(If you missed last week's post, Sleep Comes First, check here to read some of the reasons that getting enough sleep should be your #1 health concern!)
As I mentioned in Sleep Comes First, wise sleep solutions are the first step to solving any health problem related to inflammation or hormonal imbalance, and the first step is a good assessment. Are you sleeping 8-9 hours nightly, including at least 4-5 hours in deep sleep, some remembered dreams, and do you wake feeling refreshed from your sleep? If you answered yes to all those questions, congratulations! You are sleeping great and you can move on to some other article of interest to you.
If not, read on! Sleep duration is very important, and I recommend you get 8-9 hours on a regular basis. One popular and wise sleep therapist points out that it is only our abilities “in the performance of monotonous or sedentary tasks like driving, or the ability to produce creative solutions to problems, that seem to deteriorate after one sleepless night.” (Say Good Night to Insomnia, by Gregg Jacobs, Ph.D., can be helpful, but I believe he is overly reassuring about sleep loss in his effort to relieve sleep anxiety.) Estimates are that 100,000 motor vehicle accidents can be attributed to sleep loss every year in the United States. 31% of the drivers on the road are sleep deprived and liable to “micro-sleep”, those involuntary jerks of the head that occur when sleep summons your entire being. (For an excellent TED talk on many of these matters, see Russell Foster here.)
If you are not sleeping adequately, what can you do about it? “A lot!” is the answer, so let’s run through the possibilities. I have chosen to go into some detail rather than a quick summary, so make yourself comfortable, you have a lot to consider. (The suggestions are a combination of my own clinical experience and the very helpful recommendations of Dr. Kirk Parsley, who was mentioned in the first article in this series.)
Lifestyle modifications come first, otherwise known as sleep hygiene. Set yourself up for a good night’s sleep and optimize your body’s production and use of melatonin, the sleep inducing hormone. Don’t pick one or two of these, do them all.
- Schedule your sleep wisely. Keep the same rising time every day of the week, vary it by no more than 30 minutes. (If you pick 6:30 a.m., you can get up early at 6 one day, and “sleep in” until 7 on another.) It is also ideal to keep the same bedtime, with the same minimal variation. However, even if life keeps you up quite late one night, you must still get yourself up the next morning at the chosen time. Start by picking a reasonable duration of sleep (which may be less than ideal, maybe 6-7 hours), and as your sleep improves, increase the duration so you are sleeping 7-9 hours.
- Bedrooms must be dark: blackout curtains if necessary. Light sneaking in from outside lowers your melatonin levels (and raises your risk of breast cancer) at worst, and at the least provides just sufficient stimulus to wake you out of the lighter phases of sleep.
- Bedrooms should also be quiet and serene: if you fall asleep to music (not recommended but many do), the music must turn itself off after 30-40 minutes. Even the presence of a TV in bedrooms seems to shorten sleep time, so I recommend NO electronics in the bedroom at all. Sensitive people report improvement when they cut the electric breaker to their bedroom and/or turn off wireless internet signals at bedtime. At the very least, no active cell phones in the bedroom!
- Screens (iPads and other tablets, computers, and TV’s) all emit a blue light that specifically blocks the brain’s production of melatonin. Avoid them for at least 3 hours before bed. Tolerance of non-backlit readers (e.g., Kindle) is variable, so choose a book printed on paper until your sleep problem is solved. Try a Kindle at some point to see how it affects your sleep. If you must do screen work close to bed, wear some blue-blocking orange lens sunglasses, available online. They may look strange but they work well.
- Cooler temperatures are more conducive to sleep, so keep your bedroom cool and avoid vigorous exercise or a hot bath in the hour right before bed.
Hormone balancing is key. In addition to melatonin, several other key hormones can affect how you sleep. For this list, read through and consider which – any or all – hormone suggestions apply to you.
- Insulin regulates our blood sugar levels, and excess insulin can drive blood sugar levels down at night, causing restlessness and even hunger. Your blood sugar is likely to go out of balance if you carry excess weight around your middle, have strong sugar cravings, have a history of dieting and yo-yo weight loss, or if you get frequent infections, particularly yeast infections. Helpful nutrient-dense, low carbohydrates foods might be beneficial, such as the Weight Loss Eating Plan here. Healthy blood sugar balancing foods include meat and organ meat from grass-fed animals, shellfish and fish, vegetables, healthy fats (butter, avocado, coconut oil, animal fats, and fish or fermented cod liver oil), and a limited amount of fruits, with no grains or added sugars. A particularly useful food – almost a medicinal one! – might be bone broth which is high in glycine, an amino acid known to help induce and maintain the restorative stage of sleep known as deep sleep.
