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Sleep. We all need it.
But according to the National Sleep Foundation, 35% of Americans regularly report they don’t get a good night’s sleep. NSP reported that as many as 60% of people report having trouble sleeping a few nights a week or more.
Unfortunately, it may be more than just an inconvenience. We’ve all experienced sleep deprivation detrimental effect on mental and physical performance. This is a significant contributing factor to motor vehicle and work-related accidents resulting in injuries or death.
Today we want to focus on the effect of poor sleep quality and quantity on chronic diseases. We’ll then talk about a few strategies you can adopt to improve your sleep habits and health.
Metabolic syndrome, diabetes, and obesity
Poor sleep is most commonly linked with hyperphagia- increased appetite. This is partly due to sugar cravings to boost energy. Research has also linked poor sleep with increased production of the hormone leptin – which signals our brain to seek out more food and weight gain and increased risk for diabetes. More recently, poor sleep has been directly linked to impaired sugar balance, insulin resistance and pancreatic β-cell dysfunction leading to Type 2 Diabetes Mellitus (T2DM).
Furthermore, low melatonin production- a key hormone and antioxidant produced during sleep – is associated with poor production of brown adipose tissue, a valuable fat tissue that acts as an energy furnace burning excess fat.
Cardiovascular disease (CVD), hypertension and stroke
Melatonin has also been shown to be a vital influence fluid, nitrogen, and acid-base balance- contributing to hypertension and heart disease. Furthermore, the inflammatory effect of sleep deprivation is another significant contributing factor to the etiology of heart disease and incidence of stroke.
Depression and SAD and other psychiatric conditions
Alterations of sleep cycles, timing between and number of REM cycles is tied to depression. It’s interesting to note, that poor sleep can also contribute to exacerbating anxiety, bipolar, and anxiety in addition to depression. Association between sleep and seasonal affective disorder (SAD) has also been established, showing that increased requirement for sleep may contribute to incidence of SAD during winter months.
Building better sleep habits
The best way to track your sleep is by keeping a sleep journal. The National Sleep Foundation (NSF) has a PDF of a Diary Template you can download for free to use as a guide. Use the journal to jot down notes about your evening habits, bedtime, wake time, and if you get up during the night. Use the journal in the morning too to rate the quality of your sleep and to note how many hours leave you feeling refreshed (especially without an alarm clock).
Fitness devices and smartphone apps that track sleep are growing in popularity and accuracy. These can also be a helpful tool in recording sleep patterns and especially useful when combined with a journaling practice.
Keeping a record of your sleep can be great for identifying habits that might be contributing for less than optimal sleep quality or quantity.
In the meanwhile, below are some easy changes you can make now to improve sleep quality:
• Make sure your bedroom is as dark as possible- invest in blinds or curtains that can block out early morning light. Remove any gadgets that have a lite screen (even if it seems insignificant it may stimulate the brains wake mode), or use sleep mask.
• Avoid blue light from televisions, computer monitors, or cell phones – turn screens off at least one hour before bedtime. Some apps are available to filter out blue light from laptops and smartphones like F.lux.
• Reduce caffeine intake– it can stay in your system up to 6 hours later, so restrict to 6 or more hours before bedtime. Same for nicotine.
• Space your last big meal or drink 2-3 hours before bedtime. Large meals may make it more difficult to fall asleep. Drinking liquids too close to bedtime may cause more bathroom trips that interrupt sleep.
• Avoid exercise in the evening or restrict to stretching, yoga, or after dinner walk. Vigorous exercise can spike cortisol levels, which is a stimulant.
• Maintain a regular sleep time and bedtime routine – Going to bed and waking at the same time every day can help solidify good sleep pattern. Nightly rituals like taking a warm bath, using lavender essential oils, or reading a book before bed can signal the brain that it’s bedtime.
Individual sleep needs
Though the NIH recommends most adults get 7-8 hours of sleep a night, not everyone needs as much. At the same time not everyone can by on less, some need more! This is an area where a journal can be especially helpful in figuring out exactly how many hours of sleep are ideal. Other than physiological differences, other considerations for ideal sleep duration include age, shift work, heavy labor or exercise, recovering from illness or injury, time of year (in fall and winter we tend to crave more), use of certain medications/substances (i.e. caffeine, nicotine, and medications like prednisone, albuterol, stimulant/ADHD medications, estrogen therapy, thyroid medication, and antidepressants).
