You know my jam is nutrition, but as a holistic practitioner I always look at sleep as a way to improve someone’s health. Most industrialized countries, including the US are experiencing an epidemic of poor sleep. Many health conditions are worsened by lack of sleep, and poor sleep can be a contributing factor to many diseases. A vicious cycle.
Causes of poor sleep
There are multiple causes of poor sleep. It is best to work with a functional/integrative health practitioner to figure out the root causes of persistent sleep issues. Serious sleep disorders, such as sleep apnea or narcolepsy may need the attention of a sleep specialist, as those can be life threatening. Disrupted sleep can result from hormonal imbalances (and in turn lead to further hormonal imbalances), poor dietary habits, lack of light exposure, digestive issues (reflux, dysbiosis, parasites), lack of or improper exercise, and several lifestyle habits that disrupt sleep. Some people experience a drop in blood sugar in the middle of the night that may wake them up (more on that later). Women in perimenopause and menopause often have sleep difficulties, as sex hormones decline and fall out of balance. Children have higher melatonin (a sleep hormone) than adults. Fortunately, there are things we can do to increase our production of this important hormone and antioxidant.
What’s the deal with sleep?
Our bodies have a master clock (an area of the brain within the hypothalamus called the suprachiasmatic nucleus) that controls circadian rhythm. We are diurnal creatures, meaning we are meant to be active while the sun is up and go to sleep when the sun goes down. There are several hormonal changes that happen in the evening that prepare our bodies for sleep: levels of stress hormone cortisol go down, levels of melatonin, the sleep hormone go up, our body temperature drops slightly to prepare us for sleep, and then starts to rise at about 4am to prepare us for waking. Our sleep has different cycles which play important roles in growth and repair. Only during deep sleep, our brains can “clean house”, hormones can repair, and only during sleep growth hormone is released.
Why health promotion needs to include sleep
It is no surprise that depriving someone of sleep has been a type of torture during different times in history. Lack of sleep can really mess with our brain and body! Poor sleep is an underlying condition in every psychiatric diagnosis. We all know firsthand how poor sleep can mess with our brain and mood. Getting less than the recommended 7-8 hours of sleep per night has been documented to: lower the activity of the immune system, lead to chronic fatigue, anxiety, depression, heart disease, premature aging, inflammation, and insulin resistance which can lead to prediabetes and diabetes – just one night of sleep deprivation causes temporary insulin resistance. Lack of sleep also leads to overeating. In studies, people who got less sleep than needed (less than 7 hours generally), ate between 350-500 calories more the next day. That can add up to a pound of weight gain in 7 days! I hope I’ve convinced you that getting good sleep should become our priority #1.
Plan of Action
What I appreciate about integrative and holistic medicine is how it empowers patients to seek their own healing with a guidance from a trained practitioner. While you are working with a practitioner on identifying the root causes disrupting your sleep, there are several lifestyle and dietary changes that you can implement right away:
Know your chronotype – go to www.chronoquiz.com to assess what your predisposition is when it comes to what kind of sleeper you are. It was created by a sleep expert Dr. Michael Breus. You may find it fun and informative.
Try tracking your sleep for a period of time to figure out what sets you up for good sleep and what disrupts it – I like Sleep Cycle app, it has a free version, and can be used with your phone in airplane mode (which is the only way to have your phone by your bed). You can track how you sleep depending on what time you went to bed, what you ate/drank before bed, when and how you exercised that day. These data can be really helpful.
Environment
Good sleep may actually start in the morning – it is super important to get some light first thing in the morning. That turns off any residual melatonin left from the night and sets up the right hormonal tone for the rest of the day. Morning is a great time to exercise too – when our cortisol is highest – so would be great to combine exercise and being outdoors getting natural light. If natural light is not available, full-spectrum light boxes are a great alternative. You can easily find them on the internet, and try to use for at least 10-15 mins in the morning.
Sleep in a completely dark room – blackout shades or curtains are great, also take any devices that emit light out of the bedroom. Any light perceived by our eyes even through closed eye lids can interfere with melatonin production. It has even been observed that the light can be sensed by our skin and red blood cells, so even if you wear a sleep mask but your skin is exposed to some light, the pituitary gland in the brain may get the signal that it’s still light and therefore there is no need to produce optimal levels of melatonin. That almost sounds like science faction!
