The topic we are covering today is going to be a total snoozefest… but I will try to keep it interesting! Today we are talking about sleep. According to the CDC, 1 in 3 American adults do not get enough sleep. Over the years, sleep has become optional rather than critical to our overall health and well-being. The truth of the matter is that the consequences from lack of sleep are grave to both our physical and mental health. Sleep deprivation is linked to chronic diseases and conditions, such as type II diabetes, cardiovascular disease, dementia, and depression. In order to understand why sleep is so important, we need to start at the basics and explore what happens when we sleep.
What are the stages of sleep?
Sleep can be separated into two phases: rapid eye movement (REM) and non-rapid eye movement (non-REM) sleep. Non-REM sleep can be further broken down into 3 stages. We typically cycle through the following stages about 4-5 times a night!
- 1Non-REM Stage 1: This is the transition between being awake and asleep. It lasts about 1-5 minutes and is characterized by slowing of the heart rate, breathing, and eye movements. Your muscles also begin to relax with occasional twitches.
- 2Non-REM Stage 2: During this stage, your body slows down even further and your temperature drops. This stage lasts about 25 minutes.
- 3Non-REM Stage 3: This is considered deep sleep and lasts up to 15 minutes. This stage is important because it is when your body repairs itself, your immune system strengthens, and your body builds tissue, bone, and muscle.
- 4REM: This stage typically starts about 90 minutes after you fall asleep and it is the stage where you dream, make new memories, and process emotions.
Which hormones help regulate sleep and wakefulness?
Two hormones that play an important role in sleep are cortisol and melatonin. Cortisol, which is produced by the adrenal glands, is known as the stress hormone and melatonin, which is produced by the pineal gland, is known as the sleep hormone. These two hormones have an inverse relationship. We expect cortisol to be at its highest at around 6 am while melatonin should be low. The purpose of this is to help us wake up in the morning. Throughout the day, cortisol should decrease while melatonin increases so that when nighttime arrives, we feel sleepy.
Insufficient sleep raises our cortisol level, which signals to our brain that it is still daytime and reduces the production of melatonin. High cortisol levels also impair our body’s ability to stabilize blood sugar. This is because cortisol triggers the release of glucose (sugar) from our liver. When glucose enters our blood stream, our pancreas releases insulin, which is a hormone that helps glucose enter our cells to be used for energy. Chronically elevated cortisol levels can lead to more sugar in the bloodstream. The longer our blood sugar levels remain elevated, the more insulin our pancreas produces. Over time, our cells become resistant to insulin and our pancreas cannot keep up with the demand for insulin. This dysfunction is known as insulin resistance and it can lead to an array of problems, such as diabetes, increased abdominal fat, hunger cravings, and more.
Why am I waking up in the middle of the night?
If you are finding yourself waking up in the middle of the night, it could have to do with what you are eating. If you have unstable blood sugars throughout the day or eat a high carb meal or dessert prior to going to bed, your body will try to stabilize your blood sugars at night.
At around 2-3 am, your blood sugar starts to dip. Your body knows it is dangerous for your blood sugar to drop too low while you are asleep because it can lead to a coma. Therefore, it starts producing more cortisol not only to raise your blood sugar levels but also to wake you up. Many people think they wake up in the middle of the night because they need to use the restroom. However, it could be that you woke up as a result of your body trying to stabilize your blood sugars and now that you are awake, you realize you could use the restroom.
What are the causes of poor sleep?
There are many different causes for insufficient sleep at night. Here is a list of a few factors that can lead to poor sleep:
- 1Blood sugar instability: As mentioned above, when your blood sugar levels are unstable throughout the day, it causes your body to try to stabilize your blood sugars at night, which can lead to wake ups in the middle of the night.
- 2Elevated cortisol levels: Remember, cortisol is your stress hormone and it is high in the morning to cause you to wake up from sleep. If your cortisol levels are consistently elevated, whether it be due to exogenous stressors (such as your job, finances, or family affairs) or internal stressors (such as inflammation from food sensitivities or unstable blood sugars), it can lead to you having a hard time falling asleep and/or staying asleep.
