Sleep is one of our most precious health resources. Without it, our quality of life declines sharply, and we are more prone to a long list of negative health outcomes. Both acute and chronic sleep deprivation cause such drastic declines in performance that a 24-hour period of no sleep, or a week of four to five hours per night is equivalent to having a blood alcohol content of 0.1 percent. It’s no wonder that 20 percent of car accidents are related to sleep deprivation.
Insomnia includes problems falling asleep, frequent awakening, difficulty falling back asleep or waking too early in the morning. It may be classified as transient (lasting a few days to weeks), intermittent (clusters of transient insomnia occurring periodically) or chronic (occurs nightly for longer than a month).
Insomnia can also be classified as either primary—in which it has no known cause and the symptoms can’t be attributed to any typical causes, such as medical, psychiatric or environmental—or secondary, in which the insomnia is the symptom of some other problem such as a physical condition or psychological problem.
The Costs of Insomnia
The average amount of sleep a healthy adult needs is seven to eight hours per night. Inadequate sleep can cause increased heart rate and blood pressure, increased inflammation as measured by C-reactive protein, impaired glucose tolerance, increased appetite (and weight gain) and decreased immune function. Most shockingly, people who reported getting substantially less than seven hours a night had a greater risk of dying than those who didn’t.
One of the first things to address in people with insomnia is the concept of “sleep hygiene.” Sleep hygiene entails modifying all environmental and behavioral factors that may interfere with sleep. Examples of this include:
- Establishing regular sleep and wake patterns. Go to bed and wake up at the same time every day. Ideal sleep hours for many people are from 10 p.m. to 6 a.m.
- Utilize your bed for sleep only—don’t watch TV or use a computer in bed.
- Create a relaxing bedroom environment. Make your bed comfortable, keep the bedroom temperature cool and remove all sources of light, including blocking the windows and removing glowing objects such as alarm clocks and phones.
- Clear your mind. Avoid emotionally upsetting situations right before bed, such as arguments, news programs, etc. Try not to bring your problems to bed with you.
Women and Insomnia
Regular physiologic changes in women (puberty, menstruation, pregnancy, menopause) are associated with sleep issues. These tend to worsen in comparison to men over time. More specifically, women are 1.4 times more likely to have insomnia than men, while 35 to 40 percent of postmenopausal women have sleep problems.
Researchers don’t fully understand why this happens. However, the differences are clearly related to the hormonal fluctuations that women undergo. A complex subject in and of itself, postmenopausal hormone balance has many benefits beyond sleep issues and should be addressed.
Common Causes of Insomnia
The average amount of sleep reported by adults has decreased by an average of one hour per night between 1959 and 1992, while a study published in 2010 showed a significant increase in the number of people who slept less than six hours a night. These findings are most likely explained by a societal trend toward longer work and family hours that accompany modern lifestyles.
Australian culture is such that it’s common for both adults in a household to work, raise children (and involve them in multiple activities that further detract from rest time) and still attend to all of the duties of running a household.
It would seem the Australian work ethic has created mile-long “to do” lists and responsibilities that leave little time for sleep. In fact, sleep is often looked down upon and even perceived as a weakness. For example, many of my patients view sleep as something that wastes time and impedes their full task-driven potentials.
Many people claim that eating late in the evening, or eating sugary foods late, will prevent them from falling asleep. This occurs as the body is winding down and preparing to rest, but is then jolted back into working on digesting a meal, not to mention the hormonal rollercoaster that blood sugar variations cause.
Elevated blood sugar and insulin may interfere with sleep, as will the resulting low blood sugar after a high sugar meal, as the body fights to regulate hormones associated with eating rather than sleeping.
Common advice says not to eat within three hours of going to bed. Additionally, having a full stomach and lying down to bed is a common cause of acid reflux, as the stomach contents are more easily able to flow up the esophagus when a person is lying down. This discomfort can further exacerbate sleep issues.
Caffeine is a well-known stimulant that hangs around in your body longer than you may think. The half-life of caffeine is approximately five to seven hours, which means that, in that time, only half of the caffeine you ingested is out of your body.
Seventy-five percent of caffeine will be gone at 8 to 10 hours. In other words, drinking caffeine later in the day means that it will still be in your body at bedtime, albeit in smaller amounts. If you have sleep problems, a good rule of thumb is to avoid all caffeine consumption after 12 p.m.
Alcohol is well known for its sedative properties. While drinking before bed can bring on sleep, it often causes many problems with sleep quality. A study published in December 1996 showed that moderate alcohol consumption six hours before bedtime resulted in reduced sleep efficiency, total sleep time, REM sleep and stage-1 sleep. During the latter half of sleep, subjects woke up twice as often as subjects who consumed no alcohol. Because of the latent effects of alcohol on sleep, it should be avoided entirely by people with insomnia.
Vigorous exercise later in the evening causes the body to churn out cortisol and other stimulatory hormones that are responsible for the exerciser’s “high” and can keep you awake. If you prefer vigorous exercise, get it in earlier in the day. Relaxing exercises such as yoga or stretching are better suited later in the evening, as they can help you de-stress and relax your mind in preparation for sleep.
Medical conditions like an enlarged prostate or gynecologic issues may cause a person to wake up frequently to urinate. Anxiety and depression are notorious for worsening sleep, and elevated cortisol from chronic stress can disrupt sleep patterns. Insulin resistance can also contribute to poor sleep. Getting these problems addressed by your health professional can go a long way toward improving sleep.
Natural Sleep Aids
In addition to addressing the previously mentioned issues, natural sleep aids can help bring the brain into a deeper, more restorative sleep. Natural sleep aids are quite safe (when used alone and as directed) and without the serious side effects of prescription medications.
Melatonin is a hormone produced by the pineal gland in the brain and is readily manufactured in supplemental form as well. Melatonin secretion is influenced by light; that is, decreasing light stimulates melatonin release, signaling our body that it’s time to sleep. Because melatonin helps regulate the sleep-wake rhythm and induces sleep, it is a popular and useful remedy for sleep disturbances. Aim for 3-10 mg before bedtime as needed.
5-HTP (5-hydroxytryptophan) is an immediate precursor to the neurotransmitter serotonin in the brain. Serotonin regulates many brain functions, one of which is sleep. Taking supplemental 5-HTP will influence the production of more serotonin in the brain, which in turn can help with sleep onset. Take 50 to 100 mg as needed.
GABA (gamma-aminobutyric acid) is one of the most abundant neurotransmitters in the brain. It functions primarily to slow down brain function, and provide a balance from over stimulation. A study published in November 2008 showed that people with insomnia have 30 percent less GABA in their brains than those without insomnia; low levels were also correlated to more waking after the onset of sleep.GABA is especially helpful in those who “can’t turn their brains off” at night.
There are a range of herbs that directly influence GABA.
Get Your ZZZs
Insomnia is a common condition, with many different causes, most of which can be addressed by addressing lifestyle factors. More stubborn cases of insomnia warrant a complete checkup by your Health Professional, while natural supplements can safely promote better sleep.