This is part one of a four-part blog series on sleep and how to improve it. In the second post, I’ll share sleep tips that I have found most effective, from my work with a variety of patients with sleep problems. The third post will focus on women going through the hormonal shifts of menopause.
Are you sleeping?
“I didn’t sleep last night.” Do you ever say this? If you have insomnia or sleep problems, you might feel like you don’t sleep. In fact, you actually might not drop into a deep phase of sleep. You may stay in a light phase. If you wake up during light sleep it feels like you haven’t slept at all.
Lately I’ve had many patients with sleep difficulties. In my Functional Medicine approach, I talk about the four legs of a chair or stool. The four legs consist of sleep, food, stress management, and movement. If one of these four legs collapses, so does the chair. You can have the “food, stress reduction and movement” legs in place, but if you’re not sleeping properly, you won’t be well or feel well.
So just how much sleep is enough?
According to the American Sleep Association, these are sleep means by ages:
Adults: 7 – 9 hours
Teenagers: 8 – 10 hours (studies have shown teens need exactly 9.25 hours)
6 – 12 years: 9- 12 hours
3 – 5 years: 10 – 13 hours (including naps)
1 – 2 years: 11 – 14 hours (including naps)
Infants 4 -12 months: 12 – 16 hours (including naps)
We’ve all heard people who say “I don’t need that much sleep, I do fine on 5 or 6 hours.” Guess what? They are probably wrong. It’s a very rare that we can thrive on under 6 or 7 hours sleep per night, and many of us do better with 9. You know who you are.
Is it so bad if I don’t get enough sleep?
Well, yes, it is.
It’s likely you feel tired, grumpy, irritable, short tempered, drowsy, and have difficulty focusing and concentrating.
On a more serious side, short sleep duration, which is less than six hours, has been shown to increase risks for depression, diabetes, childhood obesity, high blood pressure, adult weight gain, immune system disruption, and accelerated aging.
What about the timing of sleep?
Timing does seem to matter. Recent research shows that later bedtimes lead to depression, risk-taking behavior, addiction, and day-time sleepiness in adolescents. One study shows that delayed bedtimes have shown to have poor metabolic effects in adult women, increasing insulin resistance and weight.
However, research doesn’t usually distinguish between short sleep duration and the timing of sleep. One exception is the growing amount of research on night shift work, which shows detrimental effects. In fact, there is a condition called “Shift Work Disorder.”
Going to bed early is more of an anecdotal, evolutionary, and common sense beneficial idea. It makes sense that before we could stay up with electric lights and the plethora of entertainment available through screens, we slept when it was dark, and woke when it was light. When we only had candlelight and fires, our circadian rhythms were more in tune with light and dark cycles.
Most people who stay up late are at risk for under-sleeping. Those who stay up late and then “sleep in” often do not feel as rested and energetic as those who go to bed early. There is an old saying that “every hour of sleep before midnight is worth two hours after midnight.” There is no science to support this; however, there is a lot of anecdotal evidence. Many people are tuned into knowing exactly what bedtime gives them the best energy and mental performance the following day. These bedtimes tend to be between 9 and 11 PM.
The yin and yang circadian hormones: cortisol and melatonin
When it’s light, cortisol is secreted. Cortisol is our wake-up hormone (yang, light, warm, activating). In fact, we should secrete 50% of our cortisol in the first 30 minutes of waking. When it’s dark, melatonin is secreted. Melatonin is our go-to-sleep hormone (yin, dark, cool, nourishing, restorative). These hormones oppose each other. When one is high the other is low.
If you take the the Dutch adrenal test, or the complete Dutch hormone test, you can nail exactly what is happening with your cortisol and melatonin, as well as other neuroendocrine chemicals that effect cortisol and melatonin. This includes thyroid hormones, reproductive hormones, and neurotransmitters like serotonin.
Without testing, there are ways you can figure out if your circadian hormones are off-line.
Do you stay up late with a “second wind?” Are you a “night owl?” If so, chances are good that your cortisol is elevated at night, when it ideally should go low.
Do you go to sleep easily but then wake up frequently or even stay awake in the middle of the night? Chances are good that your cortisol is rising during the night. You might be short on melatonin (or it’s precursors, serotonin and tryptophan). Or you may have enough melatonin but your cortisol overrides it.
Get your sleep hygiene in order
Sleep hygiene is kind of a funny term for practices that are conducive to good sleep. If you are not sleeping well, this is the place to start. According to the National Sleep Foundation, you should:
- Limit daytime naps to 30 minutes. Naps do not make up for inadequate nighttime sleep. However, a short nap of 20-30 minutes can help to improve mood, alertness and performance.
- Avoid stimulants such as caffeine and nicotine close to bedtime. When it comes to alcohol, moderation is key. While alcohol is well-known to help you fall asleep faster, too much close to bedtime can disrupt sleep as your body begins to process the alcohol.
- Exercise promotes good quality sleep. As little as 10 minutes of aerobic exercise, such as walking or cycling, can drastically improve nighttime sleep quality. For the best night’s sleep, most people should avoid strenuous workouts close to bedtime. However, the effect of intense nighttime exercise on sleep differs from person to person, so find out what works best for you.
- Steer clear of food that can be disruptive right before sleep. Heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks can trigger indigestion for some people. When this occurs close to bedtime, it can lead to painful heartburn that disrupts sleep.
- Ensure adequate exposure to natural light. This is particularly important for individuals who may not venture outside frequently. Exposure to sunlight during the day, as well as darkness at night, helps to maintain a healthy sleep-wake cycle.
- Establish a regular relaxing bedtime routine. A regular nightly routine helps your body recognize that it is bedtime. This could include a warm shower or bath, reading a book, or light stretches. When possible, try to avoid emotionally upsetting conversations and activities before sleep.
- Make sure that your sleep environment is pleasant. Mattress and pillows should be comfortable. Your bedroom should be cool – between 60 and 67 degrees – for optimal sleep. Bright light from lamps, cell phones and TV screens can make it difficult to fall asleep, so turn those light off or adjust them when possible. Consider using blackout curtains, eye shades, ear plugs, “white noise” machines, humidifiers, fans and other devices that can make your bedroom more relaxing,
Your comments and questions are welcome!