S7E12: How Sleep Changes Pain

Do you wonder if you're the best version of yourself? This is a question we seek to answer in this podcast. We reveal information that helps you recover your health and become resilient. Modern life makes us fragile. Our diet, lifestyle, environment set us up for failure. We do not accept this. We seek optimization. We strive to become dynamic. Hey, what's going on, Dr. Chris? I want to talk about sleep and pain and how those things correlate. So I noticed this pattern very early in my career. And it's not like we really talked about this concept in PT school. We didn't really talk a whole lot about sleep. But I definitely noticed that everybody that was on my table, almost everybody outside of some acute trauma, I'll say, was there with chronic pain, and they are all sleeping poorly. At first I was like, why, why is everybody in Cape Coral? That's where I was at the time. This whole town, like no one sleeps. Then I was like, okay, wait, I have a bias here because they're, they're in therapy. So then I was like, well, okay, I guess that kind of makes sense. They're in pain. So it's limiting their sleep. But then I started to wonder, is it the other way around? Does lack of sleep augment pain? What I've come to, come to realize is that it's a two-way street. It's a vicious, vicious cycle. As physios, we kind of have this advantage. We tend to have a lot more time with our patients. You know, if you're seeing somebody 2 or 3 times a week for, you know, up to an hour, you get a lot of time to talk to them. So I just naturally started talking to them about just their general health, not just your knee pain. You know, how are you sleeping? How's— how much do you move? How little do you move? What's your hydration like? What's your nutrition like? Are you taking electrolytes? Are you doing any supplements? So these kind of conversations naturally came up. And, you know, time and time again, it was just this pattern of No one is sleeping well, and you could track their pain and their sleep together. In fact, that's what I did. I just asked people, zero to ten, how is your pain today? And how much did you sleep last night? Not even really how deep did you sleep. Not not only quality or not even quality, just quantity. And you could just see waxing and waning of pain right along with how they slept. So it'd be common for them to come in and I slept pretty good today. And no, actually the pain's actually not that bad. And that's when I was like, okay, this, this pain, you know, lack of sleep is an amplifier. So we've been stuck in this sort of biomechanical model of pain. So if your knee hurts, your ankle hurts, it's gotta be something you're doing. You're moving wrong, which I hate, by the way. There's no really bad movements or bad exercises. It's just, you're not ready for it maybe. But the tissue is the issue. That's the phrase to kind of explain the biomedical model of pain. Pain, that it's a local issue. You're doing something that's irritating it, which certainly could be the case, but that's not really how pain works. Pain is your body's warning sign. So the pain signal goes the other way. So you think that you have an arthritic knee or torn meniscus and you step a certain way and the pain is coming from the knee. It's not really how it works. So what happens is A signal or the nervous system identifies something in the area, the knee, we'll take that example, and senses something it perceives as a threat. So some sort of change, a metabolic change, you know, maybe it is like a tear, that type of change. And it says, I think this is a threat to my survival. And I'm going to send a signal from the brain to the knee and make it hurt there. Just like a dashboard in a car says, okay, that tire is flat. It sends a signal. And so you know what's going on in that location as an attempt to get your attention and the request for a change. So basically it's trying to get you to stop moving a certain way or alter something or change your load management. But the signal comes from the brain. And the part of the brain that it comes from is next door, next door to the area responsible for emotions. So it's no surprise that your emotional state is going to have an influence On your pain, and that's what's known as the biopsychosocial model of pain. This this has been proposed since 1977, this model, and it's been around for a long time, but it just somehow has not really made to mainstream. We're still stuck with this dogmatic tissue as issue paradigm. So the the biopsychosocial model looks at all the factors of what it is to be a human, the sum total of stressors. On your body and mind, that all can influence how we perceive pain. How what is the context? How much of a threat is this? That's how it works. And so I was listening to one of my favorite podcasts the other day, Hidden Brain. I love that podcast. He gets great guests. He's a great interviewer, and just it's a lot of the same things I talk about. He helps me connect dots in my practice, and he brought on this person talking about pain science and talking about the biopsychosocial model of pain. And she told this story, which. Which is a perfect illustration of what I'm talking about. I'm just going to kind of reiterate what she said. She called it the, the