Better Sleep for Better Health
Restorative sleep is critical for optimal health and longevity.
Because cellular repair takes place when you are in stage-3 deep sleep, the inability to get adequate restorative sleep accelerates the aging process and can wreak havoc with your physical, mental and emotional health. Your sense of well-being may suffer if you fail to get uninterrupted quality sleep that allows for a minimum of four complete sleep cycles in 24 hours.
If you are one of the millions who suffer from insomnia, you know it can be incredibly frustrating. Lying awake at night trying to force yourself to sleep can be torturous. You may not even realize the toll it is taking on your health until you can regulate your sleep. It is essential that you understand the significance of sleep cycles to optimize your physical and cognitive functioning during your waking hours. The goal of this article is to provide the information you need to establish healthy sleep hygiene habits to improve your health and quality of life.
Because we are all biologically unique, we may have different sleep requirements. The average person requires 7.5 to 8 hours of sleep, but some people function optimally on 6 hours of sleep while others may need 9 hours. While an adequate number of hours is essential, what is even more important is the quality of your sleep.
Parents of a newborn who aren't able to get an uninterrupted night sleep for weeks after the baby is born can attest to the fact that if you do not get a solid 6-9 hours of continuous sleep, it can affect how well you function during waking hours. It can adversely affect your emotional balance, mental acuity, memory, productivity, creativity, and even your weight.
Unhealthy sleep habits can impede your weight loss efforts and can even contribute to weight gain because the two hormones that regulate hunger and satiety are directly affected by the quality of your sleep. Ghrelin is the hormone that stimulates appetite, and leptin is the hormone that sends the message to the brain to tell it that you are full. When you don't get adequate sleep, your ghrelin levels increase, and your leptin levels decrease. Therefore, your brain gets the message that you are hungry and need to eat and, unfortunately, does not understand the message that you are full and need to stop eating. If your weight loss efforts are not paying off, you may want to consider whether or not your sleep habits are sabotaging your efforts.
What defines restorative sleep?
For optimal health, it is imperative that you get the four stages of sleep your body and brain require and repeat this cycle four to six times each night. Each sleep stage serves the function of preparing you for the 16 or so hours of wakefulness to follow. The four stages of sleep include:
Stage 1 - Transition to Sleep: This stage lasts about 5 minutes, during which you can easily awaken. Theta brain waves are dominant during this stage. Your muscle activity slows, and your eyes move slowly under your eyelids.
Stage 2 - Light Sleep: This stage lasts anywhere from 10 – 25 minutes, during which, eye movement stops, heart rate slows, and body temperature decreases.
Stage 3 -Deep Sleep: This stage lasts roughly an hour and is the crucial restorative sleep stage, during which cellular repair occurs while your body is at rest. Your brain waves slow dramatically (Delta waves), and your blood flows away from your brain to your muscles to restore physical energy. If someone were to awaken you during this stage, you would likely feel groggy and disoriented for several minutes.
Stage 4 - REM Sleep: During this stage, your brain is processing information, and you may work through concerns in your dreams. Your brain waves, in this stage, mimic activity during your waking state, which is when beta waves are at work. Your eyes move rapidly, respiration is shallow, heart rate and blood pressure increase and arm and leg muscles become temporarily paralyzed. This is Mother Nature’s way of protecting us from physically acting out our dreams.
A complete 4-stage sleep cycle should take between 90 to 110 minutes. For restorative sleep, the sleep sequences should repeat four to six times through the course of the night. Most of your deep sleep occurs in the first half of the night. Later in the night, more time is spent in REM sleep and alternates with light stage-2 sleep.
You will spend fifty percent of your sleeping hours in restorative stage-3 deep sleep. During this stage, your body is undergoing cellular regeneration, stimulating growth and development, repairing muscles and tissues, and restoring energy to the body so the immune system will function optimally during waking hours. This stage is crucial for our brain function and cognitive operations during waking hours may suffer without sufficient sleep.
REM sleep renews the mind and plays a vital role in learning and memory. Neural connections formed during this stage strengthen memory, and the brain consolidates and processes information from the day. REM sleep enhances creativity and also helps with problem resolution during your waking state. Neurotransmitters are replenished, including serotonin and dopamine, which are the neurotransmitters that allow us to feel calm, happy, energetic, focused, and attentive.
What disrupts sleep patterns?
Medical conditions can contribute to disrupted sleep, such as sleep apnea, GERD (esophageal reflux), diabetes, hyperthyroidism, kidney disease, musculoskeletal disorders, restless leg syndrome, or breathing problems.
