Got Sleep??

MARCH 9, 2015 by DR. HEATHER MODAY, MD

“The bed is a bundle of paradoxes: we go to it with reluctance, yet we quit it with regret; we make up our minds every night to leave it early, but we make up our bodies every morning to keep it late.”

• Charles Caleb Colton

Ah sleep…. It’s that thing we all say we love, but none of us get enough of. Even when we want to sleep many of us can’t. I myself have gone through issues with sleep. First in my late 20’s, I learned how to defy sleep. As a resident staying up all night and trying to function during the day: I truly feel I lost my barometer for sleepiness. I got so used to pushing myself past fatigue that sometimes I couldn’t really tell when I was sleepy anymore. Then in my early 30’s I suffered with insomnia- racing mind at night- new job, pay those loans, save for a house. Maybe it was the cats in the bedroom? I will admit to even recently, being on vacation with friends, and half of us were up in the wee dawn hours –unable to sleep. Most of us in our 40’s – was it hormonal?

The reality is that most Americans are sleep deprived. The CDC calls it an epidemic!  Statistics show that between 50-70 million Americans have some sort of sleep disturbance issue and it affects both genders equally. And while most people put sleep on the backburner of their healthy habits list while they make green smoothies and run to the gym, the reality is our sleep habits need just as much attention if not more. We have this impression that we can outsmart sleep, by popping a Benadryl at night and hitting up a Venti Starbucks on the way to work. Unfortunately, people who have poor sleep are more likely to suffer from chronic diseases such as hypertension, diabetes, depression, and obesity, as well as from cancer, increased mortality, and an increase in accidents. Certainly this is not a list to aspire to.

We all know or at least remember what it feels like to  wake up from a blissfully perfect sleep. You literally do feel like the world is a brighter, happier place. You have more energy, your thoughts are clearer, and your mood is lighter.

So how do we get there?

We have all heard the ubiquitous “sleep hygiene” practices. God knows I have spewed them out to hundreds of patients in the past. And yes, they definetly help and we should be following them, but what if they don’t? Often times its because we do them selectively or only when its convenient for us. We are all individuals, and what works for one person does not always make a difference for another. Some of us have no problem falling asleep at all but we wake up a few hours later unable to get back there.

I believe it’s also how we perceive sleep. Integrative sleep specialist Rubin Naiman said in a lecture I attended  that “sleep is the letting go of wakefulness”. Too often people try to direct or control sleep instead of creating an environment for it to happen.

Now granted, I am not talking about sleep disturbances such as narcolepsy, sleep apnea, or restless leg syndrome- although these can also be helped through lifestyle changes, and if these are suspected a overnight sleep study and consultation with a sleep specialist is advised.

Now, a caveat here, good sleep is going to take some effort on your part. You have to be willing to make some behavior changes in your life, and give it some time or else you will continue down the tired and wired zombie road.

So let’s dissect some of the tenets of “sleep hygiene” and see if we can hack it:

Establish a bedtime ritual. Now most people think- I don’t have time for this. If you are like most busy people you are cooking, cleaning, doing the kids homework, paying bills etc right up to bedtime. Then you run off to bed and expect to fall right to sleep immediately. Wrong. OK. So you don’t have to spend an hour preparing yourself for sleep- Take 15 minutes and do it consistently like brushing your teeth.

Do a deep breathing excercise like the 4-7-8 breath. It takes just a few minutes and deeply relaxes you.

Try a progressive muscle relaxation exercise like this.

Do a 5-10 minute guided meditation for sleep. There are numerous ones on Youtube or here.

Keep a book at your bedside and read for 10 minutes –nothing too riveting or disturbing.

Write for a few minutes in a journal. This can also help by discharging some of your stress and worries from the day.

Cut out bedroom noise. Yes this includes the TV. Try recording your favorite shows to watch the next day and watching them in the living room. Do you really think you are going fall asleep after watching American Horror Story at 9 pm. Save the disturbing 11 o’clock news for the morning. It can wait. If your partner snores or your neighbor loves heavy metal, wear ear plugs, and use a white noise machine.

Dim the lights. A few hours before bed keep the lights low in the house. Your melatonin is trying to kick in telling your brain to go to sleep and even small amounts of light can suppress melatonin. Especially short wavelength blue light from computers, phones etc. If you must work close to bedtime -install apps like f.lux on your computer which dims the blue light or wear glasses like this in the evening while working. And again, don’t work in bed. Make sure your bedroom is completely dark – no nightlights or glowing lights from alarm clocks or phones.

Cut out the stimulants– But I love coffee! Ok, you may not think that caffeine is disturbing your sleep but some people are very slow metabolizers of caffeine and even if you fall asleep easily it could be what’s waking you up in the middle of the night. First try cutting down to one cup in the am, and avoiding chocolate and tea as well. If you are still having issues- take it out for one week and see how you sleep. You may be really surprised. If you love the taste of coffee you can try an alternative such as these. Also, try not to exercise too close to bedtime. Although exercise is crucial for good sleep, save the Insanity workouts for the morning or right after work. It can be too stimulating.

Lower your temperature– Your body temperature dips a few hours before you drift off to sleep. Taking a warm shower or bath before sleep induces a quick cool down period which can help you relax. Adding Epsom salts that contain magnesium also helps our muscles relax. Keep your bedroom temperature on the cool side as well.

Natural sleep aides. Sometimes you may still be having some difficulty falling asleep. Skip the Benadryl and Ambien which actually disrupt your sleep cycles and merely give you amnesia that you slept badly.

Herbal teas are great at bedtime and can be part of your bedtime routine. Look for Hops, Valerian, Lemon balm and Chamomile. You can also get these in a tincture and add to warm water.

Use a diffuser with lavender or use some lavender essential oils which has been shown to be very relaxing.

Try L-tryptophan. This is the precursor to serotonin and melatonin. Found in many foods in small amounts, to really get the effect you need, supplementing with 500-1000 mg at night for a few weeks will help.

Melatonin- This is best when your circadian rhythm is off such as when travelling or doing shift work. It doesn’t make you sleepy but it tells your body that it’s time to go to bed. Start with 3 mg 1-2 hours before bed. If you have issues with waking up in the middle of the night, take a time released sublingual version.

Love your magnesium- An essential nutrient that helps us produce GABA- a neurotransmitter with a calming effect on the brain. It also helps tight, cramping muscles. Most people are magnesium deficient and 400 mg of Magnesium Glycinate or Citrate at night helps tremendously.

Check your hormones – Women in particular during perimenopause and menopause may have difficulty sleeping because of hot flashes, and nightsweats etc. Black Cohosh and Chaste tree berry are helpful for these symptoms. Discussing bio-identical hormone therapy with a practitioner may be helpful as well if symptoms are not relieved. In addition, for women and men equally, an abnormal cortisol rhythm due to high levels of stress, may keep us wired at night and tired in the daytime. High levels at night also interfere with our melatonin production, further hindering sleep. You can identify your adrenal function through a simple saliva test.

If you remember that adequate and restful sleep is crucial to quality of life and is just as important as nutrition and exercise, it may be easier to make these changes. Give yourself a few weeks using these guidelines and see how wonderful you feel.

Happy Zzzzz.