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This article is shared with permission from our friends at dralisonchen.com.

Sleep doesn’t only have to do with the amount, but the quality.

If you are laying down for 8 hours a night but only getting 3 hours of deep REM sleep then you best believe that you’ll still be hitting the snooze button and dragging your groggy body out of bed the next morning. This article will cover your poor sleep issues regardless of if it’s due to:

In addition, at the end of the article, I lay out the five tips on how to sleep better, starting tonight.

Why is Sleep Important?

Healthy sleep affects physical and mental recovery, memory, learning, growth, and active longevity [12].

Throughout each day, there is a balance between catabolism (degradation) and anabolism (renewal) [1]. This daily balance is called the circadian rhythm and allows organisms down to the cellular level to predict environmental changes [9].

Wakeful activities, infections, surgical stress and trauma stimulate the sympathetic nervous system (SNS- fight or flight) [1]. This encourages catabolic activities, secreting hormones such as cortisol, which inhibit anabolic hormones [1]. Sleep shifts the body back towards a renewal state to allow the parasympathetic nervous system (PNS- rest and digest) to take over [1].

Let’s see how sleep affects your body’s ability to function optimally:

Benefits of Sleep and Sleep Deprivation Effects

Healing

Tissue injury and insult requires an anabolic state in order to deliver essential nutrients, white blood cells and pro-inflammatory cytokines (molecules to stimulate healing) to the affected area [1]. Adrenaline is released during wakeful acute stress, which prevents cell division that is necessary for healing [1]. Adequate uninterrupted sleep and a relaxed nervous system (PNS) are crucial for the recovery in post-surgical stress [1].

Mental Recovery

Poor sleep has a negative impact on mood [6]. The cardinal signs of sleep deprivation is a decrease in alertness, cognitive performance and decision-making abilities in unexpected and uncertain situations [20, 22].

Performance deficits can occur as early as during the first night without sleep and amplifies on the 2nd-3rd night [20].

Simple and complex task performances are impaired with sleep deprivation, as reflected by tests of reaction time, vigilance, attention, working memory, verbal fluency and speech articulation, language, logical reasoning, creative and flexible thinking and planning, decision making, and judgment [20].

Obesity

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There is an obesity epidemic. Most people realize the affects of a poor diet and lack of exercise on their weight, but what about the correlation of sleep and obesity? There is a new parameter that links the duration of sleep with obesity and diabetes [2].

Sleep restriction alters the body’s metabolic profile (ie. insulin, ghrelin, leptin, cortisol), leading to insulin resistance, increased sympathetic nervous system activity, elevated hunger and decreased satiety [16].

Even more scarily, short sleep duration is positively associated with childhood obesity [2].

