Doc On the Run Podcast - Sleep: The Recovering Runner's Secret Weapon | DOC

Sleep: The Recovering Runner’s Secret Weapon

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Today on the Doc On the Run Podcast we’re talking about how sleep is the recovering runner’s secret weapon.

Before we get started I want to let you know that we added a free self-evaluation quiz that will help you determine whether or not you may be suffering from too little sleep. It’s at the bottom of the show notes page for this episode at DocOnTheRun.com and it’s free.

Sleep

Sleep may be the most valuable, most abundant, least expensive, and yet most underutilized resource available to a recovering or injured runner.

If you are a runner, you are always recovering. You do tissue damage every time you run. If you run a little too much, or you run a little too far, you might get an over training injury. That overtraining injury is really nothing more than an exaggerated version of the intentional injury you are attempting induce when you are training.

Sleep helps you heal, running doesn’t help you heal.

Sleep is crucial for proper immune function, tissue healing and consequently healing after any hard workout or running injury. Sleep disturbances reportedly occur in one third of the U.S. population. Problems with sleep are so pervasive and detrimental that the Centers for Disease Control has declared insufficient sleep as a public health problem.

Interestingly, elite athletes have actually been cited as a group having poor sleep quality and reduced quantity of sleep in comparison to the general population.1 Why is that?

There is some speculation that sleep disturbances in athletes come from training times, stress and anxiety related to competition, muscle soreness, caffeine intake and even travel to and from events.

Although it’s completely anecdotal I will say that many of the athletes I speak to during remote consultations or during in-person evaluations seem to mostly have stressful, busy lives.

Trying to fit in family obligations, work, and career development, all while training for events early in the morning or late in the day can disrupt sleep patterns.

Research on the benefits of sleep

Deep, slow wave sleep is restorative. It is during deep sleep that the repair process happens.

Think about what happens when you do speed work or go out on a long run. Basically, you’re inducing some sort of tissue damage. For the most part, the damage is in the muscle. You get little micro tears. Your calves and quads feel sore. Those muscles repair themselves and become stronger. You have to let that process happen.

You don’t get stronger when you run. You get stronger when you rest.

The heart is a very important muscle. When you have a heart attack you get damage to the muscle tissue in the heart itself.

I found an interesting study that looked at the relationship between sleep disruption and healing in the heart muscle after a heart attack in rats. What the researchers found was that sleep restriction after a heart attack lead to dysfunctional healing of the heart muscle that led to an enlarged heart within 21 days and ultimately resulted in cardiac dysfunction and heart failure.2

So if you want your muscles to heal you need to get as much sleep as possible. I’m not exactly trying to convince you to become Rip Van Winkle but the chances are good a little more sleep would go a very long way in speeding your recovery from both over training injuries and hard workouts when you’re training.

I truly believe that sleep is the most abundant and least utilized resource to speed recovery and healing among runners.

Runners call me all the time looking for the latest developments, most advanced injury assessment tools and secret weapons to heal faster. Granted there are some. Things like bone stimulators, platelet rich plasma injections, advanced strategies for early mobilization, they can all help.

But nothing is as easy, cheap and readily available as sleep.

Ways sleep becomes disrupted among busy runners

They’re all kinds of studies published about sleep disturbances in athletes. Some of them talk about too much caffeine. Some of them talk about sleep disturbances related to travel. I’ve even read a study talking about how small rotator cuff tears can disrupt your sleep. Excessive muscle soreness after a super-hard workout can also disrupt your sleep.

But I’m not going to suggest you should limit your workouts just so you can sleep better. Actually, the converse is true. I think we all need to increase our sleep so we can train harder and recover better.

How you can tell if you’re not getting enough sleep

Most sleep questionnaires will ask you a string of the same questions. And don’t worry, you don’t need to write any of these down. They are all on the free self-evaluation quiz that will help you determine whether or not you may be suffering from too little sleep. We’ve added it to the bottom of the show notes page where you can download it for free. Just go to the podcast show notes page for this episode at DocOnTheRun.com.

Here are some telling questions. How likely are you to doze off when you are sitting and reading? What about watching TV? What about sitting in a public place like a movie theater or a meeting? Are you likely to doze off if you are riding as a passenger in a car for an hour without a break? What if you were to lie down and rest in the afternoon? Would you doze off? What are the chances you would fall asleep while sitting and talking to someone? What if you were just sitting quietly after lunch? Is there any chance you would feel like you were about to doze off?

