So many people have sleep issues these days, it almost seems commonplace. Many patients come in with a primary concern of something else and it comes up that they don’t sleep well, but that’s just “normal”. I don’t think this should be normal, and I don’t think it’s what your body needs!
Sleep disturbances can come from a variety of sources such as stress, anxiety, hormone imbalance, blood sugar dysregulation… the list goes on. A uniting factor among all conditions is that none are aided by sleep deprivation. Therefore, if not your primary concern, your lack of sleep could in fact be worsening other health issues. For example chronic sleep impairment for over 1 year increases the risk of a mood disorder such as anxiety or depression in the years to come.
Since childhood, I have never been the best sleeper, but it’s also never been my priority to fix. I tried many different treatments, with varying degrees of success, but some of the simple lifestyle changes are the things that have helped the most. The reason why these seemingly minor adjustments can make a significant impact, is because they work towards resetting and supporting the circadian rhythm. A circadian rhythm is a naturally occurring biological process that cycles for approximately 24 hours in both plants and animals. It is in essence the brain and body’s internal clock that sets the sleep-wake cycle and regulates tiredness and alertness. Your circadian rhythm is controlled by a part of your brain called the hypothalamus, but it is affected and modulated by external factors such as light/dark and temperature. At night your eyes automatically register the darkness by sending a signal to the hypothalamus which relays the message to the pineal gland triggering the release of melatonin to make your body feel tired. With bright lights inside and out, and computer, laptop, and phone screens at all times of the day/night this natural process has been completely disrupted.
Before any supplemental or pharmacological sleep aids are attempted, lifestyle modifications to support the circadian rhythm must be addressed. This foundation for sleep intervention is known as “sleep hygiene” and the guidelines are as follows:
1.Keep a regular sleep-wake schedule, with a consistent arising time 7 days a week to enhance the circadian sleep rhythm and prevent oversleeping
2. Avoid sleeping in, extensive periods of lying down, or daytime napping as these activities can worsen the subsequent nights sleep
3. Get regular exercise everyday, preferably in the morning
4. Avoid stimulants such as caffeine, nicotine, alcohol and recreational drugs as these can disturb/fragment sleep. If caffeine or smoking are unavoidable limit use to earlier in the day.
5. Avoid large meals late in the evening, however a small healthy snack of protein/fat (like a spoonful of nut butter) can help stabilize blood sugar through the night
6. Plan a quiet period and create a routine to unwind before bedtime such as a warm Epsom salt bath
7. Turn the clock face away and put your phone aside (do not sleep with it under your pillow) to prevent checking the time on waking throughout the night, but make sure to set the alarm for morning to help train your body when to get up
8. Keep the bedroom dark and quiet and plan to minimize light and noise prior to getting ready for bed (avoid bright lights and electronic screens)
9. In the morning on waking, expose yourself to natural bright light as soon as possible
10. Only use your bed for sleep and intimacy, avoid watching TV or doing work in bed as this can condition alertness in a place that is meant for rest
After consistent sleep hygiene practices have been met, the basis for good sleep has been set. If sleep issues still remain, we may need to dig deeper to uncover the root cause of this disturbance and work together to re-balance the body, however cleaning up your lifestyle is the best (but sometimes the hardest) first step!
About the Author:
- Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?. JAMA. 1989;262(11):1479-84.
- Baglioni C, Battagliese G, Feige B, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011;135(1-3):10-9.