Why is sleep so important?
Chronic sleep insufficiency, meaning less than 6hrs of sleep per night, has been shown to increase the risk of cardiovascular disease, obesity, inflammation markers, immunosuppression and all cause mortality (1,2,3,4).In regards to immune function, lack of sleep can increase risk of colds and flus and possibly lower immune response to influenza vaccines if deprived of sleep for as little as 1 week after injection. Poor quality and reduced sleep can also elicit feelings of depression or anxiety thus reducing quality of life (5).
In regards to cognitive performance, chronic sleep restriction has been shown to reduce levels of alertness and attention for several days even when sufficient sleep is restored (6). Getting less than six hours of sleep per night for 14 days in a row has been shown to reduce cognitive performance to the same degree as two nights with no sleep. Interestingly, in this study individuals seemed unaware of their reduced cognitive performance highlighting that important of sleep may be underestimated (7). In addition, sleep loss can negatively affect logical reasoning, ability to multi task and judgement (8).
When it comes to sleep issues (difficulty falling asleep, staying asleep or waking unrefreshed) there are many natural interventions that may help. Before starting any natural health products for sleep, including melatonin, its beneficial to ensure you're following proper sleep hygiene. Sleep hygiene refers to behaviours done during the day, in the evening and before bed to help you fall asleep and stay asleep during the night. Here is a breakdown of sleep hygiene habits to help you get 7-8hrs per night of quality sleep:
Sleep Hygiene (9)
Things to avoid before bed: Think 10-3-2-1 10 hours before bed - no caffeine (typically stop drinking after lunch) 3 hours before bed - no nicotine and alcohol (avoid "night caps"!)
2 hours before bed - stop doing work (allow your mind time to wind down before sleep)
1 hour before bed - no screens (phones, laptops, TVs) (10,11)
Keep your sleep environment comfortable
A quiet, dark, cool room (18-19C) is most conducive for sleep. Even a small noise, which may not wake you from sleep, can be enough to lift you out of deep sleep reducing sleep quality.
Exercise regularly
At least 20 minutes of exercise daily, enough to increase your heart rate, 4-5 hours before bed (exception - coitus). (12,13)
Allow time to relax before bed
You can't do work or read a stimulating book right before bed then expect your mind to shut off and go to sleep as soon as you hit the pillow. Mindfulness meditation is a great way to prepare your body and mind for rest. (14) As is stretching or yoga in a dimly lite room.
Don’t worry or plan in bed
If your mind is racing about events from the day or planning for tomorrow, get out of bed and go to another room, try writing things down to get them out of your head and go back to bed when sleepy.
Select a rising/wake time
Wake up at the same time every day regardless of how much you slept as it will help maintain a regulate circadian rhythm, adding light therapy in the mornings may further benefit sleep and help you get to sleep at night. (15)
A light snack may help
Avoid heavy meals right before bed but a light snack such as dairy free milk, nut butter, or crackers with hummus can help calm your body. These foods contain tryptophan and protein which may help you stay asleep.
Limit fluids in the evening Can lead to frequent awakening to use the bathroom during the night. Waking up frequently during the night (5 times or more) can lead to reduced cognitive performance and lower energy during the day.
Other tips
Getting back to sleep if you wake up
Don't lay in bed more than 20 minute if you're wide awake. It's best to get out of bed and change rooms (while keeping it dark and cool) to prevent a negative association with your bedroom and sleep. Try some relaxation techniques such as 'progressive muscle relaxation' (16) or box breathing (17). As well as herbal teas, which can be calming and help get you back to sleep, for example chamomile or lemon balm tea. If you'd rather not drink anything, lavender essential oil (DoTerra is my flavorist brand - no association with the company) can be diffused to help calm your mind.
Sleep Banking and Naps
If you know you will be experiencing less sleep due to shift work or other reasons, 'sleep banking' is something you can do a few nights before to help protect against the negative effects of sleep deprivation. You can try to nap during the day or sleep longer a few nights before to get more hours 'in the bank'. (18)
Ultimately, the best intervention for sleep deprivation is sleep. If you're practicing sleep hygiene but still having trouble with sleep, there are many natural sleep aids that can be added to your routine. Do not start these without speaking with your naturopathic doctor first or book an initial assessment with Dr. Melissa, ND to figure out the best treatment plan for you. A key part of your treatment plan will include addressing any underlying health condition which may be disrupting sleep instead of purely using sedative supplements. For example, stress management, addressing depression or anxiety, hormonal issues (menopause etc.) are a few conditions that can affect sleep.
If you have any questions about sleep and how Dr. Melissa, ND can help you please book a Free 15 minute consult call!
References
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Besedovsky L, Lange T, Born J. Sleep and immune function. P flugers Arch. 2012;463(1):121-37
Spiegel K, Sheridan JF, VanCauter E. Effect of sleep deprivation on response to immunization. JAMA.2002;288(12):1471-2.
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Hey JY, Kim K, Fava M, Mischoulon D, Papakostas GI, Kim MJ, Kim DJ, Chang KJ, Oh Y, Yu BH, Joen HJ. Effects of smartphone use with and without blue light at night in healthy adults: A randomized, double-blind, cross-over, placebo-controlled comparison. J Psych Res. 2017;87:61-70.
Chang AM, Aeschbach D, Duffy JF, Czeisler CA. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proc Natl Acad Sci USA. 2015;112(4):1232-7.
Yang PY, Ho KH, Chen HC, Chien MY. Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. J Physiother. 2012;58(3):157-63.
Hartescu I, Morgan K, Stevinson CD. Increased physical activity improves sleep and mood outcomes in inactive people with insomnia: a randomized controlled trial. J Sleep Res. 2015;24(5):526-34.
Gross CR, Kreuzer MJ, Reilly-Spong M, Wall M, Winbush NY, Patterson R, Mahowald M, Cramer-Bornemann M. Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: a randomized controlled clinical trial. Explore (NY). 2011;7(2): 76-87.
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Tsai HJ, Kuo TB, Lee GS, Yang CC. Efficacy of paced breathing for insomnia: enhances vagal activity and improves sleep quality. Psychophysiology. 2015;52(3):388-96.
Rupp TL, Wesensten NJ, Bliese PD, Balkin TJ. Banking sleep: realization of benefits during subsequent sleep restriction and recovery. Sleep. 2009;32(3):311-21.