Transcrição completa de Why You're Always Tired: The Hidden Link Between Sleep, Pain & Recovery

I have both completed the sleep and pain course in Melbourne through SD Labs, which completely changed how we view sleep, recovery, and pain. 00:03:06.080 --> 00:03:07.919 So Peter, thank you so much for joining us. 00:03:08.000 --> 00:03:10.080 And Dimi, welcome back behind the mic. 00:03:10.400 --> 00:03:11.280 Thanks for having me. 00:03:11.520 --> 00:03:12.560 Thanks for having me back. 00:03:12.719 --> 00:03:14.000 It's exciting. 00:03:14.960 --> 00:03:16.960 So Peter, let's dive in. 00:03:17.280 --> 00:03:20.960 Most physios don't talk about sleep in the consults. 00:03:21.199 --> 00:03:23.599 It's not something that we get trained to do. 00:03:24.479 --> 00:03:27.280 What drew you to specializing in sleep? 00:03:27.520 --> 00:03:30.400 Um, it was just, I guess, very fortunate. 00:03:30.639 --> 00:03:36.000 So I um work with Professor Tony Goldschlager, and he's a neurosurgeon at Melbourne Brain and Spine Group. 00:03:36.080 --> 00:03:38.400 Um, I've worked in for the last five or six years. 00:03:38.560 --> 00:03:44.800 And roughly four years ago now, he knocked at my door and said, Peter, there's a lot of my patients who are describing sleep disturbance. 00:03:45.039 --> 00:03:49.520 And you as a physiotherapist, I'm sending lots of patients your way for conservative management. 00:03:49.680 --> 00:03:54.240 And, you know, they're getting great results, but I'm still seeing that a lot of people are having sleep issues. 00:03:54.400 --> 00:03:58.400 Um, what are you as a physio doing to help people with sleep issues? 00:03:58.639 --> 00:04:06.879 And it immediately got me kind of stumped because I thought, you know what, when someone comes in, I do ask them about their 24-hour pattern of pain. 00:04:06.960 --> 00:04:08.479 I'll ask them how do they sleep? 00:04:08.639 --> 00:04:13.360 And a lot of the time they'll say, not so well, or I struggle to sleep, or I wake up sore. 00:04:13.599 --> 00:04:15.280 And that would be probably the end of what I say. 00:04:15.360 --> 00:04:17.920 I don't really talk much more because I'm out of my comfort zone. 00:04:18.000 --> 00:04:20.079 I don't know how to talk to patients much about it. 00:04:20.240 --> 00:04:23.279 I might say the token things like, do you go to bed on time? 00:04:23.439 --> 00:04:24.720 Do you wake up on time? 00:04:24.959 --> 00:04:27.519 Do you cut down on caffeine and alcohol? 00:04:27.759 --> 00:04:34.000 But actually having any meaningful, tangible advice and interventions for patients, I didn't really have much to go with. 00:04:34.160 --> 00:04:37.199 And that's really reflected in physiotherapy training as a whole. 00:04:37.279 --> 00:04:48.480 Like I think when you look at certain kind of um documents, if you look at the there's a big document that's produced in 2022 that talks about treating back pain, chronic back pain, which is incredibly common. 00:04:48.560 --> 00:04:53.279 Um, as we all know, as physios, you know, 80% of people will have some form of back pain throughout their life. 00:04:53.519 --> 00:04:56.879 Most people will recover, but unfortunately, some people go on to have chronic pain. 00:04:57.040 --> 00:05:01.680 And in Australia, um, you know, people over four million people have chronic pain. 00:05:01.920 --> 00:05:04.319 So, really, it was that it was a massive issue. 00:05:04.480 --> 00:05:07.040 We weren't having any actual meaningful outcomes for it. 00:05:07.199 --> 00:05:12.480 And we thought, well, firstly, myself and Tony, we actually spent about six months looking at the evidence and research. 00:05:12.560 --> 00:05:18.800 So Tony's a uh a researcher, he he specializes in stem cells um and in disc regeneration. 00:05:18.959 --> 00:05:33.040 Um, but we started to look at what is evidence out there regarding sleep and pain in particular, because just as you alluded to in your intro, there's a lot of evidence around sleep and um kind of cardiac disease and stroke risk and dementia. 00:05:33.120 --> 00:05:37.279 Um, but in terms of pain, it is well documented, but it's not well known. 00:05:37.519 --> 00:05:45.439 So, with regards to sleep and pain, there is some very strong evidence that shows that poor sleep goes hand in hand with chronic pain. 00:05:45.519 --> 00:05:50.399 Um, and actually, poor sleep is often preempts pain development. 00:05:50.639 --> 00:06:00.800 And for example, if you have an acute pain episode and you have in tandem with that poor sleep, you are much more likely to develop chronic pain or central sensitization, as we call it. 00:06:01.040 --> 00:06:08.879 Um, so we started to look into the evidence, we saw how strong and how big an issue it is, and we then saw that physios weren't doing anything about it. 00:06:08.959 --> 00:06:09.759 And that was my point. 00:06:09.920 --> 00:06:14.720 Basically, the document that physios deal with regards to back pain, there's literally 66 pages. 00:06:14.800 --> 00:06:19.759 And if you search for sleep within there, there's one word that says promote healthy sleep habits. 00:06:19.920 --> 00:06:21.519 So that's the only advice we get. 00:06:21.600 --> 00:06:24.319 And the doctors don't get any other meaningful advice. 00:06:24.480 --> 00:06:30.879 Um, and pretty much patients are kind of fumbling in the dark to try and find out what I can do to improve my sleep. 00:06:31.120 --> 00:06:34.319 My physio can't help me, my doctor isn't necessarily got time to help me. 00:06:34.480 --> 00:06:36.319 Um, maybe I can see a sleep physician. 00:06:36.480 --> 00:06:48.480 But again, even the sleep physicians, they're so snowed under with sleeplessness and uh the other byproducts of poor sleep that they want to try and address that pain isn't number one on their radar. 00:06:48.959 --> 00:06:56.240 So we started to think what could we actually do to provide an intervention to help those people who have sleep issues? 00:06:56.480 --> 00:07:04.480 Um, and once we knew that the evidence was there, we then saw that um one thing we could

consider would be someone's posture in bed. 00:07:04.720 --> 00:07:08.079 It's a very simple idea, but what are people actually sleeping on? 00:07:08.319 --> 00:07:16.560 So typical bed, um, typically after seven to ten years, we're expecting it to start losing for it to lose its um properties for its support. 00:07:16.800 --> 00:07:26.079 Um and you know, a lot of people are dissatisfied with their beds, but the generic way of buying a bed is you go to a bed store, you feel it, you feel for mostly firmness. 00:07:26.240 --> 00:07:26.959 Does this feel good? 00:07:27.120 --> 00:07:28.160 And you give it a go. 00:07:28.319 --> 00:07:39.279 Um, but we wanted to see was there any way in which you could actually have a better uh choice out there and do do something where your physiotherapist was maybe involved in the actual uh decision. 00:07:39.600 --> 00:07:45.680 Because prior to all this, um, if a physic if a patient came to ask me about a bed, I would always be a bit worried. 00:07:45.759 --> 00:07:47.839 I would say, it's a big purchase. 00:07:48.079 --> 00:07:55.279 You have certain dimensions, you're a certain size, you sleep in certain positions, you have other issues going on, you have a partner in bed with you. 00:07:55.519 --> 00:08:04.160 I don't really want to give you the advice on that because you could be making something uh big expensive purchase that I'm not really comfortable with giving you an advice on. 00:08:04.720 --> 00:08:20.160 So we said, why couldn't a physio be involved in the actual um identification of um sleep issues, look at musculatal complaints, what position someone sleeps in, and actually fit someone with the bed. 00:08:20.240 --> 00:08:21.600 So it all started with that. 00:08:21.759 --> 00:08:30.240 And I guess where SD Labs comes into it is one of the actual former registrars of Tony, he was a doctor, a guy called Pratique Mando. 00:08:30.639 --> 00:08:39.279 Um, amongst other things, he left being a GP to actually become a part owner of Sleeping Dock, who are a big company in Melbourne. 00:08:39.519 --> 00:08:48.240 Um, and what he said was when we approached him, sure, we'll we'll um support you guys in considering a bed that could be prescribed for people with back pain. 00:08:48.399 --> 00:08:49.200 And that's what we did. 00:08:49.279 --> 00:08:57.440 We spent a year research and developing a bed with the evidence that's out there to create something that can actually help people with pain. 00:08:57.679 --> 00:09:03.120 Yeah, so I guess what's similar in my experience as well, it's like I'd ask the questions, right? 00:09:03.200 --> 00:09:05.279 And it'd be like, okay, you know, how are you sleeping? 00:09:05.360 --> 00:09:10.879 What time you go to bed, make sure you know you're not late on your phone before bed, but that'd be it, right? 00:09:10.960 --> 00:09:12.799 There's no tool, there's no intervention. 00:09:12.960 --> 00:09:15.600 Um, it'd be a conversation, and that would be it. 00:09:15.679 -->

