Feeling tired today? According to the National Sleep Foundation’s 2020 poll, the average American feels sleepy three days a week, and close to half said this sleepiness impacts their daily activities, mood, and mental acuity. It’s no surprise that Americans are feeling sleepy. The average length of sleep per night is less than six hours, which is far from the recommended 7–9 hours. How many hours of sleep do you average per night?
The CDC found that Connecticuters who average fewer than seven hours of sleep a night are more likely to be obese and to suffer from heart attacks, strokes, asthma, arthritis, depression, and diabetes. Yes, there is a correlation between decreased sleep and chronic disease. Sleep is an essential building block in our foundation for good health.
What Happens When We Sleep?
Truthfully, we still don’t understand why humans—or any animal, for that matter—sleeps. While we sleep, we are defenseless and vulnerable for an extended period of time. Wouldn’t evolution favor creatures that didn’t need to sleep? Yet the human need for sleep has not changed in millennia. Theories about why we need sleep include full body restoration and memory consolidation.
Body and brain restoration: Growth hormone secretion peaks during sleep, contributing to muscle growth and cell regeneration throughout the body. This is especially important for an athlete’s recovery time. Brain restoration occurs during deep sleep as well—this is the only time that neurotoxic waste is cleared out of the brain. If deep sleep is not adequate, the brain’s glymphatic system is disrupted and can contribute to neurodegenerative diseases.
Memory consolidation: While we sleep, the brain consolidates memories, promotes synapse formation to consolidate learnings, and maintains cognitive function and memory.
Sleep and Our Life Cycle
Sleep changes over the course of our lifetime. Babies aged 0–3 months old start their sleep cycle directly in the REM phase, before they have developed their circadian rhythm. Teenagers have a higher percentage of deep sleep. Our sleep architecture begins to change in middle age. As we age, our circadian rhythms of temperature, melatonin, and cortisol diminish and as a result, our percentage of deep sleep diminishes, our REM stage decreases, and our percentage of light sleep increases. Our circadian regulation of sleep and wakefulness weaken, and we experience increased involuntary wakening. As a result, reduced growth hormone and dopamine levels occur, even with healthy aging.
The incidence of sleep disorders increases both with normal aging and even further with neurodegenerative disease, including dementia, Parkinson’s disease, Lewy body dementia, and Alzheimer’s disease. Those with mild cognitive impairment have more noticeable changes in deep slow wave sleep, circadian rhythm disruption, and REM sleep. Parkinson’s dementia with Lewy bodies is preceded by REM behavior disorder, which is when muscle movement occurs during REM sleep, resulting in hand twitching or thrashing about.
Insomnia and Its Causes
Insomnia is the most common sleep problem in adults 60
and older. Insomnia includes taking a long time to fall asleep, waking up in the night, waking up early and not being able to fall back asleep, feeling sleepy during the day, and not being
able to fall asleep.
There are many factors that impact sleep and can cause insomnia including:
- Stress: Increased stress means increased cortisol, the steroid hormone that has an opposing rhythm to melatonin in our circadian rhythm. Elevated cortisol can disrupt our circadian rhythm and therefore sleep.
- Hypoglycemia: If you wake up in the middle of the night, it could be due to a spike in cortisol caused by low blood sugar. If this is you, eat a small snack that is high fat with a protein about an hour before going to sleep.
- Excessive warmth: Our body expects the temperature to drop at night, so keep your bedroom cool.
- Blue light exposure: Blue light—like the sky!—has wavelengths of 450 nm. This blue wavelength decreases melatonin and disrupts your circadian rhythm. Be sure to block blue light from LED bulbs, TV screens, and your phone by shutting off electronics and shifting light to yellow-toned, low-watt lighting.
- Caffeine: During the day our cells generate energy, creating the byproduct adenosine. Adenosine builds up in the brain and contributes to our feeling sleepy at night. Caffeine blocks the adenosine receptors, which is one of the ways it helps you wake up in the morning.
