Massage and Sleep

Do you struggle with sleep problems? If so, you’re not alone. According to the CDC, more than 1 in 3 adults don’t get enough sleep. The specific types of sleep problems vary: some people have trouble falling asleep, while others have trouble staying asleep throughout the night. Some people have trouble obtaining the restful, restorative levels of deep sleep and REM sleep that we need to maintain our health and wellness. In any case, regular sleep difficulties and disturbances can lead to chronic sleep deprivation, which can have many detrimental effects on health, mood, cognitive ability, and day-to-day functionality.

There are many approaches that are suggested to remedy sleep problems. One of those approaches is the use of massage therapy, which may drastically improve sleep in some people with sleep disorders. Because massage therapy is minimally invasive and has few, if any, side effects, it can be used on a wide range of populations and is often suggested as a helpful part of many treatment regimens.

In this article, we will do a deep dive into massage therapy, exploring exactly what it is, how it works, how it is used in medicine, and how it may improve sleep. We will also explain how to go about getting a massage, and let you know what to expect.

What is Massage Therapy?

The practice of massage has a long, international history, with records dating back to ancient civilizations in Egypt, Greece, Rome, Mesopotamia, India, China, Japan, and Korea. Different types of massage styles have evolved throughout the world and throughout time, informed by cultural traditions and various understandings of the body.

Today, massage is still a common type of therapy and is used to promote wellbeing and relaxation and to treat the symptoms of various ailments and conditions. It has become increasingly popular in the United States: in 2018, it was estimated that massage therapy was an $18 billion industry and that 47.5 to 63.5 million adult Americans (roughly 19-28% of the population) have had a massage at least once.

Massage therapy can be greatly beneficial. For healthy people, it’s an excellent way to ease tension and promote general wellness. For people suffering from one or several of a large number of ailments or conditions, massage can be a helpful part of a treatment regimen.

However, not all massages are created equal. Rather, there are many techniques of massage, developed to address specific parts of the body in specific ways. When exploring massage, it’s important to note the differences between the techniques, so you can choose the best one for you and your needs.

Types of Massage Therapy

Conditions Treatable with Massage Therapy

In addition to promoting health, wellness, and relaxation in healthy people, massage is utilized as a tool to treat many different ailments and conditions. It can play an important role in treatment regimens, though, as with any treatment, effectiveness varies by person.

