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Why sleep matters even more for those with diabetes

Why sleep matters even more for those with diabetes

Why sleep matters even more for those with diabetes

Many Americans have type II diabetes or prediabetes, which impacts all aspects of their health, including sleep. Fluctuations in glucose levels can throw off your entire sleep cycle, resulting in a lack of sleep, or even a higher risk of developing another chronic condition.

Nov 15, 2022 | Natalia Russell, PTA

Why sleep matters even more for those with diabetes

Many Americans have type II diabetes or prediabetes, which impacts all aspects of their health, including sleep. Fluctuations in glucose levels can throw off your entire sleep cycle, resulting in a lack of sleep, or even a higher risk of developing another chronic condition.

What is type II diabetes?

Type II Diabetes is a metabolic disease that results in abnormally high sugar levels, causing insulin resistance. The purpose of insulin is to help lower your blood glucose levels, but when you have type II diabetes, your body can’t produce enough insulin to eliminate the resistance and can potentially stop producing insulin all together. This can cause you to have elevated glucose levels and you might need exogenous insulin to help lower it.

But while 10% of the American population has type II diabetes — 1 in 3 Americans have prediabetes. This is a condition in which sugar levels are higher than normal, but not high enough to be diagnosed as type II diabetes.

How does sleep affect diabetes?

I want you to think back to when you were a kid, and your parents would say those dreadful words, “it’s bedtime.” At that time, you most likely didn’t have any issues with falling asleep, you just didn’t want to! However, if you have diabetes or pre-diabetes, you are more prone to having issues with your ability to sleep, and it’s a deeper issue than not feeling sleepy.

When we sleep, our glucose levels have been found to stay stable during non-REM sleep and increase with REM sleep or when we are awake. If you aren’t achieving a proper amount of sleep, you are likely to have fluctuations in your glucose levels, and as a result you will feel groggy and have an increased need for taking naps throughout the day. This can throw off your sleep cycle all together; when you feel like you aren’t well rested, it can affect your overall health.

Some common issues are obstructive sleep apnea, insomnia, and frequent voiding in the nighttime. These issues may contribute to disturbances throughout the day, such as irritability, getting sleepier in the evening and waking up earlier in the morning, health problems like depression, cardiovascular diseases, high blood pressure, cognitive decline and memory loss which can contribute to an increase in accidents and falls.

How you can improve your sleep habits

We all know life can be crazy and prioritizing sleep may not be at the top of the list, but it should be. With all the demands life brings, we will sometimes get the bare minimum — or even less —hours of sleep.

Sleep is the body’s way of resting, recovering, and resetting for the next day. Unfortunately, there are many distractions that may be getting in the way of you reaching your optimal sleep goal, so here are a few tips to help you feel well rested.

  • Make a routine so your body will know you are starting to wind down.
  • Stay away from blue-light emitting devices such as smartphones, tablets, and laptops at least an hour before bed. These devices have become more prevalent today and promotes cognitive stimulation and can disrupt your sleep cycle.
  • Try incorporating exercise in your day which is beneficial for your overall health and can tire you out to improve sleep.
  • Try having a cup of tea, reading a book, doing a crossword-puzzle, or anything that gives you some relaxation to help train your body that you are getting ready for bed.

To have a good night’s rest, you should get at least 7–8 hours of sleep, especially if you have pre-diabetes or diabetes. Sleep hygiene should be in the same bucket as our other measures of health, like exercise nutrition, recovery, and stress management. It is vital to keeping us healthy and essential for our well-being.


Knutson, K. Impact of sleep and sleep loss on glucose homeostasis and appetite regulation. Sleep Med Clin. 2007 Jun; 2(2): 187-197. doi: 10.1016/j.jsmc.2007.03.004

Harris-Hayes, M., Schootman, M. The Role of Physical Therapists in Fighting the Type 2 Diabetes Epidemic. Journal of Orthopedic & Sports Physical Therapy. 2022 Jan; 2(1) 1-16.

Varma, P., Jackson, M. Dreaming of the Good Old Days: Sleep in Older Adults. Journal of Pharmacy Practice and Research (2019) 49, 205–211.

Jniene A., Errguig L. Perception of Sleep Disturbances due to Bedtime Use of Blue Light-Emitting Devices and Its Impact on Habits and Sleep Quality among Young Medical Students. Biomed Research International. 2019: 1-8.

Natalia Russell

Natalia Russell

Natalia Russell, PTA, is a physical therapist assistant based in Hamden. Natalia has a particular interest in working with older populations, knowing helping people with the smallest of things can make a significant difference in their day-to-day lives and ability to move and complete tasks.

Meet Natalia

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How a massage can decrease stress

How a massage can decrease stress

How a massage can decrease stress

Massage therapy has been shown to have innumerable benefits, both on body and mind. It has been shown to reduce stress, improve circulation, lower heart rate, and improve immune function, among other positive effects on body systems.

May 17, 2022 | Ashley Moriarty, DPT, OCS

How a massage can decrease stress

Massage therapy has been shown to have innumerable benefits, both on body and mind. It has been shown to reduce stress, improve circulation, lower heart rate, and improve immune function. It can also help relax you after a stressful day or alleviate trigger points due to injury. There are various types of massage, different techniques, and a variety of purposes behind it, but all involve manipulation of muscles and other soft tissue by a licensed massage therapist. But overall, massage can be summed up like this: it can help you to recover and feel better, both physically and emotionally.

Types of massage

While there are many types of massage, I will cover some of the more common ones. The first, Swedish massage, is generally thought of as a relaxation technique, and it uses a gentler level of pressure than others, aimed at releasing tension.

Deep tissue massage uses similar techniques to Swedish massage, including tapping, vibration, sliding and lifting the soft tissue. However, the main difference lies in the amount of pressure used, as deep tissue massages apply more of it.

Finally, trigger point therapy involves finding specific trigger points within the muscle and applying sustained pressure to decrease the tightness and increase blood flow to that area. This can be done in combination with other types of massage.

Massage and its effects on the body

While these methods used various techniques, they all provide numerous shared benefits. One of the more significant benefits is that it can help decrease mental stress via its effects on the nervous and endocrine systems. This is caused by an increased release of dopamine, serotonin, and endorphins, and can help boost mood.

Additionally, massages also help decrease levels of cortisol (the stress hormone) in the body, which can lead to improved sleep, and therefore result in better recovery after exercise and rest.

A massage can also help balance out our sympathetic and parasympathetic nervous systems. It is theorized that a short massage can stimulate our sympathetic system – what determines whether we fight or flight – and make people feel more energized, while a longer massage allows for more time to disengage the sympathetic system and engage the parasympathetic system – rest and digest.

Other body systems are also positively affected by massage, such as the cardiovascular system, lymphatic system, and of course, the musculoskeletal system. Some cardiovascular effects include increased blood flow (which in turn increases oxygen, red blood cells, and nutrients to the area), decreased heart rate, and decreased blood pressure. Lymphatic system benefits included decreased swelling and inflammation, decreased scar tissue, and improved circulation.

