SLEEP WELL

“…one of the most significant and overlooked public health problems is that many adults are chronically sleep-deprived, and most people who are do not even realize it.” American Psycological Association

Sleep is defined as “the periodic state of rest during which consciousness is interrupted”. What many people don’t realize is that when sleeping our bodies are not only being restored and rejuvenated, but important work is being done…hormones are released that are vital to our physical and mental health, our nervous system is repairing neurons that were used during the day…brain cells are being repaired, and the mind is refreshing and even detoxing.

And with an estimated 100 million people suffering with some form of insomnia it is no wonder that many are struggling wit health issues. Boston University School of Medicine found a definite connection between sleep disorders and diabetes. An American Cancer Society study found that people who slept 7-8 hours had a lower mortality rate than those sleeping more than 9 hours or less than 6 hours.

TYPES & STAGES OF SLEEP:

There are two types of sleep:

*REM = Rapid Eye Movement
REM sleep occurs about 70-90 minutes into the sleep cycle and you have approx. 3-5 episodes per night. This is when you are most likely to dream.

*NREM = Non- REM
This is when you are in a deep sleep state.

The four stages of sleep include:

Stage 1 = This is the first 5-10 minutes when you first fall asleep.
Muscle activity slows, eyes move slowly under the eyelids.

Stage 2 = Light Sleep
Eye movements stop, heart rate slow; body temp decreases.

Stages 3 & 4 = Deep Sleep
This is the period when you are in a deep sleep state and are hard to awaken.

SLEEP DISORDERS:

A sleep disorder can be determined by the following criteria:

• Difficulty falling or staying asleep
• Difficulty staying awake during daytime
• Sleeping too much
• Difficulty sleeping during normal sleep hours at night
• Disrupted sleep
• Unrefreshed sleep

Less than 6 hours and more than 9 hours are considered to be too little, or too much sleep, respectively.

There are actually over 100 types of sleep disorders, including insomnia, sleep apnea, restless leg syndrome and narcolepsy. There are doctors who specialize in sleep disorders, or your general physician can help to diagnosis and assess your situation. It can also be a symptom of another illness or something else going on in your body, so it is important to consult with a professional if nothing seems to remedy the problem.

EFFECTS OF INSUFFICIENT SLEEP:

• Immune system problems
• Metabolic changes that can lead to obesity and hypertension
• Increased risk of accidents
• Increase in BMI (Body Mass Index) which can lead to a greater chance of obesity – this is due to increased appetite caused by sleep deprivation
• Increased risk of diabetes, heart problems, depression and substance abuse
• Decreased ability to pay attention, react to signals, and remember new information
• Magnified effects of alcohol on the body

EFFECTS OF TOO MUCH SLEEP:

Sleeping too much, over 9 hours, can actually be worse than not getting enough sleep. The American Cancer Society did a study comparing people who slept too much and those who did not get enough sleep, and found that the group that slept too much actually had increased illness, accidents and even death!!

HOW MUCH SLEEP DO YOU NEED?

We all have different sleep needs, but how do you know how much sleep your body requires? Most people need at least 6 hours of sleep. But a good rule of thumb to determine if you are getting enough sleep is to evaluate how you feel - if you awaken feeling refreshed and you don’t feel sleepy during the day, you are getting enough sleep.

St. Mary’s Medical Center has a test you can take to determine your sleepiness level, the
Epworth Sleepiness Scale Test. The web link is:

www.smmc.com/Epworth-Sleepiness-Scale.105.0.html

It is possible to make up “sleep debt” if you miss a night or two of good sleep, but chronic sleep debt can have serious long term effect.

SLEEP TIPS:

Ok, so you are having trouble getting to sleep or staying asleep, so what can you do? Here are a few tips that may help:

• Go to bed when you are sleepy and turn off the lights.
• Establish a consistent sleep routine – try to go to bed at the same time each night.
• Clear your mind of anxious thoughts. (See Relaxation Techniques, Meditation, Visualization)
• Don’t exercise late in the day.
• Create a relaxing bedtime ritual – maybe a warm bath, listening to relaxing music, reading something that relaxes you (definitely NOT a mystery thriller or anything depressing!).
• Avoid alcohol, caffeine and nicotine as they are all stimulants
• Limit food intake before bed – eat 2-3 hours before going to sleep (make sure your evening snacks are not too heavy and are healthy!).
• Good foods to eat that are high in tryptophan , an amino acid that helps your body to produce serotonin, a chemical that relaxes you are milk, peanuts and turkey…I find since having plain lowfat yogurt (Fage is my favorite brand as it is very high in protein, see Recommended) about two hours before bed helps me to sleep and keeps my blood sugar at a perfect level all night.
• Studies show that lower body temperatures help people fall asleep, so to cool down try a hot bath about 90 minutes before bed – that can trigger the body to induce a drop in temperature afterwards, which correlates with sleep.

