Who Needs More Sleep? We Do! - Thriven Functional Medicine Clinic
Melatonin and Cortisol
November 25, 2019
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Melatonin and Cortisol
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Are you getting enough sleep? If not, you are have a lot of company in a world filled with people who are tired most of the time.

Although most people get less than six to seven hours a night, the World Health Organization and National Sleep Foundation recommend eight hours a night. Dr. Anderson said she routinely hears people say they are fine getting less sleep but she recommends that her patients try eight hours a night for a couple of weeks and then report back. We can “get by” on five hours a night but few people function optimally on less than seven.

Eight hours a night may sound like a lot, but doctors are beginning to sound the alarm on the national health epidemic caused by too little sleep. Indeed, Dr. Anderson has come to believe that sleep is the most important health issue she needs to address. Good sleep must come first because patients can’t make smart food choices or work on stress levels or exercise when they are sleep deprived. “Nobody functions well on less than seven hours a night and the effects are profound,” she said.


Lack of Sleep:

  • Harms the immune system – sleep strengthens the cells that fight infection and sickness and when you do fall ill, sleep reinforces the system that fights cold and the flu.
  • More than doubles the risk of cancer – the sympathetic nervous system goes into overdrive when you haven’t had enough sleep and this causes inflammation. Cancer uses this sustained inflammatory response to help grow blood vessels that feed cancer cells. Sleep deprivation also decreases levels of one type of cancer fighting immune cell.
  • May be a factor in developing Alzheimer’s Disease – getting too little sleep across your lifespan can increase chances of Alzheimers. During deep sleep, the brain cleans itself and flushes out contaminants including the amyloid protein and tau, both of which are associated with Alzheimer’s Disease.
  • Disrupts blood sugar levels to the point of being classified as pre-diabetic. Lack of sleep is linked to a decrease in your cells’ ability to absorb glucose from your bloodstream. Chronic sleep deprivation is a major factor in developing irreversible Type 2 diabetes.
  • Increases chance of cardiovascular disease and congestive heart failure – adults 45 years or older that sleep less than six hours a night are 200% more likely to have a heart attack or stroke than those who sleep seven to eight hours. Lack of sleep causes an overactive sympathetic nervous system which results in a faster heartbeat which, in turn, leads to a hypertensive state of blood pressure. Another downside of this active sympathetic nervous system is an increase in cortisol which constricts blood vessels. Additionally, the growth hormone that is released during sleep isn’t plentiful enough to replenish the lining of your blood vessels if you are sleeping poorly.
  • Can contribute to problems such as depression and anxiety and decreased concentration. Drowsy and distracted driving causes hundreds of accidents a year. Unfortunately, we adapt to less sleep and think our ability to concentrate is normal. Less sleep is also linked to instability within our emotions, along with anger and hostility.
  • Increases hormones that make you feel hungry while at the same time suppressing hormones that signal you are full, resulting in weight gain. We do not burn more calories when we sleep less because sleep is actually a metabolically active state. Additionally, when we are sleep deprived we feel less energy and have a hard time finding motivation to exercise.
  • Lack of sleep quiets the prefrontal cortex activity that we need for good judgements and controlled decisions.
  • Puts our sympathetic nervous system on overdrive and the resulting release of cortisol cultivates the bad bacteria in our gut. Lack of sleep also results in a decreased ability to make food decisions that will heal, rather than damage our intestinal system


What is making it so hard for us to get good sleep?

  • Caffeine – Dr. Anderson said most people say coffee doesn’t bother them so she recommends getting off of it for two weeks and seeing if there is a difference. “We rely on coffee so much because we are sleep deprived and our adrenals are not functioning so we are not getting a normal cortisol response in the morning,” she said. The problem is that coffee can affect you for up to 36 hours. Unfortunately, caffeine is also in energy drinks, chocolate, ice cream and even green tea and decaffeinated drinks. We might be ingesting caffeine close to bedtime and not even know it. Also, coffee has a half-life of 5-7 hours so five hours later, 50% of the coffee you drank will still be in your system.
  • Alcohol is a powerful suppressor of REM sleep. Drinking alcohol before bed results in disrupted sleep even though you might not realize it.
  • Many people are dealing with melatonin and cortisol imbalances. Electric light and LED light all day and into the night restricts the release of melatonin (see article on melatonin).
  • Warm temperatures in bedrooms at night disrupts sleep (62 to 65 degrees is recommended.)
  • Increased use of sleeping pills. You are sedated when you take sleeping pills and not sleeping naturally so you don’t get the deepest brain waves with NREM sleep. Additionally, if you take them somewhat regularly, they can cause rebound insomnia when you stop.
  • Disruptive sleep environment. Your bedroom should be cool, quiet, dark and de-cluttered. A dusty environment or sleeping with pets can trigger allergies and cause mouth breathing which disrupts sleep.


