Sleep: an Elusive Balm for Body and Soul
for the Nutritional Therapist Spring 2009
“Sleeplessness is a desert without vegetation or inhabitants” ~Jessamyn West
You are tossing and turning, muscles tense, mind racing, watching the clock tick the hours by: we all have experienced insomnia. It can be triggered by a test the next day, concerns at work, worries about our beloved children, heat, pain and any number of life’s troubling events. Unfortunately, for some, a short-term insomnia can extend into a chronic problem. Insomnia is reported to affect between 30 to 50% of adults in the U.S. The degree of this problem is reflected in the fact that sleeping pills have been one of two most commonly prescribed medications. In 2004 Americans spent a total of $2.1 billion on sleep medications.
Sleep medications, with their problematical side effects have distracted us from addressing the issues that lead to sleeplessness. These medications, which, with prolonged use become ineffective and potentially psychologically addictive, offer a far less satisfactory approach to resolving insomnia than other approaches which we will look at in this article. A review of some of the literature of effective treatments for sleeplessness, bears the good news that insomnia can frequently be resolved. Peter Hauri and Shirley Linde in No More Sleepless Nights and Gregg D. Jacobs in Say good Night to Insomnia who encourage a variety of behavioral and lifestyle changes report 80 and 90% improvement in sleep in their patients. In an interview, Gray Graham, founder of the Nutritional Therapy Association, comments on what he has found to be helpful for sound sleep.
First, a little information about sleep. Our circadian rhythms of sleep and waking are orchestrated in large part by two biochemicals. Melatonin is the primary chemical responsible for relaxation and sleep while cortisol is a key player in waking up. Melatonin is triggered by darkness and its levels increase during the night to its highest level at around midnight. With the increase of melatonin, the metabolism slows and the core body temperature cools. As melatonin reaches its lowest level at around 3:00 AM the cortisol levels rise. The highest cortisol levels should be at 5:00to 6:00 AM., just before you wake up. If this is true a person will wake up feeling refreshed and rested. The cortisol levels taper off at the end of the day and melatonin takes over again. A study from Brazil looks at the relationship between sleep, cortisol levels and healing. Glucocorticoids (of which cortisol is the most important) suppress immune function. The night time, when cortisol levels are low in a healthy sleeper, is when our immune cells are most active. People with insomnia or sleep deprivation are reported to have diminished immune function.
Sleep researchers now recognize five distinct stages to sleep. The first two stages are shallower sleep. The third and fourth stages exhibit the delta waves of deeper sleep. According to Peter Hauri and Shirley Linde in No More Sleepless Nights, during delta sleep most of the blood goes to the muscles. It is also during delta sleep that most of the human growth hormone is secreted. If one does not experience the delta sleep one wakes up feeling off. One’s body does not function as well on the following day. The fifth stage of sleep, rapid eye movement or REM sleep is when we dream. This stage appears to be more restorative to the mind. Depending on how long you sleep, the body cycles through four to six cycles of these five stages of sleep. During the earlier half of the night the deep sleep stages are longer and during the second half of the night the REM stages are longer meaning that we tend to experience the majority of deep sleep during the first half of the night and the majority of REM sleep during the second half of the night.
In the practical parts of these books I found it interesting to note that all three traditional doctors suggest an explorational approach. In No More Sleepless Nights the authors suggest “If you think you have found something useful, double check by going off of it for a while and then reinstate it to see if it as really helping. Be you own best sleep therapist. ” Great advice.
The two books agree on many suggestions for ways to improve sleep. First order of business: reduce or eliminate caffeine, nicotine and alcohol. Studies indicate that doing so has a significant beneficial effect on sleep. Caffeine can affect the length of time it takes to fall asleep as well as the number of wakings during the night. It is not uncommon for people can get into a cycle of caffeine consumption in the afternoon followed by insomnia at night triggering fatigue again in the afternoons. While there is a large variation in individual response to caffeine, insomniacs tend to have a greater sensitivity. The effects of nicotine are similar to those of caffeine: they speed up the metabolism, raise the heart rate, increase the stress hormones and can last in the system for hours. Alcohol is thought by some to aid sleep, but although it might help one fall asleep, it can cause rebound insomnia and lower the quality of sleep, often including wake ups in the early morning.
