The importance of sleep for injury recovery

Sleep plays a critical role in injury recovery. It supports tissue repair, pain modulation and psychological readiness throughout the rehabilitation process. Often in rehabilitation, the emphasis is placed on progressive loading, movement quality and graded exercise programs, but prioritising sleep for injury recovery is just as important to the healing process post-injury.

Why does sleep matter for injury recovery?

Sleep is structured into two main cycles – non-rapid eye movement (NREM) and rapid eye movement (REM) sleep – both of which contribute significantly to physical recovery and tissue restoration. Understanding the role of sleep for injury recovery requires looking at how both cycles contribute to bodily restoration.

NREM sleep

The components in NREM sleep are all vital in an injury healing process (Patel et al., 2024).

• Growth hormone release peaks.
• Tissue regeneration is supported.
• Muscle repair occurs.
• Protein synthesis occurs.
  
  

REM sleep

REM sleep is important when it comes to maintaining rehabilitation adherence and re-learning movement patterns, which are vital in the recovery process (Cousins et al., 2016).

• Dreams can occur.
• Irregular muscle movements and rapid movements of the eye.
• Linked to cognitive and emotional processing, aiding in mood regulation and motor learning.

The psychological impact

Adherence to exercise is vital in the rehabilitation process. However, reduced sleep quality can negatively impact motivational levels, resulting in reduced engagement in a physical activity program.

Additionally, physical injuries not only impact a person’s physical wellbeing, but they can also present with psychological challenges including withdrawal from pre-injury physical activity, loss of routine and uncertainty around recovery timelines. However, improving sleep quality can promote healing, and lead to an improved psychological outlook

The physical impact

When engaging in an exercise program post injury, retraining movement patterns, improving coordination and restoring functional capacity are vital.
Studies show that sleep can enhance motor skill acquisition (Pan et al., 2015; Walker et al., 2002). However, impaired sleep quality can result in decreased reaction time, coordination and accuracy which can subsequently influence movement control during exercise engagement.

It can also have a negative impact on muscle repair and tissue regeneration which can therefore slow recovery times further.

Practical implications for Exercise Physiology

It is vital for Exercise Physiologists to not only take into consideration physical presentations following an injury, but also the impacts that sleep quality can have on the recovery process.
Screening questions around sleep duration and quality can provide insight into recovery. Exercise Physiologists are able to provide education around sleep hygiene techniques to help improve sleep quality and enhance overall recovery outcomes.

Sleep hygiene

This term refers to both a sleep environment and behavioural patterns that are implemented in the lead up to bedtime. Poor sleep hygiene can have a negative impact on sleep quality and quantity.

Tips for maintaining good sleep hygiene:

1. When unable to fall asleep after 20 minutes, do not stay in bed – get up and do something relaxing, then come back and try again.
2. Maintain consistent wake up times each morning and wind down and bedtimes each night.
3. Limit time spent in bed to just sleeping.
4. Go outside during the day and do some exercise.
5. Set aside time an hour or two before bed and use this as your ‘worry time’ – use this time to think about what has happened throughout the day or any stressors.