What Does Sleep Do For Us?

Sleep is more than just a time to rest our eyes. A full night of sleep rejuvenates the immune system by strengthening fighter cells, balances insulin and improves gut health. Sleep also lowers blood pressure and calms our sympathetic nervous system.

Despite college students’ belief in all-nighters, sleep actually improves memory by taking information that has been put into the hippocampus all day and moving it to other places in the brain to be stored. Sleep removes clutter from our brain that we don’t need (where we parked at the grocery store two days ago) and puts a save on items we do need.

Matthew Walker, Ph.D. a renowned neuroscientist and expert on sleep said, “Following a night of sleep, you gain access to memories you could not retrieve before sleep.”

Not only does it help with memory, sleep also has been shown to improve creativity by allowing the brain to connect pieces of knowledge that seem unconnected. This results in problem solving and transformative thinking. REM sleep links memories and new knowledge and this helps us find solutions to problems and creates understanding.

Additionally, sleep has been shown to help us deal with painful and traumatic events. During REM sleep, we relive events from our lives but without the emotions. We are processing memories in a safe environment and without the release of stress chemicals. This helps us to think about the event later, when we are awake, without the same intense emotions.

Interestingly, people with PTSD usually experience very disrupted REM cycles so they can’t take advantage of this healing process. They also have elevated levels of noradrenaline even at night, thus the dream about a memory, becomes a nightmare.


A Brief Overview of Sleep

When it is time to go to bed sleepiness is signaled in two ways:

  1. Our circadian rhythm runs on a nearly 24 hour cycle. It activates many mechanisms during the day that work to keep us awake and it cycles down these same mechanisms at night so we can go to sleep.
  2. Certain chemical processes occur that promote sleep. Melatonin is released in the evening, regulating the timing of when sleep happens but it doesn’t affect the generation of sleep. There is a compound called adenosine that plays a larger part in sleep itself. Adenosine is a chemical that begins to build in the brain from the moment you wake. Slowly, throughout the day, adenosine accumulates, building sleep pressure, increasing the desire to sleep by nighttime. When we aren’t getting enough sleep, the desire can build to the point of causing us to fall asleep during work, at the computer, or even while driving. During sleep, receptors absorb adenosine so that we can start our day without its sleep pressure. Unfortunately, if we don’t sleep long enough to absorb all the adenosine, we must start each new day already feeling sleep pressure. At this point, many of us mute adenosine’s sleep pressure by ingesting a chemical called caffeine which blocks the receptors that take in adenosine. Caffeine blocks the sleepiness signal. Undeterred, however, adenosine just keeps building and building, waiting for the caffeine to wear off then hitting us with a wall of tiredness.

The good news is that, when our circadian rhythm, melatonin and adenosine work together to get us to sleep, we drift off to unconsciously experience the benefits of REM sleep, and non-REM or NREM sleep.

In cycles of about 90 minutes we go back and forth between these types of sleep all night. The NREM sleep tends to be deeper earlier in the night and lighter toward morning and both types are important. During NREM sleep, our brain weeds out unneeded connections and we can get rid of the superfluous information. Equally important, the brain uses this time to move pieces of information between different brain centers. During NREM our brain takes information from short-term memory centers and delivers it to long-term centers.

REM sleep, on the other hand, strengthens the connections and memories that are important while it also reviews memories and integrates them, helping us better understand the waking world.

As Matthew Walker said, “Numerous functions of the brain are restored by, and depend upon, sleep. No one type of sleep accomplishes all. Each stage of sleep – light NREM sleep, deep NREM sleep and REM sleep – offer different brain benefits at different times of the night.”

Although lack of sleep can cause numerous health issues, it’s important to remember that we are made to sleep and there are numerous ways to improve our sleep. For those of us who are trying to improve our well-being, something as natural as sleeping might be the most important thing we can do, today, for our health.


Tips for a good night sleep:

Go to sleep and wake up at the same time each day

Exercise, but not too close to bedtime

Avoid caffeine and nicotine

Avoid alcohol near bedtime

Don’t eat heavy meals late at night and minimize liquids close to bedtime

Try to limit medicines that interrupt your sleep

Don’t take naps after 3pm

Relax before bed, listen to music, read (but not on an electronic device), take a bath

Create a dark, cool, quiet, clutter and gadget-free sleeping space

Get outside for natural light exposure at least 30 minutes a day. Try waking up with the sun or using bright lights early in the day

Get help from a doctor if you suspect more serious problems such as: chronic insomnia, sleep apnea, or restless leg syndrome

Tips for a good sleep are from Why We Sleep: Unlocking the Power of Sleep and Dreams by Matthew Walker, PhD.

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