Beyond Paleo#9

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).1

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.2

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 system’s response to disease and injury.3
  • Overweight and obesity: Recent studies have shown that even one night of poor sleep can result in dramatic changes in appetite and food intake.4 Others have shown that restricting sleep to 5 hours a night for just one week impairs carbohydrate tolerance and insulin sensitivity.5 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.6
  • Cognitive decline: sleep deprivation negatively impacts short-term and working memory, long-term memory and the generation of nerve cells - all of which affect our ability to think clearly and function well.7
  • 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.8
  • Systemic inflammation: as I already mentioned above, sleep deprivation causes chronic, low-grade inflammation.9 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.10

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.11

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.12 Another study showed that the blue light emitted from alarm clocks and other digital devices suppresses melatonin production in a dose-dependent manner.13

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 sync with the daily variation in light exposure. We rose with the sun, and went to bed 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. 14

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.15 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 my patients and I tremendously. You can try a sample exercise (audio and pictures) here.