Finally, the most obvious effects are those on the musculoskeletal system: decreased physical stress, increased mobility and range of motion, decreased fascial restrictions, decreased trigger points, decreased pain, improved stiffness, improved muscle tone, better post-surgical recovery.

However, while we can name the effects of massage on various body systems, it is important to remember that all of these systems work together, influence each other, and are uniquely linked. The effects of massage are compounded for the ultimate effect: decreased stress, for both the body and mind.

Ashley Moriarty

Ashley Moriarty

Ashley Moriarty, DPT, OCS, ATC, is a board certified orthopedic clinical specialist and certified dry needling specialist based in New Canaan.

Meet Ashley

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What is vertigo, and how can it be treated?

What is vertigo, and how can it be treated?

What is vertigo, and how can it be treated?

Approximately 40% of adults experience vertigo at least once in their life. There are various causes, all of which have varying levels of treatment.

Nov 1, 2021 | Ken Rubin, DPT

What is vertigo, and how can it be treated?

Approximately 40% of adults experience vertigo at least once in their life, with women being slightly more likely to get it than men. Vertigo is a sensation of spinning that can be associated with dizziness and feeling off balance. Other symptoms associated with vertigo are nystagmus (abnormal jerking eye movements) and nausea/vomiting. Contrary to what you may think, vertigo is not a condition, but a symptom of an underlying problem. Vertigo can be classified as central or peripheral based on the origin of the symptoms. Pathology originating from the cerebellum or brainstem are classified as central, while symptoms arising from the inner ear or the vestibular nerve are classified as peripheral.


Vertigo is often caused by a problem in the inner ear. The most common causes include Benign Paroxysmal Positional Vertigo (BPPV), Meniere’s Disease or Vestibular Neuritis or Labyrinthitis.

BPPV occurs when very small calcium particles called otoconia or canaliths are dislodged from their normal location (known as the utricle) and collect in the semicircular canals. These inner ear structures are responsible for sending signals to the brain about head position and movement relative to gravity. Malfunctions in this system can result in symptoms of vertigo. These symptoms usually last for a brief period of time and are related to changes in head or body position. While there is no well-known cause for this condition, and it can occur at any age however it is more common in older adults.

Meniere’s disease is thought to result from a buildup of fluid and changing pressure in the ear. This will typically result in episodes of vertigo that last longer than BPPV and are associated with tinnitus (ringing in the ears) and hearing loss.

Vestibular Neuritis or Labyrinthitis is related to an infection, usually viral, that results in inflammation in the inner ear around the nerves that allow the transmission of signals carrying information about head/body position to the brain.

Less common causes of vertigo include head/neck injury, brain tumors/stroke, migraine headaches and side effects of certain medications.


Treatment for vertigo depends on what the cause. Oftentimes, vertigo will subside without treatment but vestibular rehabilitation is used in many cases to help strengthen the vestibular system and restore equilibrium.

Canalith repositioning maneuvers are recommended by the American Academy of Neurology to treat vertigo caused by BPPV. If your therapist diagnoses BPPV, he/she may treat you by taking your body through a series of movements that are designed to move the dislodged otoconia/canalith from the semicircular canals back to the utricle where they originated. Symptoms of vertigo occur during this maneuver but subside following. This should significantly reduce symptoms. Exercises that stress the vestibular system will be prescribed by your physical therapist following in order to “re-calibrate” your system.

Currently, there is no known cure for Meniere’s disease. However, you can take medications to treat the symptoms such as meclizine (for motion sickness) and promethazine (anti-nausea). Physical therapy is also recommended in the treatment of Meniere’s disease to improve vestibular function and balance. Alternatively, physicians can perform a number of injections to the middle ear such as dexamethasone (steroid) to reduce inflammation and mitigate symptoms.

If symptoms persist and are debilitating in nature, there are a number of surgical options available that are used as a last resort. One involves endolymphatic sac procedures, which decompress a part of the ear that is responsible for fluid levels. A shunt may also be placed to drain excess fluid that is causing symptoms. Yet another, labyrinthectomy, is a more aggressive procedure that removes the balance and hearing portion of the affected inner ear. Due to the invasive nature of the procedure, this is only performed in cases where the patient already has near or complete hearing loss.

Finally, some doctors may perform a vestibular nerve section, which involves cutting the nerve that sends signals about balance and movement to the brain while preserving hearing function. This requires general anesthesia and overnight hospital stay.

Vestibular Neuritis (or Labyrinthitis) has simpler treatments, including antibiotics, prednisone, and antihistamines as well as medications to treat symptoms such as dizziness and nausea.

Vestibular therapy

Vestibular rehabilitation is a common part of a multimodal treatment for various vestibular conditions including those mentioned above. Exercises prescribed by your physical therapist will be divided into three main categories: habituation, gaze stabilization and balance/postural control.

Habituation involves exercises that provoke symptoms using graded exposure to specific movements or visual stimuli. The goal is to provoke mild symptoms that allow the central nervous system to acclimate the body to the stimulus. An increase in symptoms should be temporary and return to baseline after 15 minutes.

Gaze stabilization is performed with the goal of improving visual acuity during head and eye movements. Common exercises include fixing your gaze on an object while repeatedly moving the object, your head, or both. Head movement can be vertical or horizontal. This can be progressed by changing the environment, body position, speed of movement and duration of exercise.

Balance or postural control exercises may be prescribed to improve steadiness during a variety of tasks in order to promote functional return to activities of daily living, work or leisure. After determining what aspects of balance are impaired, your therapist will provide exercises that are challenging — but safe — so that you are not at risk of falling. These can be progressed by introducing uneven ground, low lighting, narrow base of support, single leg standing, external perturbations, etc.

If you are experiencing vertigo-like symptoms, please contact your physical therapist to determine the appropriateness of treatment. They will be able to assist you in discerning the cause of symptoms, setting up a treatment plan, and referring to another provider if needed.

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What it means to recover from a lack of sleep

What it means to recover from a lack of sleep

What it means to recover from a lack of sleep

Recovering from a lack of sleep takes longer than you'd expect — it can take more than a week to get back to your normal self. Here's why.

Oct 15, 2021 | Performance Optimal Health

What it means to recover from a lack of sleep

(CNN)— Yawning and exhausted from another night of little sleep? Congratulations, you have joined the multitude of people around the globe who suffer from sleep deprivation, a serious problem that can affect your mental and physical health.

Sleep problems constitute a “global epidemic that threatens health and quality of life for up to 45% of the world’s population,” according to World Sleep Day statistics.

But it’s easy to recover from that sleep deficit, right, especially if you’re young? A good night’s sleep or two – and certainly a full week of sleep – and you’re back to your fully functioning self?