Both books recommend a cognitive retraining in regards to sleep. Fear of not sleeping can become a cause of insomnia. To allay the fears of insomnia they report that people observed in sleep clinics usually have slept more hours during the night and performed better the following day than they had thought. Jacobs encourages training oneself to have “positive sleep thoughts”. Never try to sleep. If not sleeping, it is important to get out of bed to avoid associating the bed with troubled sleep. Find something to look forward to when you cannot sleep. Yoga, a breathing practice, reading, memorizing poetry, a meditation practice can each have a soothing affect and help with positive sleep thoughts. The gentle rhythms of these activities replace the fast paced rhythms of an anxious mind.
The concept of sleep efficiency is a useful one. Insomniacs tend to sleep fitfully and take more hours to get their full night’s quota of sleep. To retrain people with insomnia to sleep, researchers suggests reducing sleep time to where one is tired enough to sleep deeply and then gradually increasing the time in bed. It is useful to know that the amount of sleep needed varies from person to person. While seven and one half hours is the average amount of sleep needed, some people need as little as three hours and some as many as ten.
Certain habits are helpful for sleep. Finding rituals before bed that help relaxation; giving yourself time to wind down; regular exercise while paying attention to what time of day works best for your exercise are all aids in establishing regular sleep. Light therapy is a natural way to adjust sleep patterns. This can be helpful for people experiencing jet lag or those with regular difficulty falling asleep early enough. Bright light, usually early in the day, either from direct sunlight or light boxes can help with sleep cycles as well as with Seasonal Affective Depression (SAD). These lights reset the body clock, and alter the cortisol and melatonin cycles.
It is helpful to decide how many and what specific hours would be best for you to sleep and then get up at a consistent time in the morning even if you have not slept well. This offers three benefits: it compresses sleep time, it is evidence of a positive sleep thought (because it is based on the belief that you have and will get enough sleep during your chosen hours), and it can allow you to have sun or bright light exposure early in the morning to reset your sleep clock.
And now, a look at nutritional support for sleep. There are many ways that diet can affect sleep. Eating a large meal late at night causing your digestive system to work hard during the night can interfere with a nights’ sleep. It is better to eat a large breakfast, moderate lunch and light dinner. Eating slow burning protein and fats in a dinner meal can prevent the wakeful affects of dipping blood sugar levels. The Mayo Clinic doctors report that removal of a food which causes sensitivities can often result in immediate improvement of sleep.
Specific nutrients can also be helpful for sleep. Magnesium is often helpful for relaxing. Tryptophan is a precursor to serotonin, a hormone which contributes to relaxation and is a precursor to melatonin. A significant number of studies show tryptophan to be an effective sleep aid. B vitamins and omega three oils are helpful in the production and regulation of tryptophan. Dr Casey Adams from the Tahoma clinic suggests that eating foods containing a high ratio of tryptophan mid morning contributes to greater ease in both falling and staying asleep. The neurotransmitters dopamine and GABA, also play a significant role in sleep. For all of these nutrients, a healthy diet and digestive system is necessary to help the body ingest and utilize them. Sometimes supplemental support while repairing those processes is helpful.
Herbs can be beneficial to sleep. Valerian, Passiflora and Hops have been used for thousands of years and have been shown in numerous studies to be effective in increasing sleep quality. Passiflora and Hops can elevate mood and reduce sleeplessness caused by anxiety and over thinking. “Research has shown subjective sleep quality improvements [with these herbs] and quality of life improvements comparable to pharmaceutical benzodiazepines, without their side effects and dependency issues” says Dr Casey Adams of the Tahoma Clinic. On the other hand, some people report feeling groggy in the morning after these herbs. Some careful experimentation, perhaps with the support of a practitioner, will help you determine how they work for you.