Psychological disorders that can cause insomnia include anxiety, bipolar disorder, post-traumatic stress disorder, depression, or chronic stress. Addressing these issues with your mental healthcare professional may help to resolve disordered sleep.
Medications can cause disrupted sleep. Many drugs are stimulating including: pain relievers that contain caffeine, decongestants found in many OTC cold medications, corticosteroids, beta blockers for high blood pressure, some statin drugs, (Zocor), inhalants used for treatment of asthma (Albuterol), antiarrhythmics, used to treat heart rhythm abnormalities, stimulant drugs used to treat ADHD interfere with restorative sleep and REM sleep, SSRI antidepressants decrease REM sleep.
Blood-sugar instability can cause mid-night awakening. When the blood sugar drops too low because your body has been fasting overnight, the result is a spike in cortisol and adrenalin production, which will cause a sudden awakening with no ability to go back to sleep. I recommend investing in a glucometer, so you can check your blood sugar when you wake in the middle of the night to see if your blood glucose is elevated. Many people are unaware that they have blood-sugar issues, and their sleep issues may be resolved by drinking bone broth or eating a high protein snack before retiring for the night. Chicken or turkey is ideal because it stabilizes blood sugar, and because it is rich in the amino acid tryptophan, it helps you sleep. The protein will help to sustain your blood sugar until you can eat breakfast in the morning, and the bonus is that amino acids in protein promote catabolic cellular repair overnight. Avoid foods with a high glycemic load, because the sugar in these foods will increase the likelihood of spikes in blood glucose, cortisol production, and the resulting drop in blood sugar.
Marijuana is a substance often used as a means of inducing sleep. While it tends to be soporific for most people, THC can disrupt the quality and architecture of sleep (a reduction in REM sleep) and will likely cause a rebound effect. The bigger concern is that those who use it regularly will likely develop a tolerance with repeated use, which means it requires increased amounts of the substance to obtain the same effect. This can lead to a severe rebound dependency on THC. The biggest concern with THC is withdrawal dependence. CBD is not a psychoactive substance like THC, so the effects are less deleterious. However, at lower doses, CBD can promote wakefulness but can promote sleep at higher doses (25mg).
Alcohol may relax you and help you drift off to sleep, but it will interfere with normal sleep cycles, causing fragmented sleep. Studies show that alcohol increases slow-wave sleep and suppresses REM sleep initially, but later REM increases and results in less deep, restorative sleep. After the body has metabolized most of the alcohol, sleep becomes disrupted, causing you to wake more easily. Alcohol consumption may also negatively impact blood sugar levels, which as mentioned above, may cause an increase in cortisol. Alcohol even disrupts normal breathing, because it relaxes the muscles in the back of the throat, which can lead to snoring. If your snoring isn't interfering with your sleep, it may be contributing to your partner's inability to sleep.
Dietary insufficiencies can lead to disruptive sleep, especially deficiencies in zinc, vitamin B-6, chromium, vanadium, and manganese. The amino acid, tryptophan, is a precursor for serotonin production, and because serotonin is a necessary precursor for melatonin, it is important to have adequate serotonin levels. This explains why low tryptophan levels contribute to insomnia or simply feeling unrested upon awakening. A zinc deficiency can lead to impaired conversion of B6, which is requisite for tryptophan to work in your system. If you would prefer to get your tryptophan from foods, you can eat nuts, seeds, bananas, honey, eggs, and a combination of carbohydrate and dairy foods. However, you would have to eat an abundance of these foods to get the amount necessary to make a difference in your sleep, and eating too many calories before bed can also disrupt your sleep. You may consider taking a tryptophan supplement before bed. While a dose of tryptophan may help you drift off to sleep, it may not keep you asleep through the night. Taking a 200 mg 5-HTP timed-released formula an hour before bed will increase serotonin levels, which will allow for adequate melatonin production. This will help to reduce your worry and allow you to sleep through the night because it is released over 8 hours. The bonus is that because 5-HTP increases serotonin, it reduces anxiety and elevates mood!
Hormonal issues can interfere with quality sleep. Progesterone insufficiency can interfere with sleep, so women who are peri-menopausal or menopausal may need to increase their progesterone levels through bio-identical hormone supplementation. The most crucial sleep hormone is melatonin, which is produced by the pineal gland and starts to increase when the sun goes down and gradually decreases in the early morning hours when the sun is rising. Light affects the amount of melatonin your body produces, which is why those who don't have trouble sleeping tend to go to bed earlier and arise later in the winter months when the number of hours of daylight decreases. It is crucial to avoid blue light from electronics (TVs, computers, tablets, and smartphones) before bed. When blue, green, or violet light is perceived by the eyes, the suprachiasmatic nuclei in the hypothalamus will turn off the production of melatonin, which can interfere with sleep.