tale of 2 nails. So it's both involved. Both stories involve construction workers. The first construction worker, and this is true stories, by the way, he jumped off a beam and landed on a long nail, like a 6 or 7-inch nail sticking upright. It pierced right through his boot and it came right out the top of his boot. He saw it. And went down in agonizing pain. They rush him off to the ER. They dope him up with opioids, painkillers, and then they go to remove his boot, all to find out that it missed. It missed his toe. It went between the webbing of his big toe and second toe and just pierced the boot. But he saw something that looked really traumatic and saw it pierce right what he thought was right through his foot. So the context there is super important. Like, there's zero tissue damage, but he perceived a His nervous system perceived, okay, we got massive trauma here. I'm going to make this hurt. So that's part A. Part B is just the opposite. So now you got a guy, a construction worker, he's using a brad nailer. And if you've ever used a nail gun before, sometimes you get a couple with one pull of a trigger. Sometimes a couple nails will pop out, right? So I'm not sure what he was shooting, but he, he pulls the trigger. He sees the nail go to the intended target, but he didn't know a second nail came out and somehow ricocheted and went up through his jaw, up through the roof of his mouth, and partially punctured his brain. Now, he didn't see that. He saw what he thought was supposed to happen. The nail going where it should be. Had no idea about the second one. Apparently he went home, said he had a mild toothache, and he continued to work for a few days like that. But the the mild toothache kind of persisted, and he sees his physician all to find out that he's got massive damage—a nail in his brain. He survived it; they removed it. He was fine. But I mean, this is the complete opposite story. He had zero context. He didn't know there was an issue here. And this this is a perfect analogy. So I mean, I've experienced this myself. I remember in high school, I was playing street hockey, and I slipped on some wet leaves, and I fell in a. Broken bottle, glass bottle. And I stood up, I didn't see anything happen. And it wasn't until everybody pointed at my knee and were like, oh, did I realize anything was wrong because I felt nothing. So the glass had sliced my knee open and the fat pad behind my kneecap was kind of sticking out. I was bleeding, but felt nothing. It was kind of crazy. So this model, the biopsychosocial model of pain, helps us understand the why behind pain, it also puts into context the sleep thing, right? So bad things happen to your body if you don't sleep. Hormones are dysregulated. The natural killer cells in your body that hunt down cancer are inhibited. Your blood sugar goes up. So lack of sleep puts you in a very stressed state as is. So now your body has less adaptability, less ability to handle whatever you throw at it. And remember this equation too. I love this. It kind of explains everything very succinctly. Stress plus recovery equals adaptation. What's adaptation? It's getting better, stronger, faster, whatever you want to be. So stress as in stimulus or stressor. So that could be not just psychological stress. That could be exercise. It could be sun exposure. It could be poor nutrition. There's good stressors, bad stressors, but the sum total is what you're looking at. And then you have to recover. And you kind of train to recover. Recovery is where the magic happens, and that's how you get the adaptation. The number one lever you can pull for recovery is sleep. So if you're not sleeping, that is also an additional stressor. So now you just have a lot of stress, no recovery, and you get a negative adaptation. And so if you've been listening to me for a while, you probably know I'm all about adaptability, about becoming resilient. Becoming dynamic. That's why I named my company Dynamic. Becoming antifragile, becoming more robust. All right. So I created a quick 15-minute quiz that you can take online. I'll drop it in the show notes. It's a free quiz. It'll help you identify your main constraint. So I kind of have like 5 systems of the body, sleep being one of them. It helps you identify where you have the most opportunity for growth or what I would call a primary focus. So fill out the quiz. You'll get immediate input and it'll take you to a website that will bring you to an area that has resources to sort of work on that primary focus. And there's all kinds of downloads and stuff like that. Okay, that's it, everybody. Focus on your sleep. It's so, so important for your health. A ship in harbor is safe, but that's not what ships are meant to do. What does this mean? It means exposing yourself to difficult situations so you become resilient. If you need help building resilience, check out our flagship program called Physiologic Flexibility. This is a 3-month do-it-yourself program that teaches you how to maximize your homeostatic regulators such as your pH, blood glucose, O2 and CO2 tolerance, and temperature. We give you specific action items through the program with the goal of becoming antifragile. If you want to become the inspiration for your friends and family, this is the program for you.