In a phone interview, Gray Graham, founder of the Nutritional Therapy Association, speaks about how sleep can be related to blood sugar regulation. If we have proper blood sugar regulation, the liver produces glucagon to create a gentle message to increase glucose levels. In a situation of greater blood sugar disregulation, where the liver has become overwhelmed and insulin resistance has developed, the adrenals are called into play to raise the blood sugar. They do this by secreting glucocorticoids (think cortisol) which, in addition to causing the release of glucose into the blood stream, cause a rise in energy and wakefulness (an adrenal response). When people have the experience of being awoken by intense dreams or anxious thoughts, Gray’s interpretation is that it was the cortisol which triggered the stress which is then incorporated into the dream or mind state. Dietary adjustments are the first step to address dysglcemia. Supplements which address blood sugar regulation, liver and adrenal function can also be helpful with sleeping through the night.
Although prescription medication is a popular choice for sleep support, there is an extensive array of behavioral and nutritional tools which can provide the basis for a longer lasting solution. Sound sleep is a keystone to health. In the words of Thomas Dekker, an Elizabethan poet: “Sleep is the golden chain that ties health and our bodies together.”
Sources:
Peter Hauri PhD,director Mayo Insomnia Research and Treatmant Program and Shirley Linde, PhD (1991) No more Sleepless Nights
Gregg D. Jacobs, PhD, (1999) Say good Night to Insomnia
NTA, (2009) Clinical Reference Guide and Clinician’s View
Casey Adams, PhD, DSc @ Tahoma Clinic http://www.healthiertalk.com/natural-solutions-insomnia-0201
http://www.sleepdex.org/m6.htm: Sleepdex - Resources for Better Sleep
http://www.quotegarden.com/sleep.html
Gray Graham, phone interview 7/2009
Beatriz Duarte Palma; Paula Ayako Tiba; Ricardo Borges Machado; Sergio Tufik; Deborah Suchecki,Immune outcomes of sleep disorders: the hypothalamic-pituitary-adrenal axis as a modulatory factor Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
“Sleeplessness is a desert without vegetation or inhabitants” ~Jessamyn West
You are tossing and turning, muscles tense, mind racing, watching the clock tick the hours by: we all have experienced insomnia. It can be triggered by a test the next day, concerns at work, worries about our beloved children, heat, pain and any number of life’s troubling events. Unfortunately, for some, a short-term insomnia can extend into a chronic problem. Insomnia is reported to affect between 30 to 50% of adults in the U.S. The degree of this problem is reflected in the fact that sleeping pills have been one of two most commonly prescribed medications. In 2004 Americans spent a total of $2.1 billion on sleep medications.
Sleep medications, with their problematical side effects have distracted us from addressing the issues that lead to sleeplessness. These medications, which, with prolonged use become ineffective and potentially psychologically addictive, offer a far less satisfactory approach to resolving insomnia than other approaches which we will look at in this article. A review of some of the literature of effective treatments for sleeplessness, bears the good news that insomnia can frequently be resolved. Peter Hauri and Shirley Linde in No More Sleepless Nights and Gregg D. Jacobs in Say good Night to Insomnia who encourage a variety of behavioral and lifestyle changes report 80 and 90% improvement in sleep in their patients. In an interview, Gray Graham, founder of the Nutritional Therapy Association, comments on what he has found to be helpful for sound sleep.
First, a little information about sleep. Our circadian rhythms of sleep and waking are orchestrated in large part by two biochemicals. Melatonin is the primary chemical responsible for relaxation and sleep while cortisol is a key player in waking up. Melatonin is triggered by darkness and its levels increase during the night to its highest level at around midnight. With the increase of melatonin, the metabolism slows and the core body temperature cools. As melatonin reaches its lowest level at around 3:00 AM the cortisol levels rise. The highest cortisol levels should be at 5:00to 6:00 AM., just before you wake up. If this is true a person will wake up feeling refreshed and rested. The cortisol levels taper off at the end of the day and melatonin takes over again. A study from Brazil looks at the relationship between sleep, cortisol levels and healing. Glucocorticoids (of which cortisol is the most important) suppress immune function. The night time, when cortisol levels are low in a healthy sleeper, is when our immune cells are most active. People with insomnia or sleep deprivation are reported to have diminished immune function.