Hormonal Balance 

  • Cortisol and adrenal hormones – Cortisol and catecholamines (adrenal hormones) are secreted during stressful events. Not only do they raise your blood pressure, increase your breathing rate and create tension in the body, but they also inhibit insulin secretions, which inevitably makes it easier to store fat. Sleep positively inhibits cortisol secretions [1].
  • Thyroid Hormones – During sleep deprivation, thyroid activity sharply increases (hyperthyroid-like presentation) leading to an activation of the hypothalamic-pituitary-thyroid (HPT) axis [10, 17].
    With continuous sleep deprivation, TSH (thyroid stimulating hormone) continues to elevate, which tells the HPT axis to stop producing hormones resulting in a hypothyroid-like presentation [17]. Your thyroid affects so many mechanisms of your body, including your body weight, fat storage, hair and skin quality, energy levels, metabolic rate, heart, and lung function, and ironically sleep [17].
  • Sex Hormones – Women are more at risk of insomnia and insufficient sleep as compared to men [19]. A female’s ovarian hormone cycle affects their sleep, which shows the importance of supporting healthy menstruation [19]. Talk to your Naturopathic doctor if you have menstrual irregularities. Sleep restriction, however, affects sex hormones of both women and men. Lower levels of testosterone are observed when sleep is restricted in the first half of the night [23]. Making sure you get to bed on time (ie. 10pm) will ensure your sex hormones are well balanced.
  • Melatonin, Serotonin, and neurotransmitters – Light conditions affect the internal circadian clock [18]. During the night (darkness) melatonin is prominent and serotonin levels are low, while during the day (lightness) the reverse occurs [18].
    • Serotonin (5-Hydroxytryptamine) is a neurotransmitter (a chemical that interacts with brain function) that contributes to a happy positive mood, will power and delayed gratification [21]. It’s the ‘feel good’ hormone and a precursor to melatonin [18]. Serotonin is mainly found in the gut lining, which explains why late night eating interferes with a healthy sleep cycle and metabolic regulation [21].
    • Melatonin is a hormone made from serotonin, but also can be found in certain foods we eat. It regulates the sleep cycle and is a potent anti-oxidant. The eye has melatonin production sites within the retina that signal for dopamine to be released, while dopamine regulates the production of melatonin [18].
    • Dopamine is a hormone and neurotransmitter that plays a major role in reward-motivated behavior. Basically, anything we choose to do or think is driven by our reward mechanism whether it’s conscious to us or not. How amazing is it that we can help control our motivators by getting enough sleep?
      Exposure to even low-light frequencies (ie.  electronic use) alter circadian rhythms and suppress nocturnal melatonin secretions resulting in sleep difficulties and negative mood [16].

What is REM Sleep?

REM stands for Rapid Eye Movement in which the brain emits an electroencephalogram (EEG) frequency, called the delta wave, during deep sleep [4]. As your start to fall asleep, your brain goes from short alpha wavelengths to long delta wave, which is commonly coupled with dreaming [4].

REM sleep increase in focal cerebral blood flow of the amygdala, which is responsible for gathering emotionally influenced memories [14]. Therefore the processing of memories during REM sleep creates the experience of dreaming [14].

How to Sleep Better

Be Active In The Day

To get a deeper and more restful sleep, be more active in the day. Hormones and neurotransmitters released from physical activity in the day will help to convert them into chemicals to allow a more restful sleep at night.

Along with eating healthy proteins and being exposed to light in the day, serotonin levels rise with exercise allowing melatonin to be converted at night and therefore a deeper sleep [25].

Positive Outlook

There are recent studies looking at the effect of self-induced changes in mood affecting the production of serotonin [25]. So start your daily affirmations kids.

Sleep Schedule

If possible, create a bedtime routine. Have a set dinner time and avoid stimulants or late night snacking. Stimulants can include foods, beverages, electronics, and vigorous activities (see sleep hygiene #5) . Have a set time to get into bed and make sure you ‘wind down’ at least 10 minutes before.

Getting Around Shift Work and Travel

Studies report employees who work late shifts need at least 2 days to recover [8]. Those who take longer than 2 days also have insufficient stress management strategies and impaired resiliency to stress, who then tend to chose liquor and cigarettes for stress reduction [8, 13].

You can imagine the effect of shift workers who works 4 days on then 4 days off. If it takes at least 2 days to recover, these employees are constantly trying to readjust to the flux in a sleep routine.

It’s not surprising to know that workplace productivity also declines with sleepiness [20]. Therefore, if you work a dangerous or high-risk job, please get your sleep issues resolved right away. There are many beneficial non-addictive supplements such as melatonin, so talk to your Naturopathic doctor about a healthy protocol for you.

If you have a job that requires a lot of travel or includes shift work, creating a sleep pattern will be very difficult. If you are having issues sleeping after a change in time zones or routine it will be even more important for you to practice the 5 Steps to Getting More Restful Sleep (see the end of the article).

Tackling a Restless Mind

Do you have a restless mind prior to going to bed?