00:09:15.919 Yeah. 00:09:16.080 --> 00:09:23.120 Um, going back to my previous working career as a registered nurse, we would just hand out sleeping pills. 00:09:23.279 --> 00:09:26.399 And that was that was the intervention for sleep. 00:09:26.480 --> 00:09:32.399 And if someone complained about not being able to sleep, you'd get the doctor to write a prescription for a sleeping pill. 00:09:32.879 --> 00:09:42.559 Um, but we know now that sleep is such an important part of our health, but I still feel like most people are aware of that, but they don't know what to do. 00:09:42.639 --> 00:09:52.080 They don't know, like we spend one third of our lives sleeping, but most people kind of just think of it as something that you just go to bed, close your eyes, and that should be it. 00:09:52.159 --> 00:09:54.720 Like, and then they get frustrated where that doesn't work, right? 00:09:54.799 --> 00:09:56.879 And you're like, hold on, why can't I just sleep? 00:09:57.200 --> 00:10:01.600 But you know, there's all these other things that compound into that, which we'll cover, we'll cover soon. 00:10:01.759 --> 00:10:03.840 Yeah, well, it's it's such a restorative time. 00:10:03.919 --> 00:10:10.720 And and I think we you lose that restorative nature when you take medications, when you take opioids because you've got chronic pain and you just want to get to sleep. 00:10:10.879 --> 00:10:15.840 You take alcohol because you just think I just need to sleep tonight, but it ruins your sleep architecture. 00:10:16.080 --> 00:10:25.600 You uh you take sleeping pills, which you know, in the short term, yes, okay, a week or two, maybe max, anything beyond that, you're becoming uh you're affecting your sleep architecture, you're becoming reliant on them. 00:10:26.240 --> 00:10:27.039 Why do you think? 00:10:27.120 --> 00:10:32.159 I mean, we particularly as physios, but I think general as well in society, we talk about exercise a lot. 00:10:32.399 --> 00:10:33.440 What's the best exercise? 00:10:33.600 --> 00:10:35.039 How much should you be exercising? 00:10:35.200 --> 00:10:37.919 What weight should be lifting, the intensity, HIIT training. 00:10:38.080 --> 00:10:40.320 And then we talk about nutrition, there's different diets. 00:10:40.399 --> 00:10:40.480 Yeah. 00:10:40.639 --> 00:10:42.000 How can we not talk about sleep? 00:10:42.159 --> 00:10:43.519 We're just not educated on it. 00:10:43.600 --> 00:10:49.279 Like, I think we all will innately be trying to search for advice that we can provide to our patients on sleep. 00:10:49.360 --> 00:10:55.360 I think, you know, you have Matt Walker podcasts, you've got Huberman, you've got Peter Atia, you've got all these people talking about the importance of it. 00:10:55.440 --> 00:10:58.879 And we all know for recovery, it's extremely important. 00:10:59.200 --> 00:11:05.360 But when you think about actually what's happening when we sleep, um, what's the prevalence of sleep disorders? 00:11:05.519 --> 00:11:15.200 Like how big an impact is a sleep disorder having on someone's uh pain and recovery, how big an impact is the position they're sleeping in and the posture they're in having on their recovery. 00:11:15.440 --> 00:11:19.600 I don't think we're really well versed in understanding the massive impact it can have. 00:11:19.840 --> 00:11:32.559 So I don't think we put enough value on it because we go to our really comfortable space, which we're very expert at, which is exercise and diet, and getting people moving and the biopsychosocial model and understanding all these components of just educating patients. 00:11:32.720 --> 00:11:35.120 But we're outside our comfort zone when it comes to sleep. 00:11:35.279 --> 00:11:40.559 And when patients then actually present with issues that need help for, we don't have interventions. 00:11:40.720 --> 00:11:45.120 We can't say, I want you to go and use CPAP because it's outside of a scope of practice at the moment. 00:11:45.440 --> 00:11:48.000 So, Dimmy, I'd love to get your opinion, your thoughts. 00:11:48.159 --> 00:11:56.559 Since doing the sleep course with Peter, what's changed the most in the way that you view sleep and also I guess with your clients as well? 00:11:56.879 --> 00:12:00.480 I think uh the pain course was definitely a big wake-up call. 00:12:00.720 --> 00:12:02.480 Excuse the pun on that one. 00:12:02.639 --> 00:12:10.720 Um, a lot of it I could actually apply to myself in terms of you mentioned there about sleep architecture and what sleep looks like. 00:12:10.960 --> 00:12:20.799 Um, what I got out of that course was, you know, we used to think a lot about the length, like the biggest thing that I guess we know about is, oh, you should have X number of hours per sleep. 00:12:20.960 --> 00:12:22.960 Adults should have this much, and that's that's good. 00:12:23.200 --> 00:12:27.840 But it's not just the length of time that you're sleeping, it's also the quality of that sleep. 00:12:28.000 --> 00:12:45.840 Um, and I think in that course, what we went through was, you know, the levels of sleep and REM sleep and the deep sleep and the zones and and what happens in those different zones to actually get restorative sleep or to get healing or regeneration or, you know, um reduction, inflammation, all those wonderful things that happen at sleep. 00:12:46.159 --> 00:12:49.679 So that's definitely changed the way I look at sleep. 00:12:49.840 --> 00:13:00.960 And now, you know, when patients come in and talk about their sleep, I'm thinking a lot more about what's the framework around their sleep, you know, what their sleep routines are. 00:13:01.120 --> 00:13:05.200 Um, because I'm also implementing more of that in my day-to-day. 00:13:05.279 --> 00:13:15.919 So I think I've definitely taken a personal approach into wanting to improve the sleep and understanding what's happening when I'm sleeping well, when I'm not sleeping well, and definitely applying that to patients. 00:13:16.080 --> 00:13:18.480

