Assessing sleep with pain: a quick case using Fitbit

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I have always assessed the quality and quantity of sleep patterns with my patients since I started practicing.   It is not until I am the big age of 3-2 now and have a one year old that I realized how important it is to even my various pain troubles! I never received any formal training, but simply asking how many hours do you sleep at night now, how many times do symptoms wake you, how long does it take to go back to sleep or initiate sleep, etc.  The following case displaying the Fitbit sleep log can put some objective measures to our normal subjective questioning.

I just discharged (but of course not fully discharged...) a patient who came to our office under Direct Access for chronic (30+ yrs) thoracic and shoulder pain.  She received great results overall in reducing pain and improving function, but one thing she made sure to bring to my attention was how well she is sleeping now.  She is one of my few patients who wears a Fitbit but showed me these two graphs comparing her sleep prior to initial evaluation and night before discharge date:

Since the above pictures are somewhat challenging to see, the light blue bars show when she is “restless” while asleep.  You can obviously see a big difference in before and after!

Any of you’ll who treat pain, which is majority of us, know that lack of quality sleep affects outcomes and is critical in healing and pain modulation.   Dr. Dean in 2009 says this about how physical therapists should practice in the 21st century,

Thus, a compelling argument can be made that clinical competencies in 21st century physical therapy need to include assessment of smoking and smoking cessation (or at least its initiation), basic nutritional assessment and counseling, recommendations for physical activity and exercise, stress assessment and basic stress reduction recommendations, and sleep assessment and basic sleep hygiene recommendations.

I don’t have a Fitbit myself (and not endorsing it!), nor do I know if the science behind these results is reliable and valid; but I do know it is an easy way to assess sleep patterns. This just shows can PT can improve the major health issue of sleep deprivation in our modern society.

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