Is Sleep really that important?
“Sleep that relieves the weary labourer and heals hurt minds. Sleep, the main course in life's feast, and the most nourishing”
William Shakespeare
Sleep is one of life’s mysteries. For a long time it was thought that sleep was a waste of time. However recent research has shed much-needed light on the matter, showing that sleep is a crucial component of a healthy lifestyle, and that lack of it affects everything from mood, creativity, brain detoxification to DNA expression, dementia and longevity.
Unfortunately we have an epidemic of sleep disorders - from trouble falling asleep to often-interrupted sleep to actual insomnia. It’s also a sad fact that as we age we tend to sleep less well, and often find that our sleep is easily disturbed. However in terms of avoiding chronic disease, sleeping well is not far off top of the list of lifestyle behaviours that matter. In my world of functional medicine, it is always one of our earliest priorities to help a new client pursue their healing journey.
What happens in our bodies while we sleep?
We all know the theory that high quality sleep is vital to healing. But I have never quite understood exactly what goes on during that time. Well, here you go... while the body appears from the outside to be still and inactive, it is actually pretty busy. During the night we restock our supply of hormones, process significant toxins, repair damaged tissue, generate vital white blood cells for immunity, eliminate the effects of stress, and process heavy emotions.
How much do we need? If you are aged between 18 and 65, you need seven to nine hours of high-quality sleep per night. Eugh, I can hear you all saying!
Circadian Rhythm
One of the most radical discoveries is that each organ, indeed each cell, has its own biological clock which works in tandem to maintain biological balance (homeostasis), regulating everything from metabolism to psychological functioning. (The discovery of these cellular clocks won the 2017 Nobel Prize in Physiology and Medicine).
In your brain is a master clock that synchronises all these clocks (and your bodily functions), aligning itself as much as it can to the 24-hour light and dark cycle. The timekeeping of your master clock is called your circadian rhythm.
To maintain a healthy circadian rhythm, it’s key to get bright light exposure during the day. Most people in Western societies spend much of the day indoors, which essentially puts you into a state of light deficiency, as indoor light is about 200% lower in light intensity than outdoor light and isn’t intense enough to anchor your circadian rhythm. In fact, the best way to maximise the anchoring effect is to get outside for 30 minutes early in the morning, soon after you wake up, but if you can’t do that, then certainly during the morning or at lunchtime.
At the opposite end, you need to avoid bright artificial lighting as much as possible after sunset, as light will impair your melatonin production. Melatonin is a hormone produced in the pineal gland, an ant-sized lobe near the middle of our skull, largely in response to darkness. Melatonin suppresses the activity of other neurotransmitters and helps calm the brain (in part by countering the stress hormone, cortisol), thus inducing sleep.
An interesting study compared melatonin profiles in people living in normal room light (less than 200 lux) versus dim light (less than 3 lux). Results showed that, compared with the dim light group, those exposed to normal room light before bedtime suppressed melatonin and shortened the time period when the body has good melatonin levels by 90 mins. (1). Furthermore, exposure to room light during sleeping hours, suppressed melatonin by more than 50%. (While I am at it, beta blocker meds or frequent use of anti-inflammatory painkillers can also deplete melatonin and cause sleep difficulties).
For ideal sleep, melatonin should be rising steadily, and cortisol should be rock bottom low at bedtime. However, our lifestyle choices often get in the way of these natural pro-sleep chemical shifts. We so often turn to TV, video games, email or social media for our evening entertainment. These devices mostly display with full spectrum light which can confuse the brain about whether it’s night-time or not. Watching programmes that are stressful (eg. evening news or a thriller) or dealing with work-related emails exacerbates the situation, keeping cortisol elevated and inhibiting the production of melatonin. Digesting a heavy meal eaten late in the evening can also prevent or interrupt sleep.
Sleep Deprivation – what toll does it take?
When you upset your circadian rhythm by not getting enough sleep, the results cascade down through your entire system, raising blood pressure, playing havoc with hunger hormones and blood sugar control, increasing gene expression associated with inflammation, immune activation, cancer risk, stress and much more (2).
The fact is that there are hardly any parts of your biology that are unaffected by inadequate sleep – the list of health effects linked to poor/lack of sleep keeps growing every year. For those that are interested (or maybe need motivation to pull their sleep hygiene up by its bootstraps) please refer to the list at the end of this article of some of the more obvious consequences of poor sleep.
Sleep deprivation also slows your reaction time. Getting less than 6 hours leaves you cognitively impaired. In 2021, police in the US reported that 100,000 car crashes each year are due to drowsy driving, killing 1,500 a year. Even a single night of sleeping only 4 to 6 hours impacts your ability to learn or think clearly the next day. And persistent lack of sleep has a cumulative effect when it comes to messing with your health.
