How To Sleep Better
Let's face it. We could all benefit from more sleep (and better sleep). Regarding your overall health and wellness, sleep is one of the most important things to focus on. You can only function near your best with adequate sleep. "Adequate" will change depending on the time of life you are in (as a father of two young children, I know how challenging sleep can be), but improving your sleep is one of the highest leverage things you can do to improve your health and well-being. Not getting enough sleep can lead to a range of health issues, from increased risk of injury to impaired cognitive function.
Simply put, better sleep translates to better energy, improved physical health, reduced risk of injury and disease, enhanced cognitive performance, and a better mood. The benefits are numerous, making the effort to improve your sleep well worth it.
This blog will focus on some of the basics about how to sleep better. It will cover background research about sleep and injury risk, sleep hygiene practices, and other common questions about sleep. This is a vast topic, so I'll focus on my realm as a Physical Therapist (injury risk, pain management) and the advice I give my patients. However, I've gone pretty deep on this subject, so I'll also recommend other more comprehensive resources.
Why I Ask Patients About Their Sleep
Early in my career, I worked with a patient with shoulder pain. He had some rotator cuff irritation and seemed to be doing many right things. He consistently came to Physical Therapy and did the exercises I asked him to do. Still, his pain wouldn't completely go away. It was a frustrating situation for both of us, as we couldn't figure out why his recovery was slower than expected.
One day, the topic of sleep came up. I asked him how he generally felt about his sleep quality.
He said, "Pretty good."
I pressed a little further, "Say more. How many hours do you sleep on average?"
"About 4 hours."
This led to a much more detailed conversation about how much sleep is "enough," especially when dealing with injury and pain. More than 4 hours is needed, especially regularly.
Anything else you do to improve your health will be hindered if you are underslept. I am doing a disservice to my patients if I don't discuss this. Often, when patients come in for an evaluation with a chronic pain issue, their sleep needs work.
How Much Sleep Do You Need?
The standard advice of 7-9 hours of sleep is straightforward and applicable to most people. This simplicity should reassure you that you can easily follow this advice and reap the benefits of better sleep.
To be clear, I am mainly talking about adults here, but this also applies to adolescents. Recommendations for children (especially very young) differ entirely from what I discuss in this article.
Overall, 7+ hours is a good target for most adults. Getting more sleep than this would be great, but the demands of living, working, parenting, etc., in the modern world make this challenging. 7-8 hours is a reasonable target. I'm happy if a patient tells me they consistently sleep this much. This is also the amount of sleep I tend to get.
More sleep will be better if you are highly active, injured, recovering from surgery, competing at a high level, or under a lot of stress. If you can, shoot for the higher end of the range (8-9 hours).
For my adult patients, the sleep conversation often comes up in the context of chronic pain issues.
Patients with chronic back pain, shoulder pain, knee pain, etc., often have a more acute injury that doesn't improve the way it should. Or they have frequent recurrences of a similar issue. Chronic pain usually means something about your lifestyle is not sustainable. For example, nutrition could need some work. See THIS ARTICLE and THIS PODCAST for more on nutrition for recovery.
Chronic pain often points to the simple fact that a patient isn't recovering as well as they need to. They aren't sleeping enough, so their body can't rest and repair adequately.
An article from 2018 by Afolalu and colleagues had the following conclusion:
"Studies have found evidence that poor sleep is a primary factor predicting aggravation of pain responses and determining longer-term risks of developing a pain condition."
The research is somewhat mixed on whether poor sleep causes chronic pain or chronic pain causes poor sleep (probably a little of both). Still, improving your sleep can reduce pain.
For my younger patients (middle and high school), I recommend more like 8-9+ hours of sleep. In this phase of life, these patients are growing so much, both physically and cognitively. The youth athletes I work with train and compete pretty hard. This means they need more sleep.
An article from 2014 that examined sleep and injury risk in adolescent athletes had the following conclusion:
"(Athletes) who slept less than 8 hours per night were 1.7x more likely to have an injury when compared to athletes who slept more than 8 hours."
This suggests that the 8-hour mark is a helpful cut-off. If you have young athletes in your life, do what you can to help them sleep 8+ hours per night. This doesn't even consider the other benefits, such as better mood and school performance.
Sleep Hygiene: A Primer
Sleep hygiene refers to the behaviors and environment surrounding sleep. It's a term used to describe a set of practices and habits that can help you have a good night's sleep and feel alert and well-rested during the day. You may have heard this term before, and it is a helpful way to think about how to improve sleep.
The recommendations I give here are for relatively healthy people who want to improve their sleep. Insomnia, sleep apnea, and other medical issues must be discussed with your Physician.
HERE is a sleep foundation article explaining sleep hygiene. It also gives some good, basic recommendations.
Now that we've established how important sleep is (as if we needed reminding) let's discuss some of my favorite sleep hygiene tips. These are things I regularly discuss with patients. These are the best "bang for your buck" regarding the time and energy required.