  • General Pain Relief: Massage therapy has been extensively shown to help with general pain relief, especially in the neck, back, arms, and legs. It generally compares well with other pain interventions, with the added benefit of having very few, if any, side effects. It is increasingly recommended as a pain management tool with the goal of reducing reliance on opioids in people with chronic pain.
  • Musculoskeletal Injury: Massage offers a long-term, non-invasive, cost-effective form of treatment to people who have had injuries to the muscles, bones, tendons, nerves, and other soft tissues. It has been shown to be effective in helping to treat sprains (torn ligaments) and issues like Carpal Tunnel Syndrome.
  • Hypertension: Research has shown that the use of massage along with anti-hypertensive drugs is more effective than the use of drugs alone. Blood pressure rates consistently drop immediately after massage, remaining below the base rate for up to 72 hours. Studies do indicate that the type of massage is important when it comes to hypertension: the best results come from Swedish massage, while more physically intense techniques like trigger point massage actually temporarily raise blood pressure. Still, the right type of massage can be a helpful part of hypertension treatment.
  • Diabetes: When utilized as a part of diabetes treatment, massage can offer several health benefits. Massage alone, but especially along with exercise, has been shown to improve certain diabetes biomarkers (including a reduction in glycosylated hemoglobin, an indicator of sugar presence in the blood), and to improve circulation in the legs. For diabetic people, specific forms of massage (namely, foot reflexology and Thai massage) may improve tissue health, and help maintain balance.
  • Headaches: When it comes headaches--specifically when it comes to tension-type headaches--massage can be a very helpful tool. Research has shown that massage can significantly reduce pain level and the frequency of headaches. It is so widely effective that it is consistently recommended in clinical guidelines for headache care.
  • Depression, Anxiety, and PTSD: Massage has been used extensively as part of the treatment of mood disorders, specifically depression, anxiety, and PTSD. Both aromatherapy massage and Swedish massage have been shown to decrease depressive symptoms, and massage, in general, has also been effective in lowering reported rates of anxiety in patients with a chronic anxiety disorder. This may be because massage can lower cortisol, a stress hormone, and increase serotonin, a neurotransmitter that is essential for mood moderation. A single 60-minute massage session can lower cortisol by an average of 30%, and raise serotonin levels by an average of 28%. This may boost the body’s ability to cope with sadness, anxiety, and related stress and pain. Massage also provides individuals with anxiety and depression with a safe, nurturing place in which to experience physical human touch and connection. This is especially important when it comes to its benefits for people with PTSD. Studies of people with PTSD who underwent massage as part of their therapeutic process found that they reported reduced rates of pain, tension, anxiety, irritability, and depression.
  • Autoimmune Disorders: When it comes to the challenges faced by people with autoimmune disorders, massage can be useful in various ways. Massage has been shown to improve pain, fatigue, quality of life, sleep quality, and mobility for people with diseases like lupus, scleroderma, rheumatoid arthritis, and multiple sclerosis. Massage is specifically helpful for the treatment of fibromyalgia, especially in alleviating pain-related symptoms on a long term basis, and in moderating circadian rhythm for improved sleep.
  • Painful menstruation, Perimenopause, and Menopause: Massage can be used to ease symptoms caused by menstruation and menopause. Many women experience painful menstruation, also called dysmenorrhea. Studies have found that massage can be used as a non-invasive, non-pharmacological treatment aid to alleviate painful cramping. Three types of specific massage (namely, connective tissue manipulation on the back, foot reflexology, and abdominal aromatherapy massage) have all been studied and found to be effective as a treatment option for painful periods. Moreover, they have been shown to have lasting positive effects through the next menstrual cycle. The symptoms of menopause and perimenopause, including sleep issues, mood swings, hot flashes, and other bodily changes, can also be eased by massage. Research shows that climacteric symptoms (the symptoms associated with increased sensitivity to temperature change, such as hot flashes and night sweats), as well as sleep symptoms, can be reduced in intensity and frequency by massage. Specific massage methods, such as Swedish massage (both with and without aromatherapy), foot reflexology, and Thai massage were found to be particularly helpful for women going through menopause. In fact, one study found that Thai massage may actually increase biomarkers that lead to bone formation in postmenopausal women. Though more research needs to be done on that phenomenon, it is possible that Thai massage may be used in future treatment plans to help improve bone growth and bone density in women after menopause, as bone loss is one of the major health risks faced by that population.
  • Pregnancy, Labor, and Postpartum: As stated above, there is a whole school of massage dedicated to pregnancy, and how massage can be used to ease discomfort and promote health and wellbeing throughout the process. Increased research into massage and the body during pregnancy, birth, and postpartum has revealed that massage can actually significantly improve outcomes at all three stages. Massage therapy performed during pregnancy may reduce stress and anxiety, as well as depressive symptoms. Women who incorporate massage into their prenatal care have significantly reduced levels of stress hormones, and significantly elevated levels of dopamine and serotonin, which leads to mood regulation and better heart and blood pressure health. Massage (specifically, Swedish massage) can also address discomfort associated with the changes to the muscles, skeleton, organs, and circulatory system that occur during pregnancy. It can help reduce swelling in soft tissue and joints, and can also alleviate nerve pain, which is experienced by many women late in pregnancy. In addition, massage can greatly improve sleep in pregnant women, who often experience sleep disturbances. Doulas, nurses, and other birth-facilitators have developed massage techniques for use during labor and delivery, which have also been shown to have positive health effects. Studies and literature reviews have found that massage during delivery can help shorten labor, reduce pain, and improve a woman’s sense of control during childbirth. Importantly, data shows that massage also significantly improves birth and postnatal outcomes. Massage during pregnancy has been found to reduce the risk of low birth weight, prematurity, and postpartum depression.
  • Cancer-related symptoms: People struggling with cancer and cancer treatment face a wide variety of side effects, symptoms, and potential complications. Massage can be useful in treating and easing the intensity of many of these symptoms in some cancer patients. Large-scale studies have found various types of massage to be effective in addressing cancer-related pain, as well as many other symptoms, including nausea, disturbed sleep and fatigue, anxiety, and depression. It was also consistently reported to improve the quality of life in cancer patients. Massage is particularly useful in treating two main cancer-specific side effects. Many cancer patients develop lymphedema, either from cancer itself or from the treatment. Certain types of massage, especially lymphatic drainage massage, is often an important part of the treatment plan to help reduce congestion and swelling, and can also reduce pain and rates of depression in lymphedema patients. Massage therapy can also help reduce the symptoms of peripheral neuropathy, which is a complication of chemotherapy that can cause numbness and pain. In addition, massage therapy can be very beneficial to caregivers of cancer patients. Several studies have shown that even a single massage treatment can help improve blood pressure, heart rate, and sleep quality, and a reduction in self-reported symptoms of pain, fatigue, and anxiety.
  • Elder Care, Alzheimer’s and Dementia: Older people in general benefit from massage. Extensive literature reviews have shown that massage increases the health and well-being of older people, especially older people in residential care facilities. After joint replacement surgeries, which are often needed by older people, massage may be especially effective in reducing pulmonary embolism, a potentially serious complication. In the context of Alzheimer’s and dementia, massage can be especially helpful. Massage therapy can be used alongside other sensory enrichment experiences (such as motor-skill activities, art therapy, and hydrotherapy) to improve engagement, connection, and situational awareness. It can also be useful in reducing agitation and aggressive behavior.
  • Children with chronic illness/childhood conditions: Just as massage can be helpful in treating adults with various conditions and symptoms, it can also be used effectively on children. Though there needs to be more research done on the subject, a number of studies have found that massage can be very useful in treating conditions and complaints such as low-back pain, elbow pain, asthma, reflux, anxiety, eczema, and cystic fibrosis in children. One study found that massage therapy led to lower levels of anxiety and stress hormones and an improved clinical course in both healthy infants and children and infants and children with a large variety of diseases/illnesses/conditions. Massage is especially appealing as a treatment for children because it is minimally invasive and very low-risk.