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Finding the motivation to follow through with your home exercise program

Finding the motivation to follow through with your home exercise program

Finding the motivation to follow through with your home exercise program

It can be difficult to do your homework. Here's how to find the motivation to follow through with your physical therapy home exercise programs and make the most of your recovery.

Oct 1, 2021 | Danielle Pasquale, DPTDanielle Pasquale

Finding the motivation to follow through with your home exercise program

You’ve probably heard of physical therapy homework, or home exercise programs, before. A home exercise program is a personalized exercise program tailored to an individual, to be performed outside of the physical therapy clinic as a way to maintain progress during time away from the clinic. These programs are carefully designed to maximize recovery programs and allow you to continue to work outside of the clinic.

The challenge is that a home exercise program can be easily forgotten throughout the course of care and you may not be making strides towards recovery as expected, due to not being in the clinic. As physical therapists, it is our job to make sure you’re adhering to the program and performing it outside of PT sessions. So, the question is, how do we motivate you to perform your exercise program, and what steps can you take to make sure you stick to it?

Step one is to collaboratively create a plan and schedule. When faced with an injury, creating a routine is very important in the recovery process. At first, the plan may look like rest, ice and elevation. But then, the plan will need to evolve into something more challenging in order for you to return to where you were before the injury. Just like at the beginning of the process, it’s important to make the home exercise program an integral part of your routine.

Taking a look at your schedule with your PT and deciding what time of the day will be best to complete it is a good place to start. For example, if you prefer exercising in the morning, set aside 15 minutes before you get ready to do your program, rather than leaving it to the end of the day when you are tired.

Another important part of having an effective home program and sticking to it is making sure it fits in line with your goals. Informing your physical therapist about what is most important to you and what you want to get back to will help them design the best program for you.

For instance, if your goal is to return to golfing, the home exercise program should be designed to involve specific exercises that will strengthen or stretch the muscles needed to improve your golf swing. Sitting down and talking with your PT about how each of the exercises are directly related to helping you meet your goals will allow you to understand the “why” and motivate you to take the time to do it.

We don’t want these programs to feel like a job; we want you to try and have fun with it! If you’re getting bored of your same routine, switch it up. Instead of waking up and doing your home exercises right away, plan a different time in the day to do them or try going to a new place to do them. For people who enjoy nature, bring a yoga mat and do the exercises outside or at a park on a nice day. If getting a gym membership has been something on your radar, go get one and start your workout with your home program.

You can also take this as a time to decompress and manage your stress in life. Put on your favorite music, podcast, tv show or even meditation audio and make the time you do your exercises a peaceful time. There are so many ways to make it an enjoyable time, so find what you like to do and incorporate your exercises into that!

Finding the motivation to perform a home exercise program can be challenging. Understanding why you’re doing each activity and how it can benefit you will help to create the drive needed to reach your goals. Work with your therapist to develop a plan and program to help keep you on track and allow for long term outcomes. Have fun with it and find ways to make it something you enjoy!

Danielle Pasquale

Danielle Pasquale

Danielle Pasquale, DPT, is a physical therapist based in Greenwich. She strives to create a collaborative environment with each patient, ensuring they feel equally involved in their care.

Meet Danielle

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Could the pandemic be hurting your pelvic floor?

Could the pandemic be hurting your pelvic floor?

Could the pandemic be hurting your pelvic floor?

With people sitting at their desks more often and feeling more stress during the pandemic, there's been an increase in pelvic floor issues. Here's why — and some tips to help.

Sept 1, 2021 | Performance Optimal Health

Could the pandemic be hurting your pelvic floor?

The coronavirus pandemic has been blamed for a rise in mental health conditions, weight gain, broken toes, skin picking and dental issues. But, according to physical therapists and urologists, it also may be responsible for problems in an often-overlooked part of our bodies: the pelvic floor.

Located at the base of the pelvis, the pelvic floor consists of a group of muscles that provide support for internal organs, including the bladder, rectum, uterus and prostate. The muscles are also involved in posture, urination, bowel movements and sex.

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How to overcome overtraining syndrome

How to overcome overtraining syndrome

How to overcome overtraining syndrome

Overtraining your body can lead to a variety of side effects as well as poor performance. Your body can only take so much without receiving any rest or recovery days. But you can come back from overtraining — with adequate recovery time.

Aug 15, 2021 | Brianna Clifford, CPT, CSCS

How to overcome overtraining syndrome

Intensity. Toughness. Unrelenting work ethic. When we think of these descriptions, we probably envision an uber successful professional athlete, a marathon runner, or even a bodybuilder. Generally speaking, these are positive terms that are associated with success. But what happens when these terms are taken to the extreme… when the intensity and frequency of training pushes the athlete past the point of recovery?

Effective training operates on somewhat of a bell curve. There needs to be enough stress (the aforementioned intensity and effort) on a body to create an adaptation or improve performance. However, constant overload doesn’t mean constant improvement. The body can only tolerate increased training when there is an adequate rest and recovery period. If the amount of stress continues to increase over a prolonged period, and the recovery is not adequate enough to keep up, performance results may diminish. If adaptations and progress begin to decrease, while training excessively the athlete may be experiencing overtraining syndrome.

Symptoms of overtraining can include chronic fatigue, mood swings, plateau in performance and trouble with sleeping. If left unaddressed, overtraining can even produce injuries such as stress fractures, sprains and strains or joint pain. Mental symptoms of overtraining include lack of concentration, lack of enjoyment in exercise or sport and decrease in confidence.

There can be a myriad of signs of overtraining depending on the individual athlete, but it remains true for all athletes that it is important to approach training from all angles. It’s not just the relentless physical effort that gets an athlete to achieve a goal, but the assessment of total physical and mental well-being that will ultimately progress them further. This is what separates the greatest of athletes from the rest.

So, how do we combat overtraining syndrome? The biggest factor is rest. Athletes may see improved performance by simply decreasing training volume. Training volume might be decreased by 50-60 percent, and in some cases the athlete may be asked to stop altogether for a brief period.

Aiming for seven to nine hours of sleep can also help with recovery. Turning down the thermostat, spending the last 30 minutes before bed phone-free, and making your sleep space as dark as possible are just a few ways to improve sleep quality.

Making sure you are eating enough to fuel intense workouts is an underrated tool in assisting with recovery. Working with a nutritionist can be a helpful step in making sure your macronutrient count is appropriate for the training goals.

Another approach is taking care of your mental health; perhaps monitoring time spent on social media, or maybe taking up meditation can also aide in recovery by helping you focus and relax.

Once you’ve recalibrated and when the time is right, you can gradually increase training back up, building in rest days and recovery periods. Finally, understand that overtraining is not strictly for professional athletes. If you find yourself unable to recover from extreme workouts, or start experiencing burnout, you may consider that overtraining is to blame. Working with your coach and finding a balance of proper stimulus, and adequate recovery will go a long way in achieving your fitness goals.