If nothing seems to be helping, try a sleep diary. Keep a record of the time you went to bed, the quality of your sleep, what you ate or drank before bed, your feelings, any drugs or medications you are taking. See if you can identify a pattern as to what triggers difficulty falling or staying asleep.

MORE TIPS & INFORMATION:

• It is important to make sleep a priority.
• Don’t nap – and if you have to, sleep no more than 30 minutes early in the day.
• Is your bed comfortable? What about your pillow? And are you sleeping on natural organic cotton? If not, you may be sleeping on bedding that has been heavily sprayed with pesticides and chemicals – not the best for nurturing an supporting your body. (see Recommended)
• Hide your clock where you can’t see it – looking at while you are trying to get to or fall back to sleep can increase your anxiety.
• Is the temperature in your bedroom comfortable? It is better to be cooler than warmer.
• Women: check your iron levels, low iron can contribute to sleep problems.
• And regarding sleep medications – remember they do not treat the root cause of your sleep problem and can ultimately make them worse. Sleeping pills can be addictive and require larger and larger doses, plus interfere with deep sleep, not to mention the side effects.
• For information about Melatonin*, a "natural" supplement that can be helpful in dealing with brief periods of insomnia or other sleep difficulties, see below.

For additional information on sleep, check out these websites:

www.npi.ucla.edu/sleepresearch/sciam2003/sciamsleep.pdf

www.time.com/time/magazine/article/l

www.helpguide.org/life/sleeping.htm

www.helpguide.org/life/sleep_tips.htm

www.mayoclinic.com/health/sleep/HQ01387

www.stanford.edu/~dement/temp.html

*MELATONIN

Although I don't have personal experience in using melatonin, I do know people for whom it has been helpful in overcoming periods when it is difficult for them to fall asleep. The University of Maryland Medical Center has a great website, and had lots of information about Melatonin. I have reprinted some of the information here, or visit their website: http://www.umm.edu/

Overview

Melatonin is a hormone secreted by the pineal gland in the brain that helps regulate other hormones and maintains the body's circadian rhythm. The circadian rhythm is an internal 24-hour time-keeping system that plays a critical role in determining when we fall asleep and when we wake up. Darkness stimulates the production of melatonin while light suppresses its activity. Exposure to excessive light in the evening or too little light during the day can disrupt the body’s normal melatonin cycles. For example, jet lag, shift work, and poor vision can disrupt melatonin cycles. In addition, some experts claim that exposure to low-frequency electromagnetic fields (common in household appliances) may disrupt normal cycles and production of melatonin.

Melatonin also helps control the timing and release of female reproductive hormones. It helps determine when menstruation begins, the frequency and duration of menstrual cycles, and when menstruation ends (menopause).

Many researchers also believe that melatonin levels are related to the aging process. For example, young children have the highest levels of nighttime melatonin. Researchers believe these levels diminish as we age. In fact, the decline in melatonin may explain why many older adults have disrupted sleep patterns and tend to go to bed and wake up earlier than when they were younger. However, emerging research calls this theory into question.

In addition to its hormonal actions, melatonin has strong antioxidant effects. Preliminary evidence suggests that it may help strengthen the immune system.

If you are considering using melatonin supplements, talk to your doctor.

For Insomnia:

Although results are still controversial, studies suggest that melatonin supplements help induce sleep in people with disrupted circadian rhythms (such as those suffering from jet lag or poor vision or those who work the night shift) and those with low melatonin levels (such as some elderly and individuals with schizophrenia). In fact, a recent review of scientific studies found that melatonin supplements help prevent jet lag, particularly in people who cross five or more time zones. A few studies suggest that when taken for short periods of time (days to weeks) melatonin is significantly more effective than a placebo, or “dummy pill,” in decreasing the amount of time required to fall asleep, increasing the number of sleeping hours, and boosting daytime alertness. In addition, at least one study suggests that melatonin may improve the quality of life in people who suffer from insomnia and some experts suggest that melatonin may be helpful for children with learning disabilities who suffer from insomnia. Although research suggests that melatonin may be modestly effective for treating certain types of insomnia, few studies have investigated whether melatonin supplements are safe and effective for long term use.

Available Forms:

Melatonin is available as tablets, capsules, cream, and lozenges that dissolve under the tongue.

