Dr. Adams replies: “Is this patient sleeping sufficiently? This can be critically important. Adults need 7-9 hours per day. Sleep debt is the effect of not getting enough sleep; a large debt causes mental, emotional and physical fatigue.
Sleep debt results in diminished abilities to perform high-level cognitive functions. Cognitive functions include scheduling an appointment, prioritizing times and distances, being able to re-route due to weather and traffic and budgeting time for consecutive daily responsibilities.
Patients in pain will state “I don’t sleep at all” which, while untrue, is a testimony as to how deprived they feel.” Patients, prior to injury, have had a specific schedule: when they arise, when they depart, when they arrive, and when the work day is over. Now, post injury, those “appointment times” are no longer applicable or meaningful. So we attempt to force a structure on a life that has now become unstructured, and we wonder why the patient is so resistant.
Pain patients have altered sleep as do depressed individuals, anxious individuals and those who have experienced trauma.
Humans may suffer from a number of sleep disorders. These include dyssomnias (such as insomnia, hypersomnia, and sleep apnea), parasomnias (such as sleepwalking and REM behavior disorder), and the circadian rhythm sleep disorders.
When we find a patient who seems to be noncompliant, we need to question as to whether they are getting effective rest, how they are handling their disorder and whether they feel that sleep is, for them, an obstacle in their own recovery.”