9 Steps to Perfect Health – #8: Get More Sleep

Sleeping woman

Insomnia has reached epidemic proportions. It’s estimated to be the #1 health-related problem in America. More than 1/3 of Americans have trouble sleeping every night, and 51% of adults say they have problems sleeping at least a few nights each week. 43% of respondents report that daytime sleepiness interferes with their normal daytime activities.

These problems are getting worse, not better. The number of adults aged 20 to 44 using sleeping pills doubled from 2000 to 2004, and the number of kids ages 1-19 who take prescription sleep remedies jumped 85% during the same period. Prescriptions for sleeping pills topped 56 million in 2008 – up 54% from 2004 – with over $5 billion in sales in 2010.

This isn’t surprising in a culture that values productivity and activity above all else, and is almost scornful of rest and relaxation. “Resting” for many people means watching TV, browsing the internet or engaging with some other kind of electronic device that is anything but restful for the brain and the body. We have not only forgotten the value of rest, we have forgotten how to do it.

You cannot be healthy without adequate sleep. Period.

Unfortunately for us, the body hasn’t forgotten the importance of sleep. It’s absolutely essential for basic maintenance and repair of the neurological, endocrine, immune, musculoskeletal and digestive systems. The hormone melatonin naturally increases after sundown and during the night in a normal circadian rhythm, which increases immune cytokine function and helps protect us agains infection. (This is why you’re so likely to get a cold or flu after not sleeping well for a few nights.)

In fact, sleep is so important to our overall health that total sleep deprivation has been proven to be fatal: lab rats denied the chance to rest die within two to three weeks.

Among other things, a full night’s sleep:

  • enhances memory and mental clarity
  • improves athletic performance
  • boosts mood and overall energy
  • improves immune function
  • increases stress tolerance

When things fall apart: how sleep deprivation destroys your health

Fewer than 6 hours of sleep per day is associated with low-grade chronic inflammation and worsening insulin resistance, as well as increased risk for obesity, type 2 diabetes and cardiovascular disease (CVD).

This is highly significant in light of a recent cross sectional study demonstrating that nearly one-third of US adults get less than 6 hours of sleep per 24 hour period.

Inadequate rest impairs our ability to think, to handle stress, to maintain a healthy immune system and to moderate our emotions. It’s associated with heart disease, hypertension, weight gain, diabetes and a wide range of psychiatric disorders including depression and anxiety.

The following is an abbreviated list of some of the more damaging effects of sleep deprivation:

  • Impaired immune system: a study from the University of California found that even modest sleep loss weakens the immune systems response to disease and injury.
  • Overweight and obesity: Recent studies have shown that even one night of poor sleep can result in dramatic changes in appetite and food intake. Others have shown that restricting sleep to 5 hours a night for just one week impairs carbohydrate tolerance and insulin sensitivity. Researchers now believe that sleep deprivation is the single best predictor of overweight and obesity in children – which has become an alarming problem. Finally, a brand-new study shows that not getting enough sleep causes fatty liver disease.
  • Cognitive decline: sleep deprivation negatively impacts short-term and working memory, long-term memory and the generation of nerve cells – all of which effects our ability to think clearly and function well.
  • Mood and mental health: anyone who has had a few nights of poor sleep can tell you that insomnia is associated with depression. Insufficient sleep shuts down the pre-frontal cortex and can cause or exacerbate a number of psychological conditions, ranging from anxiety to PTSD to depression.
  • Systemic inflammation: as I already mentioned above, sleep deprivation causes chronic, low-grade inflammation. And we now know that inflammation is the root of all modern disease.
  • Increased risk of death. Last, but certainly not least, not getting enough sleep reduces your lifespan.

Of course we could go on. There’s really no disease or medical condition that sleep deprivation doesn’t either contribute to directly or make worse.

I firmly believe that lack of sleep and stress are the two biggest health challenges we face today. If you’ve been reading this series (and this blog over time), you know how much value I place on proper nutrition. But it’s much easier for most people to make changes in their diet than it is for them to improve their sleep and manage their stress.

