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Over the past half-century, multitasking at the expense of sleep has almost become a badge of honor in Western society. The amount of sleep adults in the U.S. get each night declined from an average of 8.5 hours in 1960 to less than seven hours in recent years. Approximately 30 percent of adults now sleep less than six hours per night. Sleep deprivation is a hallmark of our time, but the predominant idea that it’s not really harmful couldn’t be further from the truth.
Although sleep needs vary from person to person, evidence suggests that adults need seven to nine hours of sleep per night. When we regularly get insufficient sleep to meet our needs – due to sleep disorders, other health conditions, or lifestyle factors – we can acquire a “sleep debt” that can be difficult to repay. This can have serious effects on our health, and as our debt mounts, its ramifications increase.
Effects of sleep deprivation
Moodiness, tiredness, impaired concentration, slurred speech, decreased motor function, increased appetite or thirst, forgetfulness, and even aggression are among the potential effects of a lack of sleep. With short-term sleep disruptions, these effects can be remedied relatively quickly. However, chronic sleep deprivation carries long-term consequences.
Inflammation and Disease: A lack of sleep can increase levels of C-reactive protein, a marker of inflammation. It is becoming increasingly apparent that chronic systemic inflammation can lead to disorders such as autoimmune diseases, anemia of inflammation, high blood pressure, skin conditions, and heart or vascular disease, as well as decreased pain tolerance.
Obesity: Sleep deprivation results in an increase in appetite because it suppresses production of leptin, a fat-secreted hormone that signals satiety to the brain, and increases production of ghrelin, a peptide secreted by the stomach, which stimulates appetite. Thus, it can contribute to the development of overweight or obesity.
Metabolic dysregulation: Sufficient sleep is necessary for metabolic homeostasis (proper regulation of hormonal and metabolic processes). A chronic lack of sleep can have profound metabolic implications, impacting glucose regulation and potentially increasing the risk of diabetes.
Mental impairment: Sleep deprivation can result in various types of mental dysfunction, including a lack of emotional control and reasoning power. It has been shown to lead to a loss of functional connectivity in the prefrontal cortex, adversely affecting daytime cognition and working memory. Lack of sleep related to chronic insomnia may also increase the risk of developing depression and anxiety disorders.
The circadian clock, which regulates the cycle of sleepiness and wakefulness in humans, is controlled by the suprachiasmatic nucleus (SCN) in the hypothalamus of the brain. The SCN responds to light and dark signals received by the optic nerve, and signals parts of the brain that control hormones, body temperature, and other physiological functions. For example, in the morning, when light is perceived, the SCN prompts a rise in body temperature, increased production of the hormone cortisol, and a delay in the release of melatonin, a hormone produced by the pineal gland and associated with sleep onset. At certain times during the day, our circadian rhythm dips and rises, causing us to feel relatively tired or alert. If we are sleep deprived, the dips will be more intense, as our bodies demand payment of our sleep debt. Our debt can be paid off via sleep above and beyond our basal sleep need—the amount our bodies need on a regular basis in order to function optimally- as long as it’s done within a day or two of the missed sleep. Beyond that, we may never be able to completely make up for the sleep we missed. What’s more, staying in bed late on weekends can actually backfire, making it hard to get to sleep early enough on Sunday night to start the week off right – with a full night’s restorative slumber.
While we are awake, the neurotransmitter adenosine gradually increases in our bloodstream. Over the course of a day, this chemical progressively dulls the nervous system, causing us to feel increasingly drowsy (although peaks in the circadian rhythm will counteract this temporarily). While we are asleep, adenosine breaks down, and neurotransmitters such as serotonin signal some parts of the brain to remain active and others to switch off as we cycle through five stages of sleep. (The American Academy of Sleep Medicine combined stages 3 and 4 into a single stage in 1988, but numerous sources continue to use the model described below.)
The first stage is a transition period between sleep and waking. We may drift in and out of sleep, with periods of dreaminess that resemble daydreaming, and we awaken easily. Muscle activity and eye movement are slow, and we may experience sudden twitching or jerking (hypnic myoclonia), often accompanied by a feeling of falling.