- Our adrenal glands make two stress related hormones, cortisol and adrenaline. Cortisol levels rise in any setting of perceived danger, which these days might include a near-miss at a stop sign, excessive and prolonged exercise, or a busy life balancing many duties at work and at home. Cortisol should rise in our blood stream dawn to noon and subside from noon til the following dawn. If you wake before dawn, “wide awake!”, on a regular basis, you might have early and inappropriate cortisol surges or spikes. Our whole system works best if our cortisol spikes are infrequent and transient, not when they are repeated and sustained. We all know that stress, like love, “is in the eye of the beholder”: a missed flight means two different things if your forced non-travel day is added to a vacation or subtracted from a vacation! You can serve yourself well by cultivating a relaxed response to stress, through gentle exercise, meditation, or finding ways to laugh and relax in the midst of a busy life. An overly arduous work or exercise schedule adds to stress and should be avoided where possible.
- Thyroid and sex hormones (estrogen and testosterone in both sexes, in different ratios) should be at an optimal level, perhaps requiring physician recommendations.
A few consistent rules apply for any sleep problem.
- No caffeine after 1 p.m.
- Reduce alcohol to 1 small drink before dinner or eliminate. Gentle exercise daily: walk, yoga, swim, dance. No vigorous exercise 2-3 hours before bed, and consider no vigorous exercise at all for three months if you suspect adrenal/cortisol problems.
- Sunlight levels influence melatonin production. Get outside in the morning to enhance falling asleep at bedtime; spend sometime outdoors in the pre-sunset hours to help maintain sleep through the night.
Supplements can really help. Start with the top of the list and add the rest of the list if needed to sweeten your sleep time.
- Normalize vitamin D levels with vitamin D3 supplements taken in the morning. Aim for a level of 40-65 ng/mL for most people, higher if your doctor recommends.
- Most people are deficient in magnesium: eat plenty of leafy greens, nuts, and take supplemental magnesium in the evening, if you have any magnesium deficiency symptoms (headaches, anxiety, high blood pressure or heart palpitations).
- If your sleep problem is recent, you can probably lull yourself to sleep with any of the great herbal combinations on the market (Gaia Herbs Sleep Thru is a particularly nice one) or just plain Valerian, in either tincture or capsule form.
- If anxiety interrupts your falling or staying asleep, theanine can be useful. Now Foods L-Theanine or Source Naturals Theanine Serene are both useful products.
- Melatonin 0.3 mg taken 1-2 hours before bed can be a good short-term fix, particularly if you’ve undergone a time zone change recently.
- If your sleep problem is edging towards chronic, take the following combo in the early evening after dinner: L-Tryptophan 500-1000 mg., 5-Hydroxytryptophan 50-100 mg, vitamin B6 50 mg. and Sustained Release Melatonin 0.3 mg. As a combination, it is available through my office as Sleep EN (for Essential Nutrient, because sleep is the most essential nutrient!) When taking tryptophan, eat a small serving of fruit or half a teaspoon of honey sometime between taking the tryptophan and going to bed.
- If early morning wakening gives you reason to believe your adrenal gland needs extra balancing, Integrative Therapeutics Phosphatidyl Serine taken three times a day can help you sleep through the night. Adrenal adaptogenic herbs (Gaia Herbs Adrenal Health) is a nice companion nourishment.
- If you have an elevated homocysteine, or have been told you have an MTHFR abnormality or a methylation defect, following the recommended guidelines (avoiding aggravating foods and taking methylated B vitamins) will be helpful.
Relaxation practices can be helpful in a variety of ways. There are so many scientific validations of the practice of meditation, it should be taught in school! If you’re not a meditator, simply slowing and paying attention to your breath for 20 breaths can be calming. Tai Chi and Yoga are excellent practices that combine some physical strength and agility with focusing and calming of the mind.
If you have read all the way to the end, congratulations! (Did it help you drift off for a nap?) I would be curious to hear how these suggestions help you with your sleep, so let me know: info@DrDeborahMD.com. Sweet dreams to you all!