Avoid devices and TV at least 1 hour before bed – blue light emitted from computer, TV and phone screens disrupts the production of melatonin. If you have to use your device, wear blue light blocking glasses and set your screens to f.lux mode (free download).
Read, journal, or practice breathing or meditation instead of TV before bed – there are many apps and resources to help us learn to meditate and breathe properly. I am also a huge fan of keeping pen and paper next to the bed for making a to-do list or just to jot down thoughts as they come in before bed to prevent those ruminating, worrying thoughts from keeping you awake in the middle of the night. Youtube has many videos that can tune your body into deep sleep (chanting, alpha waves, binaural beats).
Turn down the thermostat in your bedroom – You have probably heard that you need a cold room to get your best sleep. As you recall from what I said earlier about body temperature dropping in the evening, we actually do need lower room temperature to be able to fall and stay asleep. Many of us wake up in the middle of the night because we get too hot without realizing it. We think that it’s our bladder that wakes us up to pee, but in reality we may be too hot. Bladder can hold quite a bit of fluid, so we should not need to wake up to void during the night. The ideal room the temperature is said to be between 64-68 degree Fahrenheit. I have heard several practitioners having good success using Chili Pad, so check it out and see if this investment may be right for you.
Take a cold bath before bed, or a hot bath before bed – I know this may sound confusing, but there are two schools of thought on this that both make sense. The goal is to lower body temperature at night to signal the brain to produce melatonin. We can do that by taking a cold bath. But, we can potentially also do that by taking a pretty hot bath, after which our bodies cool, also signaling the brain that we are ready for bed. It is great to add Epsom salts and lavender oil for an even more relaxing experience. I’ve heard of people being able to sleep well for the first time in forever after taking a cold bath before bed for a week or so. But I get it, soaking in a cold bath may not be your idea of fun. Another health-promoting benefit of a cold bath is it provides anti-inflammatory effects, and that’s always a good thing.
Wash your sheets regularly and make your bed in the morning – these are just common sense recommendations that create a pleasant atmosphere for sleeping.
Keep consistent bedtime – Strive to go to bed and wake up at the same time every day, even on weekends. Again, our master clock works 24 hours a day like a well-oiled machine if we don’t deviate too much from the plan. If you are used to staying up until whenever, try to gradually (in perhaps 30-min increments) shift your bedtime to as close to 10-pm as possible. During these challenging quarantine times, my hope is that all of you guys are getting good sleep. However, I know that some fall into a trap of staying up late watching their favorite shows because they can sleep in in the morning. Our bodies don’t really work like that. If we sleep 7 hours between, say 2am and 9am, sleep quality is very different than sleeping 10:30pm-5:30am. The hours before 2am are said to be the most quality sleep we get.
Don’t eat within 3 hours of bedtime – this is a big one. Digestion is a pretty active process that diverts blood flow to the digestive organs, and interferes with our ability to sleep deeply. Eating too close to bedtime may cause heartburn which disrupts sleep. Ideally, we want all the digestion to be completed before we go to bed, which takes about 3 hours. Eating late at night can also interfere with detoxification which takes place while we sleep. That can lead to weight gain, low energy, and hormonal dysregulation.
Avoid alcohol or finish drinking at least 2-3 hours before bed to allow for the alcohol to get metabolized – some of us think that a drink or several help them to go to sleep, but there is a big difference between falling asleep and passing out. While drinking may help you to “pass out”, it will inevitably lower your quality of sleep and even cause you to wake up in the middle of the night. Numerous studies have shown that drinking alcohol before bed prevents us from reaching deep sleep, which is the most restorative type of sleep.
If you notice that you get a “second wind” after 10pm – do all the strategies I outlined in this article and most importantly, try to go to bed before you get that second wind. It may be particularly hard for us women, as the time after kids go to bed is our only “me” time (I know I often think I can do a lot after 9pm but in reality getting quality sleep may be the most important thing I do tonight). Tell your “today” you that “tomorrow” you would rather be rested and in a good mood!