- Alcohol: We may think a glass of wine will help us sleep but when it metabolizes it actually causes sleep disturbances, especially in the REM phase, which shortens sleep.
- Lack of oxygen by sleep apnea results in insomnia.
People with sleep apnea tend to have REM earlier in their sleep pattern instead of toward the end.
- Movement disorders such as restless leg syndrome can
wake you up.
- Working night shifts disrupts your circadian rhythm.
- Medications such as barbiturates and other antiepileptic drugs, beta antagonists, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, tricyclic antidepressants, and stimulants also delay or suppress REM sleep.
Establishing Great Sleep Hygiene
Establishing a solid sleep routine and good sleep hygiene is the most effective approach to helping the body maintain a healthy circadian rhythm. Aim to go to sleep at the same time each night, even on weekends, to keep your circadian rhythm in check. Establish good sleep hygiene by incorporating lifestyle changes that encourage you to wind down before going to sleep.
Your sleep routine can include:
- Hydrotherapy: Taking a hot bath/shower 1–2 hours before going to sleep has been shown to improve deep sleep.
- Blue blocker glasses: If you can’t turn off the screen three hours before sleep, use glasses that block blue light to ensure melatonin secretion is not suppressed.
- Eat a low-carb, high-fat dinner several hours before your bedtime. Glucose oxidation from carbohydrates suppress slow wave sleep.
- True darkness: Ensure your sleep environment is pitch black. Sunlight and blue light reduce melatonin.
- Pink noise played during the first 90 minutes of sleep has been found to slow brain oscillations and increase sleep. Check out the free app Simply Noise.
If you are following a good, solid sleep routine and still struggle with insomnia, your neurotransmitters may need a bit of help. Supplements to support good sleep include:
- Melatonin: Melatonin decreases as we age, so it is especially helpful for age-related insomnia. It also helps with insomnia due to depression, autism, or epilepsy, and helps patients withdraw from benzodiazepine therapy.
- GABA: GABA is our main inhibitory neurotransmitter of the CNS. Barbiturate and benzodiazepine medications target the GABA receptor. In my clinical experience, patients particularly appreciate GABA because it doesn’t leave them feeling drowsy in the morning.
- Glycine: Glycine is an amino acid that binds to NMDA receptors in the suprachiasmatic nucleus in the brain, which regulates our circadian rhythm. It is inhibitory and helps to lower body temperature, thereby increasing sleep.
- Magnesium: Magnesium is a mineral that catalyzes more than 300 enzyme reactions in the body, improving sleep by activating GABA.
- Tryptophan: Tryptophan is the amino acid found in turkey that is blamed for post-Thanksgiving feast naps. Tryptophan is the precursor to serotonin, which in turn is the precursor to melatonin. Studies show it has the best results when taken together with B6 and B3. Do not take tryptophan if you are on a MAOI medication.
- Valerian root, Valeriana officinalis: This slightly stinky root helps you fall asleep faster and improves sleep quality by affecting GABA receptors. However, it can sometimes have the paradoxical effect of energizing some people.
- Hops, Humulus lupulus: Yes, the same hops used to make beer also activate the GABA receptor. I highly recommend hops together with valerian and Passiflora as an aid to helping patients stay asleep.
- Passionflower, Passiflora incarnata: This beautiful flower is excellent for quelling cyclical, ruminating thoughts that can deter falling asleep. Take as a solid extract or together with valerian and hops.
- Magnolia, Magnolia grandiflora: Magnolia has the compound honokiol that activates GABA receptors and reduces cortisol. Magnolia is also a great immune help against viruses and is therefore useful for insomnia related to viral infections.
Here’s to your good night’s sleep!
Dr. Tara Tranguch wears the Oura ring to track her sleep and is passionate about improving her patients’ sleep. She is a licensed naturopathic physician in Woodbury, CT, with a focus on preventive health care, digestive issues, environmental medicine, and autoimmunity. Specialized treatments include nutrigenomics, homeopathy, and hydrotherapy.
Learn more at drtaratranguch.com and follow her at facebook.com/drtranguch.