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Solutions to Insomnia

on Jan 7, 2013 in Sleep, Wellness Blog, Wellness Seminar

Sleeping Less in San Diego

Can it Make You Sick, Fat, or Worse?

By Vicki Pepper MS, RD

If you are lucky, you will spend one-third of your life sleeping… and the other two-thirds of your life will be profoundly influenced by the quality and quantity of that sleep!  Even one night of inadequate sleep can ruin your mood, impair your judgment, and sour your interactions with others. Most adults need seven to nine hours of sleep each night. However, if you are typical, you are getting less sleep than that, and possibly less sleep with each passing year.

Before the invention of the light bulb, the average American slept nearly ten hours a night. There’s only so much you can do by candle light!  The next 50 years saw only a slight decrease in average sleep times. However, National Sleep Foundation Polls in 2005 and 2012 showed slumber decreased to seven hours by 2005 and continued to drop to an average of just 6.2 hours of sleep by 2012.  That is a drop of about three hours per night since the late 19th century; a drop of two hours per night over the past 50 years and about a forty minute drop a night just since 2005.

If sleep is so important, how is it we value it so little? One reason may be that we are not good at recognizing the negative effects of too little sleep. A study conducted at the University of Pennsylvania restricted people to less than six hours of sleep per night for two weeks; only a half hour less than the current national average. Over the two-week study, the volunteers reported only a small increase in sleepiness and rated themselves as “functioning normally.” However, when they were tested for memory, problem solving, and reaction times, their mental and physical abilities worsened progressively over the two-week study. In fact, their abilities deteriorated to such a degree that by the end of two weeks, the sleep deprived volunteers were as impaired as people who had stayed awake continuously for 48 hours.

Culturally we pride ourselves on needing little sleep. It’s not cool to be the one who goes to bed early. Pulling all-nighters and burning the candle at both ends are viewed as signs of success, strength, and importance. But sleep research tells us that, for most people, little sleep is not a sign of strength but a recipe for poor health. Dr. William Dement, MD, PhD, one of the co-founders of the Stanford University Sleep Disorder Clinic and a pioneer in sleep medicine, comments, “There is plenty of compelling evidence supporting the argument that [the quality of your] sleep is the greatest predictor of how long you will live, perhaps more of a predictor than whether you smoke, exercise, or have high blood pressure or cholesterol levels.”  There is indeed enough documented sleep research to bolster his claim. Sleep is critical for enabling the body to heal, repair, and regenerate. When sleep is compromised, normal body functions alter greatly. The need to sleep follows a circadian or daily biological rhythm; the body is ready for sleep and for wakefulness at different times of the day.  Sleep studies show that when sleep is interrupted, our entire biological rhythm is disrupted causing a cascade of unhealthy changes and long-term consequences.  Brain chemistry is altered, immune function decreases, and wound healing is diminished. Stress hormones are elevated as well as blood cholesterol, blood sugar levels, and blood pressure. There is an increased risk for diabetes, depression, heart attack, and even pre-mature death.

The Harvard Nurses’ Health Study has followed nearly 70,000 women for over 20 years connecting their lifestyle behaviors to health and longevity. Looking specifically at sleep, they found that women who slept less than six hours per night were nearly twenty percent more likely to have heart attacks than those who slept for eight hours. One of the largest, ongoing sleep studies is the Wisconsin Sleep Cohort Study. Their research found increased levels of stress hormones (cortisol and adrenaline), altered thyroid function, altered blood sugar metabolism, and insulin sensitivity in volunteers that averaged less than six hours a night for six or more nights. The changes in blood sugars were particularly concerning as some of the participant’s blood glucose levels were altered enough after only six nights of a shortened sleep cycle that their blood glucose levels classified them as pre-diabetic.

If this isn’t enough for you to want to go take a nap, consider that a review of sleep studies by Case Western Reserve University and Harvard Medical School concluded that every study documented a strong connection between sleep deprivation and weight gain. This connection was particularly true in children: all 31 studies showed an association between reduced sleep times and childhood obesity. One study on high school students found teens who slept less than seven hours a night were more than two and a half times as likely to be overweight than those sleeping more than eight hours.  Studies on food intake also support the connection between sleep deprivation and weight gain. Depending on which study you look at, sleep deprived people eat 300 to 500 more calories a day compared to when they are fully rested. If that doesn’t sound like much, then consider that over the course of a year, those extra calories would add up to a 30 to 40 pound weight gain.

Changes in appetite and satiety may be explained by hormonal changes. The Wisconsin study found that sleep deprived people secrete less leptin, a hormone that suppresses appetite, and more ghrelin, a hormone produced by the stomach that stimulates appetite. How these hormones regulate appetite and satiety is not well understood, and some of the research is confusing as higher leptin levels do not always produce satiety and low ghrelin levels do not always turn off appetite. Most likely the activity of these hormones depends on a biological or circadian rhythm very much like sleep. When the sleep rhythm is disrupted leptin/ghrelin secretion is also disrupted. This causes changes in appetite, feelings of being full after a meal, and how carbohydrates are metabolised.