Um, you know, obviously there's a bit more to go there. 00:13:18.559 --> 00:13:27.360 Like we need, you know, a bit more supporting terms of they might need different times of types of treatment or assistance and, you know, mattresses, things like that. 00:13:27.519 --> 00:13:35.679 Um, but even just being aware that that is really important and not to ignore that a bad night's sleep is just a bad night's sleep, that there's something around that. 00:13:35.840 --> 00:13:43.120 And that could be something hindering your next day and hindering how you feel in the morning and how you know you perform the next day. 00:13:43.360 --> 00:13:53.120 Um, yeah, so I'm definitely putting a lot more emphasis on the importance of sleep rather than just making sure I get to bed on time or people get a number of hours. 00:13:53.360 --> 00:13:59.039 I'd say that's probably the biggest way I've changed my viewpoint on it. 00:13:59.360 --> 00:14:06.720 One of the questions that we got taught to ask was like, How easy is it for you to nod off during the day? 00:14:07.440 --> 00:14:09.440 And I was like, that's me all the time. 00:14:09.840 --> 00:14:11.759 Yeah, in the course, yeah. 00:14:12.240 --> 00:14:15.440 And I'm like, like, if I'm in the car, I'm out. 00:14:16.080 --> 00:14:16.320 Yeah. 00:14:16.480 --> 00:14:19.840 So I'm like, is that a sleep problem or is that a not enough sleep? 00:14:19.919 --> 00:14:21.360 Is it the quality of sleep? 00:14:21.600 --> 00:14:22.480 A lot of questions. 00:14:22.639 --> 00:14:22.879 Yeah. 00:14:22.960 --> 00:14:24.799 Well, did you do the effort sleepiness score? 00:14:24.960 --> 00:14:26.080 Did you check? 00:14:26.960 --> 00:14:27.279 Yes. 00:14:27.440 --> 00:14:27.840 Yes. 00:14:28.480 --> 00:14:29.120 So yeah. 00:14:29.360 --> 00:14:32.720 Like, you know, that's your body telling you, like, shut your brain down. 00:14:32.799 --> 00:14:33.679 I'm exhausted. 00:14:33.759 --> 00:14:37.200 You need to catch sleep whenever you can because you haven't gotten the sleep quality overnight. 00:14:37.360 --> 00:14:44.480 If you're sitting having a meal and you're not off, if you're sitting relaxing after lunch and you're not off, like sometimes, yes, there's tiredness. 00:14:44.559 --> 00:14:46.559 There's we all have busy lives, you have kids. 00:14:46.720 --> 00:14:49.120 At the end of the day, we're exhausted, we fall asleep on the couch. 00:14:49.279 --> 00:14:49.759 That's okay. 00:14:49.919 --> 00:14:50.639 Like, that's normal. 00:14:50.799 --> 00:14:51.519 We're all tired. 00:14:51.679 --> 00:15:00.960 But if you're falling asleep at random times, at times when you shouldn't be, if you're yawning lots, if you find when you wake up in the morning you're unrefreshed, you should be waking up refreshed. 00:15:01.039 --> 00:15:04.000 You shouldn't feel like you're groggy, that you're exhausted. 00:15:04.159 --> 00:15:06.639 There's probably not enough sleep quality in there. 00:15:06.720 --> 00:15:11.679 That could be sleep apnea, that could be it's insomnia, and it's maybe that you're struggling to get to sleep. 00:15:11.759 --> 00:15:13.039 You've woken up during the night. 00:15:13.279 --> 00:15:16.480 So many people with chronic pain have sleep maintenance insomnia. 00:15:16.559 --> 00:15:18.240 So they struggle to stay asleep. 00:15:18.399 --> 00:15:20.480 They have their first or second sleep cycle. 00:15:20.559 --> 00:15:22.080 We have five or six during the night. 00:15:22.240 --> 00:15:26.080 They have their first or second, and then all of a sudden they're awake, they're alert. 00:15:26.240 --> 00:15:29.919 They've basically, there's their nervous system is in this fight or flight mode. 00:15:30.080 --> 00:15:34.879 Their temperatures increase, their blood pressures increase, their heart rates increased, and they struggle to then relax. 00:15:34.960 --> 00:15:37.440 And they'll say, Oh, you know, I'm just a stressor. 00:15:37.519 --> 00:15:38.480 I just think of things. 00:15:38.639 --> 00:15:40.159 But realistically, that's not normal. 00:15:40.320 --> 00:15:53.679 You shouldn't be able, you should like people to say, Oh, my mind is busy, but that's more likely a physiological issue going on within you, that you're actually in that fight or flight mode, or that your brain is unable to disengage because you are tired, but you can't sleep. 00:15:53.840 --> 00:15:55.360 So, yeah, it's a massive issue. 00:15:55.519 --> 00:16:04.799 Something like uh sleep apnea, for example, um, it's it's highly prevalent in the community, like up to about 10 to 20% of Australians will have sleep apnea. 00:16:05.120 --> 00:16:09.519 Only about 5% or 6% know they have it, 80% is undiagnosed. 00:16:09.759 --> 00:16:15.360 So sleep apnea is incredibly common, especially in the chronic pain population as well, and in athletes, actually. 00:16:15.519 --> 00:16:20.720 So in athletes, it's actually more common because of their musculature or because of their uh body types. 00:16:20.879 --> 00:16:23.679 Um, but it's an incredibly common, undiagnosed issue. 00:16:23.840 --> 00:16:26.559 And imagine, like I always think of people with sleep apnea. 00:16:26.639 --> 00:16:31.200 Imagine every hour you're having 30, 40, 50 episodes where you just stop reading. 00:16:31.360 --> 00:16:33.039 Imagine doing that in while awake. 00:16:33.200 --> 00:16:34.639 Imagine how exhausting that would be. 00:16:34.799 --> 00:16:40.879 Imagine how your body is going into this fight or flight response every single time, and that your inflammation is just going through the roof. 00:16:41.039 --> 00:16:42.879 And no wonder you wake up feeling hungover. 00:16:43.039 --> 00:16:46.240 You feel like uncomfortable, sore, you're sensitive. 00:16:46.399 --> 00:16:55.360 Like we've all had those episodes where we've drank too much alcohol and we've all snored the night away, and then we've woken up, yeah, we've a hangover, but we're also just titchy and sore and uncomfortable. 00:16:55.600 --> 00:17:06.079 So,

like, if something like sleep apnea can be addressed, and it's such an easy thing to identify, you basically score anything like five out of ten on a score, age, gender, next circumference. 00:17:06.160 --> 00:17:07.039 Uh, do you snore? 00:17:07.200 --> 00:17:08.480 Do you wake refreshed? 00:17:08.720 --> 00:17:09.839 Like easy stuff. 00:17:10.000 --> 00:17:12.880 And then when you come to insomnia, insomnia is incredibly common as well. 00:17:13.039 --> 00:17:26.480 So people with chronic pain, again, insomnia is highly prevalent, especially the they can often get to sleep, exhausted, pass out at the end of the night because you're so exhausted, but then you get woken and you just can't get back to sleep, and that's sleep maintenance insomnia. 00:17:26.640 --> 00:17:30.799 So it's just incredibly common, and CBTI is incredibly effective for it. 00:17:30.960 --> 00:17:34.640 So that's uh cognitive behavioral therapy for insomnia. 00:17:34.960 --> 00:17:38.480 80% or so of people will have a positive outcome with CBTI. 00:17:38.559 --> 00:17:40.640 It's the gold standard for treating insomnia. 00:17:40.960 --> 00:17:46.559 So instead of giving the patient those medications in the hospital, I guess in the acute setting in the hospital, it's tricky. 00:17:46.720 --> 00:18:07.920 But if you could get a patient educated in the area of CBTI, which is what we're actually doing now at SD Labs, we're actually getting our physiotherapists, which you guys might eventually do some uh extra training on, in CBTI and actually being able to run four to eight sessions with a patient, tell them about their sleep, get them to understand it, and actually identify their issues with their sleep and see meaningful changes. 00:18:08.160 --> 00:18:08.960 Um, yeah. 00:18:09.279 --> 00:18:09.519 Yeah. 00:18:09.680 --> 00:18:18.319 So is is that insomnia the problem of just getting to sleep, or is it the problem of also then waking up and then not getting the sleep? 00:18:18.480 --> 00:18:19.119 Yeah, so it's both. 00:18:19.200 --> 00:18:21.039 So you have sleep onset insomnia. 00:18:21.279 --> 00:18:24.400 So everyone will have periods in their life where they struggle to get to sleep. 00:18:24.480 --> 00:18:24.799 It's normal. 00:18:24.880 --> 00:18:27.119 So you can get acute insomnia, which is very common. 00:18:27.279 --> 00:18:36.880 But actual clinical insomnia of sleep onset is you struggle to get to sleep, it takes more than 30 minutes, and we don't encourage anyone to clock watch, but you can kind of get a sense of it's taking your time. 00:18:37.039 --> 00:18:40.079 But three nights a week for three months in a row. 00:18:40.240 --> 00:18:47.839 So if you've got that in the absence of other um maybe medical conditions that could be affecting you, then you have clinical insomnia. 00:18:48.000 --> 00:18:59.200 And it's a very common thing, unfortunately, and it is tricky to treat with pharmacological interventions and other interventions, but CBTI, as I say, can be incredibly effective. 00:18:59.359 --> 00:19:03.039 And people with insomnia are much more likely to develop pain as well. 00:19:03.200 --> 00:19:09.440 So if you have chronic pain already and you have insomnia, your pain is gonna be incredibly sensitized, your pain threshold is reduced. 00:19:09.599 --> 00:19:17.440 But if you don't have pain and you have insomnia, the likelihood is much greater, double that you will actually have back pain in the future or other forms of pain. 00:19:17.680 --> 00:19:21.359 So, us as physios, just identifying sleep issues early on. 00:19:21.519 --> 00:19:24.880 Someone comes in to you, if they have a sprained ankle, like just talk to them. 00:19:24.960 --> 00:19:25.680 Do you sleep well? 00:19:25.759 --> 00:19:26.319 How do you sleep? 00:19:26.400 --> 00:19:30.720 That's gonna improve your acute recovery, but also reduce your risk of chronic issues. 00:19:30.880 --> 00:19:33.359 Another really good example is something like frozen shoulder. 00:19:33.519 --> 00:19:36.880 You know it's going to be something that's gonna take years to probably resolve. 00:19:37.039 --> 00:19:48.240 But if you can get them sleeping better, think about the restorative and the recovery components that'll happen overnight and the reduced risk of um chronic pain and that becoming a very chronic long-term issue. 00:19:48.400 --> 00:20:07.759 So, one of the first things I'll always do with any patient really is you get a good understanding of their sleep, tell them that they need to be improving their sleep, and just give them a very bite-sized, easy to understand way of if you don't improve your sleep, you you are going to be causing yourself maybe risk of future issues in terms of chronic pain, or your current recovery may not go as well as you'd like. 00:20:08.160 --> 00:20:17.359 What's the difference between with those clients that have good sleep and the ones that don't have good sleep? 00:20:17.440 --> 00:20:18.720 So the poor quality sleep. 00:20:18.960 --> 00:20:25.519 What is actually happening in the sleep that leads them to increase of all those risks that we've spoken about? 00:20:25.759 --> 00:20:26.720 Yeah, yeah, good question. 00:20:26.799 --> 00:20:29.680 So with something like, let's say, firstly, sleep apnea. 00:20:29.759 --> 00:20:35.599 So there's look, there's over 80 or so sleep disorders, but the most common are sleep apnea, insomnia. 00:20:35.680 --> 00:20:38.400 So you have sleep onset insomnia and sleep maintenance insomnia. 00:20:38.480 --> 00:20:41.920 So wake up, can't get back to sleep, and then you have restless leg syndrome. 00:20:42.079 --> 00:20:43.680 So they're the three most common. 00:20:43.920 --> 00:20:49.599 And um, each of them will, I suppose, have their own way in which they're affecting your sleep, but they're all impacting sleep architecture. 00:20:49.759 --> 00:20:55.119 So your ability of your body to go through stages of sleep and have the restorative effect of each of those stages.

