When you think of physical therapy (PT), you might picture exercise, stretches or working through pain after an injury. According to Rudie Spigarelli, PT, DPT, associate director of clinical education and assistant professor, PT programs, at the University of St. Augustine for Health Sciences (USAHS), one of the most powerful tools for healing doesn’t happen in the clinic; it happens while you’re asleep.
Dr. Spigarelli says she could talk about sleep all day long. “Sleep is the foundation of recovery and healing,” she says. “If we ignore sleep, we’re missing an important piece of the puzzle in how our patients get better.”
Connecting sleep and physical therapy
Physical therapists (PTs) play a key role in promoting sleep health, as it is the foundation of recovery and healing.
Dr. Spigarelli’s interest in the link between sleep and physical therapy emerged naturally through her clinical practice, inspiring her to make sleep a key focus of her research.
“I started to notice that a lot of my patients had trouble sleeping, and it was making their physical problems worse,” she explains. “Their pain or injury was also negatively impacting their sleep. I wanted to know how to interrupt that cycle.”
That curiosity eventually shaped her doctoral research. “I focused my dissertation on sleep and the unique variables that influence it, things like gender, mental health or whether or not you have a partner sleeping next to you,” she says. “There are so many factors that affect sleep, and everyone’s experience is different.”
Her passion for the topic grew as she worked with physical therapy students who were also struggling with poor sleep. “Students are an interesting population,” she notes. “They’re under a lot of stress and often think that staying up late to study will help them perform better, but research shows that’s not true.”
Self-efficacy and sleep
One of the main findings from Dr. Spigarelli’s research is something called sleep self-efficacy, or how confident you feel in your ability to get good sleep.
“It points to misconceptions and expectations about what people think sleep should be,” she says.
For example, some people believe they should fall asleep immediately when they lie down, and if they don’t, they feel frustrated or anxious. “It’s normal to take up to 30 minutes to fall asleep,” Dr. Spigarelli explains. “If you think that means something’s wrong, that belief can actually make your sleep worse.”
She adds that self-efficacy builds through experience. “It’s shaped by whether you’ve had successes or failures with sleep and what effort you’re putting into it,” she says. “If you’ve had a few bad nights, it can really change how confident you feel about your ability to sleep well.”
Reframing behaviors and beliefs
To help people reset their relationship with sleep, Dr. Spigarelli draws on principles of Cognitive Behavioral Therapy for Insomnia (CBT-I), an evidence-based approach to improving sleep habits.
CBT-I looks at the relationship between cognition and behaviors. “Cognition includes thoughts and beliefs about sleep, such as wanting to get 8 hours every night,” she says.
One CBT-I technique she often shares is called stimulus control, which means training your brain to associate your bed only with sleeping. Dr. Spigarelli advises against studying or watching TV in bed. Also, if you can’t fall asleep after about 30 minutes, she says to get up, do something relaxing like stretching or meditation, and then come back. “You’re basically resetting your brain to understand that bed equals sleep,” she describes.
These minor adjustments can make a big difference, especially for students. She says that our brains are really good at making associations. For example, if you are using your bed as a study zone, your brain will think it’s time to think, not time to rest.
Setting yourself up for success
When it comes to improving sleep health, Dr. Spigarelli emphasizes strong sleep hygiene and consistency over perfection.
“Focus on waking up at the same time every day,” she says. “That’s more important than trying to force yourself to get eight hours every night.” Being overly focused on a number can create anxiety, which corresponds to the self-efficacy piece.
She also recommends paying attention to light exposure. She says blackout curtains can help block light at night, and a sunrise alarm clock can help your brain recognize it’s morning. “Light is one of the biggest factors in regulating our sleep cycles,” Dr. Spigarelli elaborates.
Other changes, like having a separate space for relaxing that’s not your bed or wearing sunglasses for late-afternoon walks, can help signal to your body when it’s time to rest.
The link between sleep and recovery
The American Academy of Sleep Medicine (AASM) advises adults to aim for at least seven hours of sleep each night to help prevent the harmful health impacts linked to ongoing sleep deprivation.
For physical therapists, understanding sleep isn’t just about wellness; it’s directly tied to how the body heals. “Tissue healing happens when we’re in deep sleep,” Dr. Spigarelli clarifies. “That’s when our immune system is active, and hormones are released to repair cells. If someone isn’t sleeping well, their healing slows down.”
Sleep shifts how we perceive pain, something PTs should consider with patients. “When you’re sleep-deprived, your brain interprets pain signals more strongly,” she says. “Poor sleep can make pain feel worse.”
Physical therapists are also in a unique position to identify issues like sleep apnea, which often goes undiagnosed. “If someone isn’t breathing properly during sleep, they’re not getting enough oxygen or going through normal sleep cycles,” Dr. Spigarelli says. She argues that PTs can help screen for that and refer them for treatment, and that the results can be life-changing.
Sleep and the student connection
Ultimately, Dr. Spigarelli hopes students, whether in PT programs or other disciplines, will think more critically about their own sleep habits. “For my students, I remind them that learning happens while you’re sleeping,” she says. Your brain integrates what you’ve studied during REM cycles. So, if you are sleep-deprived, you may not retain or respond as well.
The takeaway? Sleep isn’t a luxury; it’s a crucial part of physical and mental health. “It’s all about setting your body up for success,” Dr. Spigarelli advocates. “If anyone can learn from this and get better sleep, that’s the goal.
Learn more about Dr. Spigarelli’s work and research.
