We always hear, “remember to get your 7 to 8 hours of sleep if you want to function”, yet no one is actually listening. Apart from walking around like the undead, and hearing the screeching of nails on a chalkboard when anyone speaks to you before your morning cup of coffee, long term sleep deprivation is detrimental to the brain and body. In this blog, Osteopaths Dr Tayyar Celiker and Dr Harry Williams  will discuss the many reasons why high quality sleep should be on everyone’s daily checklist.

It is important to understand that even when we try to get to bed at an appropriate time for our precious 7-8 hours of sleep, distinguishing sleep quality and quantity is very important. While these are essentially two sides of the same coin, if you are sleeping for 7-8 hours but still waking up fatigued and lethargic (excluding other medical concerns), it could be that your quality of sleep is poor. While sleep quality is very subjective, hard to measure and affected by many factors, start with the following tips to promote a longer, deeper sleep.

1. Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during holidays.
2. Set a bedtime that is early enough for you to get at least 7-8 hours of sleep.
3. Don’t go to bed unless you are sleepy.
4. If you don’t fall asleep after 20 minutes, get out of bed. Go do a quiet activity without a lot of light exposure. It is especially important to not get on electronics.
5. Establish a relaxing bedtime routine.
6. Use your bed only for sleep.
7. Make your bedroom quiet and relaxing – keep the room at a comfortable, cool temperature.
8. Limit exposure to bright light in the evenings.
9. Turn off electronic devices at least 30 minutes before bedtime.
10. Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
11. Exercise regularly and maintain a healthy diet.
12. Avoid consuming caffeine in the afternoon or evening.
13. Avoid consuming alcohol before bedtime.
14. Reduce your fluid intake before bedtime to limit bathroom visits. 

What are the benefits of having regular good quality sleep? 

The benefits according to research include: 

• Improved exercise performance and recovery
• Reduction in chronic pain
• Increase in cognitive function 
• Improved immune response  
• Positive effects on mood and anxiety 
• Reduction in overall pain levels
• Positive effects on general body health and function.

Recovery and Performance

While the fitness industry is debating about the best form of recovery – whether it’s ice baths, saunas, spas, massage/treatment, variety of supplements etc. The best form of recovery is right under our noses and completely FREE – sleep! Sleep has shown positive effects in the recovery of exercise induced muscle soreness (Chennaoui, M et al, 2021). According to this study, sleep has positive effects on the blood serum levels of Testosterone, Growth Factor and other hormones, which in turn display positive effects in the body’s anabolic potential (ability to heal and increase muscle mass), and many other functions including cognitive capacity, vigilance, fatigue, mood disorders, and stress. In regards to performance, impairments in reaction time and cognitive function and high levels of fatigue after sleep deprivation were suggested to contribute to injury risk in adolescent elite athletes which is also affected by the circadian rhythm. Therefore, not only the quantity of sleep but quality and consistency of sleep is just as important (Chennaoui, M et al, 2021).

Immune response

Sleep and circadian rhythms are strong regulators of immune processes.

Investigations of the sleep-wake cycle have shown that the activity of certain immune cells responsible for initiating an inflammatory response peaks during the early stages of sleep. These cells are significantly less active during our waking hours, therefore, sleep disturbance can be a risk factor for the development of chronic inflammatory diseases.

Sleep deprivation involves increased activation of the sympathetic nervous system – the system responsible for our fight or flight response – and a rise of a stress hormone called Cortisol, leading to suppression of the immune system, and more bouts of sickness throughout the year.

Mood-stress/anxiety

Sleep quality can also have a significant effect on mood. As most of us probably know, the less sleep we get, the grumpier we feel. A study by Triantafillou et al. (2019), showed that sleep duration and quality impacted college students’ academic function, physical and psychological health. Poor sleep is linked to a higher incidence of stress, anxiety and depression, and is tied in with experiencing symptoms of anxiety. Reduced sleep quality predicts a higher risk of developing anxiety symptoms within the next year (Zou et al., 2020).

General body function

Sleep is a regulatory process that allows our bodily systems to function effectively. A lack of sleep can place more stress on our body and lead to disruptions in these systems. Both chronic pain and sleep disturbances share an array of co-existing physical and mental health problems, such as obesity, type 2 Diabetes and Depression (Finan, Goodin & Smith, 2014). Long-term consequences of sleep disruptions include hypertension, cardiovascular disease, weight-related issues, colorectal cancer and many more (Medic, Wille & Hemels, 2017). 