00:20:55.279 --> 00:20:57.759 So something like sleep apnea, we're stopping breathing. 00:20:57.839 --> 00:21:04.640 So our upper airway is collapsing, we're snoring, we're having episodes where we stop breathing, and we're basically depriving your body of oxygen. 00:21:04.720 --> 00:21:06.559 So you go into what's called a hypoxic state. 00:21:06.640 --> 00:21:07.839 So you're losing oxygen. 00:21:07.920 --> 00:21:16.640 And when that happens, your basic nervous system goes into this state of fight or flight and it starts to say, um, there is a threat, you're you're not breathing. 00:21:16.799 --> 00:21:21.440 Send in inflammation because what that does is it's there to actually promote healing and restorative. 00:21:21.839 --> 00:21:25.440 So if you sprain your ankle, inflammation occurs as a healing effect. 00:21:25.599 --> 00:21:36.960 But if it's happening overnight repetitively over and over again, basically what happens is your nosoceptors, which is your ability to actually feel pain and they pain signal pain, they become constantly bombarded with inflammatory signals. 00:21:37.039 --> 00:21:38.160 They're starting to get pain. 00:21:38.319 --> 00:21:40.960 Um, you start to get heightened pain sensitivity. 00:21:41.200 --> 00:21:46.160 The more and more it happens every single night, the more your body is in this primed state for pain. 00:21:46.319 --> 00:21:48.240 And everything it does is going to be painful. 00:21:48.319 --> 00:21:48.960 We all know it. 00:21:49.039 --> 00:21:52.000 Like you wake up after a night of poor sleep and you are more sensitive. 00:21:52.079 --> 00:21:55.519 Or if you have a flu, or if you have a cold, your joints are sore, your back is sore. 00:21:55.680 --> 00:21:59.440 It's all because your body is storing this inflammation, not really resolving it. 00:21:59.599 --> 00:22:05.200 So But with that, we're we're with sleep apnea, just like it's basically doing that. 00:22:05.440 --> 00:22:08.960 With insomnia, we're struggling to get to sleep, we're struggling to stay asleep. 00:22:09.039 --> 00:22:12.160 So a big thing is we're losing out on many stages of sleep. 00:22:12.400 --> 00:22:15.759 So as I say, you should have four to five typical sleep cycles. 00:22:16.000 --> 00:22:19.200 That includes stage one, stage two, three, and rem. 00:22:19.920 --> 00:22:26.319 Um, with the stage three and rem in particular, we're getting that deep restorative sleep tissue repair. 00:22:26.400 --> 00:22:35.920 Um, you're you're starting to see your blood pressure drop, you're starting to see your heart rate slow down, your system goes from the fight or flight to the rest and digest. 00:22:36.240 --> 00:22:44.480 Um, but if you're not giving yourself the opportunity to go through those stages, you're not achieving all those healthy outcomes that come from going through those stages. 00:22:44.640 --> 00:22:46.640 And that can be a big challenge for those with chronic pain. 00:22:46.720 --> 00:22:53.359 So they will often lose

out on something like REM sleep, which is towards the later part of the night, we get more REM sleep. 00:22:53.440 --> 00:23:00.559 So about 25% of your night is REM sleep, but it starts with small bouts in the first half of the night and then it becomes longer in the second half. 00:23:00.720 --> 00:23:09.359 So if you've got pain or if you've got sleep disturbance and you're not getting good quality sleep, one of the big benefits that we're now looking into regarding REM is muscle atonia. 00:23:09.440 --> 00:23:13.839 So the idea that you're asleep, you're in REM, your muscle completely disengages. 00:23:14.079 --> 00:23:18.960 So throughout the day, think that your muscles are working hard, they're doing their job, you're doing exercise, is great. 00:23:19.039 --> 00:23:20.160 They're doing what they should do. 00:23:20.319 --> 00:23:27.759 But a really great opportunity for them overnight is you go into total muscular silence in stage three, which is where your muscle activity really settles down. 00:23:27.920 --> 00:23:31.680 But then in stage uh REM, you're going into complete silence. 00:23:31.759 --> 00:23:34.240 You're going to get no activity because you don't want to act out your dreams. 00:23:34.319 --> 00:23:36.000 You're basically paralyzed. 00:23:36.240 --> 00:23:47.200 If you're not getting REM sleep, if you're not going into those stages, you're not getting the relaxation, hence, you're not getting the washing out, the flushing out of inflammation that occurs in those muscles during that stage. 00:23:47.440 --> 00:23:57.359 And you're basically waking up with a muscle that has been working that a little bit harder, it's not gotten the recuperation, and then it just repeats the cycle the next day and the next day, and it's just this constant cycle. 00:23:57.599 --> 00:24:05.119 So promoting um longer sleep, more sleep stages with insomnia certainly allows the body to go through those stages better. 00:24:05.920 --> 00:24:07.039 That's really interesting. 00:24:07.200 --> 00:24:23.039 And it brings me to a lot of, I guess, patients that I can think, gosh, I can list you so many of them that are probably fitting what you're saying is not getting that deep restorative sleep and feeling those effects of the um the you know, not getting rid of that inflammation. 00:24:23.279 --> 00:24:28.319 Um how do you think sleep position then comes into play? 00:24:28.480 --> 00:24:32.160 Um, so I have a patient at the moment who's in her mid to late 30s. 00:24:32.240 --> 00:24:34.160 She's got a four-year-old daughter. 00:24:34.400 --> 00:24:38.720 She's doing lots of carrying and lifting, but she's also working um full time. 00:24:39.039 --> 00:24:42.880 And she's been complaining of this shoulder pain, right? 00:24:42.960 --> 00:24:45.599 So shoulder, a little bit of hip as well, but it's really bugging her. 00:24:45.680 --> 00:24:49.200 And one of the biggest things she says is she wakes up and it feels the worst. 00:24:49.359 --> 00:24:52.400