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Recovery: the forgotten element of a successful training regimen

Recovery: the forgotten element of a successful training regimen

Recovery: the forgotten element of a successful training regimen

People often overlook recovery and how it compliments — and accelerates — performance in whatever activity you partake in. Here are some ways that different recovery modalities can help facilitate a robust recovery program to match the intensity of your fitness program.

Aug 1, 2021 | Jordan James, CSFC

Recovery: the forgotten element of a successful training regimen

Over the past 25-30 years in the fitness industry, we have heard everything. From exercising at a moderate intensity for 150 minutes to how blood flow restriction can accelerate your rehab protocol, we are constantly fed with new information on how to tweak and improve our workouts. Yet many still face the same results and give up on their goals.

What people often fail to mention is the recovery aspect and how it compliments — and accelerates — performance in whatever activity you partake in. Here are some ways that different recovery modalities can help facilitate a robust recovery program to match the intensity of your fitness program and help you achieve your goals. Here are some different ways to implement recovery into your life:

Hydration: as sweat evaporates from your skin during exercise, it removes heat from the body, but you also lose body fluid. So, you need to drink fluid during exercise to replace the fluids you lose when you sweat. That way, you'll reduce the risk of heat stress, retain normal body function and maintain performance levels. Water plays a significant role in the process of recovery, from helping digest vital nutrients to repairing muscles damaged during exercise. Remember that our muscles are actually 75% water! It is recommended to have at least eight ounces of water within 30 minutes of exercise.

Normatec: An underrated form of recovery comes in the form of compression therapy. By using Normatec compression sleeves, you can accelerate recovery after exercise, allowing you to get back onto your feet more quickly. They can be used daily for 20-30 minutes, and come in the form of leg, arm and hip sleeved. Here are some of the researched backed evidence benefits when active individuals incorporate Normatec sleeves: reducing swelling and inflammation, speeding up muscle recovery, preventing delayed-onset muscle soreness, relieving muscle pain, improving athletic performance, and increasing flexibility and range of motion.

If you prefer more old-school methods of recovery, think about incorporating massages into your regimens. Massages that focus on techniques such as deep tissue can sooth your muscles, increase flexibility, reduce stress and reduce risk of future injuries. Another important component is reducing lactic acid buildup. During exercise, especially strenuous anaerobic exercise, the lactic acid levels can rise, causing fatigue, decreased blood flow to the area and elevated levels of soreness. A sports massage promotes recovery to these affected areas by flushing the lactic acid build up and circulating re-oxygenated blood.

It is also important to tailor your recovery approach to the type of workout you want to complete. For example, cardio-focused training, such as sprinting or long-distance running should be followed by Normatec compression therapy and cryotherapy to help eliminate toxins and decrease inflammation throughout the body. Stretching is also key here, both before and after a workout.

If you are focusing on strength training, it is essential to alternate high and low intensity and volume days to allow your body enough time to recover. An example of this could involve doing a heavy workout on Monday, following it up with a lighter workout with a focus on mobility and recovery on Tuesday.

If you want to take the next step in planning out your recovery, we recommend using a smartwatch, Oura ring of Whoop strap to track your body’s feedback. From examining your heart rate to tracking how your workouts affect your sleep, wearable technology can give you detailed insights into how your body performs and reacts to the stress of a workout. If you don’t have any of these devices, simply listening to your body and responding appropriately will make a difference. If you notice you are more tired after HIIT days, it may be helpful to schedule your rest day the day after you complete a HIIT workout.

At the end of the day, while there are some things everyone should do to recovery (hydrate, sleep, take a day off), ideal recovery programs vary from person to person. Trying out various methods and combinations can help you maximize your recovery — and your training. Don’t know where to start? A trainer or recovery specialist can help!

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What happens when an Olympic athlete overtrains

What happens when an Olympic athlete overtrains

What happens when an Olympic athlete overtrains

Pushing yourself too hard is no joke. When Olympic athlete Simone Manuel didn't get enough rest & recovery, overtraining syndrome hit her — hard.

Jul 15, 2021 | Performance Optimal Health

What happens when an Olympic athlete overtrains

OMAHA, Neb. — In an afternoon practice session last month in Palo Alto, the Stanford women’s swim team pounded through a vigorous freestyle set. Working with resistance equipment and then performing a grueling series of short-rest sprints, Greg Meehan’s team was pushing itself hard.

In an adjacent pool, Olympic gold medalist Simone Manuel was doing a much more gentle workout, and it ended early. This was a time of intense final preparation for U.S. Olympic trials, and Manuel wasn’t up for it. Something clearly wasn’t right, but the American record-holder, reigning world champion and Olympic gold medalist in the 100-meter freestyle wasn’t ready to discuss it at the time.

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Recovery spotlight: massage

Recovery spotlight: massage

Recovery spotlight: massage

While there are various methods of recovery, few have been around as long as massage. Here's the quick rundown on everything you need to know about the wonders of massage.

Anne Triano, LMT

Jun 15, 2021 | Anne Triano, LMT

Recovery spotlight: massage

“Massage.” The word itself sounds peaceful and calming. It’s derived from many ancient languages and cultures: from the French “massage,” meaning “friction of kneading” to the Arabic “massa,” meaning “to touch, feel or handle” to Latin’s “massa,” meaning “mass, dough.”
While those are simple definitions, the word today is actually easier to describe than to define. Massage is “the manipulation of the soft tissues (muscles, tendons, ligaments, fascia and skin) and joints of the body to gain a therapeutic response, aiding in the healing process, and promote relaxation and well-being.”

The practice of massage has been around for thousands of years. The power of touch can be so comforting, assuring and healing, something of high importance, especially in these current times. It is not fully known why massage has so many benefits, but the nervous system sheds some light on it. Our nervous system consists of two parts: the “fight or flight” stress response – our sympathetic nervous system; and the “rest and digest” parasympathetic nervous system, which brings balance to the sympathetic nervous system.

Massages bring balance to the nervous system

A massage can release endorphins by stimulating the autonomic nervous system. As the sensory receptors in our skin and muscles send messages through our nervous system, our brain will use that stimulation as a directive to find balance. As a result, massages decrease pain and stress as well as provide an increase in relaxation and calmness. For example, an athlete may experience sore muscles, and a massage can loosen up those muscles, balancing out the pain.

Many of us have life stressors, injuries, tight, tense muscles and general pain. Along with other modalities to assist these issues, massage can be an immensely helpful addition to relieve many physical and mental difficulties. Not only can massage help with physical issues, but there’s also proof that massage can help with anxiety and depression. Our lives are busy and can be complicated. Getting a massage can loosen tense, tight muscles after just 30 minutes on the massage table. Relief to specific areas are noticed and felt by the massage therapist during the session, allowing them to constantly react to the person’s body cues. Right after the massage, people will notice that they have less tightness, tension, and less pain. This relaxation, rest and recovery are signs of your parasympathetic nervous system doing its job.

