The National Sleep Foundation recommends that adults (18-64) get seven to nine hours sleep per night, with requirements dropping slightly to seven to eight hours for those aged over 65. 

Despite this advice, and perhaps not surprisingly, almost 1 in 2 (45%) Australians are not getting adequate sleep in either duration or quality, which is detrimental to the body's ability to repair and rejuvenate – a significant role in rehabilitation and recovery. 

However, it's not just recovery that is affected according to physiotherapist Karen Chan who says sleep impacts all areas of a patient’s physical and mental wellbeing, making it a critical factor in holistic treatment.

“Memory, quality of life, life expectancy, creativity, energy, functional capacity, alertness, weight control, stress levels, moods and academic performance are all affected.

“There are also associated impaired driving and risk-taking behaviours, impaired social relationships and evidence to show decreased performance in elite and amateur athletes.

“Ongoing sleep deficiency is also linked to increased risk of cardiovascular, hypertension and kidney disease, Type 2 diabetes, stroke and even cancer,” said Ms Chan.

Physiotherapist Ashley Mason agrees that sleep is vital to many areas of a patient’s health and wellbeing and is a critical factor in recovery.

“I talk to my patients about sleep a lot.

“When I ask them about their sleep cycle, I’m most often met with groans and sighs. Not many people experience the blissful joy of a good and long night’s sleep,” said Ms Mason.

If a patient presents with any musculoskeletal injury or pain, Andrew Wynd, a master sports physiotherapist, says he strongly suggests discussing sleep.

“I tend to ask questions within my subjective assessment about the amount, and more importantly, quality of sleep.

“At some point during the consultation, I’ll link any sleep comments back to their injury and ensure the client understands why I’m mentioning it.

“Simple education about sleep hygiene and ensuring the client has a suitable mattress and pillow goes a long way to addressing any deficits in this area,” said Mr Wynd.


Sleep and injury

Inadequate sleep can cause both an increase in the incidence of injury and a delay in the speed of recovery, explained Ms Mason.

“Studies have proven that on average athletes who receive less than eight hours of sleep per night are 1.7 times more likely to have an injury.

“If you’re not sleeping well, it’s likely that it will take longer to recover from an injury.”

The significance of sleep on injury incidence and speed of recovery could be explained by blood flow and hormones said, Ms Mason.

“When you sleep your blood pressure drops, and your breathing slows and deepens. 

“Whatever blood is not being used by your brain at rest gets redistributed around the body which in turn means increased oxygen and nutrients to your muscles.

“When your body reaches its deepest stage of sleep, called non-REM sleep, your pituitary gland releases growth hormones.

“These hormones aid in metabolism regulation, cell reproduction and regeneration, which in turn stimulates muscle repair and growth.

“Your pituitary gland also releases prolactin, which is one of your body’s natural anti-inflammatory hormones to relieve any achy joints or tired muscles,” said Ms Mason. 

Reasons for inadequate sleep

If your client is not getting enough good quality sleep, there could be a few reasons why.

“Several sleep disorders can contribute to poor sleep, such as sleep apnoea and restless leg syndrome.

“However, in the absence of a medically diagnosed sleep disorder, there are a few things you can recommend for getting a better night’s sleep,” said Ms Mason.

Learn to meditate

“We live in a world where “busy” is the norm.

“Rates of stress and anxiety are higher than ever, and yet there still seems to be a common expectation that if you’re not stressed and busy, you’re probably not working hard enough.

“Being in a prolonged state of stress, including the stress of pain and injuries, results in an increase in cortisol in the blood.

“Cortisol is your body’s stress hormone, which is vital for helping you wake up in the morning, but elevated cortisol levels at night result in the “tired but wired” paradigm.

“Studies show that meditation before bed is effective at lowering cortisol levels in the blood. It also activates your parasympathetic or “rest and digest” state, which is crucial for a good night’s sleep.

“You don’t have to be an expert meditator. Even if you find meditation difficult, there are plenty of free guided meditation apps on the market that teach you to meditate.

“I recommend ‘Smiling Mind’ for beginners, or ‘1 Giant Mind’ if you’re interested in learning how to meditate like a guru.

Avoid screens for two to three hours before bed

“Blue light from electronic devices is great during the day as it has been proven to improve attention, increase reaction times and elevate mood, but when you're trying to wind down in the evening, your phone screen is detrimental to your sleeping pattern.

“Blue light suppresses the body’s production of melatonin, the hormone that regulates your circadian rhythm, or sleeping pattern.

“A recent study conducted by Harvard University researchers found that when compared to green light, the blue light can suppress melatonin production for twice as long and shift circadian rhythm by twice as much.

“Most smartphones have a ‘blue-light filter' function; however, your best bet is to just completely avoid electronic screens for two to three hours before bed.

Upgrade your mattress and pillow

“Tossing and turning throughout the night? It’s a common problem I see, and a common question I get asked is, ‘Can my mattress and pillow be contributing to my pain or affecting my sleep?’ The answer is absolutely! 

“If you've been sleeping on the same mattress for ten years, it's time for a new one.

“Likewise, with your pillow. There are several great brands of orthopaedic pillows on the market, each made from different materials. Some are contoured, and others aren't. The best pillow is the one that sits comfortably between your shoulders and head to keep you aligned without bending your neck,” said Ms Mason. 

So, whether your patient is an athlete, a weekend warrior, or is merely suffering from any pain condition or injury, discussing sleep is vital, as there is no substitute for a good night's rest when it comes to health and recovery.