How Massage Therapy Can Help Sleep

One of the most consistently reported health benefits of massage is improved sleep.

Who Can It Help?

Massage can improve sleep in people of all ages. Studies have found that infants and toddlers showed significant improvements in sleep after massage therapy and that children and adolescents, who are particularly at risk for sleep disturbance and chronic sleep deprivation, also showed marked sleep improvement with the implementation of massage. A number of studies have also shown that massage promotes sleep health in adults of all ages, from young adults to the elderly.

Massage can also improve sleep in both healthy people and in people with underlying conditions. Many health conditions can cause and be exacerbated by a lack of sleep. Massage has been shown to improve sleep, and therefore improve overall health and quality of life, in patients with many of these conditions, including psychiatric disorders, cancer, fibromyalgia, heart disease, cerebral palsy, multiple sclerosis, HIV/AIDS, chronic pain (especially lower back pain), migraine, and a number of other chronic illnesses.

As mentioned above, massage therapy is so versatile and can treat so many different types of people because it is a minimally invasive, cost-effective, extremely low-risk therapy. This doesn’t make it any less effective: in fact, the statistical evidence behind massage as a treatment for poor sleep is all the more impressive for being so widely applicable.

How Does It Work?

Both research and self-reported experiences show that massage can help some people with sleep, often significantly. There are several different factors and theories that go into exactly how massage helps with sleep.

Alters Sleep Hormone Production

The science of sleep is complex, and is still being studied. However, research has found that there are several hormones in the body that are central to maintaining the sleep-wake cycle, or the ability of the body to maintain healthy sleep patterns and achieve deep sleep. One of these hormones is serotonin, which impacts sleep in several ways. For one, serotonin is used by neurons in the area of the brain that moderates sleep (known as the raphe nuclei) to communicate with one another, which may make it essential when it comes to the brain’s ability to signal when it’s time to go to sleep and when it’s time to wake up. Serotonin is also a precursor to the production of melatonin, a chemical that helps regulate the body’s sleep-wake cycles.