Types of massages

You may think a massage is just a massage, right? Not so much. There are various types of massages that are used for different purposes. Each massage is tailored to the person’s needs, and it can be used to solve a variety of problems. A wellness massage can help you relax after a long day, relieving tension in your muscles. A medical massage can aid in recovery from injuries, surgeries or procedures. Similarly, a sports-focused massage, tailored for athletes, usually features a rigorous approach pre-events through increased movement throughout the session and applying deeper pressure, followed with a less rigorous approach post-events. However, each of these three types of massage have the same overarching goal: to help you recover.

Now that you know what the general massage categories are, let’s break them down further.

Wellness Massage

This type of massage is meant to aid in relaxation, reduce tense, sore muscles and to help calm the mind. There is usually a range of styles of massage focusing on the hand pressure, varying from light to deep. Many techniques are used to allow for the sense of relaxation and calm.

Medical Massage

When a client has a specific medical situation – post-surgery, post-injury or possibly experiencing general chronic pain or soreness, a medical massage can manage pain and discomfort. For example, a massage therapist can release the ropy bands in the shoulders or the areas around the surgical or injured site to help keep inflammation and soreness to a minimum. Hip replacements, rotator cuff surgeries and knee replacements are all common reasons to receive a medical massage.

Sports Massage

Whether you’re a young athlete, seasoned runner or a weekend warrior, any athlete can benefit from a massage to loosen chronically tight muscles or give the athlete pre-event energy by invigorating the muscles or release built-up tension in your muscles by applying deeper pressure. The goal is to give the sports-minded more energy for their sport or activity as well as help with relaxing their well-used muscles after any event.

The key takeaway? Massages have been used for centuries to relieve stress and aid in recovery. The benefits that massages provide for our nervous system can be used for many situations and reasons, making them a great tool for recovery.

Anne Triano

Anne Triano

Anne Triano, LMT, is a seasoned massage therapist who specializes in various massage techniques such as trigger point therapy, sports and deep tissue, Swedish and relaxation.

Meet Anne

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How much does Russell Wilson spend on recovery?

How much does Russell Wilson spend on recovery?

How much does Russell Wilson spend on recovery?

Seattle Seahawks quarterback Russell Wilson takes his recovery seriously, spending about 1 million per year to keep his body healthy.

Jun 30, 2023 | Performance Optimal Health

How much does Russell Wilson spend on recovery?

Since being drafted in 2012, Seahawks quarterback Russell Wilson has never missed a start. When Wilson takes the field against the 49ers on Sunday, it will mark his 133rd consecutive regular season start, which is the second-longest active streak in the NFL.

The key to keeping the streak alive is two-fold: You have to play well so you don't get benched and you have to stay healthy. Based on the way Wilson describes it, that first thing might actually be easier than the second thing, because it appears the 31-year-old spends nearly all of his free time trying to help his body recover and trying to stay healthy.

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What in the world is pelvic physical therapy, and why have I never heard of it?

What in the world is pelvic physical therapy, and why have I never heard of it?

What in the world is pelvic physical therapy, and why have I never heard of it?

Even though it has been around for centuries, pelvic physical therapy is a largely unknown to the average person, preventing people from addressing common issues that are treatable.

May 1, 2021 | Jessica Klecki, DPT

What in the world is pelvic physical therapy, and why have I never heard of it?

I remember sitting in my penultimate semester of physical therapy school thinking (probably out loud if you know me), “wait, wait, wait, we can do what? Where? Why would anyone want to do that?”

Like many physical therapists, I started school with the goal of working with high-level athletes and the dream of working for a professional team. Oh, how dreams can change.

You’re probably wondering what possibly could have shocked me that far along into our physical therapy coursework. The moment in class I was referring to was, of course, the (very) short blurb that was the “intro to pelvic health” presentation that included a vague explanation of an internal coccyx (tailbone) mobilization technique.

This information rocked my world! It changed how I thought about my own body and it changed how I looked at physical therapy as a profession. That day, I realized we are so much more than just the rehabilitation of sports injuries, and I needed to know more.

So, what exactly is the pelvic floor?

Take a moment to consider your abdominal area as a soda can with the respiratory diaphragm as the top, your “core” muscles as the front and sides, and your back muscles as the back of the can. The can is still missing a very important component: the bottom!

Your pelvic floor supports the bottom of the can by providing a hammock, or bowl-like support, at the bottom of the pelvis. It has five very important functions:

1.Supports the internal organs
2.Sphincteric control of urethra and anus (urine and stool)
4.Stabilization/core activation (completes the soda can!)
5.“Sump pump” for circulation/lymphatic system

Origins of pelvic physical therapy

Now, since no one knows about pelvic physical therapy that must mean it's new, right? Nope!

Some of the techniques used by pelvic physical therapists have been described in the ancient texts of Chinese Taoism 6,000 years ago. Hippocrates and Galen of Ancient Greece and Rome also taught pelvic floor exercises. However, these techniques were long forgotten during the dark ages until modern medicine received its first dose of pelvic floor-specific exercises.

Margaret Morris stepped up to the plate when she connected the importance of pelvic health to the overall health and well-being of her dancers. She published a paper in 1936 that introduced British society to pelvic floor physical therapy. Unfortunately, she is often overlooked in history. Many erroneously think the world was introduced to pelvic floor exercises by Dr. Arnold Kegel in the 1940s. While Dr. Kegel helped spread knowledge of pelvic health and his “Kegel” exercises, his techniques had been used around the world for centuries.

What does pelvic physical therapy look like today?

Today, pelvic floor physical therapy is so much more than just “Kegel” exercises. As pelvic floor/pelvic health therapists, we are musculoskeletal experts that specialize in the area associated with and within the bony pelvis. This includes the innominate (ilium, ischium, pubis), sacrum, sacroiliac joints, and coccyx. The pelvis houses the pelvic floor which is a region (not just one muscle!). We seek to see and treat the body as a whole and treat our clients as a WHOLE person. We are interested in how the gastrointestinal tract, reproductive, orthopedic, urologic, neurologic, and dermatological systems function together and how that affects your overall function and health.

The muscles of the pelvic floor are skeletal muscles. They behave just like other muscles in the body: they can be too short/tight or too long, or they can be weak and ineffective at their “jobs,” or they can even lack coordination. And did you know that eight out of 10 patients who are performing “Kegels” on their own are doing them incorrectly? Often this is due to poor proprioception (awareness of the position/movement of the body and its parts). It is hard to master the coordination of these muscles when you can’t see them working!

It's not just you — and you can get help.

Unfortunately, many of these pelvic health issues go untreated and undiagnosed because of one simple fact. It’s a little weird to talk about, but it shouldn’t be!