Life stress is one of the leading causes of sleep disruption. Those who have difficulty putting their concerns to rest at the end of the day take those problems to bed with them and may lie awake grappling with them all night. High anxiety causes a state of hyperarousal, which can make it difficult to go to sleep and remain asleep through the night.
Stress-related factors:
Feeling angry, anxious, and worried before you go to sleep can seriously interfere with your ability to go to sleep and stay asleep. Whoever recommended that couples "never go to sleep mad" was spot on! The negative energy left over from an argument will keep you from sleeping if the issue does not get resolved before you go to sleep. The bedroom should be a stress-free zone, so avoid arguments before bed and keep your bedroom a conflict-free zone. Take the discussion to another room in the house if necessary.
Unplug from work, and leave your job at work. If you work from home, set a time to stop working for the evening, as you would if you traveled to your work location. Making a habit of setting time limits around work takes discipline, but it is well worth the effort. Your clients will not expect you to work 24 hours a day unless you lead them to believe you will be at their beck-and-call. Set healthy boundaries, and leave a message on your voicemail that indicates the times you are available to do business.
Avoid reading email or social media before bed. The light from the computer suppresses melatonin production (because it triggers the suprachiasmatic nuclei) and may also stimulate thoughts that can wait until the next day.
If you are preoccupied with thoughts about what you have to do tomorrow, keep a pad of paper by your bed, make a list of these concerns, and put them to rest for the night. If your thoughts continue to revisit them, remind yourself that there is nothing you can do to resolve these issues in the moment and that you can refer to your list and deal with them tomorrow.
Therapeutic journaling before bed can be a helpful way to unload concerns that are weighing on you cognitively and emotionally.
Another good way to reduce anxiety and get closure to problems at the end of the day is to pray or meditate. Surrender the problem to your higher power or the universe, and pray for a peaceful, restorative sleep. Give thanks for the blessings in your life, and pray for those who are less fortunate. It helps put things in perspective when you consider how truly blessed you are despite the problem underlying your anxiety. Moreover, expressing gratitude for all that is right in your life is very healing.
Unhealthy gut bacteria can be responsible for mid-night wakening. If you have a disturbance in your microbiome, you may have unwanted "gut bugs" living in your gastrointestinal system. These bacteria produce waste-products that can be toxic to the human body. These microorganisms tend to be more active at night when you are sleeping, and this activity can cause the immune system to react, stimulating the production of cortisol, which can cause you to awaken in the night.
Stimulation too close to bedtime can interfere with your ability to wind down and fall asleep. Stimulants such as caffeine, decongestants that contain pseudoephedrine, or herbal supplements such as ginseng, gotu kola, guarana, ashwagandha, ginger, gingko biloba, and astragalus root can interfere with sleep. Chocolate contains caffeine, so you may want to indulge in your chocolate craving early in the day instead of late at night. Avoid caffeine consumption for 8 hours before bedtime. Nicotine is stimulant, so avoid it at least 30 minutes before going to bed. Avoid active exercise for 2 hours before bedtime, because the body will be too stimulated to wind down. Blue light is also stimulating, so avoid bright light from blue light bulbs, televisions, and computers for an hour before bedtime, as well as back-lit devices such as smartphones, ipads, or kindles.
Electromagnetic fields (EMFs) can interfere with sleep, and your house is full of them! Experts recommend turning your WiFi off before bed, turning off electronics, and advise against sleeping with a computer, cell phone or tablets in your bedroom. Lamps on bedside tables are still emitting EMFs, even if they are in the off position, so unplug them.
Age-associated changes can affect sleep quality. Natural melatonin production declines as we age due to calcification of the pineal gland, which explains why so many of us begin experiencing insomnia in our 50s or 60s. Melatonin supplementation can be beneficial in regulating the circadian rhythm for some but not for everyone. The proper dosage of melatonin is critical. Sleep experts recommend no more than 1.5 mg of melatonin because taking more can have a paradoxical effect. If you are going to use melatonin to help regulate your circadian rhythm, I suggest using a 3 mg Dual-Release Melatonin formula, which you can purchase online. This 3 mg dose is released in 1.5 mg twice through the night, so it helps you to go to sleep and stay asleep throughout the night. Melatonin has also been proven to be an effective intervention for those suffering from a seasonal affective disorder (SAD), otherwise known as "winter blues."