It's the worst first thing in the morning, like as she's waking up. 00:24:52.960 --> 00:24:56.640 And, you know, that's starting to make me think, well, what's going on during her sleep? 00:24:56.799 --> 00:24:59.039 But again, well, you know, what do you do? 00:24:59.119 --> 00:25:07.839 You know, what's going on at during sleep in terms of positioning, you know, how does that affect the sleep cycles or the Yeah, yeah, yeah. 00:25:07.920 --> 00:25:08.240 Good question. 00:25:08.319 --> 00:25:10.559 That's what we're really working on with the bed that we've developed. 00:25:10.720 --> 00:25:16.960 So the issue with the standard bed is it's one single level of firmness, you don't put much of thought into it, you lay on it, and it might feel good initially. 00:25:17.119 --> 00:25:20.880 Those first few moments when you're awake, yeah, it feels nice, you're relaxed, you're comfortable. 00:25:21.039 --> 00:25:26.960 But think about when you go through the different stages, when you go into REM where you're atonic, no muscle uh control at all. 00:25:27.119 --> 00:25:30.240 So basically you're draped over the surface that's that you're lying upon. 00:25:30.400 --> 00:25:52.480 So if you're lying on your side and you've got a back that needs the support of a firmer bed, medium firm, firm, but your shoulder being a wider area that is basically got less tissue across it to actually protect the structures of the shoulder, the bursa, the tendons, they're going to be being put under extra load because you've got the broader shoulders and you've got the firmer surface. 00:25:52.640 --> 00:25:57.759 So people that are in bed and they're sidelining in particular on a sore shoulder, well, you're getting pressure. 00:25:57.920 --> 00:26:02.240 So you're getting pressure on certain structures of such as the bursa, such as the tendon. 00:26:02.400 --> 00:26:08.079 You're potentially also not getting the restorative effect of sleep because you're having restless sleep because you're sore. 00:26:08.160 --> 00:26:10.319 So you're moving around a bit because you're uncomfortable. 00:26:10.480 --> 00:26:13.920 So, what that means is you're probably not getting the muscle relaxation. 00:26:14.000 --> 00:26:14.880 So in the shoulder. 00:26:14.960 --> 00:26:16.480 So, what happens with relaxation? 00:26:16.640 --> 00:26:31.119 The capillaries, which are those tidy blood vessels within a muscle, they're they're when they're when they're engaged, when the muscles are tight, they're constricting, they're choking the muscles, they're stopping the muscle from be perfusing, basically blood flow moving through it and nutrients moving through it. 00:26:31.359 --> 00:26:35.440 If they're overly engaged, just like in the back, they're not getting that restorative effect. 00:26:35.519 --> 00:26:41.839 And therefore, you wake up in the morning, you're stiff, you're sore, you're not having that flushing out of inflammation. 00:26:42.079 --> 00:27:04.079 If you're on a slightly more, I

guess, um, forgiving surface, such as a softer shoulder area, an area that's not compressing the actual tendon, the joint, the bursa, uh, and they're encouraging and promoting relaxation in the area of the muscle, you're going to get perfusion, you're going to get blood flow, you're going to get the washing out of inflammatory proteins and toxins that accumulate. 00:27:04.160 --> 00:27:08.160 And the person gets up and hopefully feels like their shoulder is not so stiff and not so sore. 00:27:08.319 --> 00:27:10.079 And it's the same for any other body part. 00:27:10.160 --> 00:27:16.880 Like if you can get the muscle in the most optimal, relaxed position, we encourage perfusion, we flush out inflammation. 00:27:17.039 --> 00:27:20.400 And that's why, you know, posture in the lower back is also so important. 00:27:20.640 --> 00:27:28.720 If the lower back is feeling any way threatened, like if you're in a sideline position, you're slightly sagging, seven-year-old bed, you think, oh, you know, it's a bed, it doesn't matter. 00:27:29.039 --> 00:27:30.559 Posture is not that big a deal. 00:27:30.799 --> 00:27:45.839 If it's in a position where the QLs, so the supportive paraspinal muscles or the deep down multifidus, which is that deep stabilizing muscle at the back, if they don't feel like they're safe enough to allow the spine to relax, because basically their job is I need to protect your spine. 00:27:46.000 --> 00:27:52.960 Think about when you're standing day-to-day life, they're working hard, they're doing their job, you have a pain event, they go into guarding, so the signals are there. 00:27:53.119 --> 00:27:56.079 The spinal cord could be at risk here, we've got to protect it. 00:27:56.240 --> 00:27:59.519 Then you go into lying, you should be completely switched off. 00:27:59.599 --> 00:28:01.759 They should have the opportunity to rest and recuperate. 00:28:01.920 --> 00:28:15.119 You lay in a poor position, you could even come into rem and you get what's called REM fragmentation, which is where you want to go into atonia, muscle relaxation, but your multifidus, your QL says, no, danger, can't relax because it's actually going to be in a poor position. 00:28:15.200 --> 00:28:18.079 My disc could be at fault here, my spinal cord could be at risk. 00:28:18.240 --> 00:28:20.400 So you get this broken sleep structure. 00:28:20.559 --> 00:28:28.000 So um that's just one component, like you know, of the shoulder, for example, pressure, muscle, but then you think about the disc as well. 00:28:28.079 --> 00:28:42.079 So if you're thinking about the disc in the lumbar spine, there's a process called disc imbibition, basically, where think of the disc like a sponge all day, it's getting squashed, it's getting axial load, it's getting pressure of gravity squatting down on it, and that's normal. 00:28:42.160 --> 00:28:44.160 We lose about 10 to 20 percent of disc height. 00:28:44.319 --> 00:28:45.680 Absolutely normal, no issue with that. 00:28:45.759 --> 00:28:47.359 You know, we all want to live active lives. 00:28:47.519 --> 00:28:50.319 But what should be happening overnight is that that re-inflates. 00:28:50.480 --> 00:28:59.200 So you basically wake up in the morning, you're taller, you're maybe one or two centimeters taller, um, and you're feeling like your back is actually not quite so stiff. 00:28:59.359 --> 00:29:07.440 But what's happening is you lie in a slightly suboptimal position, the muscles get tight, and they're actually restricting the opening up of the fascia joints. 00:29:07.519 --> 00:29:09.039 So the discs get a bit stiff. 00:29:09.279 --> 00:29:13.599 The disc isn't actually drawing in as much nutrients and water as it should do. 00:29:13.759 --> 00:29:16.559 It doesn't fill up and inflate, stays stiff. 00:29:16.640 --> 00:29:22.480 Um, and you wake up and you haven't received that therapeutic benefit of being asleep and being in a good position. 00:29:22.640 --> 00:29:35.759 And then something like disc desiccation, which is just that natural degenerative changes that occur in all of us in discs, but maybe it's more accelerated than those people because they're not getting that therapeutic basically plumping up of the disc every single night. 00:29:36.000 --> 00:29:45.039 So that was a long answer, but there's um yeah, a lot of reasons why that person, but that's a very common thing, like shoulder pain and sleep disturbance. 00:29:45.119 --> 00:29:46.640 Like it's it's I think 89%. 00:29:47.039 --> 00:29:48.880 I think I think it's really, really common. 00:29:48.960 --> 00:29:55.680 Um, and certain shoulder conditions are even more um affected by uh affected sleep. 00:29:55.839 --> 00:30:01.119 So as I say, frozen shoulder, for example, 100% of people with frozen shoulder will describe sleep disturbance. 00:30:01.200 --> 00:30:03.039 Um, it's probably the biggest challenge. 00:30:03.119 --> 00:30:16.799 And as I say, then that just puts them into that chronic pattern of sensitization and potentially then elongates the whole uh recovery process if if they do recover, and some people don't, they just have chronic shoulder issues then as a result. 00:30:17.519 --> 00:30:18.319 So yeah. 00:30:19.519 --> 00:30:20.799 Yeah, yeah. 00:30:21.039 --> 00:30:28.079 So I guess are you saying that simply changing their position can improve their sleep quality? 00:30:28.400 --> 00:30:30.799 Yeah, I look definitely in some ways. 00:30:30.960 --> 00:30:33.279 So um we'll all do it subconsciously. 00:30:33.359 --> 00:30:40.400 You will move your sleep position overnight because you your body is telling you this is a suboptimal position for me to be recovering. 00:30:40.559 --> 00:30:44.880 I'm lying in a position and my shoulders getting compressed, so I'm gonna roll onto my back. 00:30:45.039 --> 00:30:49.839 Or my back is a little bit twisted in this position, so I'm gonna kind of stack my knees and tough each other. 00:30:49.920 --> 00:30:55.920 So we all do it, and you