New moms in France are referred to a pelvic physical therapist immediately after birth and are insured for a minimum of 10 visits, which is obviously not the case in the United States. But it’s not just recent moms who are in need — there are many reasons to see a pelvic physical therapist. Common diagnoses treated by pelvic therapists include (but certainly are not limited to):

  • Incontinence (urinary and fecal)
  • Prolapse
  • Constipation
  • Vulvodynia and Vaginismus
  • Dyspareunia (pain with intercourse)
  • Coccyx pain
  • Diastasis Recti
  • Interstitial Cystitis
  • Polycystic ovary syndrome
  • Endometriosis
  • Chronic pelvic pain

Although talking about issues in the pelvic region can seem a little strange, and maybe even a little taboo at first, it is important to see how important this little area is to overall health and quality of life.

Jessica Klecki

Jessica Klecki

Jessica Klecki, DPT, is a pelvic health specialist whose unique approach involves creating comprehensive treatment plans that incorporate various exercises, breathing techniques and stretching methods.

Meet Jessica

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The importance of getting evaluated following a concussion

The importance of getting evaluated following a concussion

The importance of getting evaluated following a concussion

Concussions have not always been treated as seriously as they should have, but with new reports coming to light, people are starting to realize it is essential to start managing and treating concussions at a young age, especially for young athletes. Here's why.

May 15, 2021 | Robert Mahlman, DPT

The importance of getting evaluated following a concussion

Concussions have not always been treated as seriously as they should have. But with reports coming to light about the NFL hiding the full extent of the dangers of concussions, the public has come to realize it’s not something that should be ignored. It is essential to start managing and treating concussions at a young age, especially for young athletes, before the issue progresses.

What is a concussion?

A concussion, as per the Centers for Disease Control and Prevention, can be defined as a mild traumatic brain injury resulting from a blow or quick jar to the head which results in the brain rapidly moving back and forth. This back and forth motion results in a chemical cascade within the cells of the brain, which can result in rapid short-lived impairment of neurologic function. Symptoms can include dizziness, amnesia or loss of consciousness, headaches, fogginess, sensitivity to sound and light, difficulty with balance and various other neurological impairments; all these symptoms can develop in a matter of minutes or hours post-concussion.

The CDC estimates that 1.6 to 3.8 million concussions occur annually. Now, this is not meant to scare you from having your children play sports: a total of 60 million children and adolescents participate in sports annually and a total of 400,000 experience concussions. The actually scary statistic is that it is estimated that more than 500,000 children and adolescents that experience sports-related concussions are not treated in a health care setting. (Gaw and Zonfrillo 2016, Zogg et al 2018).

Diagnosis of concussion

To make some sense of all of this, let’s discuss how concussions are diagnosed and why it is important to perform a diagnosis in the first place. The first line of diagnosis in the on-field assessment, which is usually performed by a trained physician or athletic trainer. These clinicians will commonly use the Sport Concussion Assessment Tool, known as the SCAT 5, for on field/sideline assessments of athletes.

The SCAT 5 assessment has various components, with the most important being emergency assessment and stabilization of the athlete in serious situations. It also contains a cognitive assessment that examines the athlete's orientation and concentration. Based on an athlete's overall responses and symptoms, along with a balance assessment, the medical provider can properly triage the patient to the emergency department, hold them from the game or allow them to return to play.

Though the assessment itself is straightforward, the diagnosis may not be. In concussion literature, there is a strong emphasis on the recognition and diagnosis of concussions as soon as possible in order to promote healthy outcomes. After an athlete sustains a concussion, they should have a follow up evaluation by their primary care doctor who is familiar with concussion management and/or a concussion specialist. As medical providers know, no one truly presents the same symptoms, and this is especially evident with concussions.

Dr. Audrey Paul, MD, Ph.D., FACEP, FAAP, of Advanced Concussion Solutions works closely with our physical therapists. “Unfortunately, there is no single test that diagnoses a concussion. Concussion diagnosis involves a multifocal evaluation of several systems including the vision, balance, cognitive function and exercise tolerance,” Dr. Paul said. A proper initial evaluation also takes time, at least 30 minutes. There are also new tools becoming available that assist with concussion diagnosis and prognosis, including quantitative EEG, according to Dr. Paul which can make the diagnosis process more consistent. The in-office evaluation that will be performed by a physician and eventually a physical therapist will include a thorough patient history to discuss prior concussions, past medical history and background on the current concussion sustained.

Various factors have been shown to increase recovery time, including female gender, history of any anxiety or depression, dizziness, higher baseline symptom scores and history of migraines (Kutcher and Eckner 2010, Hou et al 2012). A concussion can present with a wide array of symptoms and impairments, so a thorough physical exam is necessary. This will include, but is not limited to, an examination of a patient's cognition, vestibular/ocular motor function, cervical spine, balance and blood pressure. Based on this information, a team-based approach can be taken to manage a patient following a concussive event.

A major change in the way concussions are managed is a transition to focusing on recovery and being active throughout the recovery period. A study by Schneider et al. 2014 noted that randomized athletes with sport-related concussions into three groups; standard rehabilitation (non-treatment), cervical spine rehabilitation and vestibular rehabilitation. In eight weeks, 73% of the treatment group recovered, while only 7% of the control (non-treatment) group recovered. Following a concussion, people can experience a major exercise intolerance which fortunately can be addressed with a targeted and patient-specific active recovery.

Concussion Treatment

Treatment for concussions initially revolved around rest and time to heal known as cocoon therapy. What we have learned over the last five years is that targeted active recovery is a better recovery method. A study by Thomas et al in 2015 took concussed students and randomized them into two groups: one to two days of rest or five days of strict rest. It was found that those in the first group recovered more rapidly than the strict five-day rest group. However, there have also been several animal-based studies that have looked at the use of exercise and activity too early in the recovery process, which had a negative effect on the body. What this tells us is that it all comes down to a balance, and recovery truly is patient specific.

Balance deficits and dizziness are found in up to 67% of patients with concussions. Athletes with vestibular based symptoms such as these are likely to have longer recovery times, sometimes up to six to seven times more likely to have a prolonged recovery. Alsalaheen et all 2010 found that athletes with vestibular symptoms that underwent physical therapy were significantly more likely to recover faster and return to sports sooner than those who did not.

Visual impairments, which include blurry vision, double vision, light sensitivity and abnormalities in eye movements, are found in 42% to 50% of patients following a concussion. About 92% of athletes with concussions also experience headaches. With a strong relationship to the cervical spine, physical therapy has been proven to be very helpful for the management of headaches in the concussed population. Lastly, the implementation of aerobic exercise when appropriate has significantly improved recovery time in adolescent athletes and decrease prolonged symptoms post-concussion.

As the athlete nears full symptom alleviation, they should be put through a combined battery of physical and mental tests that will promote a safe to return to sport. These can include vigorous treadmill and bike interval testing with the heart rate being monitored, sport-related agility and coordination drills and lastly mental/reactionary tasks layered in for specific cases. “Return to sport testing is essential for safe return to athletics to prevent a second concussion or an orthopedic injury. Current literature has shown that the best way to assess recovery is through heart monitoring and exercise tolerance,” Dr Paul explained.