Sleep researchers now recognize five distinct stages to sleep. The first two stages are shallower sleep. The third and fourth stages exhibit the delta waves of deeper sleep. According to Peter Hauri and Shirley Linde in No More Sleepless Nights, during delta sleep most of the blood goes to the muscles. It is also during delta sleep that most of the human growth hormone is secreted. If one does not experience the delta sleep one wakes up feeling off. One’s body does not function as well on the following day. The fifth stage of sleep, rapid eye movement or REM sleep is when we dream. This stage appears to be more restorative to the mind. Depending on how long you sleep, the body cycles through four to six cycles of these five stages of sleep. During the earlier half of the night the deep sleep stages are longer and during the second half of the night the REM stages are longer meaning that we tend to experience the majority of deep sleep during the first half of the night and the majority of REM sleep during the second half of the night.
In the practical parts of these books I found it interesting to note that all three traditional doctors suggest an explorational approach. In No More Sleepless Nights the authors suggest “If you think you have found something useful, double check by going off of it for a while and then reinstate it to see if it as really helping. Be you own best sleep therapist. ” Great advice.
The two books agree on many suggestions for ways to improve sleep. First order of business: reduce or eliminate caffeine, nicotine and alcohol. Studies indicate that doing so has a significant beneficial effect on sleep. Caffeine can affect the length of time it takes to fall asleep as well as the number of wakings during the night. It is not uncommon for people can get into a cycle of caffeine consumption in the afternoon followed by insomnia at night triggering fatigue again in the afternoons. While there is a large variation in individual response to caffeine, insomniacs tend to have a greater sensitivity. The effects of nicotine are similar to those of caffeine: they speed up the metabolism, raise the heart rate, increase the stress hormones and can last in the system for hours. Alcohol is thought by some to aid sleep, but although it might help one fall asleep, it can cause rebound insomnia and lower the quality of sleep, often including wake ups in the early morning.
Both books recommend a cognitive retraining in regards to sleep. Fear of not sleeping can become a cause of insomnia. To allay the fears of insomnia they report that people observed in sleep clinics usually have slept more hours during the night and performed better the following day than they had thought. Jacobs encourages training oneself to have “positive sleep thoughts”. Never try to sleep. If not sleeping, it is important to get out of bed to avoid associating the bed with troubled sleep. Find something to look forward to when you cannot sleep. Yoga, a breathing practice, reading, memorizing poetry, a meditation practice can each have a soothing affect and help with positive sleep thoughts. The gentle rhythms of these activities replace the fast paced rhythms of an anxious mind.
The concept of sleep efficiency is a useful one. Insomniacs tend to sleep fitfully and take more hours to get their full night’s quota of sleep. To retrain people with insomnia to sleep, researchers suggests reducing sleep time to where one is tired enough to sleep deeply and then gradually increasing the time in bed. It is useful to know that the amount of sleep needed varies from person to person. While seven and one half hours is the average amount of sleep needed, some people need as little as three hours and some as many as ten.
Certain habits are helpful for sleep. Finding rituals before bed that help relaxation; giving yourself time to wind down; regular exercise while paying attention to what time of day works best for your exercise are all aids in establishing regular sleep. Light therapy is a natural way to adjust sleep patterns. This can be helpful for people experiencing jet lag or those with regular difficulty falling asleep early enough. Bright light, usually early in the day, either from direct sunlight or light boxes can help with sleep cycles as well as with Seasonal Affective Depression (SAD). These lights reset the body clock, and alter the cortisol and melatonin cycles.