know that people who are restless sleepers typically goes hand in hand with people who have some form of pain. 00:30:56.160 --> 00:31:05.279 So, what we're saying is that if you can actually create the optimal environment for that body to actually go into a restful state, you'll actually have less movement, which we've shown. 00:31:05.359 --> 00:31:18.559 We've done sleep studies, we've seen people that are wearing overnight devices that are moving less, they're getting to sleep quicker, potentially because their body is able to go into a relaxed state easier because it feels like, okay, I'm safe, I can relax here, I can switch off. 00:31:18.720 --> 00:31:20.640 The guarding doesn't have to take place. 00:31:20.799 --> 00:31:23.680 Um, and they're often then waking up with less stiffness. 00:31:23.839 --> 00:31:31.200 I think stiffness is a really good outcome to look at for most patients with regards to how is their recovery overnight going? 00:31:31.519 --> 00:31:35.440 If someone's saying, Look, I don't have much pain, but I wake up with six out of ten stiffness. 00:31:35.599 --> 00:31:38.079 I get out of bed first 20 minutes, I can barely start straight. 00:31:38.240 --> 00:31:39.279 Like it's really common. 00:31:39.440 --> 00:31:40.319 It's actually really common. 00:31:40.480 --> 00:31:42.240 You'll say to people, Do you struggle with sleep? 00:31:42.319 --> 00:31:42.960 Do you have pain? 00:31:43.119 --> 00:31:43.839 No, no, no, no. 00:31:43.920 --> 00:31:44.720 How do you get up in the morning? 00:31:44.799 --> 00:31:47.839 Oh, well, you know, I'm a bit stiff for the first 20, 30 minutes. 00:31:48.000 --> 00:31:53.440 Um, and that's a clear indication that the muscles have had to work harder than they should have. 00:31:53.680 --> 00:31:56.319 The recovery hasn't taken place as well as it could have. 00:31:56.480 --> 00:32:09.920 So, what we're saying is if we can prescribe a bed, if we can get the lumbar spine in the optimum position to promote complete relaxation, flushing out of inflammation, if we can deload the shoulder, if we can have the head in conjunction with that, the pillow. 00:32:10.000 --> 00:32:13.039 So we basically got a pillow that's going to be fitted with the mattress. 00:32:13.119 --> 00:32:15.759 So you basically have the head in a neutral position. 00:32:15.920 --> 00:32:23.759 What we were trying to achieve is not perfect alignment, because perfect alignment is such a silly thing idea because everyone has different postures and different positions. 00:32:23.839 --> 00:32:32.240 And if you have a scoliosis, you will have a natural curve, you will have a little bit of a different posture, and that perfectly straight line through the lumbar and thoracic isn't achievable. 00:32:32.400 --> 00:32:35.759 But if you can match what your body is is used to. 00:32:35.920 --> 00:32:43.680 So in standing, if you've got a excessive rounding of your thoracic, so you sleep on your back and you're really hunched over in sleep. 00:32:43.759 --> 00:32:47.119 That's the position that your skeletal system has has now adapted. 00:32:47.279 --> 00:32:48.720 That's what we want to try and promote. 00:32:48.880 --> 00:32:55.359 Because if we don't, your body's gonna say, This isn't the position that I'm comfortable in, and it's gonna guard and it's gonna get stiff and get sore. 00:32:55.599 --> 00:32:57.920 Um, so yeah, I think that was a long answer. 00:32:58.160 --> 00:32:59.279 Yeah, there's a lot to it, isn't it? 00:32:59.359 --> 00:33:10.160 And I think coming back to something you said that really resonated, and and we've touched a lot on this in some of the podcasts, is getting your body to feel like it's not under threat is really, really important. 00:33:10.240 --> 00:33:21.039 And if you can create an environment that's comfortable and not threatening, and it it can then actually relax and like you said, get those muscles to switch off, you're gonna get that restorative sleep. 00:33:21.119 --> 00:33:26.000 So you're gonna move through those cycles of sleep a lot better, which is gonna give you the benefits of that sleep. 00:33:26.240 --> 00:33:30.640 But if you're not comfortable, you're not feeling supported, that's where you're gonna cause a lot of issues. 00:33:31.519 --> 00:33:41.759 Which also then made me think a lot, and what are we doing during the day that's potentially causing us to have poor sleep quality? 00:33:42.160 --> 00:33:44.400 What are the habits or activities? 00:33:44.480 --> 00:33:47.680 Um, like you mentioned a bit before, opioids, alcohol. 00:33:47.839 --> 00:33:56.720 Um what other things are causing us to interrupt our sleep or put us into a state where we're not getting into those deep sleep, we're not feeling relaxed. 00:33:56.960 --> 00:33:57.200 Yeah. 00:33:57.279 --> 00:34:05.759 So I think I guess these are kind of well thought out ideas that are well researched, and certainly the big things that people will always be mindful of is coffee. 00:34:05.920 --> 00:34:08.239 So caffeine has a half-life of six hours. 00:34:08.480 --> 00:34:11.519 Caffeine um will reduce your sleep drive. 00:34:11.599 --> 00:34:13.039 So it basically we all feel it. 00:34:13.119 --> 00:34:16.960 It wakes us up in the morning, and what it's doing is it's blocking what's called adenosine. 00:34:17.039 --> 00:34:20.400 So it's stopping that, um, which is basically sleep drive. 00:34:20.559 --> 00:34:24.880 By the end of the night, it works in conjunction with your circadian rhythm and helps you fall asleep. 00:34:25.039 --> 00:34:30.400 Is adenosine is the chemical in your body that makes you feel really tired, makes you feel like, okay. 00:34:30.719 --> 00:34:36.480 There's two main processes that help you go to sleep, which is one is called adenosine, and the other is circadian rhythm. 00:34:36.559 --> 00:34:41.280 So adenosine is it starts, the clock starts in the morning, you wake up, it starts to build. 00:34:41.440 --> 00:34:43.360 And what caffeine does