What about while in a car, stopped in traffic for a few minutes?

Taking the self assessment quiz can really help you evaluate whether or not your sleep is sufficient.

Most of us are not falling asleep at the wheel. And many of us who fall asleep in meetings at work probably tend to think it is just commentary on the content or the speaker, not our state of physical condition.

Tips for sleeping better

Decrease your caffeine

This may be a tough pill for many runners to swallow. I love my coffee. And I know lots of other runners who do as well. I don’t seem to be alone in this sentiment. I won’t go so far as to call it an addiction, but some others might. In fact, I had two different friends give me T-shirts as gifts that reference caffeine.

The fact is, I love my coffee. I justify it because I eat a relatively disciplined, very healthy diet. I exercise a lot. I don’t drink any alcohol. So basically caffeine is my primary vice.

I’m not going to tell you to stop drinking coffee. But what I would suggest is that limiting your caffeine intake later in the afternoon could significantly help you get to bed earlier, and sleep more productively.

You need deep sleep to recover. You need deep sleep to heal.

If you are drinking coffee late in the afternoon, there is a very good chance you are not only making it more difficult for yourself to get to bed earlier, you are probably decreasing the quality of your sleep throughout the entire night as well.

Although many people will tell you you shouldn’t drink any coffee at all after 12 o’clock noon, I just basically try my best to have no coffee after 2:00pm. Having said that, I will openly admit that a few years ago my cut off time was 4 PM. About two years ago, I moved the time back to 3:00 pm. With each additional hour taken off my afternoon caffeine boost, I have noticed an increase in the quality of my sleep. I also noticed a corresponding ease of waking up early without an alarm clock.

Check your gels and make sure you are eating non-caffeinated energy gels if you exercise after work. Face it, energy gels help. A lot has been written about how caffeine can help you sharpen your focus, stay on pace, and actually decrease the amount of pain you experience during your hard workouts.

But the benefits of getting in a little bit harder workout late in the afternoon or early evening may be to your detriment. If you kill it in your workout, but then can’t sleep well, you’re not even going to reap all of the benefits of that hard effort. So in the sense, you’re killing it for no reason.

If you want to get faster, stronger, and heal, you have to sleep well. And caffeine is one of the most common offenders of disrupted sleep patterns.

If you use energy gels when you work out it may help a lot if you just use caffeine-free energy gels or blocks when you exercise in the afternoon. No matter what your favorite energy gel, most are available in both caffeinated and non-caffeinated flavors. Save the caffeine for your morning and midday workouts.

Decrease the amount of light

Light is one of the most powerful regulators of sleep cycles and hormones. The most illustrative way to think about this is the use of light therapy in those with seasonal affective disorder. Too little light can literally make you depressed. But too much light can prevent you from sleeping.

For years I have argued that hospitals are a terrible place for sick people. The nurses are coming in and out of the rooms turning on lights in the middle of the night and waking patients up.

An interesting research study conducted in the Netherlands and in published in 2017 tried to evaluate the effect of patient room lighting and its influences on sleep patterns of hospitalized patients. The authors reported hospital patients who had lower nocturnal levels of light slept 29 minutes longer than patients in standard hospital rooms.3

Think about how much more rested you might be if you got only 29 minutes more sleep every night.

Tonight after you shut off your lights, look around your bedroom. Do you have LED indicator lights that are almost as powerful as night lights? Is there a clock with bright numbers casting a glow across your comforter? Does your phone keep lighting up the room every time someone sends a text message your way?

Is there light pouring in from outside? I once lived in a house that had a street light unfortunately positioned so the streetlight sent this bright sliver of light straight across the bedroom and across the bed right to my very pillow. This may be a testament to my southern upbringing. But I actually got out of bed one night and applied duct taped to the window to keep the light from coming in.

If you aren’t crude enough to put duct tape on your window, and you can’t seem to remove all of these LED indicators and other sources of light in your bedroom you could always use an eye mask. I personally can’t sleep with an eye mask on my face but many people find them soothing, comforting and certainly effective.

Power your devices off an hour before bedtime. All of my friends and every one of my patients actually have my cell phone number. But that doesn’t mean I have to leave my phone on all the time.

Whenever I do surgery or any sort of invasive procedure that has even a minor risk of developing a problem, I leave my phone on. I want to make sure if a a patient has a question in the middle of the night, they can call me. No patient should ever have to wake up in the middle of night and wonder whether or not something is normal after an injection or after surgery.

