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Sleep Hygiene

Sleep hygiene is an important consideration for life but when you are healing from an injury or surgery, it is even more important.

I often ask my patients who come into the pool for their therapy, “How are you sleeping?” A surprising number report that their sleep is terrible and that they either can’t get to sleep in the first place or that they wake up and can’t get back to sleep somewhere in the middle of the night.

What keeps you up?

Sometimes pain wakes them up and they can’t get back to sleep due to the pain itself, general insomnia and resulting worry. Further questioning reveals a lot of TV watching until the wee hours of the morning and other bad habits such as vigorous exercising and eating large amounts of food/caffeine/ chocolate right before trying to go to bed.

Whether conscious or not about good behavioral practices to improve the quality and quantity of sleep, if you are trying to heal your body from injury, surgery or chronic pain, achieving properly balanced sleep habits is one thing you can do for yourself to enhance your physical therapy goals and to get better.

So how do we improve our sleep hygiene?

What we have some control over is our “sleep hygiene”. Sleep hygiene is a phrase used to describe techniques to improve the quality of sleep through behavioral and environmental modifications. For instance, pick a time at night to start getting ready for bed that is approximately 8-9 hours before you need to get up in the morning, then honor it by getting into bed close to that time. Turn off all light sources such as TVs and cellphones, close light-blocking draperies and make sure the room is quiet, cool (but not cold).

Another tip, don’t eat a heavy and/or spicy meal, don’t consume alcohol or smoke cigarettes and don’t exercise vigorously for at least 1-2 hours prior to bedtime.

Why is sleep hygiene important?

It is very important for many reasons to sleep when your body is prepared to sleep. Circadian rhythm is our internal body clock that regulates when we sleep, awaken and feel hungry.

According to the NIH, REM sleep is when we dream and Non-REM sleep is known as deep sleep. Three to five cycles per night of each is recommended.

Worrying about Sleep Keep You Awake

Another problem is when you wake up and can’t get back to sleep or you can’t get to sleep in the first place. The Mayo Clinic suggests you practice what is called sleep restriction: instead of lying in bed worried about the loss of sleep, they suggest you get up in the quiet room and do something inactively like reading or meditating. This technique is also known as remaining “passively awake” so that you are not worrying about “not sleeping” and likewise you are not over-stimulating yourself visually or physically.

Applying these suggestions will improve your sleep hygiene and you will be honoring your circadian rhythms to improve your chances of getting a good night’s sleep.

What happens when you sleep?

What happens on the cellular level only while we are getting proper sleep? Blood pressure drops, muscles relax and breathing slows. Blood supply to the brain, muscles, and tissues increases to repair damages, remove waste products and grow new tissues. Short-term memories are consolidated into permanent memories. The immune system is replenished; hormones are re-balanced for things such as healthy appetite suppression and proper growth. Even cortisone dips during proper sleep, which decreases cortisone build-up, which in turn, decreases chronic stress and allows morning alertness.

Essentially, we heal in every way while we sleep. Sleep deficiency contributes to serious chronic health problems such as diabetes mellitus, stroke, obesity, heart and kidney disease, high blood pressure and depression. Feeling tired increases the common risk of accidents leading to injuries. In other words, if we don’t sleep properly, we aren’t able to heal properly.

How can proper sleep hygiene help your physical therapy?

What does this mean for improving our physical therapy outcomes? To get the most out of your time spent at physical therapy appointments, arrive well-rested, hydrated, dressed appropriately for exercise and having eaten and taken medicines properly for the best pain management and energy levels. If one of these key components is off, the therapy session can be compromised and might even have to be discontinued for another day, interrupting your progress.

When you are in rehab, your body is not only healing but also building muscle and enlarging brain-body relationships such as balance and coordination. Sleeping properly before and after each therapy session helps you to feel better, recover faster and to have more long-lasting positive benefits.


Article by NIH staff (March 2017). Insomnia: Relaxation techniques and sleeping habits. Retrieved from

Article by Mayo Clinic staff (2017). Insomnia treatment: Cognitive behavior therapy instead of sleeping pills. Retrieved from

Sharyn Frederick, PTA graduated from Baltimore City Community College AACC/CACHE Physical Therapist Assistant Program in May 2015. She returned to college after over 20 years working in architecture & residential landscape design as a result of acting as primary caretaker for a loved one who passed from cancer at a young age. Physical therapy, particularly aquatic therapy, piqued her interest as a healthcare specialty that teaches patients to truly better care for themselves in the healing, warm waters. Sharyn is most interested in training a wide variety of rehab patients by pursuing continuing ed to incorporate principles of yoga, myofascial release, dry needling, breath work, healthy nutrition & lifestyle choices for graceful aging. Free time is spent enjoying music, gardening, traveling, family & pets.

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