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By Dr. Frank Lipman
In addition to a healthy diet and regular exercise, getting enough restful sleep is the most important thing you can do for your health. Proper sleep is one of the keys to looking and feeling your best, yet itís estimated that up to 70 percent of Americans are chronically sleep deprived. Unfortunately this is consistent with what I see in my NYC practice.
Chronic sleep problems interfere with your bodyís natural rhythms and rob it of the time it needs to restore itself. The incidence of many diseases including diabetes, high blood pressure, heart attacks and depression increases with a lack of sleep. Recent research has even shown a connection between poor sleep and weight gain. We simply werenít built to just go, go, go. We were built to go, go, go and then rest, rest, rest. We evolved according to the natural rhythms of darkness and light; our bodily functions reflect this and undergo similar fluctuations. They perform best when we live in accordance, as much as possible, with these cycles.
It is during sleep that your bodyís innate healing capacities kick into full gear. Your immune system gets revitalized. Hormones and metabolism are balanced, and general maintenance, fine-tuning and repair of all bodily systems is performed. A good nightís sleep, not just once in a while, but on an ongoing basis, is absolutely critical for your good health.
an ongoing basis, is absolutely critical for your good health. Insomnia is not a disease, but is usually a symptom of a deeper underlying bodily imbalance which can be corrected. For real success, the causes of the imbalance must be removed.
The most common underlying causes of chronic sleep issues are:
Although each of us is unique and, ideally, treatment should be individualized, my experience shows that the most effective long-term strategy for overcoming the most common type of insomnia in our fast-paced world is to better attune our bodies to the natural rhythm of darkness and light. This ultimately brings it back in sync with its natural rhythm. This can be done, for the most part, by changing bad habits and behaviors. In my practice, by doing this, I have seen a normalization in hormonal imbalances and a calming of the over-active nervous system, the two most common causes of sleep disorders.
As a result of living in tandem with the predictable patterns of day and night for thousands of years, these 24 hour cycles and rhythms became imprinted in our genes and, over time, we have developed internal body clocks that run in sync with nature. They are comprised of a variety of rhythmic patterns influencing every aspect of bodily function including hormone levels, digestion, body temperature and sleep.
But still our biology has not yet caught up with our ability to live without rest. And one of the most fundamental stresses on our systems is that we are living so out of sync with the natural fluctuations of light and dark. Our bodies evolved in dependence on signals from the sun, but to a large extent, we now get up without the sun, go to bed long after dark, work longer and longer days indoors under artificial lighting and spend little time outdoors, even in summer. During the day, we receive artificial light from fluorescent bulbs rather than the vitamin D-rich sunlight that our bodies need. Then, at night, when we need the dark to trigger essential melatonin production, excessive light throws our body rhythms out of balance even more.
Since the invention of the light bulb, obvious as its benefits have been, our lifestyles have really changed. Staying up all night can really sabotage our health. With light as with food, we must be careful of being overfed and undernourished. It becomes all too to easy to miss the very signals that regulate almost every system in the body, signals weíre primed to receive and without which we cannot function properly.
Itís essential to understand that itís not just what you do at night that affects your sleep. How you go about your day and shift into the evening also plays a big role in how well you sleep. So, Iíve put together some general sleep-friendly tips, broken down into daytime, evening and night time to help you start thinking in terms of how your body is affected by the day/night cycle and how you can get more in sync with it.
Maintaining a sense of calm throughout the day, getting some natural light and avoiding stimulants is essential for restoring normal sleep chemistry.
Sleep researchers at the Mayo Clinic believe that if you need an alarm clock to wake you up, itís a sign that youíre not sleeping right. Alarm clocks interrupt the sleep cycle and prevent sleep from completing naturally, pushing sleep problems into succeeding days. Dawn simulation devices are much more effective at establishing a healthy sleep cycle and gently rousing you from sleep.
Close your office door, or find a quiet spot somewhere and get comfortable. Take 5 minute breaks throughout your day to focus on your breath. If thatís challenging, then focus on your feet and then your hands. Feel them for a few minutes; become aware of them. This will calm you down. Quieting and slowing your mind calms the body, which is the perfect antidote to the over-stressed state we are often in.