Stage 2 is where we spend about half of our sleep time. In this stage, body temperature starts to drop and heart rate decreases. Eye movement stops and brain waves begin to slow, but we do experience some sleep spindles, or rapid brain waves.
During stages 3 and 4, our bodies enter restorative deep sleep, with little eye movement or muscle activity.
It’s hard to awaken, especially in stage 4, and some people, especially children, experience sleepwalking, bedwetting, or night terrors. Slow delta waves begin in stage 3, interspersed with smaller, faster waves. Stage 4 consists mostly of delta waves. These are thought to play an important role in memory consolidation, whereby the brain stabilizes information that was learned or experienced earlier.
In deep sleep, cardiovascular and kidney functions slow, but cellular regeneration increases. Production of growth and various other hormones is at its peak – recharging our bodies, aiding in nutrient absorption and bone marrow production, and, consequently, boosting immune function.
Stage 5 is known as rapid eye movement (REM) sleep and covers about 20 percent of a typical night’s sleep for adults. REM is characterized by dreaming, rapid shallow breathing, increased heart rate and blood pressure, reduced ability to regulate body temperature, paralysis of voluntary musculature, and, as the name suggests, the darting of the eyes back and forth.
During an average night, adults go through four or five sleep cycles. Each time, the deep sleep stages decrease in length while REM increases, starting with about ten minutes of REM. The last cycle before people awaken for the day has almost no deep sleep, and consists almost entirely of light sleep and as much as an hour of REM. If this stage is disrupted, the body may go directly into an extended REM stage the next time sleep occurs.
The time spent in the various stages of sleep changes over the course of our lives. The percentage of time spent in REM sleep is highest during infancy and early childhood – up to 50 percent – and declines in adolescence and young adulthood. Just as our sleep cycles change, so do our needs for sleep. These needs vary from person to person, and will fluctuate for the individual, with one of the most significant factors being age.
Babies: Newborns usually sleep from fourteen to eighteen hours per day. Patterns of naps and nighttime sleep begin to emerge in two to three months, and parents and caregivers can help develop the infant’s circadian rhythms by keeping them in a light room by day and putting them to sleep in a darkened room at the same time each night. A consistent evening routine – feeding, bathing, perhaps singing a lullaby – will begin to signal the baby that it’s time for sleep. Whether for naptime or at night, putting a drowsy baby to bed before sleep sets in is important training. This helps the baby learn to self-soothe and fall asleep after awakening in the middle of the night. Getting enough sleep is vital to the baby’s future health, and chronic sleep difficulties in infants have been shown to increase body fat by age seven.
Preschoolers: As toddlers enter the preschool years, they begin to need less sleep – between ten and twelve hours each night – and too little sleep can manifest in ADHD-like behavioral problems. Some outgrow the need for naps at this age, but most still sleep for short periods during the day. Not allowing them to nap if they do need it can be detrimental to their learning, as napping enhances memory consolidation.
Children’s sleep quality may be impacted by breathing difficulties. They may breathe through their mouths due to slight deformities that may be treated with orthodontic treatment or alleviated by simply sleeping on the left side. Snoring can be the result of poor air quality from outdoor air pollution or second-hand smoke, or a medical condition such as swollen tonsils or adenoids. Youngsters with sleep-disordered breathing (snoring, sleep apnea, and mouth breathing) may develop behavioral problems by age seven because of disrupted oxygen flow to the brain during a critical time for brain development.
School-Age Children: The U.S. Department of Health and Human Services asserts that school-age children need at least ten hours of sleep per night. Their circadian rhythms shift at this time, causing melatonin secretions to rise later at night, delaying the onset of sleepiness and making it harder to wake up in the morning. As with younger children, a lack of sleep at this age can result in ADHD-like symptoms and behavioral problems. Quality sleep plays an important role in learning, enhancing important mental functions, including memory, reasoning, and problem solving.
