I’m going to present the same case scenarios I present to all of my orthopedic residents when I introduce the topic of pain.
If you were to provide recommendations for lifestyle habits, including sleep, nutrition, and physical activity, would they be the same or different for the following two people?
A high-earning professional living in a leafy suburb with a stay-at-home partner and safe access to a well-equipped gym, who easily finds opportunities to exercise after work and enjoys being active after sitting at work for much of the day.
A single parent looking after two young children and working three low-wage jobs, who is living in a small studio in an apartment block where it is unsafe to go outside after dark, and who has limited opportunities to exercise (and after paid work, looking after the house and caring for the children, is fatigued and just wants to rest).
These two cases are from the paper Privileging the Privileged. As a physical therapist, I would provide different recommendations. I wouldn’t change the facts — such as the health benefits of sleep — but I would provide information that's beneficial to the patient.
What benefit would I gather from telling the single parent with two kids that she needs to get at least seven hours of sleep a night, exercise 45 minutes per day, and only eat home-cooked meals? There are many strategies to being healthy and we need to understand each person’s situation is different.
Stop sleep-shaming people.
We have enough articles listing all the detriments of poor sleep and the benefits of a restful night. There are plenty of those floating around this publication, let alone the internet at large. I wrote one and I cringe looking back on the article.
We get it, research is clear sleep influences our mental and physical performance, dietary habits, pain, and body composition. What is often neglected is, like any health endeavor, getting good sleep will look different from person to person.
The personalized approach is key, as many of the articles available to educate people, whether intentional or not, contain a shaming message.
Most fitness, nutrition, and sleep articles I read to sell a specific approach to health that the reader would be foolish to ignore. In the fitness world, rather than attempt to help people meet exercise guidelines by teaching about exercise efficiency and providing options that fit various schedules and access to resources, they promote expensive, time-consuming programs that require specific facilitates or space.
If you lack the financial resources, prioritize your money better. If you don’t exercise 60–90 minutes a day, be better at managing your time. Won’t buy my product? Do you even care about your health?
Similar asinine messaging occurs in the nutrition and sleep space.
Eric Cressey is one of the most successful strength and conditioning coaches in the baseball area, working with many professional and collegiate athletes. The man lives and breathes performance. He has his recommendations for optimal sleep but he also understands the barriers of life.
There is never a one-size-fits-all approach. That does not mean, however, we should simply ignore the issues.
Personalize your approach to sleep
I swear by my Tempurpedic pillow while my wife didn’t make it through the first night (despite the purchase being her idea and justifying the cost via the two for one sale…moving on.) Some people like a cold room while others like it warm. Some prefer stomach sleeping and others wake up in pain if they roll off of their side. There is no ideal sleep position (just like there is no ideal posture).
But let’s take it a step further than sleep comfort. Even the duration of optimal sleep varies from person to person. The range of 7–9 for adults is a statistic representing averages. You have flexibility based on your lifestyle habits, season of life, and recent physical and mental demands.
That flexibility does have limits though. Here is the section of the article where I provide the reminder that sleep is important. We can value sleep without demonizing sleep loss and shaming people into believing they lack priorities.
I see sleep deprivation every day, whether it be patients in the clinic or clinicians in the classroom. Poor sleep habits are often swept under the rug as sleep loss is perceived as normal. Cultural norms don’t change the negative impact sleep loss has on our bodies.
The prevalence is concerning with 53% to 90% of people with chronic pain having a clinically significant degree of insomnia. And insomnia is not total sleep deprivation for multiple nights. More than 30 minutes of sleep latency and/or minutes awake after sleep onset for more than three days per week for at least three months is considered insomnia.
This is a problem, but the solution is not to simply get more sleep by trying harder.
I have a one and a three-year-old and I have not had optimal sleep for almost four years. I can’t have a heart-to-heart with an infant and a toddler, explaining their needs is interfering with my sleep. It doesn’t work that way.
Schedule challenges aren’t reserved for parents with young children. I’m not going to tell someone to change careers and find new aspirations because the current one interferes with sleep. Instead, find a schedule and habits that work well in your life.
For me, I focus on quality and consistency. On the weekends and when I travel, I go to bed and wake up within an hour of my normal workdays, keeping my circadian rhythm consistent. I avoid alcohol and food several hours before bed. I read and avoid screens during the last hour of the day. These strategies work for me and fit into my routine.
If getting into a routine is unrealistic in your current season of life, then shoot for one good night every now and then.
The power of one good night of sleep
Sleep deprivation won’t resolve with a single good night of sleep, research suggests you need roughly nine good nights in a row. One good night can have drastic impacts, however.
Research shows people with chronic pain spontaneously engage in more physical activity following a single better night of sleep. Additionally, one night of good or bad sleep will impact pain sensitivity.
As a physical therapist, I understand each session with a patient is a single snapshot of their daily lived experience. If I want to test their strength and power, I reserve testing for days following adequate sleep. If I am trying to determine their prognosis and design a plan of care, I need to know their current sleep status, both acutely and chronically.
So, if you have a big event — whether it be sporting or work — try planning ahead. It may be more realistic to plan for one good night of sleep two weeks from now than getting a good night of sleep every day.
Again, the goal is not to shame people into sleeping more, rather, to understand the big picture and how to best help them.
Understand how sleep loss will affect you and compensate
Consider how a single night of total sleep deprivation (e,g, an all-nighter studying) leads to generalized hyperalgesia (increased pain sensitivity) and increased anxiety in healthy people.
While I don’t advocate for all-nighters — the negative impacts of sleep loss will be greater than the knowledge gained from studying longer — in some cases sleep deprivation is unavoidable.
Up all night with a sick child or pulling a double shift? You need to understand this will negatively impact your mental performance. So plan accordingly.
When I was in the newborn phase with my kids, I asked my colleagues to review my work more frequently (within reason). I time blocked more often, reserving complex tasks requiring focus to the morning when I was most productive. I asked for feedback regularly to ensure my performance was meeting the standard.
I also gave myself a break.
I knew my capacity was diminished. I did not expect the same level of work from myself as when I was in the ‘pre-kids’ era. This may mean leaning on others more. If you foresee a season of sleep loss, prepare ahead of time where you are able to.
Like Eric Cressey, I won’t let a 24-year-old social media influencer without kids shame me. My priorities differ and I stand by them.
Building good sleep, exercise, and dietary habits are goals I encourage everyone to set. But life often gets in the way of designing our perfect schedule. Find what works for you.
Sometimes, one good night of sleep is the best thing for you.