Make your sleep space as perfect as possible
Sleep in complete darkness. Even the tiniest bit of light, eg from a clock radio LCD screen, can disrupt your internal clock and production of melatonin and serotonin. If you don’t have blackout blinds, consider using a well-fitting sleep mask. Don’t turn on any light at all during the night, even if you have to go for a pee. If you absolutely have to, use a red bulb.
Keep the temperature of your bedroom no higher than 20 degrees C. When you sleep your body’s internal temperature drops to its lowest level, generally about 4 hours after you fall asleep, so keeping your room cool mimics this natural temperature drop. Sleeping in the buff might help; studies do show it improves sleep quality, but also metabolism and blood circulation. (3)
Turn off your Wi-Fi at night. Wi-fi in your home is more of a danger than what’s coming from outside your home. We don’t need wifi while sleeping, so this exposure is unnecessary.
Keep your mobile phone as far away from your bedroom as possible, if you have to leave it on. If you keep it in your bedroom, either shut it down or put it in airplane mode. Keep alarm clocks and other electrical devices away from the bed, preferably at least 3 ft.
Make sure alarm clocks are silent and think about how you would like to be woken up. It’s stressful to be jolted awake by a loud noise. If you go to bed early enough and get enough sleep, an alarm clock my not be necessary, but otherwise consider a battery powered alarm clock that talks so there is no electricity or light.
Lastly, try and keep your bedroom for sleeping and sex! If you also use it for watching TV or working in bed, you may find it harder to relax and drift off to sleep.
Here are 8 tips on how to prepare for sleep
Go to bed as early as possible. Ideally around 10pm. Your body, particularly your adrenal system which produces all your stress hormones, does the majority of its recharging between 11pm and 1am. And during the same period, your gallbladder dumps its toxins! If you are awake, guess what? The toxins back up into the liver, which isn’t good.
A very sophisticated recent study that focussed specifically on sleep timing and shows that there is literally a sweet spot for going to sleep – between 10pm and 11pm, both for longest sleep duration and for risk of cardiovascular disease (highly correlated with sleep). Either before or after this one hour gives rise to less good outcomes (4)
Go to bed at the same time every day, even on weekends. Getting into a sleep rhythm makes it easier to fall asleep and to get up in the morning.
Establish a bedtime routine. Loads of people I know have wonderful morning routines, but often night-time routines are not so well adhered to. It could include 10 mins meditation, deep breathing, an Epsom salt bath with some lavender essential oil (double whammy). The key is to find something that makes you feel relaxed and do it every night.
Don’t drink within 2 hours of going to bed – not even water or camomile tea (unless you specifically need it to destress (see below). For those over 50 this will dramatically reduce the need to get up and go to the loo. For those men who have an enlarged prostate (most men over 55 do) this is particularly important. You won’t die of dehydration! You can easily get all the hydration you need by drinking earlier on in the day.
Don’t eat within 3 hours of bedtime. This is a particularly powerful one that surprises many. Particularly don’t eat sugar, grains or simple carbs. These will put your blood sugar up steeply, delay sleep and increase your risk of acid reflux. Later, when your blood sugar level drops lower than it should (as a result of poor blood sugar control and possibly hyperinsulinemia), you may well wake up and be unable to fall back to sleep.
Aside from that, eating too close to bedtime causes oxidative stress.
And, of course, while the body is busy digesting food from your evening meal, it can’t get on with the huge sleep healing agenda described early on in this article.
Dim the lights in the evening. After sunset, try to keep the lights as low as possible. Use incandescent light, not LEDs or fluorescents. Red and amber wavelengths will interfere least with your melatonin production, while blue and green wavelengths interfere the most. Consider wearing blue blocking glasses after sunset, and certainly for watching TV or looking at a computer screen.
Minimise use of electronic devices during the day and in the evening. Electronic screens are sleep thieves, robbing you of the ability to fall asleep easily. There is loads of research on this – the more time you spend on devices during the day, and especially in the evening, the longer it takes to fall asleep AND the less sleep you get overall (5). Teenagers are no exception (6).
Don’t watch TV for at least an hour before bedtime. It’s way too stimulating for the brain, preventing you from falling asleep quickly. Thriller movies get your cortisol levels going up, which inhibits production of melatonin. If you must watch TV (or use any electronic devices) late into the evening, do install blue-blocking software or wear blue blocking glasses. TV in the bedroom is not a good idea.
Don’t work right up to bedtime. Same reason as above. You need to give your mind a chance to unwind and go to sleep feeling calm, not hyped up from the work you have been doing.
Make sure you don’t have cold feet! It’s amazing how many people wrestle with freezing feet at night. Just wear a pair of socks. Spoil yourself with a cashmere pair and keep them just for bed!
