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August 15, 2018

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Sleep: Why It's So Important and How To Get More Of It

July 1, 2019

 

Sleep is crucial to keeping your brain and body healthy and functioning at peak performance. Ironically, it is common in today’s culture to view sleep as impedance to accomplishment, and thus purposely delay or shorten sleep time in the interest of productivity (or sometimes just to watch more television or spend more time on social media). As a result, many people are chronically tired and rely on stimulants to get them through the day, only to repeat the cycle that night. Hopefully by the end of this post you will have a better understanding of how important sleep is for your health, both short- and long-term. In addition, if you are struggling to get adequate or good quality sleep, the following information should help you take some steps towards a better night’s rest.

 

Many people inaccurately think of sleep simply as a time of rest. However, sleep is actually a very active time physiologically. It’s more accurate to think of sleep as a dynamic and complex process you need to experience each night to ensure your overall well-being and long-term survival. While much about sleep remains a mystery, we have learned some of the general functions of sleep. There is the obvious tissue healing and overall restoration that occurs, but in addition to this, sleep is a time when your brain removes toxins, organizes and consolidates memories, and does general housekeeping. Lack of sleep can result in these important processes going awry or simply undone. To understand the implications of this, consider what your house would look like if various items were never put away while others were put away in the wrong place, the garbage was never taken out, and basic cleaning was left undone. Needless to say, it’s not a house many people would want to live in. We also need sleep to regulate our mood and modulate our immune system, which helps explain why being short on sleep can lead to a cranky disposition and more frequent colds. But sleep deprivation doesn’t just cause immediate, short-term problems, it has also been linked to increased risk for obesity, cardiovascular disease, type 2 diabetes, and cancer. Perhaps unsurprisingly given its critical role in brain health, long-term sleep deprivation is also associated with increased risk of mental illness, dementia, and Alzheimer’s disease. To avoid these health risks, research suggests that getting 7-8 hours of uninterrupted sleep per night is ideal for adults (sleep requirements for other age groups can be found at this link).

 

Unfortunately, getting good quality sleep is easier said than done for many people with busy and stressful lives. In addition, some people are unknowingly sabotaging their own sleep with daily habits that have implications for sleep onset, quality, and duration. This includes consuming caffeine in large quantities or later in the day, having an erratic schedule, and not having a relaxing nighttime routine. In addition, many people are in the habit of utilizing electronic devices (cell phones, iPads, computers, and so on) until they want to go to sleep, and then find that they have trouble falling asleep. Because these devices emit blue light from their screens, they stimulate the brain in such a way as to promote wakefulness. A good rule is to avoid screens for two hours before bedtime. Likewise, make a point of exposing yourself to bright light early in the day while keeping lights low in the evening. Another habit that may not seem detrimental on its face is drinking alcohol before bed. It’s important to know that while alcohol may promote drowsiness initially, it can contribute to rebound nighttime waking later. Try to avoid alcohol for a couple hours before bed, and know that each alcoholic drink consumed before bed can affect two hours of sleep. Along the same lines, sleeping in a room in which a television is on, even if it helped you fall asleep initially, will negatively affect the quality of your sleep.

 

Many chronic conditions can affect sleep, including anxiety, depression, and obstructive sleep apnea. Addressing such underlying issues is critical to improving your sleep and protecting your long-term health. Therefore, please seek care if you think you may be suffering with one of these conditions.

 

