• JK

THE ROLE OF PHYSIOTHERAPY IN SLEEP

Updated: Jul 24



Low back pain and osteoarthritis

  1. Insomnia symptoms are highly prevalent in individuals presenting with musculoskeletal pain, with 71% of people with osteoarthritis, 59% with low back pain, and 41% with neck pain either diagnosed with insomnia or reporting significant insomnia symptoms.

  2. There is low to moderate evidence that non-drug treatments including aerobic exercise and cognitive behavioural therapy can improve sleep quality in patients with back pain and osteoarthritis, compared to sleep hygiene advice alone of treatments that do not include a sleep education component (Ho et al., 2019)

  3. Aerobic exercises (endurance training, walking, or tai chi) with moderate intensity (60-85% of the peak heart rate for 40-60 mins) has a moderate beneficial effect on sleep quality and sleep medication usage, but exercise does not change sleep duration, efficiency and disturbance.

Fibromyalgia

  1. More than 80% of people with fibromyalgia experience severe fatigue or poor sleep quality.

  2. There is low to moderate evidence that exercise training particularly mediative exercise (e.g., tai chi, yoga) can improve sleep quality in people with fibromyalgia.

  3. Strength and flexibility training have similar effects. Water and land-based exercise have effects on sleep and fatigue, with no one exercise being superior to another.

Sleep quality in axial spondyloarthritis

  1. Axial spondyloarthritis is a chronic inflammatory rheumatic disease primarily affecting the spine.

  2. Sveaas et al found that high-intensity exercise can improve sleep quality and reduce fatigue in this population when compared to education alone

  3. The supervised exercise in this trial consisted of 40 mins of aerobic exercise (70-90% of maximal heart rate on a treadmill or a cycle ergometer) and 20 mins of strengthening exercises (2 sets of 8-10 reps focusing on major muscle groups - squats, leg press, deadlifts, rows to chest, bench press, shoulder press, pulldowns and sit-ups).

Obstructive sleep apnoea

  1. Weight loss improves obstructive sleep apnoea. There is no apparent threshold amount of weight loss needed to improve obstructive sleep apnoea severity; greater weight loss is associated with greater benefit.

  2. Aerobic exercise may improve obstructive sleep apnoea independently of weight loss. There is a dose-dependent association of exercise with lower prevalence of obstructive sleep apnoea - for example, people who exercise seven hours a week have lower apnoea severity compared to people who exercise one to two hours or three to six hours.

  3. Inspiratory muscle training can be helpful for reducing apnoea and breathlessness in patients with obstructive sleep apnoea. In one randomised study, the training comprised of 30 breaths each day for six weeks using an inspiratory threshold training device, with the inspiratory muscles training group trained against a resistance set to 75 per cent of their maximum inspiratory pressure. Participants receiving this training experienced better improvements over the control group, which received inspiratory muscle training set to 15 per cent of their maximum inspiratory pressure (Gottlieb and Punjabi, 2020).


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