Teens: Most teens turn to caffeinated beverages such as sodas, energy drinks, and coffee to boost their energy. Caffeine can interfere with the normal effects of adenosine by binding with its receptors, creating a caffeine “buzz” and impairing the body’s natural signals to fall asleep.
According to the latest information from Pew Research, 84 percent of teens with cell phones “sleep” with them near their heads. There’s no doubt the late-night texts, phone calls, and flashing lights are a large part of the reason that only about 20 percent of teens get the nine to ten hours of sleep they need each night. Moreover, electromagnetic radiation from sleeping with cell phones so close to the head may have other damaging health effects.
Young Adults: As the teenage years come to an end, people need slightly less sleep (seven to nine hours per night), but most young adults still seem to have a hard time getting enough. For many of those pursuing higher education, college life means juggling academics and jobs, so it’s not a surprise that 70 percent of college students suffer from insufficient sleep. Whether students or not, many young adults ramp up their social lives with partying and alcohol consumption, which takes a toll on sleep quality and quantity, and, by extension, health and safety. Young adult males are statistically overrepresented in automobile accidents involving drowsy drivers.
This time of life presents all sorts of possible sleep disruptions, including snoring roommates. Such challenges become magnified in partner relationships. A recent Danish study found that patients with sleep disorders – and their partners – had higher healthcare anedication costs, lower incomes, and greater unemployment rates than those unaffected by sleep disorders.
Many young adults just entering the job market become involved in night shift work. The International Agency for Research on Cancer (part of the World Health Organization) has classified shift work involving circadian disruption as “probably carcinogenic to humans.” Female long-term night shift workers have a higher risk of breast cancer than those who work during the day, most likely because a disrupted circadian rhythm and suppressed melatonin production dysregulate genes involved in tumor development.
Parenthood: As young people become parents, they experience a whole new set of sleep circumstances.
During pregnancy, women may need several extra hours of sleep per night and may find it hard to get comfortable enough to sleep well. Sleeping on the left side with a pillow between the knees can help. For many new parents, alternating caregiving shifts is a way to get longer blocks of sleep.
Midlife: Middle age brings more challenges that can affect sleep patterns. Circadian rhythms change again, encouraging earlier bedtimes and earlier rising. For some, children at home and aging parents who need help create demands on time that threaten sleep. In addition, for about 50 percent of peri and postmenopausal women, fluctuating hormones, hot flashes, and night sweats make it difficult or impossible to get undisturbed sleep.
Seniors: Seniors’ circadian rhythms typically demand even earlier bedtimes and wake times. Their deep sleep stages tend to become shorter or, in some cases, cease completely. But seniors generally need about seven to nine hours of sleep per night – the same amount as in early adulthood. Insomnia and trips to the bathroom due to incontinence, an enlarged prostate, or other health issues may interfere with their sleep.
Health conditions and sleep quality
Our bodies often try to tell us when we need more sleep, but we don’t always listen. Experts warn that if we feel drowsy during the day or fall asleep almost immediately upon lying down, we are sleep deprived.
Under these circumstances, we may experience microsleep, with regions of the brain undergoing a sleeplike state for very short periods while the rest of the brain appears to be awake, leading to moments of unresponsiveness to the environment – or even traffic accidents. In many cases, however, our lack of sleep may be due to underlying health conditions, not to burning the candle at both ends. Understanding what sleep-related disorders we may have can be an important step in achieving sleep health.
The most prevalent breathing-related sleep disorder is sleep apnea. With this condition, breathing pauses repeatedly during sleep (sometimes hundreds of times per night), interrupting both the sleep cycles and the supply of oxygen to the brain and body. This chronic condition can lead to high blood pressure, stroke, heart failure, diabetes, depression, and ADHD-like symptoms.