We live and work in artificially lit environments and often miss out on the strongest regulatory signal of all, natural sunlight. Researchers at Johns Hopkins University found that itís actually light itself that governs our sleeping patterns. As sunlight enters our eyes it regulates and resets our biological clocks, which involves triggering our brains and bodies to release specific chemicals and hormones that are vital to healthy sleep, mood, and aging. Studies show that adults across America are spending less than one hour outdoors each day, far less than in the past. Try to get at least half an hour of regular exposure to natural sunlight a day.
Exercise is one of the best defenses against insomnia because it increases the amplitude of our daily rhythms. It signals the body to promote deeper sleep cycles. Both aerobic and anaerobic exercise work well. The best time to exercise is 4 - 6 hours before bedtime, but studies also show that people are more likely to stick to a routine if they exercise first thing in the morning. In general try to avoid exercising after 8pm as it may be too stimulating to your body and make it more difficult to get to sleep. This effect does vary, however, from individual to individual. Make an exercise plan for yourself that works for you and that you can stick to.
Caffeine, even in small doses, blocks sleep neurotransmitters, the calming chemicals your body makes to make you sleepy. If you have a problem with sleep, you must cut out all caffeinated beverages, even your morning cup of coffee. But caffeine is not just in coffee. Itís in colas and other soft drinks, teas, including herbal teas, chocolate and some medications. Thereís even a little caffeine in decaffeinated coffee. Caffeine is a powerful stimulant with effects that can last up to 7 hours. For people who have liver problems, or who are taking oral contraceptives or other medications (Anacin and Excedrin, for example), caffeineís effects can last much longer. It interferes with the bodies natural regulatory rhythms and chronic use of it can create a chronic bodily imbalance.
Go for it! For two weeks, eliminate sugar, corn syrup, sodas, refined grains and processed foods. These are metabolic disruptors which overstress the organs involved in hormone regulation and can seriously affect your sleep cycles. In addition, avoid dairy and gluten products, especially wheat, for the two weeks as these can cause food reactions or sensitivities which can affect your sleep cycle, too.
Your digestive system function peaks at lunchtime, so most of your food should be eaten by then. Your metabolism slows down in the late afternoon, leaving you poorly prepared to digest a large dinner; in other words: have a small one. Eat it early, at least 3 hours before going to sleep. Give your body a chance to recover and rebuild, instead of having to work on digestion while you sleep.
Medications such as antihistamines, diuretics, antipsychotics, antidepressants, decongestants, asthma medications, and some blood pressure medicines can cause sleeplessness. If youíre taking any necessary medication that interrupts your sleep, talk with your doctor about an alternative.
Expecting to go from full speed to a standstill without slowing down first is unrealistic. You should prepare for sleep by giving your body the right signals. It takes time to produce the sleep neurotransmitters needed by the brainís sleep center to release the hormones that will allow you to sleep. Reducing stimulation in the evening before going to bed boosts the production of sleep hormones. Taking some time to wind down and prepare your environment before hopping into bed will encourage a good nights sleep.
By 10 pm, stop sitting in front of your computer or TV screen and switch off all other electronic devices. They are too stimulating to the brain and inhibit the release of these sleep neurotransmitters.
Dim the lights an hour or more before going to bed, take a warm bath, listen to calming music or soothing sounds. Remove any distractions (mental and physical) that will prevent you from sleeping.
Too much stress is one of the most common causes of sleep disorders so learning to relax is key. Many people tell me they canít switch off their racing minds and therefore have trouble sleeping. Do some breathing exercises, restorative yoga or meditation. These will calm the mind and reduce the fears and worries that trigger the stress.
Creating consistency and optimizing the sleep environment are essential.
Going to bed around the same time, even on weekends, is the most important thing you can do to establish good sleep habits. We stay up late on weekends, expecting to make up sleep later or use the weekend to make up for lost sleep during the week. Both practices disrupt bodily rhythms and late night weekends, in particular, can cause insomnia during the workweek. We often think we can make-up for lost sleep by going to bed extra early another night, but the body clockís ability to regulate healthy sleep patterns depends on consistency. A regular sleep rhythm reminds the brain when to release sleep and wake hormones, which in turn effects all the other hormones, ultimately effecting our overall health.
