By Dr. Lisa Williams
Having it all can sometimes mean not having enough sleep. Sleep disturbances are one of the most common patient complaints in medical offices today. Thankfully, there are many ways to encourage a good night’s sleep.
Impairment of sleep is not just an issue of annoyance or daytime discomfort. Several negative health consequences of sleep deprivation have been studied, including cardiovascular disease, delayed healing, disruptions in metabolism, gastrointestinal disorders and Hypothalamus, Pituitary, Adrenal (HPA) axis dysregulation. Sleep impairment has even been studied as a public health issue, with links to increased motor vehicle accidents and critical job errors.
A recent study highlights sleep deprivation’s potential impact on the endocrine system. The study, published in the Journal of Clinical Sleep Medicine, notes sleep debt resulted in long-term metabolic disruption and may promote progression of type 2 diabetes in newly diagnosed patients. Patients in this study were more likely to suffer from obesity when sleep debt was present. Another interesting study, in a murine model, suggests a continuous environment of light may be implicated in the pathogenesis of hyperandrogenism and polycystic ovarian syndrome, implicating poor sleep habits may be an important factor in the development of PCOS.
Insomnia, blood sugar instability, sleep apnea, restless leg syndrome, sleepwalking, jet lag, bruxism, medication effects, narcolepsy, nightmares, neuroendocrine imbalance and disruptions in melatonin phases are several of the possible etiologies behind sleep disturbances. While some etiologies require more extensive treatment, consider prioritizing sleep hygiene to create the foundation of a healthy sleep wake cycle. Sleep hygiene may sound like a term used to describe the act of showering before bed or falling asleep in freshly laundered sheets; however, this is a term commonly used to refer to the behaviors and habits surrounding sleep preparation. When utilized appropriately, sleep hygiene can improve not only sleep quantity, but also sleep quality.
- A bedtime that allows for 8 hours of sleep (the average adult, ages 18-40, requires 7-8 hours of sleep each night)
- Consistent daily sleep and wakes times, even for weekends and vacation days
- Daily exercise
- Adequate exposure to natural light during the daytime to encourage proper melatonin levels
- A pleasant and relaxing bedroom environment (a cool temperature, dark, quiet, and free of distractions such as pets and electronics)
- A pre-bedtime routine: a warm bath, meditation, stretching or a non- rigorous yoga session are possible options
- Association of bed with sleep. Limit other activities such as reading, writing, eating or electronic utilization to areas outside of the bedroom
- Keeping a notepad beside the bed to jot down thoughts or ideas and clear the mind
- The use of natural sleep aides like Melatonin (Helps you fall sleep), 5 HTP (Helps you stay asleep), Herbs like Valerian root and Hops, Phenibut and amino acid L-theanine which down-regulates adrenaline.
- Caffeine consumption
- Alcohol consumption
- Nicotine use
- Large meals and/or large quantities of water close to bedtime. If blood sugar dysregulation is present a few grams of complex carbohydrate and protein before bed can be helpful
- Decrease Light exposure (especially blue light from screens) in the evening time, which decreases melatonin levels
- Strenuous exercise within six hours of bedtime
- Use of sleeping pills, which can be habit forming
Clinically, optimization of sleep hygiene is an effective place to start as it is low of therapeutic order and may address sleep issues before more potent treatments are needed. Remember that daily habits performed throughout the day, not just those performed close to bedtime may affect sleep-wake cycles.
When sleep disturbances run deeper than simple sleep hygiene habits, testing for salivary melatonin and cortisol levels may be the key to restoring altered circadian rhythms while allowing for targeted treatments
Dr Lisa Fitzwilliams has been in clinical private practice for 31 years. She is a licensed Certified Clinical Nutritionist, Doctor of Chiropractic, and Functional Medicine practitioner.
- Arora T, Chen MZ, Cooper AR, Andrews RC, Taheri S. The Impact of Sleep Debt on Excess Adiposity and Insulin Sensitivity in Patients with Early Type 2 Diabetes Mellitus. J Clin Sleep Med. 2016.
- Kang X, Jia L, Shen X. Manifestation of Hyperandrogenism in the Continuous Light Exposure-Induced PCOS Rat Model. Biomed Res Int. 2015;2015:943694.
- Stepanski EJ, Wyatt JK. Use of sleep hygiene in the treatment of insomnia. Sleep Med Rev. 2003;7(3):215-25