Natural Sleep Aides
While melatonin is not going to work for everyone, I've had clients who've reported resolution of their insomnia after taking melatonin for a week or two because it helped to normalize their circadian rhythm. Others reported feeling less anxious and more relaxed during the day after taking melatonin in the evenings to help them sleep. Their spouses also noticed a significant improvement in their disposition while they were taking melatonin, possibly because they were finally getting the rest their body needed, which resulted in improved mood.
GABA (Gamma-Aminobutyric acid) is an inhibitory neurotransmitter produced in your brain, which has been shown to diminish with age in some people, a deficiency of GABA may be responsible for neurodegenerative disorders such as dementia. The role GABA plays in the brain and central nervous system is to reduce neuronal activity, the result of which is reduced stress, mood stabilization, alleviation of pain, and improved sleep. Many of the psychotropic pharmaceuticals target GABA receptors, such as barbiturates, benzodiazepines, antidepressants, and anticonvulsants. GABA supplements are available over-the-counter and can be found online at websites that carry nutritional supplements.
There are herbal supplements you may wish to try if melatonin is sufficient to help you sleep. Apigenin is the active compound in chamomile, which acts as a natural muscle relaxant and is the key ingredient in "sleepy time" teas. Kava Kava and Valerian Root may markedly diminish your anxiety, which helps to alleviate anxious thoughts that may keep you awake. Combination supplements that contain both Valerian Root and Kava Kava are very effective at inducing sleep, though I would recommend against using them long-term. I strongly advise against using these supplements in combination with alcohol, as they are potent herbs that can intensify the effects of the alcohol. ***Always check with your doctor or pharmacist before taking herbal supplements to ensure that they will not adversely interact with medications you take.
What You Should Know About Conventional Medicine Sleep Disorder Interventions
I believe the use of sedative-hypnotic medications, such as Ambien, should be avoided, not only because they create dependency and are ineffective in the long term but because these can cause liver toxicity, especially when used for extended periods. The sedative-hypnotics were initially designed to be taken for no more than seven days to help regulate the circadian rhythm, but pharmaceutical companies have found them to be so lucrative, they are recommending physicians prescribe them for long-term usage, which is detrimental to patient health in the long run. A better way is to address the issue is to examine what underlying issues may be contributing to the sleep disorder. Exploring and correcting the cause of the sleep disruption makes more sense than adding a sleep medication that may cause side effects and risk to bodily organs.
I’ve seen many clients whose physicians kept them on pharmaceutical sedative-hypnotic sleep medications consistently for years. People who use these drugs on a nightly basis will develop a dependency on these medications and will be un able to sleep a wink if they fail to take their sleep medications for one night. The reason for this is that they experience a withdrawal syndrome upon cessation of the medication on which their body has become dependent (symptoms of withdrawal from medication will be the opposite of the results the drug induces). What makes it worse is that they develop a tolerance for the drug, at which point the medication that worked to help them sleep is now ineffective. The physician will increase the dosage until they've reached the maximum dosage, which will eventually become ineffective when they develop a tolerance that dosage. When their body becomes tolerant of that medication, the physician will try them on different sedative-hypnotic medicines, and the same process of drug tolerance will develop until they've done a trial of every sleep medication in the pharmaceutical arsenal. After they've exhausted every option in that drug class, they end up suffering from withdrawals and don't sleep at all for two or three days. They are then forced to live without sleep medication and manage to develop coping mechanisms to be able to sleep without the assistance of drugs. It is too bad they had to go through years of medication dependency to do something they could have done when the problem started. Rather than try natural interventions to resolve issues, we have become too dependent on a "magic pill" to solve all our problems despite the harmful side-effects of the medication.
Here is the good news! If you have developed a dependency on sleep medications, take heart in knowing that you can overcome sedative-hypnotic dependence. Those who can get through the withdrawal, after several sleepless nights, can learn to sleep on their own without medication. Keep in mind that withdrawal from a drug is going to produce symptoms that are opposite of the effect of the medication. If sleep medication makes you sleepy, going off of it is going to keep you wide-awake until your body can detox from the drug. Tell your health care professional that you want to get off the sedative-hypnotic medication so that they can guide you through a safe withdrawal. Don't let them talk you into trying a different sleep medication, because you are merely postponing the inevitable withdrawal if you switch medications. Remember that you may have to go several nights without sleep to learn how to sleep without the assistance of drugs. It is not a pleasant experience, but if you want to win the battle over-dependence, your body must learn to function without the aid of medication. There are healthier ways to manage sleep disturbances. If you need assistance working through this dependency, I am happy to help. Feel free to contact me for a free 30 minute consultation.
In good health,
Valerie Folsom-Martin, MSW, LCSW, CIMHP, CCTP, FDN-P, CHHC
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