is it blocks it. 00:34:43.440 --> 00:34:45.440 So it blocks it, you feel a little bit more alert. 00:34:45.599 --> 00:34:52.079 You get the two o'clock slump, you have in the caffeine, you go again, you're an athlete, you take your energy just before maybe a 7 p.m. 00:34:52.239 --> 00:34:53.920 match, and great, you feel better. 00:34:54.000 --> 00:35:00.000 But what that's doing is it's obviously impacting then your sleep quality because that sleep drive isn't quite so much there. 00:35:00.239 --> 00:35:11.360 What also means is you might fall asleep, but let's say the half-life of coffee is six hours, you've had four coffees and maybe 7 a.m., 10, 12, 20, that all adds up accumulatively. 00:35:11.519 --> 00:35:15.599 So at the end of the day, 2 a.m., you could still have the equivalent of let's say two coffees. 00:35:15.760 --> 00:35:17.519 It could just be like you've just had two coffees. 00:35:17.679 --> 00:35:21.440 And your body will go through maybe the initial sleep stages, but then be woke and struggle to sleep. 00:35:21.599 --> 00:35:25.920 So a big one is for everyone just uh cut your coffee off by 10, 11 a.m. 00:35:26.320 --> 00:35:28.800 I think that's a tricky one for some people, but it's a good one. 00:35:28.960 --> 00:35:30.239 Um, another is alcohol. 00:35:30.639 --> 00:35:31.760 Just have all my coffee. 00:35:31.920 --> 00:35:32.159 Yes. 00:35:32.320 --> 00:35:32.559 Yeah. 00:35:32.880 --> 00:35:35.599 Depends on if you have a mass, how many shots can I have? 00:35:35.760 --> 00:35:39.679 If you have an overdose of coffee, the half-life of that dose will be six hours. 00:35:39.840 --> 00:35:43.199 So uh it'll slowly just dwindle down, quarter life, 12 hours. 00:35:43.280 --> 00:35:44.960 So you'll still have a bit in your system. 00:35:45.039 --> 00:35:50.000 But um, caffeine is obviously in tea and energy drinks and lots of other things as well. 00:35:50.079 --> 00:35:55.119 So I think it was my wife who didn't realize she just bought decaf coffee uh tea bags every night. 00:35:55.199 --> 00:35:56.960 She was having tea and then didn't realize. 00:35:57.119 --> 00:35:59.039 Um, other things, uh alcohol. 00:35:59.119 --> 00:36:07.920 So alcohol is a sedative, it will often make us feel sleepy, which is, you know, for some people a good thing, but it massively impacts your sleep architecture. 00:36:08.079 --> 00:36:12.239 So you start to drop down, you don't go through the four natural stages of sleep. 00:36:12.320 --> 00:36:16.639 You drop straight down at the REM, and then you come shooting back up into light sleep. 00:36:16.800 --> 00:36:22.000 And anyone who's drank too much alcohol will always know that their sleep is, they often feel tired. 00:36:22.079 --> 00:36:26.800 The next day they're often um cranky, they're sore, they're eating more. 00:36:26.960 --> 00:36:33.199 Um eating more is another idea because we actually do uh when we don't sleep well, we do eat more. 00:36:33.360 --> 00:36:36.800 The I think up to some studies suggest up to 600 calories per day. 00:36:36.960 --> 00:36:41.119 So if you want to lose weight, you have to be sleeping well because otherwise it's just impossible. 00:36:41.280 --> 00:36:43.199 Your your your hormones will be different. 00:36:43.280 --> 00:36:45.519 You're your your leptin and your ghrelin. 00:36:45.599 --> 00:36:50.960 So your feeling of satiation and your feeling of um hunger will be heightened. 00:36:51.360 --> 00:36:54.880 Um what else in terms of exercise? 00:36:55.039 --> 00:36:57.840 So exercise first thing in the morning is often a good thing. 00:36:57.920 --> 00:37:04.719 It sets and it goes in line with your circadian rhythm, so it can really help your body to understand when is um morning time, when is night time. 00:37:05.039 --> 00:37:12.639 You can exercise later in the day, but they do say that up to two to three hours before bedtime you should be cutting off. 00:37:13.039 --> 00:37:16.400 Um, other things like blue light is another big one. 00:37:16.559 --> 00:37:24.000 Again, we'll all look at our phones, um, we'll all do all those sort of things, but what it's doing is it's suppressing melatonin secretion. 00:37:24.159 --> 00:37:30.239 So at nighttime, your body will naturally secrete melatonin and it will tell you to add that to get ready for sleep. 00:37:30.400 --> 00:37:35.360 Um, if you have blue light in your face, it will actually start to suppress the secretion of it. 00:37:35.599 --> 00:37:40.960 So ideally, you would be cutting down on blue light, which would be the filter on your phone, maybe. 00:37:41.119 --> 00:37:46.320 And there's actually also research that shows that how close that blue light is to your face also impacts it. 00:37:46.400 --> 00:37:51.280 So if you can't put down the phone, at least keep it away from your face, keep it down around your lap or somewhere. 00:37:51.599 --> 00:38:02.800 Um yeah, other like there's there's there's whole heaps of of ideas that people should be considering with sleep, but you also don't want to you also don't want to become anal about it and also cause yourself insomnia. 00:38:03.039 --> 00:38:10.320 You don't want to be thinking about the other way, yeah, sleep and and be so uh anal about it and think, oh, I've got to worry about my sleep now. 00:38:10.400 --> 00:38:14.000 Um if you don't have sleep issues, you know, it's fine. 00:38:14.159 --> 00:38:21.840 Like you can do all these things, the odd occasion you have alcohol, or you do try and cut down your caffeine because it doesn't impact your sleep architecture. 00:38:22.000 --> 00:38:36.800 But in general, if you can just um yeah, the one I missed actually, sorry, was uh morning light, which we kind of all um I think are aware of, but the idea that the body then again, the the eyes will take on light, they'll be able to realize that it is morning. 00:38:36.880 --> 00:38:38.320 Again, it's for your circadian rhythm. 00:38:38.400 --> 00:38:48.880 It's basically so that you're you're if you

ever travel, for example, the big thing is to actually go and get a good amount of light into your system so that your circadian rhythm starts to think that it's daytime and it's nighttime. 00:38:49.199 --> 00:38:57.039 If our listeners could only change three things today to help their sleep and their sleep quality, what would you pick for those top three? 00:38:57.360 --> 00:39:12.239 Um Well, because I'm so invested in certain areas, I'll give maybe slightly skewed answers, but one would be understanding that sleep disorders have a massive impact on um your overall well-being. 00:39:12.400 --> 00:39:17.199 Um, something like snoring, like we'll all have potentially family members, parents. 00:39:17.280 --> 00:39:23.280 Uh I know my dad for 30 years was snoring the house down, and now I think this guy 100% had sleep apnea. 00:39:23.360 --> 00:39:28.400 And he never, I never like I'd love to have told him about it because the impact that's having on his quality of life. 00:39:28.559 --> 00:39:33.679 Um, so I think one is just don't like disregard things regarding sleep. 00:39:33.840 --> 00:39:44.320 So if your sleep is bad, do something about it because it has such a powerful impact on your well-being, um, pain, but also so many other facets of life, mental health. 00:39:44.480 --> 00:39:49.440 Um, so if you think that you have any signs of sleep issues, it's very easy to just get it assessed. 00:39:49.519 --> 00:39:56.480 And now the physios here can obviously advise and talk to you, but then you can also sleep, speak to doctors and sleep physicians about it. 00:39:56.719 --> 00:40:06.159 Um, you could do something like, as I say, a stop bang, which could be a questionnaire to check for sleep apnea, or the Epbert sleepiness score for am I excessively sleepy? 00:40:06.400 --> 00:40:12.400 Um, another, again, I'm going to lean into just the area that I'm focusing on is your sleep environment. 00:40:12.559 --> 00:40:14.960 Um, so that comes down to a number of things. 00:40:15.119 --> 00:40:18.000 So, in terms of at nighttime, keeping the room nice and cool. 00:40:18.159 --> 00:40:21.199 So, about 19 degrees is a good temperature to have in your room. 00:40:21.440 --> 00:40:22.400 You want darkness. 00:40:22.480 --> 00:40:25.440 If you need to use eye masks or earplugs, then you should. 00:40:25.599 --> 00:40:35.840 Um, the bedding that you're sleeping on, um, the actual mattress, the bed, the pillow, should be considered in terms of anything beyond seven to ten years, it's getting old, it's getting past its due date. 00:40:36.000 --> 00:40:41.760 Um, the research does suggest that in general a medium firm mattress is more superior to a firm mattress. 00:40:41.920 --> 00:40:46.000 So if you were to just buy a generic one, you might consider a medium as opposed to firm. 00:40:46.639 --> 00:41:04.400 Um, but if you are having stiffness, if you have chronic pain, um, if you're an athlete who wants to get that extra few percent out of your performance

and recovery, um consider our system, the Z10 sleep system, because honestly, the results we're seeing now are incredible. 00:41:04.559 --> 00:41:13.440 The fact that you can trial a system for 12 weeks, you can be fitted by your physio who can understand your specific needs and who can track. 00:41:13.599 --> 00:41:14.239 That's the key. 00:41:14.320 --> 00:41:18.000 Like you go and you buy a bed, you spend thousands of dollars on it, you don't know if it's good or bad. 00:41:18.159 --> 00:41:25.119 But this way you can track, you can actually see am I seeing tangible improvements in my pain, in my recovery, my sleep quality. 00:41:25.280 --> 00:41:32.639 We will do sleep scores before, we'll do them after, we'll do pain scores, and you can get a really good sense as to whether or not you're seeing improvement. 00:41:32.800 --> 00:41:34.559 Um, so that would be a second one. 00:41:34.719 --> 00:41:42.480 And then thirdly, I think it's all of the stuff that I really talked about to begin with, which was really the basic sleep hygiene ideas. 00:41:42.639 --> 00:41:44.719 They the research really strongly supports them. 00:41:44.800 --> 00:41:46.159 Like they really are effective. 00:41:46.320 --> 00:41:55.679 If you cut down on caffeine, cut down on alcohol, get your morning light, do your daily exercise, um, reduce your blue light. 00:41:55.840 --> 00:42:00.960 Yeah, if you can do those basic ideas, then you can certainly set yourself up for a better night's sleep. 00:42:01.199 --> 00:42:02.159 Yeah, no, I love that. 00:42:02.320 --> 00:42:11.840 It's so much more involved, and there's so much more to sleep than just this thing that we just shut our eyes and we we go to bed and then hope for the best, right? 00:42:12.000 --> 00:42:24.559 So I think today's conversation is just the start of something, like you said, and to be able to become aware of your symptoms and understand that there's probably more to it than just being tired or fatigued or waking up stiff. 00:42:24.639 --> 00:42:34.480 And the more we can become aware and more of these conversations we start is gonna open up to improving so much more better life quality. 00:42:34.719 --> 00:42:39.280 Um, and we know that if we improve our sleep, it's gonna improve the longevity, right? 00:42:39.360 --> 00:42:39.519 Yeah. 00:42:39.599 --> 00:42:40.880 And it's such an important part. 00:42:41.039 --> 00:42:50.239 And if we can start to make those small little habit changes, the sleep quality, improve our sleep environment, you know, we might be doing all the exercise and might be doing all the eating right. 00:42:50.320 --> 00:42:57.360 But if we're missing out on that last component and you're doing all those bad things, you know, you're taking away from all the effort that you're doing. 00:42:57.599 --> 00:43:01.679 And it's like you're you're you're not getting the benefits of all the hard work you're doing. 00:43:01.840 --> 00:43:07.599 So this is something that, you know, a conversation