There are three types of sleep apnea:
- Central sleep apnea (CSA): when the brain doesn’t properly signal the muscles that coordinate breathing
- Obstructive sleep apnea (OSA): the most common type of sleep apnea, in which the muscles in the throat relax too much and the airway narrows or closes
- Mixed sleep apnea (MSA): a combination of central and obstructive sleep apnea
People who snore loudly and often and who sometimes stop breathing or gasp during sleep may need to be tested for sleep apnea. Being overweight, having high blood pressure, and dozing or falling asleep during the day are also risk factors. Diagnosis may be made through home sleep tests or polysomnographic testing in an overnight sleep center.
The most common treatment for moderate to severe sleep apnea is a positive airway pressure (PAP) machine, which has a mask that is placed over the nose (and sometimes the mouth) during sleep and supplies pressurized air to the upper airway. Types of PAP machines include the CPAP (continuous positive airway pressure), which delivers a constant flow of air, and the BiPAP (bilevel positive airway pressure), which allows for different inhalation and exhalation air pressures. Other treatments for sleep apnea include mandibular advancement devices that pull the lower jaw forward to open the airway, and, if other measures fail, surgery to remove excess soft tissue that can block the airway.
Overweight, chronic nighttime nasal congestion, and tobacco smoking are risk factors for OSA, and drinking alcohol can exacerbate it. In mild cases, lifestyle changes such as losing weight and quitting smoking may be sufficient to correct the problem.
Nearly everyone who suffers from sleep apnea snores, and treating the apnea usually takes care of the snoring as well. However, not everyone who snores has sleep apnea. Snoring is common in adults, and it’s more than just an annoyance to others – it interferes with restorative stages of sleep. Moreover, depression, cognition challenges, and, in older adults, dementia can be related to snoring, as well as other sleep-disordered breathing, which includes sleep apnea and mouth breathing.
Narrowed facial structure – the type observed by Dr. Weston A. Price, DDS, in people eating modern, denatured diets – and dental malocclusion can contribute to sleep apnea and snoring, and may be treatable with dental appliances. Sleeping on the side (particularly the left side), and using adhesive nasal strips that open the nasal passages may help with snoring. People who breathe through the mouth can sometimes be trained to break the habit by taping their mouths shut.
Insomniacs may have trouble falling asleep (sleep onset insomnia) and/or staying asleep (sleep maintenance insomnia). The problem may resolve itself if it’s caused by a temporary situation. However, when someone has trouble falling asleep or staying asleep three or more nights per week for three months or longer, it’s considered chronic insomnia and there may be underlying medical or psychiatric conditions that need to be addressed. Certain medications – such as those taken for colds, allergies, high blood pressure, heart disease, and depression – may also contribute to insomnia. Moderate aerobic exercise (walking) seems to help insomnia over time, but intense aerobic exercise (running) or resistance exercise (weight training) doesn’t have the same effect.
Diabetics can suffer from nocturnal hypoglycemia, a serious drop in blood glucose level during sleep.
Sometimes, the only clue that this has taken place is a severe headache afterward or a sleep partner noticing excessive thrashing and sweating during sleep. Symptoms of sleep deprivation, such as decline of mood and cognitive function, may occur. In some cases, nocturnal hypoglycemia can result in loss of consciousness, convulsions, seizures, or coma, and can contribute to cardiac arrhythmias and sudden death. Nocturnal hypoglycemia can be minimized by having an appropriate snack (usually containing some protein) before bedtime, especially if the person has exercised in the late afternoon or evening.
Restless legs syndrome
The neurological disorder called restless legs syndrome causes unpleasant sensations in the legs and the irresistible urge to move them frequently, interfering with sleep. Current research suggests that this condition is associated with a host of immunological diseases and that it may also be caused or exacerbated by inflammation. Supplementation with minerals – specifically iron (have ferritin levels checked first), calcium, and magnesium – as well as wild lettuce extract is sometimes helpful.
Cognitive and neurodegenerative disorders
Poor sleep quality is found frequently in people with diagnosed depression, and sleep disturbance is a core feature of bipolar disorder. In addition, many schizophrenics report disturbed sleep. For psychiatric patients, medications may play a role in sleep disturbances. Alzheimer’s, Parkinson’s, and Huntington’s disease patients also tend to suffer from sleep disorders.