And here’s the thing: you can eat a perfect diet and take all the right supplements, but if you’re not sleeping well and managing your stress, all bets are off. I see this every day in my private practice.

How to get a good night’s sleep

Before we get into natural tips on improving sleep, I want to say a few words about sleep medications. In spite of their popularity, they are not without risk – including dependence, rebound insomnia, drowsiness, memory loss, bizarre sleep walking behavior, changes in brain chemistry, constipation and much more.

On the other hand, there is a point at which the harmful effects of sleep deprivation start to outweigh the potential adverse effects caused by sleeping pills. This is when I believe sleep meds should be used as a last resort, presuming all non-drug approaches have failed. Once you get into extreme sleep debt, it can be difficult to make it out without some biochemical assistance.

That said, there are many ways to prevent this from happening in the first place and to naturally improve the quality of your sleep if it’s poor.

Reduce your exposure to artificial light

Artificial light disrupts our circadian rhythm and throws off our sleep. Just a single ‘pulse’ of artificial light at night disrupts the circadian mode of cell division, which can not only impact our sleep, but also increase our risk of cancer. Another study showed that the blue light emitted from alarm clocks and other digital devices suppresses melatonin production in a dose-dependent manner.

Follow these tips to avoid light exposure:

  • Don’t use a computer for 2 hours before going to bed. No staying up late on Facebook and Twitter!
  • Use blackout shades to make your bedroom pitch black.
  • Cover your digital alarm clock or get an analog clock.
  • Turn off all digital devices that glow or give off any type of light.
  • If you can’t do these things for some reason, use a sleep mask.

Don’t be too full – or too hungry

Some people sleep better after eating a light dinner. This is especially true for those with digestive issues. Others – like those with a tendency toward hypoglycemia – do better with a snack before bed (and possibly even during the night).

Go to bed earlier

You’ve all heard the saying “an hour before midnight is worth two hours after”. It turns out there is some truth to that. When you fall asleep, you go through a 90-minute cycle of non-REM sleep followed by REM sleep. But the ratio of non-REM to REM sleep within those 30 minute cycles changes across the night. In the early part of the night (11pm – 3am), the majority of those cycles are composed of deep non-REM sleep (stages 3 and 4) and very little REM sleep. In the second half of the night (i.e. 3am – 7am) this balance changes, such that the 90-minute cycles are comprised of more REM sleep (the stage associated with dreaming) as well as a lighter form of non-REM sleep (stage 2).

What’s important about this is that deep stage 3 and 4 sleep is where our body regenerates and repairs tissue and engages in other restorative processes. If we don’t get enough deep sleep, we can’t rejuvenate and heal.

So you say you’re a night owl?

Patients often tell me they’re “naturally” night owls, and they’ve always preferred to stay up late and sleep in. But in truth there’s nothing natural about this. For millions of years of human evolution sleep patterns remained in synch with the daily variation in light exposure. We rose with the sun, and went to be soon after sundown. This is what our bodies are adapted for.

In almost all cases, having a lot of energy late into the night is a sign of a disrupted circadian rhythm. Normally, cortisol should be high in the morning and taper off throughout the day and into the evening. This gives us the energy we need to wake up in the morning, and allows us to start winding down after dark so we’re ready to sleep. In people who’ve been exposed to significant chronic stress, this rhythm goes haywire. They have low cortisol in the morning (which makes it very hard for them to get going) and high cortisol at night, which gives them that late second wind. While drinking several cups of coffee in the morning mitigates the morning fatigue to some degree, it also perpetuates the pattern by revving them up in the afternoon and evening.

When I treat these so-called “night owls” for cortisol and melatonin rhythm dysregulation, one of the first things they report is feeling tired at night. And that’s a good thing! It takes them a while to adjust their lifestyle, but ultimately they’re better off for it.