Sleep is necessary for proper brain function as well. Sleep deprivation causes poor memory, lack of concentration, moodiness, and irritability. While insomnia has not been linked with causing depression, research suggests that people with insomnia have a tenfold risk of developing depression compared with those who sleep well. A report published in Internal Medicine News in 2005 documented that the effectiveness of antidepressant medication is enhanced when combined with medication for insomnia, suggesting that insomnia greatly increases a person’s risk for depression and complicates their recovery.

Needless to say, sleep is extremely important to your health, your weight, and your mental wellbeing.  It may indeed be the first step to achieving your personal best health; without enough sleep it is harder to make wise food choices, harder to exercise, more difficult to recover from exercise, and harder in general to make good life decisions.

STRUGGLING WITH SLEEP AND/OR GAINING WEIGHT?

  • CONSULT WITH A PHYSICIAN. If you have been struggling with insomnia for more than three months, consult with your Primary Care physician. You may need medication and your physician can rule out medical conditions that may be part of the problem.
  • CONSIDER BIOFEEDBACK. The combination of cognitive/behavioral strategies, relaxation techniques, and deep breathing used in Biofeedback are very helpful in resolving insomnia.  Biofeedback is available at the Positive Choice Integrative Wellness Center, Call (858) 573-0090 to schedule a FREE information session.
  • GET HELP FOR LOSING WEIGHT. Call the Positive Choice Integrative Wellness Center and learn about our many medically managed Weight Management Programs. Positive Choice offers several options for weight loss including full food plans and plans using either full or partial meal replacements.

Strategies for Better Sleep

  • Keep your sleep routines as regular as possible. Go to bed and wake up at roughly the same time on most days. Boring – yes, but important, especially if you are struggling with chronic insomnia. When daylight savings time-shifts occur, alter your wake/sleep routine by 15 minutes at a time until you get back into your regular cycle.
  • Increase your exposure to bright light or sunshine as soon as you wake up. The nerves in your eyes are designed to help you wake up when exposed to light. Use this as a way to help you wake-up and set your circadian rhythm. If you are a graveyard shift worker, wear dark sun glasses as you leave work and keep your eyes shielded from the light so that you won’t release hormones that will stimulate your wake cycle.
  • Spend time outdoors late in the afternoon or early evening. Human sleep cycles are heavily dependent on nature and light/dark cycles of the sun. This is especially important during the dark winter months. Keep active in well-lit places until eight p.m. and then gradually dim the lights in your house to mimic the gradual dimming of light that occurs in nature.
  • Be Nap Smart! In general it is best to avoid naps if you’re having problems with sleep. However, research shows older adults do better with light napping. If you do nap, do so before 3:00 p.m. and keep the nap time limited to 20 to 40 minutes in length.
  • Keep your feet and hands warm, and your bedroom chilly. Optimum sleep temperature is between 65 and 67 F°. Low room temperature increases melatonin production- a hormone that helps control sleep/wake cycles. Curiously, having a cool face but warm hands and feet has been found to help people fall asleep more quickly.
  • Take a warm bath or shower 30 minutes before sleep. The temperature difference from being very warm from bathing and then cooling off stimulates the pineal gland to produce more melatonin.
  • Ease up on evening liquids. Do not drink caffeine after noontime and no alcohol after dinner.
  • Keep your room dark and quiet. Light of any kind can trigger hormone release that causes you to waken. Those who struggle with insomnia may even be sensitive to the low red light of an alarm clock or the blue LED lights from electronics. If so, turn the clock away from your pillow and remove devices that emit light.
  • Avoid work or anything overly stimulating two hours before bedtime. Develop a relaxing routine before bedtime. The onset of sleep starts well before your head hits the pillow. Gradually allowing your body and mind to relax before you retire will help ensure an uninterrupted night of slumber. Avoid big screen TVs, they over stimulate the reticula (eye) activating system. Smaller TV’s emit less light and are less stimulating.
  • Invest in quality bedding. Mattresses should be changed every ten years; pillows should be replaced every two to three years.
  • Try listening to a sleep CD before bedtime. There are CDs composed with progressive relaxation exercises and tranquil music designed to induce sleep. If you are a Kaiser Permanente member visit kp.org and go to Health & Wellness/Live Healthy on the Kaiser Permanente website. There is a podcast specifically for sleep that you can listen to or download on a smartphone, ipod, or computer – and they are free!
  • Sleep alone if you can and don’t let Fido in the bed.  If you are having sleep problems keep pets away, and consider separate beds.
  • Maintain a regular, gentle exercise routine. Movement helps your body burn off stress hormones and release endorphins, hormones that aid sleep.
  • Make it a priority to spend time with good friends, doing fun things. The stress of everyday living, grieving a loss, or isolation can alter hormone production that controls sleep.