Dosage:

There is currently no recommended dose for melatonin supplements. Different people will have different responses to its effects. Lower doses appear to work better in people who are especially sensitive. Higher doses may cause anxiety and irritability.

The best approach for any condition is to begin with very low doses of melatonin. Keep the dose close to the amount that our bodies normally produce (< 0.3 mg per day). You should only use the lowest amount possible to achieve the desired effect. Your doctor can help you determine the most appropriate dose for your situation, including how to increase the amount, if needed.

• Insomnia: 3 mg one hour before bedtime is usually effective, although doses as low as 0.1 to 0.3 mg may improve sleep for some people. If 3 mg per night is not effective after 3 days, try 5 to 6 mg one hour before bedtime. An effective dose should produce restful sleep with no daytime irritability or fatigue.
• Jet lag: 0.5 to 5 mg of melatonin one hour prior to bedtime at final destination has been successful in several studies. Another approach that has been used clinically is 1 to 5 mg 1 hour before bedtime for 2 days prior to departure and for 2 to 3 days upon arrival at final destination.

Because of the potential for side effects and interactions with medications, people should take dietary supplements only under the supervision of a knowledgeable healthcare provider. Some people may experience vivid dreams or nightmares when they take melatonin. Overuse or incorrect use of melatonin may disrupt circadian rhythms. Melatonin can cause drowsiness if taken during the day. If you experience morning drowsiness after taking melatonin at night take a lower dose. Additional side effects include stomach cramps, dizziness, headache, irritability, decreased libido, breast enlargement in men (called gynecomastia), and decreased sperm count. Pregnant or nursing women should not take melatonin as it could interfere with fertility. Some studies show that melatonin supplements actually worsened symptoms of depression. For this reason, individuals with depression should consult their doctor before using melatonin supplements.

Although many researchers believe that melatonin levels diminish with age, emerging evidence has brought this theory into question. Since findings are inconsistent, people older than 65 years of age should consult their doctor before taking melatonin supplements, so blood levels of this hormone can be monitored appropriately.

If you are currently being treated with any of the following medications, you should not use melatonin without first discussing it with your doctor. Antidepressant Medications In an animal study, melatonin supplements reduced the antidepressant effects of desipramine and fluoxetine. More research is needed to determine whether these effects would occur in people. In addition, fluoxetine (a member of a class of drugs called selective serotonin reuptake inhibitors or SSRIs) has led to measurable depletion of melatonin in people. Antipsychotic Medications A common side effect of antipsychotic medications used to treat schizophrenia is a condition called tardive dyskinesia, a movement disorder of the mouth characterized by a constant chewing motion and darting action of the tongue. In a study of 22 people with schizophrenia and tardive dyskinesia caused by antipsychotic medications, those who took melatonin supplements had significantly reduced mouth movements compared to those who did not take the supplements. Benzodiazepines The combination of melatonin and triazolam (a benzodiazepine medication used to treat anxiety and sleep disorders) improved sleep quality in one study. In addition, there have been a few reports suggesting that melatonin supplements may help individuals stop using long-term benzodiazepine therapy. (Benzodiazepines are highly addictive.) Blood Pressure Medications Melatonin may reduce the effectiveness of blood pressure medications like methoxamine and clonidine. In addition, medications in a class called calcium channel blockers (such as nifedipine, verapamil, diltiazem, amlodipine, nimodipine, felodipine, nisoldipine, and bepridil) may decrease melatonin levels. Use of Beta-Blockers (another class of high blood pressure medications including propranolol, acebutolol, atenolol, labetolol, metoprolol, pindolol, nadolol, sotalol, and timolol) may reduce melatonin production in the body. Blood-Thinning Medications, Anticoagulants Melatonin may increase the risk of bleeding from anticoagulant medications such as warfarin. Interleukin-2 In one study of 80 cancer patients, use of melatonin in conjunction with interleukin-2 led to more tumor regression and better survival rates than treatment with interleukin-2 alone. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) NSAIDs such as ibuprofen may reduce the levels of melatonin in the blood. Steroids and Immunosuppressant Medications People should not take melatonin with corticosteroids or other medications used to suppress the immune system because the supplement may cause them to be ineffective. Tamoxifen

Preliminary research suggests that the combination of tamoxifen (a chemotherapy drug) and melatonin may benefit certain patients with breast and other cancers. More research is needed to confirm these results.

Other Substances

Caffeine, tobacco, and alcohol can all diminish levels of melatonin in the body while cocaine and amphetamines may increase melatonin production.