Journaling. I know, ‘whoo-whoo’. ‘PD has finally lost it’. No, it works - but I took a lot of convincing. Just write down your thoughts and empty your head. BUT if you will just suspend your cynicism for a moment, and open your curiosity, try Gratitude Journaling – writing down 3 things that you are grateful for. You will be amazed at what this does for your mood, sleep and general outlook on life.
Aspects of your lifestyle that may be impacting your sleep
So that is what I recommend in terms of preparing for bed. But what about what you do during the day? I wonder whether you realise how many things impact the way you sleep hours later.
Cut down on the alcohol. Sorry to be boring, but if you have a sleep problem and you really want to fix it, listen-up. Alcohol will make you fall asleep quickly but you are highly likely to wake up 2-3 hours later, and be unable to fall back to sleep. Alcohol induces sleepiness by increasing the action of GABA, a calming neurotransmitter, in the brain, while blocking the action of glutamate, a stimulating neurotransmitter. This is why alcohol makes us feel mellow and we find it easy to fall asleep. However, once the alcohol is metabolised and its effects wear off (3 hours later), there is a rebound effect that increases glutamate, which wakes you up and makes for light or interrupted sleep for the rest of the night.
Even when you are asleep, the alcohol in your system prevents you from entering into deep sleep, which is when your body does most of its healing. There is a huge amount of science on the interconnectedness between alcohol and sleep problems.
A simple solution is to take the amino acid Taurine (500 mg) when you go to bed. This helps to increase GABA receptor binding and reduces the effects of the rebound in the middle of the night. The impact of this is likely to be a deeper, more restful night of sleep – maybe even breaking the cycle of stress that makes you feel like you want a drink every evening.
Avoid caffeine after 2pm. Not everyone can metabolise caffeine efficiently (you can gene test for this), leaving you feeling the effect long after consumption. Best to avoid caffeine after 2pm, other than maybe a cup of mid afternoon tea.
Get outside early in the morning. This will set your circadian rhythm correctly and make sure that melatonin is produced on cue in the evening
Exercise regularly (but not within 3 hours of bedtime). Exercising for 30 mins a day can improve your sleep, particularly if its outside. Try and exercise in the morning if you can manage it.
Lose excess weight. Being overweight hugely increases your risk of sleep apnea, which can seriously impair your sleep as well as lead to all sorts of related chronic health issues.
Supplement with B Complex. We need B6 to make seratonin which is the precursor to melatonin, the hormone necessary for sustained sleep. We need B2 to convert B6 to its activated form of P5P. All the B vitamins work synergistically, so better to take a good quality B Complex than just these two in isolation.
What if none of this is enough?
Sleeping pills may be useful for acute situations – for instance when one is going through short-term trauma. However, they all work as mild sedatives and are not addressing the root cause of any long-term sleep disturbance. They also come with a wide range of side effects that render them non-ideal for long term use – dry mouth, stomach-ache, hangover-like fatigue the following day. But it is also important to understand that many of these medications can increase the risk of both cancer and death even with just occasional use. I quote from this study conducted between 2002 and 2006 on 10500 patients with a mean age of 54: ‘Receiving hypnotic prescriptions was associated with greater than threefold increased hazards of death even when prescribed <18 pills/year’.
Here are a couple of alternative strategies:
If you have trouble falling asleep consider 300mcg or 1mg of melatonin 30 mins before bedtime. Start with the lowest dose for several days before increasing, as this is often enough. Taking too much will result in grogginess the next morning. This is safe for short term use. (Note that melatonin also helps to reduce blood pressure during the night too, a key benefit for those with hypertension). But if this doesn’t help, then there may be a different imbalance at play. Read on…
If you fall asleep ok but wake in the middle of the night and cant easily go back to sleep, your problem is probably an insufficient steady supply of melatonin throughout the night. In this case, melatonin before bed won’t help much. Instead, consider 100-200mg of 5-HTP before bed. (Nerdy explanation: the body makes melatonin from a neurotransmitter called serotonin. Serotonin synthesis is dependent on the amino acid tryptophan. 5-HTP is the hydroxylated form of tryptophan, which, in a healthy body, is converted via serotonin to melatonin after a few hours). Note: do not take 5-HTP if you are on an SSRI or SNRI or other serotonin-enhancing antidepressant or sleep medications without your doctor’s oversight as there is a risk of developing serotonin sickness.
If you have fully-fledged insomnia, a combo of melatonin and 5-HTP (you can have both at the same time) is often helpful in combo with all the tips set out above, at least in the short term. However, stress is probably playing a big part in this and ought to be the subject of your focus. There are many techniques to alleviate stress, but not for this article.
If you find it difficult to get stressful thoughts out of your mind at bedtime, or you can’t sleep due to pain, this is probably due to an imbalance of glutamate (excitatory) and GABA (inhibitory, or calming). You will probably benefit from taking calming herbs 1to 2 hours before bedtime. There are so many blends, but I recommend any blend based on Ashwagandha or Holy Basil (Tulsi).