Pain

Sleep disturbance is a strong predictor for the presence of pain. Research shows that sleep impairments reliably predict new incidents and aggravations of chronic pain and are present in 67-88% of chronic pain disorders and at least 50% of individuals with insomnia suffer from chronic pain (Finan, Goodin & Smith, 2014).Furthermore, Sleep deprivation has also been shown to lower pain thresholds, as a consequence stimuli that wouldn’t normally be painful to initiate a pain response (Krause et al., 2019). This is due to a reduction of sleep altering brain chemistry and the way the brain processes pain at multiple levels of the central nervous system (Finan, Goodin & Smith, 2014). Poor sleep therefore not only affects general health but has a direct impact on inflammation, pain response, and experience. Improving sleep in people living with musculoskeletal conditions and with chronic pain has the potential to deliver great benefit to many (Whale & Gooberman-Hill, 2022).

Memory and Learning

Lack of sleep has been shown to produce deficits in memory consolidation, and plays an important role in brain development and brain plasticity in several developmental stages of the human brain. Studies have shown that subjects experiencing sleep deprivation perform significantly worse on visual and auditory memory tests. Rapid eye movement (REM) sleep is that stage of sleep where we dream. This is the stage of sleep where memories and learning are consolidated. REM sleep will happen roughly once every 90 minutes while we sleep, the first stage lasts around 10 minutes, and gets longer each time therefore getting less sleep each night significantly reduces the amount of REM sleep, which means learning and memory will suffer.

Authors: Dr Tayyar Celiker BSc (osteo) MHSc (Osteo) & Dr Harrison Williams BSc (osteo) MHSc (Osteo)

References

American Sleep Association. What Is Sleep and Why Is It Important? (https://www.sleepassociation.org/about-sleep/what-is-sleep/).

Aschbrenner, K. A., Naslund, J. A., Salwen-Deremer, J. K., Browne, J., Bartels, S. J., Wolfe, R. S., Xie, H., & Mueser, K. T. (2022). Sleep quality and its relationship to mental health, physical health and health behaviours among young adults with serious mental illness enrolled in a lifestyle intervention trial. Early intervention in psychiatry, 16(1), 106–110. https://doi.org/10.1111/eip.13129

Besedovsky, L., Lange, T., & Born, J. (2012). Sleep and immune function. Pflugers Archiv : European journal of physiology, 463(1), 121–137. https://doi.org/10.1007/s00424-011-1044-0

Chennaoui, M., Vanneau, T., Trignol, A., Arnal, P., Gomez-Merino, D., Baudot, C., Perez, J., Pochettino, S., Eirale, C., & Chalabi, H. (2021). How does sleep help recovery from exercise-induced muscle injuries?. Journal of science and medicine in sport, 24(10), 982–987. https://doi.org/10.1016/j.jsams.2021.05.007

Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: an update and a path forward. The journal of pain, 14(12), 1539–1552. https://doi.org/10.1016/j.jpain.2013.08.007

Hershner, S., & Shaikh, I. (Eds.). (2021, April 2). Healthy sleep habits. Sleep Education. Retrieved December 5, 2022, from https://sleepeducation.org/healthy-sleep/healthy-sleep-habits/ 

Kohyama J. Which Is More Important for Health: Sleep Quantity or Sleep Quality? Children. 2021; 8(7):542. https://doi.org/10.3390/children8070542

Krause, A. J., Prather, A. A., Wager, T. D., Lindquist, M. A., & Walker, M. P. (2019). The Pain of Sleep Loss: A Brain Characterization in Humans. The Journal of neuroscience : the official journal of the Society for Neuroscience, 39(12), 2291–2300. https://doi.org/10.1523/JNEUROSCI.2408-18.2018

Medic, G., Wille, M., & Hemels, M. E. (2017). Short- and long-term health consequences of sleep disruption. Nature and science of sleep, 9, 151–161. https://doi.org/10.2147/NSS.S134864

Miller, K. E., & Gehrman, P. R. (2019). REM Sleep: What Is It Good For?. Current biology : CB, 29(16), R806–R807. https://doi.org/10.1016/j.cub.2019.06.074

Potkin, K. T., & Bunney, W. E., Jr (2012). Sleep improves memory: the effect of sleep on long term memory in early adolescence. PloS one, 7(8), e42191. https://doi.org/10.1371/journal.pone.0042191

Triantafillou, S.,Saeb, S., Lattie, E. G., Mohr, D. C., & Kording, K. P. (2019). Relationship Between Sleep Quality and Mood: Ecological Momentary Assessment Study. JMIR mental health, 6(3), e12613. https://doi.org/10.2196/12613

Whale, K. and Gooberman-Hill, R. (2022), The Importance of Sleep for People With Chronic Pain: Current Insights and Evidence. JBMR Plus, 6: e10658. https://doi.org/10.1002/jbm4.10658

Zou, P., Wang, X., Sun, L., Liu, K., Hou, G., Yang, W., Liu, C., Yang, H., Zhou, N., Zhang, G., Ling, X., Liu, J., Cao, J., Ao, L., & Chen, Q. (2020). Poorer sleep quality correlated with mental health problems in college students: A longitudinal observational study among 686 males. Journal of psychosomatic research, 136, 110177. https://doi.org/10.1016/j.jpsychores.2020.110177