- 3Magnesium deficiency: Magnesium is a mineral that helps with relaxation, muscle recovery, muscle cramps, headaches, mood, and bowel consistency. If your body lacks this important mineral, it can make sleep at night difficult.
- 4L-theanine deficiency: L-theanine is a natural amino acid that helps regulate stress and anxiety. Our body does not make l-theanine so we have to obtain it through foods, drinks, or supplements. When our bodies do not have enough l-theanine, cortisol levels can spike, which as we discussed previously, impacts our ability to sleep.
- 5Medications: Stimulants as well as some reflux medications can deplete vitamins and minerals that are essential for good sleep.
- 6Obstructive sleep apnea: This is a disorder in which your airway becomes obstructed at night, causing you to wake up. This can be diagnosed through a sleep study. Treatment involves a continuous positive airway pressure (CPAP) machine.
- 7Restless leg syndrome: This is a disorder characterized by the uncomfortable urge to move your legs particularly after long periods of inactivity, such as when you are laying in bed. This is often associated with low ferritin, or iron storage, levels.
- 8Poor sleep hygiene: Your sleep habits could be impacting your sleep at night. I will discuss a few tips below on how to improve sleep hygiene.
Should I use sleeping pills to help me sleep?
Sometimes medical providers will prescribe sleep aids such as Lunesta, Ambien, or Unisom for trouble falling and/or staying asleep. However, some studies have shown that long term use of these medications can increase your risk for Alzheimer’s, dementia, and memory loss.
Now you may be wondering if taking a melatonin supplement is a better alternative. Although melatonin is a more natural option, it should only be taken short term and should not exceed more than 5 mg. Taking too much melatonin can lead to serious side effects such as changes in heart rate and blood pressure, drug interactions, respiratory distress in those with obstructive sleep apnea, and impaired glucose regulation to name a few.
What can I do to improve sleep?
Here are a five tips you can implement today to help you get better sleep at night:
- 1Keep your bedroom dark: Even the smallest amount of light can impact sleep. A dark room will stimulate production of melatonin, which as we mentioned above promotes sleep. A good pair of blackout curtains can help keep your room dark!
- 2Avoid screens in bed: This means no TV, tablets, electronic reading devices, or cell phones before bed. The blue light emitted from these screens will signal to your brain that it is not time to sleep yet and may make it difficult for you to fall asleep.
- 3Spend time out in the sun: Sun exposure during the day can help regulate your circadian rhythm, which is the process that controls your sleep-wake cycle. Aim to spend at least 20 minutes a day in direct sunlight for better sleep at night.
- 4Get your body moving: Exercise during the day helps with stress reduction and promotes better sleep at night. However, avoid vigorous exercise at least 2 hours before bedtime as this can lead to an increase in cortisol levels.
- 5Avoid caffeine and alcohol before bedtime: Caffeine is a stimulant, so it keeps you awake and alert. It can take up to 10 hours for caffeine to be completely out of your system so it is best to avoid caffeine after lunchtime to make sure your body has cleared most of it. Alcohol, on the other hand, can initially cause you to feel sleepy, but as your body metabolizes it and clears it from your system, it can lead to interrupted sleep.
So, how much sleep do I actually need?
The answer to this question can vary. However, the average adult needs 7-9 hours of sleep at night. And not just any sleep, but uninterrupted sleep where you are making it into the deep stages of sleep.
At Berman Health and Wellness, we help clients identify the root cause for their sleep problems on a daily basis. If you have any questions or concerns regarding troubled sleep, please reach out to us. Let us help you regain control of your sleep again!
An Increased Risk of Reversible Dementia May Occur After Zolpidem Derivative Use in the Elderly Population - PMC (nih.gov)
Sleep hygiene guidelines - UpToDate