Our bodies need complete darkness for production of the important sleep hormone, melatonin. If your bedroom is not pitch dark when you go to sleep, it interferes with this key process and disrupts your circadian rhythms. Even the tiniest bit of light in the room can disrupt your pineal glandís production of sleep hormones, disturbing your sleep rhythms. Look around your bedroom for glowing indicator lights and try to remove or cover them: alarm clock read-outs, charging indicators on cell phones or PDAís, the monitor on your computer, battery indicators on cordless phones or answering machines, the DVD clock and timer etc. Cover all the lights of any electronic device and use dark shades or drapes on the windows if they are exposed to light. If any of this is not possible, wear an eye mask.
Lowering ambient temperature sends a feedback signal to the brainís sleep center that it's nighttime, and that it needs to release more sleep hormones. A sleeping temperature of 60 to 65 degrees is best for most people, even in the winter. In hot weather, use a floor or ceiling fan to create a breeze, or an air-conditioner set at about 70 degrees. Interestingly, I have heard from a number of patients with chronic cold feet who swear by wearing socks to bed.
If noise from the street, an upstairs neighbor, pets or a snoring bed partner is a problem, try using earplugs, an electronic device that makes ďwhite noiseĒ or a fan that hums to drowns out the surrounding sounds.
Sleeping pills mask sleep problems and do not resolve the underlying causes of insomnia. Many sleep studies have concluded that long-term use of sleeping pills, whether prescription or over the counter, do more harm than good. They can be highly addictive and studies have found them to be potentially dangerous. If you have been taking them for a long time, ask your doctor to help you design a plan to eliminate them.
Because of alcoholís sedating effect, many people drink to promote sleep. Alcohol does have an initial sleep inducing effect, but as it gets broken down by the body it sends the wrong metabolic signals which can cause you to wake up later on. It usually impairs sleep during the second half of the night leading to a reduction in overall sleep time.
Instead of sleeping pills or alcohol, try some supplements or herbs that have a calming effect half an hour to an hour before bedtime. Magnesium (300-600 mg) can be helpful as can calcium. The amino acids, L theanine (100-500mg), 5 HTP (50-100mg), taurine and GABA, and herbs like lemon balm, passion flower, chamomile, magnolia and valerian root can also help.
For some people, melatonin can be extremely helpful. The dosage I usually use is anywhere between half a mg to three mg right before bedtime (sublingual tablets are better than oral). Melatonin is good for initiating sleep, not maintaining it.
Often just thinking about sleep affects your ability to fall asleep. What happens frequently is that the way we cope with the insomnia becomes as much of a problem as the insomnia itself. It often becomes a vicious cycle of worrying about not being able to sleep which leads to worsening sleep problems. Like so many things in life, it is about letting go and going with the flow. If you canít fall asleep, donít fight it Ė instead try to do something that will help you relax, and then try again. Sleep needs to become a natural rhythm like breathing, something that comes automatically.
Although the vast majority of my patients have been helped with these general tips, addressing the particular causes more specifically in some cases is necessary. Those with thyroid, adrenal or gastro-intestinal dysfunction, and women in peri-menopause or menopause may need additional targeted treatments. Similarly for women in peri-menopause or menopause. Those in pain may need more specific treatments and for chronic insomniacs, especially heavy snorers and those who are obese, it is a good idea to rule out Sleep Apnea as the cause. This is a serious condition that affects at least 12 million Americans, many of whom have not been diagnosed.
I know from personal experience and from the many patients I have seen, that incorporating these sleep tips into our lives has made a huge difference. There is nothing quite like going from being worn out and exhausted to bouncing back to life when you find a new sleep groove; start catching your sleep wave and start sleeping well.
The British poet Thomas Dekker observed that sleep is ďthe golden chain that ties health and the body together.Ē I couldnít agree more. Hereís to a good nightís sleep on a regular basis.
Frank Lipman MD, is the founder and director of the Eleven Eleven Wellness Center in NYC, where he practices a combination of Western and Eastern Medicine and the many other complimentary modalities he has studied.
He is the author of the recent REVIVE: Stop Feeling Spent and Start Living Again (2009) (previously called SPENT) and TOTAL RENEWAL: 7 key steps to Resilience, Vitality and Long-Term Health (2003).