Sleep Hygiene Tips From a Physical Therapist
Below, I'll cover some of my favorite sleep hygiene tips. Many of my patients need to improve their sleep, so I focus on simple, foundational strategies. I will keep this brief and give you more resources to dive deeper at the end of this article.
Consistent sleep and wake times. This is probably the most important advice I can give. Try to stay as consistent as possible with the time you go to bed and wake up. Your body and brain will learn the schedule, and it will be much easier to sleep when you want to and be awake when you don't.
Keep your bedroom quiet, dark, and cool. You want it to be like a cave. If it is too loud, you won't sleep well. White noise can also be helpful here because it is a consistent, quiet noise that can drown out other noises. Turn off electronics, use blackout curtains, and keep the room cool. It is better to be a bit cold than warm for sleep quality.
There should be no electronics in the bedroom. Don't have a television in your room; leave your phone elsewhere. The blue light and constant stimulation from screens do not allow your brain to power down for the night. Get an old-fashioned alarm clock and leave your phone elsewhere.
Have a wind-down routine and sleep cues. Take the last few minutes (or more) before bed for a wind-down routine. This can include personal grooming (brushing teeth, stretching, meditation, breath work, reading, journaling, etc.). The key is to keep it consistent so your brain starts associating these activities with sleep. I've seen everything from 5-10 minutes of reading to more elaborate routines, including meditation, journaling, breathwork, and more. Above all, keep it consistent and doable.
Associate your bed with sleep. This ties into the two above points. Keeping electronics out of your bedroom and having a wind-down routine help your brain associate your bedroom with sleep. Try to avoid doing a bunch of other things in your bedroom. It's for sleeping (and adult time).
Have a morning routine. On the flip side of the wind-down routine, it can be beneficial to have a morning routine. There was a trend where people got way too intense about this. That is unnecessary, and you can be as elaborate or simple as you want. This could be as simple as doing a quick stretch or getting some water or coffee. Again, the point is for your brain to associate this with something (being awake, in this case). If you can get up consistently and have a good routine in the morning, you'll be less likely to hit snooze. This then makes it more likely you will go to bed on time. You can see how this would reinforce good habits.
Don't exercise or eat too close to bed. Try not to do intense exercise or eat a lot in the 2-3 hours before bed. Your body needs time to wind down and digest.
Get a good mattress. This one seems obvious, but you would be surprised how many people don't like their mattresses. You spend up to a third of your life in bed. If you can afford it, get a good mattress that you like. It's an investment in your health.
These tips should get you started. Please remember that we are looking for progress, not perfection. Don't stress yourself out over creating the perfect routine or tracking everything. That is the opposite of what we are going for here.
Please do your best to be consistent, keep it simple, and not be too hard on yourself. Also, don't be puritanical about sleep. Stay up late occasionally and have fun, but don't make it a habit if your goal is to improve your health and well-being.
Quick Thoughts on Sleep Trackers
Activity and sleep trackers have become much more common recently. The technology is improving, and they are much better at actually tracking sleep. However, they could be better. They are estimating at best, especially when it comes to tracking sleep stages.
So, should you use a sleep tracker?
Here's my short answer: A tracker could be helpful if you are simply curious about your sleep. In this case, more information about it could lead to more (and better) sleep. Many people benefit from these trackers' feedback because they experiment and see what works for them.
If you will be stressed out by the data and criticize yourself for not hitting some arbitrary goal, don't bother with a tracker.
Other Common Sleep Questions and Resources
In the realm of sleep, there are many more topics to cover. I often get questions about the following:
Caffeine
Melatonin
Sleep medications
Sleep disorders (sleep apnea, etc.)
Alcohol, THC, etc.
These are beyond my scope as a Physical Therapist and beyond the scope of this (already long) article. There are entire books written about these topics and I will share one below for reference.
Sleep Resources
Here are some great resources to learn more about sleep. If you are interested in this topic, I highly recommend them. They all come from a sleep researcher named Matt Walker. He has written an excellent book on the subject, been on multiple podcasts (and hosted one himself), and given a fantastic TED talk.
One caveat about Matt Walker: he gives excellent advice on adult and adolescent sleep, but I recommend looking elsewhere for advice on sleep for infants and very young children. That is an entirely different ball game, and conversations about sleep training and other similar topics should be left to experts in that area. Matt doesn't frequently discuss this, but it is one area I can't entirely agree with him on. Otherwise, I am a fan.
Injury Rehab and Wellness Coaching In Lakeville, MA
At Wagner PT & Performance in Lakeville, Massachusetts, I help people deal with pain and injury and return to their best.
As you can see from this article, I combine Physical Therapy, manual techniques, exercise, programming, and lifestyle coaching to help patients achieve exceptional results.
If you want to work with us, check out our Orthopedic PT and Youth Athlete services.
I also offer free discovery calls. If you want to discuss something with me, these 15-minute calls are perfect. You can book yours below.