An estimated 6 to 10 percent of Americans used a hypnotic sleep drug, such as zolpidem (Ambien and others) or temazopam (Restoril), in 2010. However, it’s important to understand that some pharmaceutical sleeping pills can actually interfere with quality of sleep, and many can be habit forming or addictive. Prescription sleep aids may have dangerous side effects, including cancer, early death, and unwitting eating, driving, sexual activity, and even murder.
With that in mind, here are some tips for getting better sleep without the use of pharmaceutical sleep aids.
Preparation for a night of good sleep begins long before bedtime. A bedroom that is cool (68 degrees F is optimum), quiet, and dark, and a comfortable mattress and pillows are basic elements. It’s best to banish all noisy, light- and radiation-emitting electronic devices from the bedroom. Eye masks and earplugs can help with unwanted light and sound. White noise or sound machines may help adults fall asleep, but it should be noted that these may hurt babies’ developing ear canals.
Slowing down to help your body relax about half an hour to an hour before bedtime is also helpful. This time might include meditation, a hot shower, or a warm bath with Epsom salts (which allows the body’s temperature to rise and then drop, signaling that it’s time to sleep, while supplementing magnesium in the body and reducing inflammation). You might drink a glass of warm milk, a practice that has helped many generations of people go to sleep. A carbohydrate-rich, lower-protein snack or meal about four hours before bedtime can help provide the brain with tryptophan, which is necessary for sleep-inducing serotonin (and melatonin) production. However, experts recommend that you don’t eat heavy meals within two hours of bedtime.
Chronic stress – far too prevalent in today’s society – is tied to sleep disorders, and these factors can interact in a vicious cycle. However, the good news is that dealing with one also helps the other; quality sleep helps relieve stress, and eliminating chronic stress promotes quality sleep. Find the stress management techniques that work best for you, from relaxation techniques or deep breathing to spending more time in nature or with your pet.
Diet and nutrition
Eating a balanced diet and avoiding processed sugars and grains provides a foundation for healthy sleep.
Refined carbohydrates and sugars are metabolized quickly, causing blood sugar to spike and then plummet, disrupting sleep.
Caffeinated beverages consumed after noon may keep you awake at night, and although alcohol may make users sleepy initially, it can disrupt sleep cycles and prevent restful sleep. Smokers may wake every few hours due to nicotine withdrawal. Each of these substances may hamper the REM sleep phase.
Richard Wurtman, MD, a professor of neuropharmacology at MIT, feels that proper supplementation with melatonin can correct insomnia and age-related sleep disorders. His recommended dosage is only 0.3 mg, which is about one-tenth the dosage of a typical supplement. He has found that too much melatonin over a period of time can have unwanted side effects, such as hypothermia, morning grogginess, or even desensitization of the brain receptors on which melatonin acts to promote sleep.
Valerian root is a traditional herbal sedative, considered safe for use as a sleep aid. Although it may take a few weeks for the effects to be noticeable, 400-900 mg of the extract, taken two hours or less before bedtime, seems to help with insomnia and other sleep difficulties.
Lemon balm has been used for centuries as a sedative sleep aid, sometimes taken as a tea or in conjunction with valerian extract. One formulation includes 120 mg valerian extract and 80 mg lemon balm extract, to be taken three times daily.
Chamomile, in the form of tea, capsules, liquids, and tablets, is another traditional herbal sleep aid.
Generations of people have used a cup of the tea as a folk remedy for anxiety and sleep disorders. Dosage varies, and it is generally understood to be safe, but those who are allergic to ragweed or other members of the daisy family may be adversely affected by it.
Hops is known as a calming agent and can be used as a mild sedative.[38,39] For insomnia, dosages of hops extract between 30 and 120 mg, to be taken just before sleep, are typical. In tablet form, hops and valerian extracts are sometimes combined.
Passionflower extract in liquid form (30-60 drops daily), or 90 mg per day in tablet form, can help reduce anxiety and therefore help with sleep onset and duration.