Concussions are a major player in many adolescent athletes' lives. The medical profession has made great strides over the years to improve its diagnosis, examination and treatment of patients with concussions. Most importantly, we have learned that a timely and effective diagnosis and examination can decrease prolonged recovery and limit long term effects of concussions. And most importantly a patient centered active recovery leads to an earlier and safer return to play for athletes.


Alsalaheen BA, Mucha A, Morris LO, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34(2):87-93.
Gaw CG, Zonfrillo MR. Emergency department visits for head trauma in the United States. BMC Emerg Med. 2016;16(5).
Hou RH, Moss-Morris R, Peveler R, et al. When a minor head injury results in enduring symptoms: a prospective investigation of risk factors for post-concussional syndrome after mild traumatic brain injury. J Neural Neurosurg Psychiatry. 2012;83:217-227.
Kutcher JS, Eckner JT. At risk populations in sport related concussions. Curr Sports Med Rep. 2010;9(1):16-20.
Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cervicovestibular rehabilitation in sports-related concussion: a randomized control trial. B J Sports Med. 2014;48:1294-1298.
Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke T. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics. 2015;135(2):213-223.
Zogg JK, Haring SR, Xu L, et al. The epidemiology of pediatric head injury treated outside of hospital emergency departments. Epidemiology. 2018;29(2):269-279.

Robert Mahlman

Robert Mahlman

Robert Mahlman DPT, PT, OCS, is the Physical Therapy lead at Performance and a certified Schroth therapist who specializes in the treatment of various orthopedic injuries, along with scoliosis and concussion management.

Meet Robert

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How do I prepare for my COVID vaccine?

How do I prepare for my COVID vaccine?

How do I prepare for my COVID vaccine?

You may be wondering how you should best prepare for the vaccine to maximize its effects. Here's what you need to know.

Apr 14, 2021 | Performance Optimal Health

How do I prepare for my COVID vaccine?

As of this week, over 75 million people in the United States have been fully vaccinated, paving the way for a return to normalcy. With about 3.4 million going into arms each day, experts predict the country will achieve herd immunity by the fall.

You may already know friends, family, or even some of our team members who have already received their vaccines. You may even be counting down the days until you can get it, too. This may lead you to wonder how you should best prepare for the vaccine to maximize its effects.

What side effects may I experience?

The first thing you should be aware of is the likelihood of feeling side effects within 24 hours of receiving your dose. These often include pain and discomfort in the arm you received the shot, fatigue, fever, muscle pain, chills and nausea. However, some people may experience rare allergic reactions, which is why most vaccination locations ask people to sit and wait in a waiting room for at least 15 minutes after receiving your shot.

Effects also tend to intensify after receiving the second shot, so we recommend you schedule your second shot (if applicable) appropriately. Try to take it on a Friday or Saturday, or take a day of from work the day after. This will allow you to adequately rest and recover from any symptoms you may have.

Experiencing any of the common side effects is no reason to worry — it is just a sign that your body is working to build protection against the coronavirus. On the flip side, if you don’t experience any side effects, that does not mean the vaccine did not work: you will still be protected.

To alleviate any discomfort you feel in your arm, the Center for Disease Control recommends applying a clean, wet washcloth on the area and to move your arm around. The CDC also recommends drinking plenty of water and dressing lightly to combat fever. If any of the side effects persist after a few days, you should contact your healthcare provider.

Decreasing the severity or likelihood of side effects?

Now, in order to decrease the severity or likelihood of side effects, you should avoid drinking alcohol the night before and get a good night’s sleep to keep your body alert and well-rested the next day. You should also avoid taking anti-inflammatory medications leading up to the vaccine, such as aspirin, ibuprofen or other types of pain relievers. These medications may interfere with your immune response, weakening its reaction to the vaccine.

Other medications to look out for are steroids; if you take steroids for chronic conditions, that should not pose an issue. But if you are taking steroid injections, you should discuss taking the vaccine with your health provider first. Additionally, if you are also in the process of taking another vaccine, you should leave a 14-day buffer period in between taking the different vaccines. This will let your body mount an adequate response to both triggers.

However, most other medications are safe and will not interact with the vaccine, such as those for blood pressure, diabetes, asthma and other common conditions.

Next steps

Both the Moderna and Pfizer mRNA vaccines are about 95% effective at preventing COVID-19 two weeks after the second dose. However, this does not mean that all precautions should go out the window. The CDC still recommends against participating in medium or large gatherings, both inside or outside, as well as interacting with non-vaccinated people indoors without masks.

Yet the CDC also lessened other restrictions for those who are vaccinated: they are allowed to be indoors with other vaccinated people, for one. They can also visit other unvaccinated households whose occupants are not at risk of serious disease. Traveling domestically without a pre- or post-travel test is also an option, as well as not having to quarantine upon arrival. For a full overview of the CDC’s recommendations for people fully vaccinated, you can find out more on their website.

A force to be reckoned with

A force to be reckoned with

Trish Kirsch discusses how Performance helped her daughter, Saylor, recover after an injury; Though doctors were unable to help at first, they were finally able to discover the source of her Saylor's injuries and put her on the path to recovery. It was not an easy path, but Saylor defied odds and returned stronger than ever to the sport of diving.

Mar 1, 2021 | Performance Optimal Health

A force to be reckoned with

We interviewed Trish Kirsch and discussed how Performance helped her daughter, Saylor, recover after an injury; Though doctors were unable to help at first, they were finally able to discover the source of her Saylor's injuries and put her on the path to recovery. It was not an easy path, but Saylor defied odds and returned stronger than ever to the sport of diving.

What brought you to Performance?

My daughter Saylor has had a passion for diving since she was seven. She’s been a force to reckon with, competing nationally and diving for the Greenwich Marlins and the Junior Olympic Team, but she started to experience knee problems around the age of 14. It even came to the point where Saylor could not go out shopping at the mall with her friends, she was in so much pain.

We looked for answers every day; we saw countless doctors and physical therapists, but Saylor was not getting better. Finally, Dr. Bryan Kelly at the Hospital for Special Hip Surgery realized that Saylor’s knee problem originated from her hips, and that she had labral tears on each side. Dr. Kelly sent her to Performance’s Shane Foley to prove this theory, which he did. In 2018, Saylor had two consecutive hip surgeries that finally set her on the road to recovery.

How did Performance get Saylor back on her feet?

Shane set up both Saylor and her coach with a plan to recover. He even came to the Greenwich YMCA in the spring of 2019 to watch her dive for the first time in a year. Shane sat on the deck, observing how diving impacted Saylor’s body, and developed a physical therapy plan suited to her needs. Not only does he know so much about the human body, he knew just how much to push it — and when it needed to rest.

Why is Performance different?

The constant communication. Shane was always speaking with Dr. Kelly, both before and after Saylor's surgeries. We could not find a practice that had this level of a connection with a doctor — and we looked everywhere, even in the city. Shane and Dr. Kelly provided ongoing conversations and constant care, allowing Saylor to recover with enormous support. When Saylor was diving again, Shane was there for her, checking in during meets to make sure she wasn’t pushing herself. Shane was our lifeline.