So for a couple of days after every surgery or platelet rich plasma injection, I leave my phone on at night so my patients can call me at any hour if they have questions. However, if I haven’t done a procedure for a couple of days my phone is off one hour before I go to bed.

There’s a lot of evidence that screen time can disrupt your sleep patterns. The bright light from a cell phone, laptop, tablet or TV can prevent you from getting to bed, and entering into deep sleep quickly. That’s the primary reason I power off my cell phone one hour before bed.

The second reason I power off my cell phone is that light isn’t the only problem. Our cell phones keep our minds engaged constantly and indiscriminately. I work with runners all over the world. In the last couple of days I received emails, phone calls and consultation request from runners in the United States, South America, Europe, Australia South Africa and the Middle East.

Because of the different time zones, many of those incoming inquiries show up on my computer and my cell phone when I should be asleep. I just can’t afford to have pop up indicators, pinging sounds and other alarms putting me on a state of alert when it’s time to go to bed.

Email, phone calls and text message interruptions are so pervasive that I could literally spend all day just responding to them. As an unintended consequence of publishing many research articles, writing books, and creating self-diagnosis courses I get literally hundreds of emails per day.

I have had to develop strategies to protect myself from the onslaught of the inbox. I have filters set up so I only see emails from active patients. Yet, the volume of inquiries is astonishing. As of today, I have over 20,000 unopened unread emails sitting in my inbox.

That brings up side point. If you send an email to me with a question and you don’t get a response within 24 hours I will probably never see it. So send your email to me again. As an alternative, if we worked together in person or during a Virtual Doctor Visit, you can always call my cell phone. I return those calls all day long in between consultations.

But just because I published lots of research and work with runners all over the world it doesn’t make me unique in the volume of incoming information. All of those incoming messages keep your mind active and prevent you from sleeping.

How many emails did you get today? How many times did you get some notification of an incoming email or some post on social media on your phone? You have the power to limit all those distractions.

In fact, I don’t even have a text message notification indicator on my cell phone at all. I shut off the notifications on my phone so that I’m not continually bombarded with interruptions while I’m seeing patients or when I am trying to get to bed in the evening.

For this very reason every single email I send out has a line at the bottom that tells patients I don’t respond to text messages. I don’t even see them unless I go looking for them specifically. The problem isn’t just your phone.

You have to power your mind down as well. Work through your thoughts about the day before you start your bedtime routine. Talk about the best parts of your day and even the challenges over dinner. Write out a gratitude list to help calm your mind and remove some of the continual streams of thought about your day. Don’t let thoughts about the day keep you up at night.

Stop drinking water two hours before bed.

One time I was on a flight on the way to a marathon. I was lucky enough to be seated next to a long time marathon runner who happen to be a urologist. Not only was he a true expert on hydration, he was very friendly and willing to share all of his knowledge about how we process fluids. So, I started asking him all kinds of questions about hydration strategies.

Of the things he told me was we should stop drinking water two hours before going to bed. Even when hydrating before a marathon, you should stop drinking water two hours before going to bed. It takes about that long for your body to take water you drink, process it, and then subsequently fill your bladder.

A full bladder will wake you up. Waking up in the middle the night to go to the bathroom is not conducive to restful sleep.

Simple tricks to help you to get to sleep earlier.

I would admit may be difficult to start going to bed earlier. But there are some tricks that can help you get to bed and get to sleep earlier.

Grant Cardone is a productivity expert and in one of his books he says the best way to get to bed earlier is to first decide what time you need to go to bed. You can’t control how much sleep you’re going to get if you don’t control when you’re going to go to bed.

Don’t leave your bedtime up to chance. Don’t wait until you’re tired to get in bed and go to sleep when you know you have to get up early. Set an alarm clock for when it’s time to go to bed.

When I am well rested, on schedule and on track with my goals I wake up without an alarm somewhere between 4:00a.m. and 4:45 a.m. But that only happens when I go to bed early.

If traveling to medical conferences, family obligations, late night Skype consultations or other commitments keep me up for just a couple of days in a row, I have to use my alarm clock to make sure I will wake up on time.

If I am still deep in a dream state when my alarm close clock goes off, there is no way I got enough sleep that night.

It may sound silly but you need to relax.