Kava kava in liquid, powder, capsule or tablet form may help with anxiety-related sleep quality and onset, but there is some concern about its safety as it has been implicated in rare cases of liver disease. Recommended doses range from 70 to 210 mg, to be taken an hour before bedtime.
Magnesium plays essential roles in muscle relaxation and the deactivation of adrenaline. Unfortunately, magnesium deficiency is a serious problem for much of the population, and is often the cause of sleep difficulties. In this case, magnesium supplementation before bed may be a tremendous help with both falling asleep and staying asleep. Magnesium and calcium work together in the body (along with vitamin D3), and calcium deficiency is also related to interrupted sleep. Supplementing with calcium when warranted can often help with better sleep.
Tryptophan (a serotonin precursor) is an essential amino acid, meaning it must be ingested and is not synthesized by the body. Taking 500-2000 mg of tryptophan or eating a tryptophan-rich snack such as dairy products, eggs, meat, nuts, or fish 30 to 45 minutes before sleep can aid the natural process of serotonin and melatonin production. Although larger doses are sometimes recommended, smaller doses help maintain the balance of amino acids in the system, and as little as 250 mg of tryptophan has shown to help with OSA (but not CSA). L-theanine, another amino acid, may also be helpful. Supplementation with 50-200 mg at bedtime may help maintain deeper sleep.
L-theanine is also found in green tea, but in amounts insufficient to address sleep problems.
It’s best to consult with a qualified health professional to determine what supplements are best for your individual needs. Herbs should be researched to preclude possible contraindications or interactions with drugs. Also, please note that potency of herbal supplements can vary greatly from brand to brand, so please see the product label for precise dosing instructions.
Gentle yoga or stretching exercises before bedtime can aid relaxation, and moderate exercise during the day reduces stress, loosens muscles, and helps to maintain a healthy body – all of which help you get to sleep at night. A regimen of moderate exercise has been found helpful in overcoming sleep problems, but vigorous exercise did not have the same effect in a review of human insomniac studies. It’s best to exercise in the morning, and exercising less than an hour before bedtime can actually keep you awake.
Blue light-producing electronic devices, such as computers and televisions, should be avoided at least an hour before bedtime. Such devices, as well as blue light-producing energy efficient bulbs, can suppress melatonin production for over an hour after exposure.
Serotonin is only converted to melatonin in darkness. Blackout curtains and shades can help block disruptive light from outside, particularly benefiting shift workers and others who must sleep during daytime. However, exposure to bright, full-spectrum daylight in the morning triggers nocturnal melatonin production earlier and helps you enter into sleep more easily.
Sleep timing and naps
Circadian rhythm disruption, whether due to jet lag or short sleep, can be gradually repaired by going to bed slightly earlier each night until the desired bedtime is reached. Napping can help you get over any mid-afternoon dip in your circadian rhythm, as long as the naps are before 3 p.m. and are only 15 to 30 minutes in length. Longer naps can actually work against you, delaying sleep onset at night.
There isn’t a magic sleep formula that’s universally right for everyone, and discovering what works best for you takes a certain amount of trial and error. Try to listen to your body – eight hours of sleep leaves some exhausted during the day but makes others struggle to get to sleep at night. To further complicate matters, the amount of sleep your body requires changes over the years, so pay attention and adjust your sleep schedule accordingly.
As in so many other areas of health, a proper balance of foods, vitamins, minerals, exercise, and common sense can help you get a good night’s sleep. Each of these factors are necessary to ensure good sleep quality, an essential element in attaining optimal health.
About the Author
Alice Abler is a health, food, and sustainable living writer with a background in art and design. She has lived in several countries, learning about their cultures and food, and now resides in Southern California, where she enjoys studying and incorporating age-old principles of permaculture and sustainability at her home. She is the Life and Health editor for Vision.org and maintains a website at ReNourishment.org.
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Published in the Price-Pottenger Journal of Health and Healing
Fall 2014 Volume 38 Number 3
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