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Is Sleep The Most Important Element of Low Back Pain?

April 7, 2016

This morning I woke up with the first thought of how great I slept last night.  This is a rare event for me lately with a business to run, patients to treat, a toddler who sometimes sleeps all night and sometimes doesn’t and a wife who is about to have another child any day now.  So needless to say sleep is a rare event.  Last night’s sleep was super important though. I’ve been recently training for a half marathon that takes place in a few months and two days ago I had my longest run yet, 9 miles.


So naturally after that far of a run my body needed some rest and recovery. Unfortunately, the night after the run my sleep was interrupted many times. I felt especially sore and fatigued the next day.  But today after a great night sleep I can tell my body had a chance to recovery and I am ready to run again.  And when I woke up this morning I thought to myself how important sleep is and how I absolutely have to write this down and share it with you.

We all know that sleep is important but I don’t think all of us know how important it is for the healing process. When we enter sleep we go through several phases of sleep cycles.  The one I want to focus on is called REM sleep.

sleep cycle

This is the deepest sleep cycle and lasts only 90 minutes and we usually only get 3-4 cycles of these each night.  REM stands for Rapid Eye Movement but for the sake of this conversation I want to focus on what happens during REM sleep.  There are many things that happen but most importantly our body releases Human Growth Hormone (HGH) during these cycles of sleep.

how HGH works

HGH is responsible for our cell recovery and growth.  In fact, this is the only time the body releases these hormones is when we sleep. This hormone is responsible for rebuilding our broken down body tissues.  It is essential to healing.  Those of you that have experienced pain know how sleep can be effected and usually decreases our sleep in total.  I want to point out how important sleep is to the recovery process.  Frequently I hear people talking about having recovery days as it relates to physical therapy or exercise but I don’t think people understand really how the body recovers. Most of our painful conditions that we experience with any condition, but especially with lower back pain, is related to inflammation.  Inflammation as mentioned early is the bodies first step in the healing process.  It is the step where the body’s immune system begins to section off damaged cells and eat or reprocess the dead cells.  Then as we sleep HGH stimulates the next phases of healing.

A patient that I worked with a few years ago comes to mind. He was recovering from a shoulder surgery and he was not making much progress.  His tissues were inflamed and painful. His range of motion was poor and he was about 4 weeks behind where he should be.  As I got to talking with him I made a comment about how tired he looked.  He mentioned that he hadn’t gotten more than 2 hours of sleep in over 2 months. At that moment I stopped his physical therapy session and discussed the importance of sleep.  He agreed that sleep was important but was lacking the strategies on how to get better sleep.  So we came up with this.  He was on a regular dose of NSAID’s to reduce his pain level.  So he decided to take the PM version of his NSAID’s for one weekend to see how it went. He came in Monday morning with a huge smile on his face. In just 3 nights he was able to reduce his pain level by 50% and his range of motion increased to a normal level for that phase after surgery. Unbelievable results with simply tweaking the sleep cycles.  You see the body has an amazing ability to heal itself.  Nobody can do that for it. But it only heals itself when given the proper environment.  That environment must include sleep, nutrition, oxygen, and water.  The physical environment is also an important one but is not as important as the essentials just mentioned.

should surgery

So with all of that encouragement to sleep I want to say I understand how hard it can be.  So here are a few tips for you to try and follow to get better sleep to allow for a quicker and more efficient healing process.

  • Go to bed. It is important to make bed time a habit.  Habits are created with consistent practice.  Setting a bed time is essential to this process, even if you don’t think you will be able to fall asleep.  Of course it is recommended to get 8 hours of sleep per night.  But set your bed time 30 minutes before that 8-hour mark to allow yourself some time to actually get to sleep.  I personally set a bed time of 10pm and wake up at 6am. I usually try to get into bed at 9:30 to give myself some time to actually fall asleep. 
just go to bed
  • Stay Hydrated. Research identifies that is someone is not hydrated properly that they will not get to sleep as easily and will not stay asleep.  This is especially important the older we get because I often times hear people saying that they are frustrated at how many times a night they have to get and go to the bathroom so they simply don’t drink water before bed.  I would argue that going to the bathroom at night is a totally different issue that can be address by following a voiding schedule but we will not cover that in this chapter but if this is your problem I would encourage you to look that up online and educate yourself on ways to improve your voiding schedule.
drink more water
  • The Bedroom is for sleeping and Sex only. This was once told to me by a neuroanatomy professor in graduate school but research does back up the idea that removing distractions from the bedroom does allow for optimal sleep. That includes removing TV’s or radios or iPhone from your site while in your bedroom. 
  • 2-hour break from screen time. New research shows that having your face in front of a screen 2 hours before bed has a negative effect on sleep.  This is because it has an effect on your brains circadian rhythm that is usually stimulated by sunlight.  So no screens before bed. 
screen time
  • Find a pain free position. This is particularly important for you low back pain sufferers who just really have a hard time getting to sleep due to pain. There is no right or wrong position to sleep in for your back.  Just find one that feels the best.  For me it was laying on my back with pillows under my knees.  For you it will be different.
  • Cool Environment. Research also indicates that we sleep better in cool environments. So turn down the heat, reduce a blanket or two, take of some layers of clothing and get some better sleep.

I hope these simple tips can help you get better sleep.  Remember it will help your lower back heal faster.  You must consider sleep a top priority.  If you would like to learn more about how the body heals itself and what you can do to optimize it especially when dealing with lower back pain, we are hosting a Free Lower Back Pain and Sciatica Workshop. You can learn more by clicking here. 

P.S. I wrote a book for you on lower back pain as well...

truth about lower back pain

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