Newsletter #7: How Are You Sleeping?
July 11, 2012
We have all experienced the effects of impaired sleep on mood and physical and mental performance. Unfortunately, for many of us sleep deprivation is more the norm then the exception and we more or less adapt. But what has become abundantly clear in numerous studies is that how long and how well we sleep is not only related to our quality of life but has profound effects on our health. A large body of research attests to the effects of inadequate sleep on impaired hormonal function, weight gain, insulin resistance (which can lead to type 2 diabetes), heart risk and compromised immune function which can leave us more vulnerable to many risk factors from the common cold to cancer, and the list goes on. In fact, our sleeping habits can bear directly on how fast we age and our life expectancy.
Conventional medications are not the answer either. In a recent study published in the British Medical Journal, people who regularly took sleep medication were five times more likely to die over a two and a half year period than those who didn’t take them at all. Sleep medication alters sleep cycles, and so although they may help us go to sleep they interfere with the deep restorative benefits of natural sleep. They also adversely affect memory and coordination which is especially problematic for older folks who are more likely to take these medications. The study in the BMJ alludes to the “meager benefits” of sleep medications and the greater success of behavioral methods of dealing with insomnia.
While it is true that behavioral changes like:
- going to bed at the same time
- low lighting
- reduced excitatory stimulation (most commonly from the TV) at least two hours before bedtime
- eliminating stimulants like coffee and tea from the early afternoon on
- eliminating naps
- exposure to early morning sun for at least ten minutes to reset your biological clock
can help us fall asleep more easily, the real culprit is often the physical and mental stressors which keep waking us up, making it difficult to fall back asleep.
The most common physical stressor is chronic pain and I often see patients resume normal sleep patterns simply by addressing this one issue. But for many people the most challenging form of insomnia is anxiety, stress and worry. This is all too common, as we all know, and often leaves people feeling hopeless and depressed.
One of the characteristic markers of a chronically stressed nervous system is waking up in the wee hours with the mind chattering away and, before you know it, you are wide awake and unable to relax, much less fall asleep.
This is the most common and chronic type of insomnia that I see in the clinic and is one of the effects of the “fight or flight response” inappropriately producing stress hormones like cortisol and epinephrine which turns our biological clock into an alarm clock that wakes us up.
Most of us can remember a limited period in our life when we were affected in this way ,but when it becomes a chronic condition it becomes a serious mental and physical health risk that needs to be addressed.
So, if medication is not a good option, what can you do, especially when the stress in your life may be ongoing?
- Make sure you exercise, preferably in the morning. When we are already exhausted from lack of sleep and feel overwhelmed it seems counter intuitive to force the exercise, but there is a large body of research that confirms that doing so not only improves sleep quality but also helps to moderate anxiety, stress and depression.
- Research also strongly supports techniques for inducing the “relaxation response”. Our body must shift into a parasympathetic state which is mentally and physically the opposite of the fight or flight response in order to both fall asleep and sleep soundly. Instead of napping during the day which further confuses your biological clock, try lying face up with your eyes slightly open (so you don’t fall asleep) and practice abdominal breathing, deeply and slowly, paying careful attention to the breath and consciously relaxing and re-relaxing your muscles on the long slow out breath. Use a digital timer and practice at least 15 minutes (longer is better). For more on this see newsletter #4. Repeat focused abdominal breathing again when you get in bed. Now you will close your eyes and simply attend to the breath and deep relaxation.
- Remember, the more anxious you are about being able to sleep (anticipatory anxiety), the more difficult it will be. Learning how to enter the deep relaxation state is pleasant. Do not feel you are in a hurry to sleep; the sleep state will come on naturally.
- Additionally, over the counter sleep aids such as melatonin, tryptophan and stress relieving compounds can be helpful.
- Acupuncture is an effective tool in promoting the parasympathetic side of our autonomic nervous system which helps to foster the relaxation response, and I often use this with specific neurotransmitter support to help with anxiety and chronic stress and encourage the patient to use all the guidelines discussed in this newsletter.
You can overcome this problem to the credit of your health and wellbeing.
A final thought: Be on the alert for symptoms of sleep apnea. It is easy for both patient and doctor to overlook and can be a very serious health risk. If you are aware that you sometimes awaken air hungry and gasping for breath you should have a sleep study scheduled (this can be done locally) and seek treatment. This can also be observed in a partner that appears to hold their breath for ten or more seconds when sleeping.
If you are seeing me for any reason and are having sleep related problems please remember to tell me.
To Your Health and Wellbeing,
Dennis R Tucker, Ph.D., L. Ac.