Keep a notepad beside your bed so that you can write out all of your thoughts. Whether they are to-do lists or ideas for outrageous inventions, get them out and onto a piece of paper. It will be reassuring that you won’t forget all of your brilliance and allow you to sleep more soundly.

After your ‘brain dump’, follow-up with a relaxing practice from Healthy Sleep Hygiene Tip #4 at the end of the article to turn your nervous system off of sympathetic mode.

Are Your Sleep Issues More Serious Than You Think?

Many people who have trouble sleeping have more than just a busy mind. Stress is a huge factor in sleep difficulties, but something else could also be going on.

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Insomnia or hypersomnia can be caused by irregular sleep patterns, anxiety, stress, overwork, excessive exercise, jet lag, and endocrine disorders [12]. Many people with trouble staying sleeping have a combination of the following:

If you think your insomnia is due to something more than just a busy mind, visit your local Naturopathic doctor to figure out where the imbalance is.

Who Do I Follow-Up With?

For unexplainable or chronic sleep disorders, it’s best to book a visit with your Medical physician and Naturopathic doctor. They may refer you to a sleep clinic or order some lab work to get further information on your symptoms.

Sleep clinics are especially good at tracking sleep apnea (interrupted sleep due to lack of oxygen consumption) [15]. They aren’t the most comfortable experience– being hooked up to a machine in a foreign room overnight, but they are able to track your sleep cycle accurately.

There are also various apps and pieces of technology to monitor your sleep patterns at home. For example– Beddit, FitBit, Jawbone are popular products; along with apps that track the lighter parts of your sleep to wake you gently, like — Sleep As Android, SleepBot, Sleep Cycle. They record noises, sounds, and movements in the night to see what is bringing you out of deep REM sleep.

Why You Might Be Waking Up in Pain

Between 10-30% of the population report chronic pain with over half claiming sleep complaints [6]. Sleep deprivation is correlated with increased inflammatory markers and decreased pain tolerance [6]. It’s an awful cycle when pain leads to poor sleep, which then contributes to even more pain, etc.

The way you sleep can be a large contributor to pain as well. For example, if you have low back pain you should avoid sleeping on your stomach due to the excess pressure of a hyperextended posture on the spine for many hours.

The best postures for sleep is on your side and back. But what about pillows?

Under Your Head – While side lying, you should have a higher pillow under your head to fill the gap between your shoulder and head. While on your back, use a thinner pillow under your head. Your goal is to maintain a neutral spine (ie. when you’re standing with good posture and not perfectly flat).

Body Pillows – You should also utilize extra pillows at your knees to maintain a neutral posture. While side lying the width between your knees and elbows are much more narrow than your hips and shoulders, respectively. Placing a pillow between your knees and arms will take pressure off your hip joints and low back.

When sleeping on your back, put a pillow under your knees to release low back stress. If you must sleep on your stomach, putting a pillow under your abdomen and hips will decrease the extension of the low back and will help with back pain, but not your stiff neck from the excessive rotation.

Does My Mattress Really Matter?

I got the down low on the importance of mattresses when Casey and his girlfriend Molly came to live with Jon and I in Uruguay. Casey Sasek is the owner of the Wildcat Mattress store in Nicholasville, Kentucky and he says that the best mattress you could ever sleep on it made of latex.

Common mattresses have springs within them. When the weight of your body presses down on the springs it can inhibit blood flow to those areas of the body and can inadvertently wake you from your deep REM sleep.

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Latex mattresses are made from a natural rubber tree. They are thick, flexible and soft enough to conform to your body to allow proper support without limiting blood circulation. This allows for faster injury recovery, longer duration of sleep in one position and more continuous restorative sleep.

5 Tips to Improve Sleep Quality

How to sleep better, benefits of sleep

1. Resolve Your Issues

Whether it’s a disagreement with your spouse, conflict with a colleague or you are being hard on yourself again, resolve it in whatever way possible. If you can’t resolve the issue face-to-face, go a little deeper and see if you can’t identify what about the conflict bothers you. Do you feel angry, sad, betrayed, guilty or manipulated? Is this a common theme in many of your relationships?