Yoga, meditation and prayer are all activities that have been shown to slow your breathing and heart rate. Deep breathing exercises can also stimulate the parasympathetic system, calm you down and potentially help you relax enough to start to fall asleep sooner.

A hot bath just before bed can also help loosen your muscles, raise your body temperature and then when you get out of the bath your body will cool down. Studies have shown a warm bath before bed could help people fall asleep. Part of the reason for this is that your body temperature decreases in preparation for sleep. Cooling down after getting out of a warm bath can mimic your body’s natural preparation for a sleep cycle.

Aromatherapy can also help. Studies have shown that the scent of lavender can help those with insomnia fall asleep more easily, and encourage deeper sleep. If you are an athlete who is recovering from a hard workout or an over-training injury, deep sleep is what you’re really after.

Once you wake up, get some sunlight first thing in the morning. Exposure to natural sunlight within about 15 minutes of waking up can help you reset your biological clock and make it easier to get to sleep earlier that evening. That may be difficult to do in the winter months, when its still dark outside. But do it when you can.

Just like all of the other recommendations I make for healing faster, every little bit helps. It’s not about perfection. It’s more about progress and improvement.

A small improvement in your nutrition can make a big difference in the available building blocks your body needs to rebuild and repair tissue.

A very small decrease in the amount of stress applied your foot when you run can allow you to run a lot farther without increasing your risk of crossing over that threshold for injury.

An additional 30 minutes of sleep, or even a little bit deeper sleep can position you to recover faster.

Try to identify all of the variables you can control. Get rid of some extra light. Gradually get to bed a little bit earlier every night. Cut some of your caffeine where you can. Unplug and relax.

Nobody is in control of your recovery but you. Nobody has the power to make you heal faster than you. Think about the little choices you can make to recover faster than less disciplined runners.

Your doctor may not even talk to you about all the benefits of sleep when you are injured. Your coach is probably more likely to talk to you about the necessity of sleep when you are at risk of developing overtraining injury. But obviously, if you’re here, right now, you are already way ahead of the competition.

Take what you know and put it to use.

Don’t forget to go to the show notes page for this episode to download the free self-assessment questionnaire to help you figure out whether or not you’re getting enough sleep.

And tonight, unplug, wind down, get to be early and get some deep sleep!

References:

  1. Halson SL, Juliff LE. Sleep, sport, and the brain. Prog Brain Res. 2017;234:13-31. doi: 10.1016 /bs.pbr.2017.06.006. Epub 2017 Jul  17.
  1. Aghajani M, Faghihi M, Imani A, Vaez Mahdavi MR, Shakoori A, Rastegar T, Parsa H, Mehrabi S, Moradi F, Kazemi Moghaddam E. Post-infarct sleep disruption and its relation to cardiac remodeling in a rat model of myocardial infarction. Chronobiol Int. 2017;34(5):587-600. doi: 10.1080/07420528.2017.1281823. Epub 2017 Feb 3
  2. Giménez MC, Geerdinck LM, Versteylen M, Leffers P, Meekes GJ, Herremans H, de Ruyter B, Bikker JW, Kuijpers PM, Schlangen LJ. Patient room lighting influences on sleep, appraisal and mood in hospitalized people. J Sleep Res. 2017 Apr;26(2):236-246. doi: 10.1111/jsr.12470. Epub 2016 Nov 10

 

Doc On The Run Quiz for Sleep Assessment

 

If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!

Dr. Christopher Segler is a podiatrist and ankle surgeon who has won an award for his research on diagnosing subtle fractures involving the ankle that are often initially thought to be only ankle sprains. He believes that it is important to see the very best ankle sprain doctor in San Francisco that you can find. Fortunately, San Francisco has many of the best ankle sprain specialists in the United States practicing right here in the Bay Area. He offers house calls for those with ankle injuries who have a tough time getting to a podiatry office. You can reach him directly at (415) 308-0833.

But if you are still confused and think you need the help of an expert, a “Virtual Doctor Visit” is the solution. He has been “meeting” with runners all over the world and providing just that sort of clarity through online consultations for years. He can discuss your injury, get the answers you need and explain what you REALLY need to do to keep running and heal as fast as possible.

You can arrange a Virtual Doctor Visit with a true expert on running injuries. Right from the comfort of your own home you can meet online with the doctor, discuss your running history, talk about your running injury and figure out a customized recovery plan that will help you heal the running injury so you can get back to running as quickly as possible.

Book your Virtual Doctor Visit with Doc On The Run now!