I've really been wanting to have because a lot of this gets missed. 00:43:07.840 --> 00:43:15.760 And it's it's sad from my side when I see people trying their best to do their best, but they're missing such an integral part. 00:43:16.079 --> 00:43:26.079 And I really believe that if people can get the movement, can get the nutrition, and now get the sleep, all that makes such a good foundation that then everything starts to fall in place. 00:43:26.639 --> 00:43:27.039 100%. 00:43:27.519 --> 00:43:27.840 Yeah. 00:43:28.079 --> 00:43:28.719 Awesome. 00:43:28.960 --> 00:43:32.960 Is there anywhere where our listeners can find some more information around sleep? 00:43:33.280 --> 00:43:41.920 Yeah, look, um firstly, we've your physiotherapists now, we have 60 clinics cross country being able to talk about sleep in a very meaningful way. 00:43:42.000 --> 00:43:48.320 So some of the stuff I've spoken about um is something we're trying to get into the physiotherapy community as a whole. 00:43:48.400 --> 00:43:55.440 You know, universities are asking us to speak now because sleep isn't something that's on their current curriculum and they want us to be able to involve, get involved with their students. 00:43:55.599 --> 00:43:59.760 But your physios now can be someone you can talk to, and certainly in this clinic, you both you guys. 00:44:00.000 --> 00:44:05.199 And hopefully more of your um physios and EPs can potentially go down the route of training as well. 00:44:05.440 --> 00:44:10.719 Um, then there's all the typical kind of avenues, such as just even speaking to your GP. 00:44:10.800 --> 00:44:17.519 You can get a fully Medicare rebatable sleep study if you simply have signs of sleep apnea and you also have sleepiness. 00:44:17.679 --> 00:44:23.039 So, you know, it's not that hard to make the first steps of just investigating these things. 00:44:23.119 --> 00:44:33.440 And the difficulty is it's this silent kind of killer, I suppose, because it can kill you, obviously, obviously prolonged poor sleep, but um you don't appreciate it because you're asleep, you're at time. 00:44:33.599 --> 00:44:46.559 But it's it's one that if you actually do put some effort into and actually do um investigate and treat, like people call it like the fog has been lifted, um, their lifestyle improves so much, their mental health improves so much. 00:44:46.719 --> 00:44:52.800 Like I would say that every major disease is as has like sleep affected with it. 00:44:52.960 --> 00:44:57.039 Um, and a big component of that is inflammation and inflammation in the body. 00:44:57.119 --> 00:45:07.280 And if you can actually use the body's natural way to restore itself, to heal itself through just improving itself and over sleep, you just got to give it the right uh tools and right environment to do so. 00:45:07.519 --> 00:45:11.519 Um, so yeah, I'd say just have the conversation with your physio, with your doctor. 00:45:11.599 --> 00:45:21.039 Um, if the doctor who is incredibly

busy struggles to kind of go into a meaningful conversation with you around sleep and pain, I would certainly speak to the physio who's now expert in that area. 00:45:21.280 --> 00:45:24.159 Where can all this find out more information about SD Labs? 00:45:24.559 --> 00:45:26.960 Yeah, so uh SD Labs, SD laboratories. 00:45:27.039 --> 00:45:33.199 If you search either online, you'll find our website where you'll see uh a little bit more about what we're actually doing. 00:45:33.440 --> 00:45:46.719 We have been in recent um on the on the website, there's recent newspaper articles and uh client stories because uh I suppose at the end of the day, what we're really trying to see is meaningful changes in people's lives, and across the board we are seeing those. 00:45:46.800 --> 00:45:54.239 So you can learn about some of those on the website, um, our LinkedIn, uh, our socials in terms of Instagram, SD Labs. 00:45:54.480 --> 00:45:58.320 Um, and I would imagine the kids are using TikTok, which I don't use. 00:45:58.400 --> 00:46:00.159 Danny and our team is probably doing that. 00:46:00.320 --> 00:46:02.800 Um, so yeah, so there's heaps of ways in which you can learn more. 00:46:03.039 --> 00:46:04.159 Thank you so much, Pedo. 00:46:04.320 --> 00:46:05.039 That was awesome. 00:46:05.199 --> 00:46:09.920 There was a lot more questions that we didn't get through, but that's all we have time for today. 00:46:10.000 --> 00:46:14.400 So thank you so much for coming into Active Movement Studio, all the way from Melbourne. 00:46:14.559 --> 00:46:19.440 And thank you so much, Demi, for joining us back behind the mic on the treatment table. 00:46:19.599 --> 00:46:21.360 Hopefully, we can get you back on again. 00:46:21.760 --> 00:46:25.199 A lot more questions to ask and carry through. 00:46:25.280 --> 00:46:28.480 And I think more conversations around sleep is so important. 00:46:28.639 --> 00:46:29.920 I think this is just the start. 00:46:30.000 --> 00:46:37.280 And so thank you so much for bringing the conversation to light, and thank you so much for driving this as an important tool. 00:46:37.360 --> 00:46:46.480 I think um that, like I said, it's an area that hasn't been addressed enough and there's not enough that we can practically do. 00:46:46.639 --> 00:46:55.440 And so I think it's a great first step in terms of making, you know, like you said, better outcomes in terms of not just our clients' lives, but everyone around us. 00:46:55.599 --> 00:46:56.159 So thank you. 00:46:56.400 --> 00:46:57.199 Thanks for having me. 00:46:57.280 --> 00:46:59.199 Uh, I will be back up in the near future. 00:46:59.360 --> 00:47:02.480 I will be up to talk to uh your team members in clinic about this. 00:47:02.559 --> 00:47:07.760 So it'll be nice if any uh listeners want to actually attend in the night and actually have any further questions that you want. 00:47:08.079 --> 00:47:09.519 More than happy to spend some time with them. 00:47:09.840 --> 00:47:10.239 Amazing. 00:47:10.320 --> 00:47:10.719 Thank you. 00:47:10.960 --> 00:47:12.239 Thanks for having me back on. 00:47:12.400 --> 00:47:13.519 Thanks to see you again, Peter. 00:47:13.760 --> 00:47:14.639 Yes, I see you too. 00:47:14.880 --> 00:47:16.159 I can finally sleep better now. 00:47:16.320 --> 00:47:18.559 We've completed the three-legged stool. 00:47:18.719 --> 00:47:19.360 Yes. 00:47:20.480 --> 00:47:28.400 If you've enjoyed this episode, please subscribe, leave us a review, or share it with someone who probably needs a better night's sleep. 00:47:28.639 --> 00:47:35.199 And remember, as a listener of the Treatment Table podcast, you get 20% off your first appointment at Active Movement Studio. 00:47:35.280 --> 00:47:41.760 So you can head to our website, active movement.com.au, and use the code TREATMENTTABLE20 when booking. 00:47:41.920 --> 00:47:45.679 We'll see you next week back for another mini consult episode. 00:47:45.840 --> 00:47:55.679 So if you've got any questions, please make sure you can send us through your questions through Instagram or send me an email at treatmenttablepodcast at gmail.com. 00:47:55.760 --> 00:47:57.840 We'll see you next week on the treatment table.