It is helpful to decide how many and what specific hours would be best for you to sleep and then get up at a consistent time in the morning even if you have not slept well. This offers three benefits: it compresses sleep time, it is evidence of a positive sleep thought (because it is based on the belief that you have and will get enough sleep during your chosen hours), and it can allow you to have sun or bright light exposure early in the morning to reset your sleep clock.
And now, a look at nutritional support for sleep. There are many ways that diet can affect sleep. Eating a large meal late at night causing your digestive system to work hard during the night can interfere with a nights’ sleep. It is better to eat a large breakfast, moderate lunch and light dinner. Eating slow burning protein and fats in a dinner meal can prevent the wakeful affects of dipping blood sugar levels. The Mayo Clinic doctors report that removal of a food which causes sensitivities can often result in immediate improvement of sleep.
Specific nutrients can also be helpful for sleep. Magnesium is often helpful for relaxing. Tryptophan is a precursor to serotonin, a hormone which contributes to relaxation and is a precursor to melatonin. A significant number of studies show tryptophan to be an effective sleep aid. B vitamins and omega three oils are helpful in the production and regulation of tryptophan. Dr Casey Adams from the Tahoma clinic suggests that eating foods containing a high ratio of tryptophan mid morning contributes to greater ease in both falling and staying asleep. The neurotransmitters dopamine and GABA, also play a significant role in sleep. For all of these nutrients, a healthy diet and digestive system is necessary to help the body ingest and utilize them. Sometimes supplemental support while repairing those processes is helpful.
Herbs can be beneficial to sleep. Valerian, Passiflora and Hops have been used for thousands of years and have been shown in numerous studies to be effective in increasing sleep quality. Passiflora and Hops can elevate mood and reduce sleeplessness caused by anxiety and over thinking. “Research has shown subjective sleep quality improvements [with these herbs] and quality of life improvements comparable to pharmaceutical benzodiazepines, without their side effects and dependency issues” says Dr Casey Adams of the Tahoma Clinic. On the other hand, some people report feeling groggy in the morning after these herbs. Some careful experimentation, perhaps with the support of a practitioner, will help you determine how they work for you.
In a phone interview, Gray Graham, founder of the Nutritional Therapy Association, speaks about how sleep can be related to blood sugar regulation. If we have proper blood sugar regulation, the liver produces glucagon to create a gentle message to increase glucose levels. In a situation of greater blood sugar disregulation, where the liver has become overwhelmed and insulin resistance has developed, the adrenals are called into play to raise the blood sugar. They do this by secreting glucocorticoids (think cortisol) which, in addition to causing the release of glucose into the blood stream, cause a rise in energy and wakefulness (an adrenal response). When people have the experience of being awoken by intense dreams or anxious thoughts, Gray’s interpretation is that it was the cortisol which triggered the stress which is then incorporated into the dream or mind state. Dietary adjustments are the first step to address dysglcemia. Supplements which address blood sugar regulation, liver and adrenal function can also be helpful with sleeping through the night.
Although prescription medication is a popular choice for sleep support, there is an extensive array of behavioral and nutritional tools which can provide the basis for a longer lasting solution. Sound sleep is a keystone to health. In the words of Thomas Dekker, an Elizabethan poet: “Sleep is the golden chain that ties health and our bodies together.”
Sources:
Peter Hauri PhD,director Mayo Insomnia Research and Treatmant Program and Shirley Linde, PhD (1991) No more Sleepless Nights
Gregg D. Jacobs, PhD, (1999) Say good Night to Insomnia
NTA, (2009) Clinical Reference Guide and Clinician’s View
Casey Adams, PhD, DSc @ Tahoma Clinic http://www.healthiertalk.com/natural-solutions-insomnia-0201
http://www.sleepdex.org/m6.htm: Sleepdex - Resources for Better Sleep
http://www.quotegarden.com/sleep.html
Gray Graham, phone interview 7/2009
Beatriz Duarte Palma; Paula Ayako Tiba; Ricardo Borges Machado; Sergio Tufik; Deborah Suchecki,Immune outcomes of sleep disorders: the hypothalamic-pituitary-adrenal axis as a modulatory factor Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil