Sleep Continued…
We often think of sleep as something we “do”. But, in fact, sleep is a well regulated physiologic process that “happens” if our neurohormonal systems and circadian rhythms are allowed to do their job.
All creatures, from insects to reptiles, birds and fish to humans, require sleep. We can observe how natural sleep is by watching a baby. They sleep when they need to and cannot be forced to do so if they are not tired.
Each of us has a unique circadian rhythm of approximately 24 hours and 15 minutes. It is independent of the light/dark cycle of day, although that certainly does affect sleep as well. The hormones melatonin and adenosine naturally rise and signal our bodies to sleep when tired. However, that process can be counteracted by caffeine, erratic schedules, and our mindset, as well as other factors. 5-6 hours after drinking a cup of coffee, half the caffeine is still in our system. 9 hours later one quarter of the caffeine is circulating. Keeping hours that do not sync with our normal circadian rhythm will lead to poor sleep quality. Worry can stimulate the sympathetic nervous system, increasing heart rate and our level of arousal, thus interfering with sleep. Too much time indoors divorces us from the natural effects of sunlight on our body rhythm. And of course, that most modern of sleep-inhibiting factors- screen time. The blue light emitted from screens does delay the body’s production of melatonin in the evening, thus encouraging later sleep times.
More and more things occur as we grow older that interfere with our innate body schedule, such as: school, work, worry, anxiety, medical conditions, as well as body transitions such as puberty, menopause, “manopause”. Inadequate sleep can cause a variety of problems:
-short term memory loss
-difficulty focusing
-irritability
-“micro sleeps”- lapses of 1-3 seconds can occur without warning, particularly dangerous while driving
-depression
-weakening of the immune system
Sleep hygiene measures were described in Dr. Dirksen’s earlier sleep blog. They are extremely important to counterbalance the effects of day to day life on our sleep. Hunger and thirst are generally obvious enough to stimulate us to eat and drink. Unfortunately life’s distractions often drown out the sleep drive. The benefits of deep breathing and mindfulness techniques cannot be overestimated. A long deep inhalation followed by a longer slow exhalation stimulates the vagus nerve and with repetition causes relaxation. AND, if you are concentrating on breathing, you are NOT concentrating on your worries. Guided meditations are available on phone apps to calm the mind and allow sleep to occur
Prior to considering medication for sleep, CBT or cognitive behavioral therapy, is recommended. This usually comprises 4-8 sessions with a therapist to learn to associate our bedroom with calmness. It helps reframe any worrisome or negative thoughts we may associate with going to bed. There are also virtual options to do this on one’s own (for example the VA offers an app for veterans and non-veterans called CBT-i Coach). The benefits are substantial.
Medications for sleep are not meant to be taken long term as they will further disconnect the body from its normal sleep drive.
A unique contribution to sleep problems came with the pandemic:
- Blurring of lines between work/school and home life
- Irregular schedules, maybe sleeping later, staying up later
- Overall less outdoor time and physical activity
- Erratic meal times
- Less social connection
It is important that we look at how each of our lives has been impacted and aim to reestablish a more normal schedule, going to sleep and awakening at about the same time every day. Definitely avoid napping later in the day. Get your exercise earlier in the day. Get exposure to sunlight as early as possible to turn off the natural melatonin that stays in our system if we sleep. Do not do computer work, or really any work, in bed.
As Shakespeare said: “sleep is the chief nourisher in life’s feast.” Life cannot be sustained without it.
Please feel comfortable reaching out to us if you want to discuss your individual sleep concerns.
References:
Carskadon, M.A. and Dement, W.C. (2011) Monitoring and staging human sleep, from Principles and Practice of Seep Medicine
Prather, Aric A, "The Sleep Prescription", Pub- Penguin, 2022
Sejnowski, T. and Dextexhe, A., Brain Research, volume 886, issues 1-2, 15 Dec, 2000 - Martin, Jennifer L., Cognitive Behavioral Therapy for Insomnia in Adults, from Up To Date, October 16, 2022
Winkelman, John W., Overview of the Treatment of Insomnia in Adults, Up To Date, August 29, 2022
Walker, Matthew, "Why We Sleep", pub Scribner, June 19, 2018