Our modern lives tend to create glutamate-dominant (stimulating) dynamics which challenge the brain to calm down and allow sleep. The conversion of glutamate to GABA (calming) which if out of whack is the reason for so many sleep issues, requires magnesium and B6 as cofactors. Magnesium is depleted in most of the population and particularly by stress, and B6 is depleted by certain drugs, especially estrogen-containing medications/contraceptives. Consider taking 300mg of magnesium glycinate in the evening and a B complex supplement in the morning. L-Theanine can also help to increase GABA activity - you could take 400mg about an hour before bed.
Lastly you might try EFT (Emotional Freedom Techniques), aka Tapping. This can be learned very quickly and involves gentle tapping on various places in the body to balance your body’s bioenergy system and resolve some of the emotional stresses that are contributing to your insomnia at a very deep level. The results are typically long lasting and improvement is remarkably rapid. An ex-client of mine from my old business days has recently married one such practitioner, and I am going to shortly know a lot more about it!
Conclusion
Without restful sleep, sustainable healing in the body is nearly impossible. Consistent, deep, sustained sleep is a seemingly simple, not-so-sexy but scientifically-anchored imperative for getting well and staying well. In functional medicine, we address poor sleep as an initial priority in our work with clients. Make it a priority for you too.
Appendix: Consequences of poor sleep
Impaired memory and reduced ability to learn new things. Due to your hippocampus shutting down, you will experience a 40% decline in your brain’s ability to make new memories when sleep deprived
Reduced productivity at work (or poor grades at school)
Reduced athletic performance
Reduced creativity across all parts of your life
Increased risk of depression, dementia and Alzheimers. Your blood-brain barrier becomes more permeable with age, allowing more toxins to enter (7). This together with the reduced efficiency of the brain’s lymphatic system due to lack of sleep, allows for more rapid damage to occur in your brain, which is thought to play a significant role in the development of Alzheimers.
Increased risk of Type 2 diabetes. Daytime sleepiness or taking long daytime naps (1 hr or more) may increase your risk of T2D - according to one study by 56% and 46% respectively (8)
Increased risk of obesity. Lack of sleep increases feeling of hunger, even if you have already eaten.
Weakened immune function. Research suggests that deep sleep strengthens your immune system’s memories of previously encountered pathogens (this is the job of your T cells and B cells). If the memory is strong, your immune system can mount a much faster and more effective response when an antigen tips up for a second time
Increased risk of cancer. Tumours grow two to three times faster in laboratory animals with severe sleep dysfunctions. The primary mechanism that is thought to be responsible for this is disrupted melatonin production, a hormone with both antioxidant and anticancer activity. Melatonin, which is secreted by the pineal gland in the evening to prepare the body for sleep, inhibits the proliferation of cancer cells and triggers cancer cells apoptosis (self-destruction). It also interferes with angiogenesis (the new blood supply that tumours require for rapid growth).
Increased risk of high blood pressure, heart attacks and cardiovascular disease. This is a biggie. If you are interested in this subject, there is an amazing book by Matthew Walker PhD, Founder of University of California’s Center for Human Sleep Science: “Why We Sleep: The New Science of Sleep and Dreams”. In this book he cites Japanese research showing male workers average 6 hours or less of sleep per night are 400 to 500% more likely to suffer one or more cardiac arrests than those getting more than 6 hours sleep. One quote I cant resist…
“In the spring when we lose one hour of sleep, we see a subsequent 24% increase in heart attacks. In the fall, when we gain one hour of sleep, we see a 21% decrease in heart attacks. That is how fragile your body is with even the smallest perturbations of sleep….”
Increased risk of osteoporosis
Increased risk of pain and pain-related conditions such as fibromyalgia. In one study, poor or inadequate sleep was the strongest predictor for pain in adults over 50. (9)
Increased susceptibility to stomach ulcers
Low libido and poor sexual function
Poor regulation of emotions and emotional perception. Your amygdala is the part of your brain where fearful and threatening stimuli are processed, giving rise to fear-related behaviours and the switching on of the ‘fight or flight’ response (eg increased heart rate and respiration to prepare for action). This becomes about 60% more reactive than usual when you’ve slept badly, resulting in increased emotional volatility.
Increased risk of depression and anxiety (including PTSD), schizophrenia and suicide. In fact sleep problems are defining factors in diagnosing psychiatric disorders (10)
Premature aging. This happens because poor sleep interferes with growth hormone production, which is normally released by your pituitary gland during deep sleep.
Increased risk of mortality. Compared to people without insomnia, the adjusted hazard ratio for all-cause mortality amount those with chronic insomnia was 300% higher. (11)