If you’ve been struggling with insomnia and would like to address it without the use of medication, Cognitive Behavioral Therapy for Insomnia (CBT-I) is a great place to start. This is considered first-line therapy for insomnia by sleep experts, possibly being as effective as medication but with more long-term success and without the risks inherent in taking prescription sleep aids. The four main focus areas of CBT-I are: sleep deprivation, stimulus control, relaxation therapy, and cognitive restructuring. Each will be discussed briefly in turn. Sleep deprivation refers to the practice of intentionally moving one’s bedtime up to the time that they are currently falling asleep (while still allowing for at least 5 hours of sleep). For example, if you go to bed at 10pm but don’t fall asleep until midnight, your new bedtime is moved up to midnight and then moved back in 30-minute intervals, a week at a time, until the desired bedtime is reached. The idea behind sleep deprivation is to reinforce the connection between the bed and sleep by reducing the time spent in bed awake. Similarly, stimulus control refers to only utilizing the bed for sleep. That means if you are unable to sleep after 10-15 minutes of effort, you should get up and leave your bedroom, instead doing something quiet in another room until sleepiness returns, at which point you can return to your bedroom. Relaxation therapy is used to help bring about sleep and may include techniques such as progressive muscle relaxation, guided imagery, and meditation, all of which can be learned from a trained practitioner or readily available resources such as online programs. Finally, cognitive restructuring is intended to address the inaccurate beliefs that perpetuate insomnia. This means checking in with one’s thoughts, such as: “If I can’t sleep tonight, I will fail my test tomorrow”. Chances are this is not the case, and recognizing such a thought as distorted lessens its grip. If you are interested in going more in depth with CBT-I, consider seeing a counselor who is trained in utilizing CBT-I with their clients.

 

A discussion about sleep is not complete without discussing the many medications and supplements used and marketed for insomnia. The unfortunate reality is that, while medications/supplements may help to a degree for a short period of time, the magnitude of their therapeutic effect is often over-estimated and tends to lessen over time, leaving the user even more frustrated. In addition, prescription medications such as zolpidem/Ambien have been linked to increased risk of all-cause mortality (death). The supplement melatonin (generally dosed 1-3mg half an hour before bed) can modestly shorten the amount of time needed to fall asleep and is generally regarded as safe. Herbal supplements present an attractive alternative but there has not been much research on their safety or effectiveness. However, there are many herbs that have historically been used as sleep aids. In no particular order these include valerian, chamomile, passionflower, lavender, California poppy, hops, lemon balm, motherwort, and skullcap, among others. Commercially available herbal blends that incorporate various combinations of these herbs may be a reasonable place to start if you’re suffering from a bout of insomnia that is not responding to the previously discussed behavioral measures and you wish to avoid the risks associated with prescription sleep aids (always look for GMP or USP certification seals on the label when purchasing herbs and supplements to help guide you to a high-quality product). Do not make the mistake of thinking that taking a pill, supplement, or herb can make up for daily habits that are contributing to poor sleep. A truly holistic approach to improving sleep considers one’s day-to-day behaviors first and foremost. And remember, nothing can do for the brain and body what a good night’s rest can.

 

Sources

 

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2. Ooms S, Overeem S, Besse K, Rikkert MO, Verbeek M, Claassen JAHR. Effect of 1 Night of Total Sleep Deprivation on Cerebrospinal Fluid β-Amyloid 42 in Healthy Middle-Aged Men: A Randomized Clinical Trial. JAMA Neurol. 2014;71(8):971–977. doi:10.1001/jamaneurol.2014.1173

 

3. Sherzai, D., & Sherzai, A. (2017). The Alzheimer's Solution. New York, NY: HarperCollins.

 

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6. Rasch, B., & Born, J. (2013). About sleep's role in memory. Physiological reviews, 93(2), 681–766. doi:10.1152/physrev.00032.2012

 

7. 1 in 3 adults don't get enough sleep. (2016, February 18). Retrieved April 15, 2019, from https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html

 

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10. Sleep and mental health. (2009, July). Retrieved April 15, 2019, from https://www.health.harvard.edu/newsletter_article/sleep-and-mental-health 

 

11. Blask, D. (2009). Melatonin, sleep disturbance and cancer risk [Abstract]. Sleep Medicine Reviews, 13(4), 257-264. https://doi.org/10.1016/j.smrv.2008.07.007 

 

12. Excessive sleepiness: Safety. (n.d.). Retrieved April 15, 2019, from https://www.sleepfoundation.org/excessive-sleepiness/safety 

 

13. Mitchell, M. D., Gehrman, P., Perlis, M., & Umscheid, C. A. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC family practice, 13, 40. doi:10.1186/1471-2296-13-40

 

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15. Jacobs, G. D., Pace-Schott, E. F., & Stickgold, R. (2004). Cognitive behavior therapy and pharmacotherapy for insomnia: A randomized controlled trial and direct comparison. Archives of Internal Medicine, 164(17), 1888-1896. https://doi.org/10.1001/archinte.164.17.1888

 

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