By Dr. Jeremy Girmann
In the previous month’s column, we considered the importance of sleep and examined potential consequences of sleep deprivation.
The goal of this month’s column is to outline several ways in which we can improve the duration and quality of our sleep.
Our bodies function according to various rhythms. These rhythms govern the release of hormones, the fluctuation of body temperature, the regeneration of cells, and many other biological activities. The circadian rhythm, a 24-hour oscillation, is inextricably linked to the light-dark cycle. Have you ever wondered how this biological rhythm is maintained? Specialized cells in the hypothalamus region of our brains, collectively called the suprachiasmatic nucleus, serve as the master regulators of the circadian clock. These cells receive information from our eyes related to the light of day and the dark of night. This information is interpreted and passed along to another region of the brain called the pineal gland. When this gland receives signals indicating that it is nighttime, a hormone called melatonin is secreted, which prepares the brain and body for sleep.
Given that the sun was the major source of light for the vast majority of our existence, this process functioned well with the rising and setting of the sun to maintain our sleep-wake cycles and associated biologic processes. The advent of artificial light, however, has allowed illumination of our evenings well beyond the setting of the sun. The result is a discordance between the darkness of night and our preparedness for sleep. This leads to the first sleep-saving recommendation:
Try to avoid staying up for hours after the sun goes down.
Okay, so this is clearly much less practical during the shorter days of the year when the sun sets in the early evening. During these times, however, we can minimize the impact of artificial light on our sleep by limiting our exposure to certain types of light.
Limit exposure to blue light.
Though all light can inhibit the secretion of melatonin, the short wavelengths of blue light can be particularly problematic. Historically our evenings were illuminated by the red, orange, and yellow hues of fire. The longer wavelengths of these colors cause fewer disturbances in our melatonin-secreting mechanisms. Today, energy-efficient lights and electronic devices emit many more blue light wavelengths that impair our brain’s sleep signal.
Some things to consider:
-Use incandescent bulbs before bed. Incandescent bulbs produce less blue light than fluorescent light bulbs.
-Wear blue blocker glasses/goggles. Most are big, orange, and look ridiculous. I tend to do a fair amount of work on my computer before bed and when I first started using blue blocker goggles, my wife thought that I was a maniac. She quickly changed her opinion of my goofy goggles, however, after I began to snooze soundly while she continued her struggle to fall asleep.
Maintain a consistent sleep schedule.
Maintaining a consistent sleep schedule allows the internal clock to function optimally. Going to bed at different hours impairs the body’s sense of time. It’s much like that wristwatch with the dying battery that always seems to be pointing its hands at the wrong numbers. Once you achieve a consistent schedule, you might even find that you regularly wake without an alarm.
Avoid caffeine, nicotine, and alcohol before bed.
While caffeine can impair sleep for obvious reasons, many people are surprised to learn that it tends to hang around in your system for an average of 6 hours. While this varies between individuals, an afternoon soda, cup of coffee, or pre-workout concoction can often influence your ability to sleep even many hours later.
Nicotine can also disrupt sleep. (As if you need another reason to quite smoking.)
While alcohol can in fact help you to fall asleep, it can also erode the quality of sleep. Specifically, alcohol is known to disrupt the rapid eye movement (REM) phase of sleep, which can significantly impair your memory and concentration. As with many sleep aides, merely having your eyes closed does not guarantee restful and restorative sleep.
Avoid eating big meals at night.
Eating a big meal before bed places demands on the digestive system, which prevents the body from going into a complete rest mode. Heavy, spicy, and acidic foods can be particularly disruptive.
Get regular exercise.
Rigorous exercise results in restful sleep but even brief periods of walking have been shown to improve sleep quality. While some can exercise at any hour, others must finish their workouts at least 3 hours before bedtime in order to avoid difficulty in falling asleep due to the stimulatory effect of exercise.
Expose yourself to sunlight during the day.
Getting proper exposure to sunlight during the day can insure that the body’s internal clock is properly configured. Limited daytime light exposure and loss of day/night orientation can cause profound problems. In fact, this is a common cause of delirium in the hospital setting.
Use a light therapy box if necessary. Therapy boxes provide a balanced spectrum of light equivalent to standing outdoors on a clear spring day. This can be particularly helpful during the shorter days of winter. In medical school I would routinely use a light therapy box to illuminate my room in order to stay awake and alert during my hours of reading.
Keep the bedroom cool.
When you begin to fall asleep, your body temperature naturally begins to decrease by 1 to 2 degrees. This is thought to occur in order for the body to conserve energy for other functions that would normally be spent on maintaining a regular body temperature during the day. Sleeping in a cool bedroom can help your body to achieve an optimal core temperature.
TVs, phones, and computers – get them out of the bedroom. Your brain should associate the bedroom with sleep, not with sitcoms, work, or Facebook. If you feel compelled to have your phone in the room because it serves as your alarm clock, buy an alarm clock.
Many people report finding it difficult to fall asleep for the reason that they cannot stop their minds from racing after the events of the day and in anticipation of the what tomorrow might bring. Practice being mindful in the moment. If you are someone who takes tension to bed, you might find that your tongue is pressed against the roof of your mouth. Allow for it to relax. Let shallow breaths become deeper and tension to dissipate with each exhalation. Feel the softness of your pillow and the warmth of the covers. Imagine your body switching into repair mode. Count sheep if you must.
Take supplemental melatonin.
While behavioral and environmental considerations are of utmost importance for insuring quality sleep, supplemental melatonin can help. Found to be particularly useful for alternating shift work or jetlag, melatonin can help to establish a normalized sleep pattern. In addition to facilitating normal sleep, melatonin also acts as a powerful antioxidant and is being studied for its potential role in the prevention of cancer and the treatment of high blood pressure, osteoporosis, fibromyalgia, metabolic syndrome, and a number of other conditions.
Another plus? It’s a very safe and affordable supplement.
For more information related to the potential role of melatonin supplementation, I’d refer you to the prolific work of Dr. Russel Reiter.
A few interesting side notes about melatonin:
While melatonin is produced in the pineal gland of humans, it’s also produced in other areas of the body including bone marrow cells, the retina, and the gastrointestinal tract. Given its role in the GI system, I have found that many patients with heartburn benefit from melatonin supplementation. Melatonin has also been discovered in many plants and while its function in plants is still a focus of ongoing research, the antioxidant properties of melatonin are thought to be of critical importance to the plants in order to help them cope with harsh environments and conditions.
Get a sleep study.
Do you snore? Do you wake in the mornings never feeling refreshed? You might have sleep apnea. A common disorder and cause of innumerable additional health problems, sleep apnea is a condition that often goes undiagnosed. Characterized by shallow or paused breathing during sleep, sleep apnea can be diagnosed with a formal sleep study and appropriate treatment often allows people to feel and function much better throughout the day.