For more good recommendations on improving sleep, read Mark Sisson’s Definitive Guide to Sleep.

When good sleep hygiene isn’t enough

I’m reluctant to make any recommendations about supplements and nutrients for sleep problems, because the decision about what to take depends on what the underlying cause of the problem is in the first place.

In general, though, magnesium is a good choice. Most people are deficient in it and it is not toxic at daily doses up to 800 mg. It’s also cheap and easy to find. I prefer the chelated forms of magnesium like glycinate and malate, but others like a product called Natural Calm which is mixed in warm water before bed. Be careful – it can have a laxative effect.

Melatonin is another commonly used sleep aid. But I don’t recommend it for anything more than emergency, short-term use. Why? Because melatonin is a hormone. Taking any supplemental hormone disrupts our natural regulatory mechanisms of that hormone and throws our internal production of it out of whack. This can create dependence over time and disrupt our circadian rhythm, which is crucial not only to sleep, but to overall health.

What I recommend instead to all of my patients with sleep issues – and what I use myself – is a program called Rest Assured. The premise behind the program, which I agree with completely, is that the most important factor in getting a good night’s sleep is managing stress during the day.

Most of us run around like chickens with their heads cut off all day, and then wonder why we can’t fall right asleep as soon as our head hits the pillow. If our nervous system has been in overdrive for 16 hours, it’s unrealistic to assume that it can switch into low gear in a matter of minutes simply because we want it to. Of course this is why sleeping pills are growing in popularity each year.

The Rest Assured program has simple, easy-to-follow breathing and movement exercises designed to promote daytime relaxation and a good night’s sleep. It helped me and my patients tremendously. You can try a sample exercise (audio and pictures) here.

Do you have trouble sleeping? What has worked for you? Leave a comment under the “Sleep More Deeply” post on my Facebook page.

Categories

Perfect Health

Join the 89,165 others
taking control of their health.

Get clarity, personalization – and motivation.

Register for Free Today

Comments Join the Conversation

  1. says

    Chris,

    In your opinion, is the Rest Assured program more effective at treating difficulty falling asleep, or difficulty staying asleep? Or is it just as effective at both since it lowers stress levels in general? I’ve had sleep issues in the past half year or so that are becoming chronic and am strongly considering giving the program a try. Thanks for any input!

    • Chris Kresser says

      It is effective for both in my experience, because it mitigates the overall impact of stress on cortisol and the adrenals.

  2. says

    Chris,

    What about the suggestion of a sleep study to see if someone has sleep apnea? They often treat this with a CPAP machine which usually helps people sleep better.

  3. Trey says

    What about sleeping in. I’m thinking blackout curtains will improve this but I can’t seem to sleep past 6-7am. I know that’s probably when I should be getting up and that the real answer is to go to bed earlier. I’m working on some of the obligations that keep me away from the house after sundown – but you’re correct, these changes are much harder than eating and exercising right.

  4. Julieta Worley says

    Chris,

    Do you have any suggestions for people who work grave shifts? My husband has been working grave for 4 years and unfortunately because of the economy he has not been able to find a different job (he’s been looking for almost 2 years). His health has definitely suffered and even though we’ve gone “Primal” he’s been unable to lose much weight or fell much better. We just know it’s because of the sleep!

    • Asia says

      My question too. How is cortisol/melatonin dysregulation treated? Please, nothing has worked for 25 years!

  5. says

    Great articles on health Chris, I’ve really enjoyed reading so far, I was wondering what your thoughts are on using 5HTP as a natural sleep aid? I know its often used for depression, but I’ve found it combined with magnesium and zinc can work well for my clients?

