Sleep is a part of a circadian rhythm with an approximate occurrence of once in 24 hours. It is timed to the light/dark cycle with sleep occurring in the period of darkness for humans and during the period of lightness in rats and mice. There are two processes controlling the sleep period. Process C which is governed by Clock genes and Process S which is governed by rising levels of adenosine. These processes also influence hormone release and gene expression in cells to promote proteolysis or proteogenesis. The cellular processes in musculoskeletal tissues promote fibroblast, chondrocyte, osteoblast and osteoclast proliferation and differentiation. In addition, cellular processes also control the release of cytokines and the stimulation of the unfolded protein process. Sleep loss has been shown to have adverse effects on these processes. Hypoxia stimulates the release of vascular derived endothelial growth factor which should have beneficial effects on wound healing but can be countered by pro-inflammatory cytokines. Manipulating and improving sleep and hypoxia may lead to stable and well-timed cellular process to encourage healing and improve stem cell survival.