Where is Saylor now?

We had no idea Saylor could come back from her surgeries, but she proved everyone wrong with Performance’s help. She was back to competing at the AU Nationals in California just last year and was recruited to dive at several colleges in the fall! Ultimately, Saylor chose Fordham University and its’ Swimming and Diving team, but she showed it was possible to come back from multiple surgeries better than ever, and we are so proud of her and her amazing accomplishments.

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The importance of a good night’s sleep

The importance of a good night’s sleep

No matter how much we take care of our bodies while we are awake, sleeping poorly can erase many of those gains. In order to be successful, happy and healthy, we must pay attention to the quality of the sleep we are getting.

November 15, 2020 | Ashley Moriarty, DPT, OCS


No matter how much we take care of our bodies while we are awake, sleeping poorly can erase many of those gains. We must pay attention to the quality of the sleep we get to be successful, happy and healthy.

Defining Sleep

Sleep is a naturally occurring, easily reversible state that is marked by the absence of wakefulness and a loss of consciousness. It is typically associated with certain body postures (such as lying down with your eyes closed) and marked by changes in brain activity. It is considered essential for the recovery of the body’s physical and mental functions.

In terms of evolution, sleep would be considered a weakness. If the goal is survival, sleeping, with its accompanied loss of consciousness and incognizance of surroundings, would leave you vulnerable to predators. So why then, do we spend so much time sleeping? In order to determine its importance, most researchers assess what happens when someone is deprived of sleep. Studies have shown that as little as 24 hours of sleep deprivation can lead to hallucinations and psychosis. Lack of sleep is also is correlated with higher incidences of heart disease, diabetes, cancer and other illnesses. Sleep is good for overall health both physically and mentally, but it is primarily a restorative process for the brain.

On average, your brain uses only half the usual amount of glucose (energy) during sleep, allowing your energy reserves to be restored. It drives out toxins, clearing out waste products that are created during the day. Most importantly, however, sleep helps with neuroplasticity, or your brain’s ability to learn new skills, create new memories and evolve.

Sleep Requirements

Adults require eight hours of sleep. One could function on less, but that would create a sleep deficit, causing physical and mental harm. Overall, Americans get 6.8 hours of sleep per night on average, a number trending down each year. Work schedules are busier, modern society encourages us to stay up later and wake up earlier and there is more pressure for daily productivity.

School-age children and teens require 10–12 hours of sleep. As a result, some school districts opt for later start times to allow kids to get a full night’s sleep. Preschool-age kids need 10–13 hours, and toddlers need even more than that, somewhere around 11–14 hours.

Breaking Down Sleep Cycles

Sleep can be broken down into REM and non-REM states, with non-REM being further broken down into three phases.

  • Non-REM phase one begins when you start moving from being awake to asleep. The pattern of your brainwaves change, your muscles begin to relax — although you may experience muscle twitching — and heart rate and breathing begin to slow.
  • Non-REM phase two follows as a period of light sleep, like phase one. Brain wave activity slows with occasional bursts, body temperature drops and heart rate and breathing continue to slow.
  • Phase three, often considered the most important phase, is deep sleep. Heart rate and breathing are at their slowest and your brain is restoring energy. It is during this phase that memories are created and hormones are release to aide in tissue healing and growth. This phase tends to be longer during the earlier hours of sleep, but shorter as you get closer to waking up.
  • REM stands for rapid eye movement and is a phase marked by side to side eye movements, higher brainwave activity and dreaming. Your arms and legs are slightly paralyzed during this phase as a protective mechanism to prevent flailing as you dream. You reach your first REM phase about 90 minutes into sleep and cycle through all stages throughout the night.

A person can go through all sleep cycles three to four times a night, although this fluctuates from people to person. Improving sleep hygiene can lead to a more predictable and consistent sleep pattern. Ideally, adults should spend 20–25% of total sleep time in REM sleep and phase 3 non-REM should be around 13–23%. On the other hand, toddlers should spend half of total sleep in REM sleep and the other half in phase three non-REM sleep. Because both cognitive and motor memories are created in deep sleep, toddlers need a high amount of it. Since they are leaning and developing at such a rapid rate, it only makes sense that toddlers benefit from the sleep phase that aides in neuroplasticity.

Impact of Sleep on the Body's Recovery

Sleep can also affect immune function: generally speaking, good sleep acts positively on the immune system, and bad sleep acts negatively. Cortisol, the stress hormone, decreases at night, while human growth hormone and prolactin, both released naturally, increase at night to promote tissue healing. T cells, the body’s fighter cells, and their helper cells both function better with higher quality sleep. Poor quality sleep can lead to impaired cognitive function and impaired memory, and can have long term consequences. This includes an increased risk of cardiovascular disease, hypertension, coronary artery disease and diabetes. A good night’s sleep is necessary to allow your body to recover properly.

How to Get a Good Night's Sleep

You can take a guess at how good your sleep is based on how rested you feel in the morning or how soundly you slept through the night. However, the best way to really find out if you are getting high quality sleep is to track it. One sleep tracking device that we use at Performance is the Oura ring. You wear the Oura ring for three to four weeks to establish a baseline for yourself. It tracks how well you sleep, how frequently are you sleeping well and how much sleep are you getting. Once that is complete, you can reassess your approach to sleep.

If you are not getting good quality sleep or enough of it, there are many strategies to help, outlined below. We suggest implementing one or two at a time and seeing what works best for you.

Tips For Improving Sleep Quality:

  • Avoid caffeine late in the day. Caffeine has a half-life of six hours, so if you have a cup of coffee at 12 p.m., at 6 p.m. there is still half of it left in your system, and it is not fully out of your system until midnight.
  • Avoid alcohol, as just one drink can create sleep problems. Yes, alcohol is a sedative and may help you fall asleep, but it will not be a natural sleep, but fragmented with periods of wakefulness throughout the night. Drinking decreases REM sleep and learning capacity and can even affect memory formation days later.
  • Decrease artificial light throughout the day. Our bodies release melatonin in response to darkness, so getting more light later in the day decreases our levels of circulating melatonin.
  • Use blue light glasses for LED bulbs, such as those found in screens such as phones, tablets and TVs. Blue light is a daytime stimulus, so try minimizing exposure two to three hours before going to bed.
  • Keep your bedroom dark. Avoid putting a TV in your room and use blackout curtains or a sleep mask.
  • Keep your bedroom cool. 65 degrees Fahrenheit or lower has proven to be ideal for sleep.
  • Help lower your body temperature: wash your hands or face before bed to stimulate body temperature change. Do not wear socks and try keeping your hands and feet out of the sheets.
  • Make time to wind down. Dial into your parasympathetic nervous system, practice mediation, mindfulness or deep breathing.
  • Maintain a regular sleep schedule, even on weekends.