    Thanks Ollie

  6. sara says

    Sorry – I am really late to post on this one… I’m wondering if you have any suggestions on children (namely my 2 year old!) who prefer to sleep with a night light/the door open with the hall light on. We use a night light with him & he is now asking to keep his bedroom door open with the hall light on. I’m not sure if he’s really scared of the dark (he doesn’t seem to be but I don’t want to cause him to be) or if he is just trying to make his own decisions (you’ll learn all about this when your’s is two!). Anyway, I am concerned about the artificial light disrupting his sleep (for the most part he sleeps great, but it’s taking him longer & longer to fall asleep at night…he doesn’t cry at night but lays & talks in his crib for quite a while), but at the same time I don’t want him to be scared so we continue to use the lights. Any suggestions???

  7. Jim says

    An acrylic or wool winter hat is a great way to cover an alarm clock to hide the light emission.

    I happen to be travelling this week and even though the hotel has think drapes, there is a lot of light. After sleeping in complete darkness at home, I do notice the difference sleeping away from home with artificial light sneaking in.

  8. Jason says

    How can too much sleep affect one’s health (i.e. 8-9 hours sleep @ night + 3-4 during the days on weekends)? I know someone who is pregnant and practices this sleep pattern.

  9. Nadine says

    And you haven’t even mentioned the effects of grehlin and leptin on our appetites, from lack of sleep or enough sleep. This has a huge effect and it has been well proven in scientific tests.

    Then once you have diabesity and get sleep apnoea, then it’s a vicious cycle! Not enough sleep makes you gain weight, gaining weight means you keep your sleep apnoea.

    I personally think that poor sleep patterns that are given to our children by our lack of discipline can cause a trend towards obesity. I know there are many other factors, but this is definitely one of them imho. Babies need 18 hours a sleep when they are tiny, and small children still need over 12 hours sleep a day.

  10. Andy says

    Dear Chris,

    I had a tumor removed from my bladder and it came back low grade low stage nonevasive carcinoma and have gotten over that yet simulaniouly was diagnosed with severe fatty liver disease and exteinsive fibrocious from NAFLD. We are in Bangkok Thailand and I have not sleep well in a month. I am told to lose wieght and it if falling off too fast and in fact they said slow down cause the liver scores are climbing. The Doc here gave me xanax and sitll not taking it.

    Sorry for bothering you yet wnated to know your ideas on this. I can call you as well.

    Andy

  11. Angela says

    Hello Dr. Kresser,

    I have been dealing with insomnia quite some time. My practictional put me on bioidentical hormones for about a year, but that didn’t solve the problem. Later found out I have Adrenal Fatigue, where my cortisol is low all day but up at night. Currently I am on adrenal supplements, but I am still waking up middle of night and can’t go back to sleep. I have no problem falling asleep at night, but I am constantly waking up middle of night to go bathroom, then can’t seem to fall back to sleep. My diet is pretty solid, eating paleo for more than a year, and I rarely crave sugar or eat sugar (including fruits). Would you recommend having a light snack before going to bed? If you do, what do you suggest? Nut better, fruit, eggs, leftover dinner??
    Thanks,
    Angela

  12. Alexander says

    Chris, you say sleep aids can be used as a last resort. I’ve tried everything and feel I as if I’m at that point. If not melatonin, which sleep aids would you suggest that wouldn’t cause too many gut problems? Which do you feel are the least damaging?

  13. Linda says

    I tend to wake up every time I need to move (about every 90 minutes or so). I can usually go right back to sleep, but my sleep is still disturbed. I have chronic pain for which I have taken ibuprofen, but I don’t want to be dependent on taking it every night just so I can sleep. I’m sure that the pain is part of what is keeping me from sleeping more deeply. I have not had any success in trying to treat the pain in and of itself. Any suggestions?

  14. E. ismai; says

    hi
    i wrote to u on supplements, and breifely mentioned that I have sleeping problem. For over 10 years a doctor told me to take atarx to help me sleep. i did not realize it and time past by.
    Over 6 months ago, i had gone through some kind panic due to temporary problem with PB, it is stable now, however this has created huge anxiety problems and panic that i went into almost depressed state, Due to this the Atrax could not help any more, i stopped, and after months later i did not realize this and I opened my eyes on the sleeping problem, to discover that it is the one causing me all tension, aches in knees , arm muscles, lack of energy.