Massage can increase the production of serotonin, which in turn may lead to better neural communication in the raphe nuclei, more melatonin production, and a healthier, better moderated sleep-wake cycle.

Releases Tension, Fights Hyper-arousal, and Decreases Stress Hormones

One of the main functions of massage is to release tension stored up in the muscles and soft tissues. This has been shown to decrease levels of cortisol, one of the main stress hormones in the body. Less cortisol can lead to reduced rates of insomnia and sleep disturbance

Additionally, massage stimulates the Vagus Nerve, which is the major nerve in the parasympathetic nervous system (otherwise known as the “rest and digest” system.) Stimulating the Vagus Nerve forces the entire body to relax: it slows heart rate, lowers blood pressure, relaxes muscles, increases gut function, and further decreases cortisol levels, allowing the body to ease into rest.

Tension release, cortisol reduction, and Vagus Nerve stimulation all fight “hyperarousal”, or the feeling of always “being on.” Hyperarousal is closely tied to insomnia and other sleep problems, and often causes something of a vicious cycle: being hyper-aroused makes it difficult to rest, which causes sleep problems; sleep deprivation then further aggravates the hyper-aroused condition. Massage can be used to break that cycle, forcing the body to relax and overriding the hyperarousal drive.

Addresses Common Sleep-Disturbing Conditions

Massage can also help with sleep by alleviating conditions that may impede or disturb sleep. These include chronic pain issues, especially hip pain, back pain, and shoulder pain, all of which are pressure points that may be hit during sleep. Massage can also treat Restless Legs Syndrome, a condition that specifically affects sleep. One study, for instance, found that three weeks of myofascial release, trigger point therapy, deep tissue massage, and sports massage on the hamstring muscles greatly decreased RLS symptoms. It can be incredibly difficult to fall asleep and stay asleep with these symptoms, so massage can improve your odds of getting good, restful sleep by alleviating them.

Massage can be used in conjunction with many other sleep-improving practices, including but not limited to:

  • Getting regular exercise
  • Dietary changes (ie, avoiding large meals, alcohol, and/or caffeine before bed)
  • Improving sleep hygiene (ie, keeping a regular bedtime; having a nightly routine)
  • Creating a comfortable, quiet, and dark sleep environment
  • Limiting screen time in bed.
  • Taking supplements, such as melatonin, ginko biloba, glycine, valerian root, magnesium, L-theanine, or lavender.

Though massage has very few risks, especially compared to medical or surgical interventions, it is recommended to consult with your doctor before taking on a course of massage therapy, especially if you have chronic health conditions that a physically intense massage may exacerbate. In addition, you should check with your doctor to rule out additional, underlying causes for sleep issues, such as sleep apnea, which requires a specific intervention (namely, the use of a C-PAP machine.) However, for most people with sleep problems, massage can be a safe, holistic tool to promote healthy, restful sleep.

Where to Get a Massage Therapy Appointment

As we mentioned previously, massage is quite popular in the United States and is offered in a variety of different venues. Each venue has its own pros and cons, and some may be better suited to your needs than others. Here’s what to expect:

Massage Resources

Now that you know more about massage and the ways it can help facilitate sleep and general wellness, you might want to keep exploring. We’ve put together a list of online resources that you can use to continue your journey.

  • Massage Fact Sheet: An in-depth fact sheet and analysis of massage and its benefits from the Mayo Clinic.
  • American Massage Therapy Association: A verified hub of information, research, publications, and community resources, including a very helpful section on insurance coverage and massage.
  • Massage Magazine: An information source with fascinating articles, resources, FAQs, and general up to date information about massage therapy.
  • Insomnia and Massage: The Integrative Healthcare Organization’s thorough, vetted run-down on the science behind massage and sleep.
  • MassageTherapy.com: Associated Bodywork and Massage Professionals’ central website, where you can find a comprehensive database of massage-based information and resources.
  • Massage and Kids: A run down from The Nursery Collective on the benefits of massage for kids, from infants to pre-teens.

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