If so, this may be a chance for you to do some personal reflection.

2. Shutting Down Means Shutting Off

Light and noise pollution can make it difficult to fall and stay asleep. Try turning off all lights, covering your clocks and using blackout blinds. If you sleep with a partner who snores, is a restless shifter or goes to bed after you, make sure they are mindful of not disturbing you. Same goes for you if you are the night owl.

You may need to wear earplugs and an eye mask, change to a non-spring mattress or convince your partner to change their sleep patterns to go to bed earlier. Wearing eye masks and earplugs have shown to significantly improve sleep quality [24].

3. Disconnect

Unplug all the electronics in your bedroom before you go to bed (or just keep them out of the room). This includes mobile cell phones, cordless phones along with their base stations, wifi devices, microwave ovens, television and radio transmitters [3, 5]. Some people report a high sensitivity to radiofrequency (RF) electromagnetic fields (EMF). Despite inconclusive findings for negative effects of chronic low-frequency EMF exposure, I’d recommend minimizing your intake and avoiding long-term close contact of your devices to your body (ie. sleeping with your cell phone under your pillow) [3].

If you read before bed, use a physical book. The light from many electronic devices trigger your sympathetic nervous system and release of cortisol and inhibit melatonin. This will make you more energized and alert, which interrupts your sleeping pattern. There are many new eReaders that help to minimize light stimulation before bedtime, so shop carefully.

Also, avoid reading in bed. Make bed a place for physical intimacy and sleep, ONLY. Start creating a psychological association of bed to sleep.

And don’t forget to set your phone on airplane mode to avoid incoming calls, messages, and EMFs. Don’t worry, your alarms will still work, I use this every night.

4. Find a Way To Wind Down

Practice a relaxing exercise before going to bed:

  • Have a lukewarm bath
  • Use lavender candles or relaxing essential oils on your pillow
  • Listen to calming music or meditation
  • Have some chamomile tea

Get in the habit of following the same routine every night.

Something I recently tried was a sensory-deprivation pod, in which you lay in water of neutral temperature with a very high salt or magnesium concentration allowing you to float [11]. They are also called isolation tanks or floating baths and create a virtually stimulation-free environment. The room goes completely dark and you are without any sensory distractions (noise, sight, touch, smell, taste). Participants show a significant decrease in blood pressure and more relaxation post-treatment (45 min) [7].

5. Avoid Stimulants After 4pm

This means no caffeine, sugar, or herbal stimulants.

  • Caffeine: Coffee, green or black tea, yerba, soda, red bull, etc.
  • Herbal stimulants: Ginkgo, Ginseng, Glycyrrhiza.
  • Electronic usage: TV, computer, tablets, video games (especially violent or emotionally stimulating content).
    Use of multiple electronic devices is associated with less sleep at night and increased sleepiness in the day [R].
  • High energy activities: Cardio, weight training and yes, even sex could be potential stimulants.
    Although there are many others who find these activities beneficial to fall asleep, studies show that late night exercise significantly lowers nocturnal melatonin [V]. In both cases, I would avoid eating after the activity (unless you are a 300lb body builder needing to refuel your massive swollen muscles).

So, How Much Sleep Do I Need?

As you can see from above, there are many factors that affect the quality of sleep. Sleep deprivation affects your entire body, from your weight and thyroid function to your energy levels and cognitive performance.

For adults, 7-8 hours per night is recommended for optimal sleep, although there is a variation between men, women and age groups  [2, 12]. Women between 50-70 years old appear to require the most sleep [12]. When we start practicing the above Healthy Hygiene Habits, the quality of sleep improves and the number of hours you require to feel at your optimal self may actually decrease!

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Dr. Alison Chen
Naturopathic Doctor
Contributor to The Hearty Soul.
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