Be aware of stimulants – coffee, tea, chocolate, energy drinks may all interfere with our ability to fall and stay asleep. We all have different genetic predisposition to how quickly or slowly we metabolize caffeine. There is genetic testing that can shed light on that. But as a general rule, don’t consume caffeine after 2pm. Some people say that a cup of coffee doesn’t affect their ability to fall asleep, but studies have shown that sleep quality gets affected. This is especially important to keep in mind as we are spending more time at home now, and it can be all too easy to have that extra cup of coffee later in the day to combat boredom.
Be aware of nutrition supplements you are taking – if you work with a qualified practitioner, you were probably told the best time to take your supplements, but if not, there are a few that need to be taken in the morning to avoid sleep disruption: multivitamins that contain B vitamins, B vitamin complex, vitamins B5, B6, and B12, magnesium malate – all these are energizing and should be taken with food in the morning.
If you’ve noticed that you wake up in the middle of the night with a racing heart – this may be a sign of blood sugar falling too low and you body responding by producing more cortisol and adrenaline to a) wake you up and b) raise your blood sugar by breaking down stored glucose (glycogen) in the liver. If this sounds like you, try to make sure to eat some complex carbs with dinner and perhaps push your dinner time to a bit later. If you have to, eat something small that contains carbohydrates and protein (nuts, crackers, a little whole grain cereal, nut butter, fruit) when you wake up at night. For most, however, night-time eating is a habit and not a good one.
Open your windows for a while before bed, or sleep with your windows open if weather allows – air inside our homes can be many times more polluted by off-gassing of building materials, furnishings, rugs, and even our mattresses than air outside, so it’s important to get fresh air. This will also lower the temperature in the room. If your bedroom is small, air purifier or opening windows is even more important, as we exhale carbon dioxide which can build up in a small bedroom particularly if the doors are closed.
Perimenopause and menopause – ladies, do I need to say more? Sleep gets severely affected by the fluctuating hormones. Waking up at night from hot flashes, night sweats, and low or unbalanced hormones is a fact of life for many. Waking up at night may be due to hormones and not your bladder calling. Work with an integrative practitioner to have your hormone levels evaluated and corrected as needed. We do not need to suffer, there is hope!
Supplements that may be helpful: melatonin – try to support your own melatonin production by using the strategies I outlined. But taking melatonin supplement is perfectly ok and may be very beneficial. Taking melatonin as a supplement does not block our own production, so that is not a concern. As far as dosing, again, there are two different ways to go about it. We can take a small dose (0.5-1mg) about 3 hours before bed to trigger our own production OR take a higher dose about 1 hour before bed. Start with 3mg, if that doesn’t seem to work add another 3mg in a few nights, and I’m comfortable with taking up to 9mg each night 1 hour before bed. If that dose doesn’t work, you may want to try adding herbals like valerian root or passion flower, and I also like a supplement of L-Theanine and Magnesium Glycinate before bed. Women in general tend to be deficient in magnesium, so this is often a very helpful supplement. If you tend to wake up in the middle of the night try sustained release (also known as prolonged release) melatonin. Melatonin is not only a sleep hormone but an important antioxidant in the body. Melatonin is much higher in children than adults and is said to be one of the reasons why children have much milder COVID-19 cases. Melatonin is also being explored as one of the naturopathic treatments for COVID-19. One night of poor sleep temporarily “paralyses” the immune system responsible for fighting pathogens, so sleep is a very important part of health equation.
If you’d like to purchase any supplements I mentioned here and for more suggestions on natural sleep aids, please visit my online dispensary here. I put together a Sleep support protocol which you will be able to access once you register. All the supplements are professional grade, and I’d be happy to provide specific recommendations once you create an account.
Hope you find these tips informative and helpful. If you’d like help navigating hormones or any other issues that affect sleep, please reach out to me for an evaluation. I would love to help!
Be well,
Natasha Coughlin, MS, RDN, HHC
Integrative Dietitian Nutritionist
natasha@integrativehealthrd.com
