a body and mind that do not get proper and restorative sleep each night.

Improving our sleep

How do we improve our sleep? • Sleep hygiene • Sleep nutrition/supplementation • Sleep mechanics.

Sleep hygiene

Sleep hygiene involves prepping yourself and your environment for a great night. Sleeping in a cool room (60-67 degrees F) is a good place to start. Limiting caffeine is important. Individuals respond differently to caffeine influenced by age, weight, and more. Exposure to blue light from TVs, computers and phones signals the brain to stay awake. This was not an issue before electricity. Our bodies and minds knew to prepare for sleep when the sun went down and light was scarce.

Sleep nutrition

Vitamin D is an essential component for sleep nutrition/supplementation. It is actually a hormone and not a vitamin. We make Vitamin D from cholesterol receptors on our skin that we get from the sun. Knowing your D levels is important. According to Dr. Gominak, the sweet spot for Vitamin D and sleep is 60-80 ng/ml. Wor with a clinician for proper recommendations about D supplementation. Geography, season, age and cholesterol medications can alter D. Other nutritional/supplementation considerations are B vitamins, iron, and cherry juice concentrate (CJC). CJC can help boost melatonin production. Efficient levels of magnesium can positively affect sleep. Magnesium impacts muscle, nerve, and brain function. Nervous system health is vital for addressing pain. A final nutritional consideration with sleep is our gut bacteria. Sleep is one of the many areas we are learning about the importance of the microbiome. The gut bacteria makes 7 of 8 B vitamins and is important to consider with chronic pain, burning in hands, swelling, and more.

Sleep mechanics

An efficient airway (sleep mechanics) is essential for quality sleep. Where is your tongue when your mouth is closed and at rest? An efficient state is on the roof of your mouth. When it is pushing on your teeth or dropped down, this alters the airway. Take a slow deep breath with your tongue on the roof of your mouth and then not. Is it different? The mechanics can be addressed through manual work by a trained clinician and/or appliances created by a functional or biologic dentist.

Go to sleep! Seems so simple. Yet it is quite complex and essential for your health and healing. What changes will you make to allow the construction crew to do its work at night and facilitate better days?

Please be sure to consult your healthcare about making any changes that may or may not interfere with your current regimen.

References and where to learn more:

Sleep and Physical Therapy with Dr. Catherine Siengsukon https://www.ispinstitute.com/pain-reframed-podcast/ Dr. Stasha Gominak https://drgominak.com/ Tart Cherry Juice https://valleysleepcenter.com/the-truth-about-tart-cherry-juice-and-sleep/ Sleep Stats https://www.americashealthrankings.org/explore/2015-annual-report/measure/sleep/state/VA Sleep Stats https://www.sleepassociation.org/sleep/sleep-statistics/ Temperature for sleep https://sleep.org/articles/temperature-for-sleep/ Sleep and Wellness https://www.apta.org/PTinMotion/2017/11/Viewpoints/ Sleep Stages https://sleepdisorders.sleepfoundation.org/chapter-1-normal-sleep/stages-of-human-sleep/

*Jen DeLorenzo is a 1991 graduate of the University of Scranton in Pennsylvania. She has worked in multiple treatment environments, including travel PT. She has settled into an outpatient focus for the past 20 years. Her approach with patients has been strongly influenced by the Institute of Physical Art and the International Spine and Pain Institute (ISPI). In addition to PT, Jen integrates Wellness Coaching into most sessions as she is also a National Board Certified Health and Wellness Coach. Jen loves teaching and has been doing so since 1998. She has taught with Rehab Connections in Chicago, The Jackson Clinics in Virginia, and has been adjunct faculty with the Institute of Physical Art based in Colorado. She is thrilled to join the ISPI teaching team. Jen has owned a small private practice since 2007. Outside of physical therapy, Jen is a passionate mom to three busy kids!

Contact Jen at delotherapy@yahoo.com or 703-859-3415 Jen DeLorenzo PT CFMT TPS NBC-HWC DeLorenzo Therapy and Wellness Licensed Physical Therapist Certified Functional Manual Therapist Therapeutic Pain Specialist National Board Certified Health and Wellness Coach