    Due to this i have re structured my eating habit again into better way(before i used to follow also good practices) but when i lost lots of Kg i had to do better. Actually it worked my health is good, but i still experience the aches and lack of energy. I used few times sleeping bills but i stopped, i did not want to be hooked.
    Iam seeing Ayurveda doc for 5 weeks, couple of weeks was ok, but then I lacked sleep again. i told the doctor so, and she told me take the atrax and continue their medication. i actually did instead i took anti histamine histalog 10mg, it is giving me some sleeping hrs.
    I do not like it, i like to find solution if i can without medication that cause severe side effects.
    I prefer natural,
    can u advise by email, iam willing to accept some consultation fees, for guiding me

  15. Dave says

    I think caffeine deserves more of a mention hear considering 90% of the population are addicted to it. In my experience when you take most people off caffeine 100% the insomnia disappears

  16. says

    Hi Chris,

    I have scoured books and the internet for help with early morning awakening. I wake faithfully between 3-4 am, no matter what. I go to sleep easily, sleep well, but have for years woken early. I have tried going to bed later, but I end up even more sleep deprived as I still wake at the same time!! I have read that this is hormone related, but I as of yet have not been able to remedy the situation. No caffeine, good diet, minimal stress, regular bed time….but still no change. I use magnesium and sometimes GABA. I don’t like melatonin for the same reasons you state. I have tried a little fat and good carbs before bed. Can you or others recommend anything else? I sure would like to sleep in a little….even until 5!

    • Inde says

      This is for Amy:
      Maybe you have the same problem I have and are an “incremental” sleeper, a person who sleep in 4 hour intervals? I do, no matter when I go to bed…if at 10:00 pm – I’ll wake up at 2:00 am and then, after being “wide awake for a few hours” – I’ll sleep another 4 hours. I know I’m not alone in doing this and wish, Chris would address this!

  17. Trish Davies says

    Hi Chris, I tried Holy Basil/ginseng and magnesium which did help, but the most effective thing I did was start to go to bed earlier AND wearing a face mask to block out all light. It also stopped me from opening my eyes to the faint light. My eyes are kept closed and I certainly sleep better. I find too, that getting out into the sun during the day helped get my rhythym working.

  18. Karl arman says

    I have been a poor sleeper for 30 years. I have tried it all, twice. Refuse any drugs. Chris, if you come up with a surefire remedy, you would end up being the richest man in the world.

  19. Susan says

    I am disppointed there is no mention of sleep studies. Sleep apnoea is a major cause of sleep disruption and increases the risk of many health problems. For example it increases the risk of a CVA threefold and shortens lifespan. Treatment is either with CPAP or a mandibular advancement splint. Both great drug free treatments. A sleep study can rule sleep apnoea in or out, just like having a blood test. No amount of supplements, avoiding bright lights or caffeine for example will overcome the powerful force that is sleep apnoea.

  20. John McDonell says

    thanks Chris for this beginning discussion on an extremely important topic. Reading many of the comments, I get the distinct impression that sleep (because this-time -’forced’-upon-us & is not-chosen, that it is simple). Her book called ‘Lights Out’ by T.S. Wiley paints a simplified version that only hints at how complex & busy sleep actually is.

    A rather simple illustration: the color indigo (very deep blue) is the predominant color of the sky at night. The healing qualities of this color precisely mimes that of the famous blueberry. By sleeping indoors, do we minimize the effects of this color? How about nighttime UV + natural magnetic radiation (the kind that birds migrate by) + the circular magnetic patterns emitted by all modern AC electric wires … and we wonder why our hormone/stress/cortisol levels are so high.

  21. Jayme Wolk says

    I am a night person and am productive more at night. I also don’t get home till 8 ish and enjoy relaxing and eating slowly. My biggest problem is I am on Effexor and progesterone and they knock me out and I wake up in a stupor and during night! This effects my work any suggestions

Join the Conversation