The short answer is YES! Did you know that researchers studying chronic pain in relation to sleep deprivation actually found that people who were not sleeping enough experienced pain quicker and in greater intensity? When you are coming to physical therapy, many physical therapists will never ask how you are sleeping, what your diet is like, or how you are coping with stress. These might seem off topic to you, but research has shown us that although physical therapy is meant to treat a physical condition, many other factors like these can play a direct role into how well and how quickly you will heal. Sometimes, if physical therapists can dig deeper into you as an entire person, instead of just looking at your knee, or your back for example, they might be able to treat you more efficiently by simply understanding how optimal your other systems are. Pain is very complex, and sleep is just one of the many factors that will affect how successfully you heal from an injury that you may be coming into physical therapy for.
In a review published in the Neuropsychopharmacology Journal, researchers describe several different mechanisms by which insufficient sleep can alter pain responses. Sleep deprivation can affect our immune system, nervous system, endogenous opioid production, hormone production and more! In this article ‘Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications’, researchers reviewed over 100 articles and concluded that cognitive behavioral therapy (CBT) was the most effective in addressing sleep disturbances. With this knowledge, if you are someone who has been dealing with chronic pain, CBT should be highly considered! When coming to physical therapy, it is vital to remember that healing should be a multidisciplinary approach to best find the root cause.
Another article published in the Sleep Medicine Journal ‘Cognitive consequences of sleep and sleep loss’ explained how in our REM sleep (AKA deep sleep), we go through a process of “decoupling emotion from a memory”. What does this mean? Simply put, when we sleep well, and sleep deeply, our emotional, even stressful memories are stored with less emotional tone. Even further more, if we do not get proper REM sleep, the opposite occurs where we remember the memory with even more emotional tone and greater anxiety associated. We also know that chronic pain essentially re-wires our brains into a higher, more excited state, so associating chronic pain with lack of sleep will lead to our nervous systems being completely out of control! If our nervous system is not regulated, healing from an injury becomes extremely difficult.
What’s the take home message? Healing from an injury or living a pain free life may not always be straight forward. We are extremely complex, which is what makes us humans elaborate; albeit convoluted. If you are someone dealing with chronic pain, consider CBT and furthermore looking into your overall well being. How is your diet? How are your family and friend relationships? How is your work life? How are you currently maintaining your stress levels? These are just some of the questions that should be considered if you have been struggling to cope with your healing and/or pain. Remember, a complex system should not be isolated and your sleep may be more important than you think.
Haack, M., Simpson, N., Sethna, N., Kaur, S., & Mullington, J. (2020). Neuropyschopharmacology, 45: 205–216. https://doi.org/10.110138/s41386-019-0439-z
Walker, M. P. (2008). Cognitive consequences of sleep and sleep loss. Sleep medicine, 9, S29-34.