I tried everything and I still don’t sleep well, now what?
It can’t be emphasized enough that good sleep is critical. If you’ve tried the above suggestions and haven’t had any success, it might be smart to consult with a Functional Medicine practitioner. He/she can look at contributing factors that maybe at play. For example, a good starting point maybe checking your cortisol levels, running organic acid testing or genetic testing to determine if there’s a neurological or neurotransmitter issue that needs to be supported.
It’s also worth noting that certain conditions can contribute to difficulty with sleep. Those include chronic pain or chronic systemic inflammation, restless leg syndrome or muscle cramping, blood sugar fluctuations, tinnitus, anxiety, menopause symptoms, among others. These may be the direct cause of poor sleep or a contributing factor. A qualified Functional Medicine practitioner can help you manage those contributing factors while at the same time improving sleep quality and overall health.
References
Briançon-Marjollet A, W. M.-R. (2015). The impact of sleep disorders on glucose metabolism: endocrine and molecular mechanisms. Diabetol Metab Syndr, doi: 10.1186/s13098-015-0018-3.
Cizza G, R. M. (2011). Chronic sleep deprivation and seasonality: implications for the obesity epidemic. J Endocrinol Invest, 793-800.
DM, A. (2015). Impact of Sleep and Circadian Disruption on Energy Balance and Diabetes: A Summary of Workshop Discussions. Sleep, 1849-60.
GE, P. (2006). Sleep and Vasculr Disorders. Metabolism, S45-9.
Hakim F, W. Y. (2015). Chronic sleep fragmentation during the sleep period induces hypothalamic endoplasmic reticulum stress and PTP1b-mediated leptin resistance in male mice. Sleep, doi: 10.5665/sleep.4320.
NIH. (2012, Feb 22). Retrieved from Natinal Institute of Health: http://www.nhlbi.nih.gov/health/health-topics/topics/sdd/why
NSF. (n.d.). Healthy Sleep Tips. Retrieved from National Sleep Foundation: https://sleepfoundation.org/sleep-tools-tips/healthy-sleep-tips
Thomas KS, M. S. (2011). Sleep depth and fatigue: role of cellular inflammatory activation. Brain Behav Immun, doi: 10.1016/j.bbi.2010.07.245.
Torterolo P, e. a. (2015). Melanin-Concentrating Hormone (MCH): Role in REM Sleep and Depression. Front Neurosci, doi: 10.3389/fnins.2015.00475.
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Great writeup on sleep. I would really like to know the best sleep monitoring platform that we can do at home.
For acute pain or inflammation alternating hot and cold compresses can be helpful. For me that would have been two buckets of water next to the bed, one hot, one with ice cubes. I used a heating pad for a long, long time on the lowest setting but be careful with them. For anxiety, or to quiet your mind find an easy meditative methodology.
Some of us do shift work, 2nd or 3rd shift. If you are on 3rd shift I recommend leaving that shift behind at all costs.
If you are falling behind or run down by the end of the week supplement by napping on the weekend or a short nap after work. Sometimes just closing your eyes for 15 minutes can be helpful, you can do this on your break times at work as well. I sometimes go all out on the weekends and nap for 3-4 hours at a time.
Drinking to much coffee can deplete minerals from your body, inflammatory foods can be contributory to pain and sleep difficulties. Alcohol can hinder or help, depends on the person.
I’m surprised Kara brought up nicotine, the associations with this drug are horrible, some people can’t wait to get out of bed so they can get jacked back up on this, same for any drug, horrible for sleep, although cannabis can be helpful for some, but like any sleep med it will lose it’s efficacy, then you have dependency or with drawl issues, not helpful. Experimentation with herbs like Melatonin, Valerian Chamomille, teas, etc. are a better option, but read up on all the side effects and contraindictions with herbs.
I’m always intrigued by others sleeping habits, I don’t understand how a M-F early riser can sleep until noon on the weekends, I have a tendency to stick to a sleeping pattern, but am thrown off easily, i.e. now that the summer heat is coming on it wakes me up, or .. who knows, this morning I was awakened by a deep itch on the inside of my leg. Light sleepers have to be constantly adjusting things.
One last sleep aid for the HSP or light sleepers, background noise, white, grey, brown, pink, blue, violet noise, pick your color, and they have applications for smartphones, handhelds, computer, etc. I’m currently using a combination of grey and brown.