A Deep Dive into Dreamland
Are you feeling tired today? According to the National Sleep Foundation’s 2020 Poll, the average American feels sleepy 3 days a week. And close to half said this sleepiness impacts their daily activities, mood and mental acuity.
It’s no surprise that Americans are feeling sleepy. The average length of sleep per night is less than 6 hours, which is far from the recommended 7-9 hours. How many hours of sleep do you average per night?
The CDC found that Connecticuters who average less than 7 hours of sleep a night are more likely to be obese and to suffer from heart attacks, strokes, asthma, arthritis, depression, and diabetes. Yes, there is a correlation between decreased sleep and chronic disease. Sleep is an essential brick in our foundation for good health. But how much emphasis do we put on it?
America runs on Dunkin’
We are familiar with this coffee chain’s ad jingle. It’s catchy and it’s true. As a society we value speed, efficiency, productivity, multi-tasking and squeezing the most out of each moment. Being busy means you are a valuable contributor to society. The more you do, the better you are, right?
But how can we do so much on so little sleep? We can’t.
It is no surprise that the average American coffee drinker consumes over 3 cups per day in addition to caffeinated soda and energy drinks. We are replacing valuable sleep with stimulant-fueled work overdrive. And the result is poorer health across all systems in the body.
We value organic food, clean water and high quality supplements. Now let’s begin to value sleep.
What happens when we sleep?
Truthfully, we still don’t understand why humans - or any animal for that matter - sleeps. While we sleep we are defenseless and vulnerable for an extended period of time. Wouldn’t evolution favor creatures that didn’t need to sleep? Yet the human need for sleep has not changed in millennia. Theories about why we need sleep include full body restoration and memory consolidation.
Body and brain restoration - Growth hormone secretion peaks during sleep contributing to muscle growth and cell regeneration throughout the body. This is especially important for an athlete’s recovery time.
Brain restoration occurs during deep sleep. This is the only time that neurotoxic waste is cleared out of the brain. If deep sleep is not adequate, the brain’s glymphatic system is disrupted and can contribute to neurodegenerative diseases.
Memory consolidation - While we sleep the brain consolidates memories, promotes synapse formation to consolidate learnings and maintains cognitive function and memory.
Stages of Sleep
Source: Neuroscience. 2nd edition, Purves D, Augustine GJ, Fitzpatrick D, et al., editors. Sunderland (MA): Sinauer Associates; 2001.
Sleep is categorized as rapid eye movement (REM) or non-REM (NREM) sleep.
We go from being awake to:
NREM light sleep - this is 5-10% of our total sleep. In Stage I our skeletal muscles can still move and breathing is at a regular rate. If you wake up in this phase you might not even know you were asleep.
In Stages II-III heart rate and body temperature drop. Sleep spindles activate the brain in Stage II and accounts for 45-55%, the largest percentage, of our sleep. Benzodiazepines increase sleep spindle activity and work at this level.
NREM Deep sleep or slow wave sleep is Stages III-IV. It is characterized by delta waves in the brain and accounts for 15-20% of our sleep. This stage occurs in the first half of the night and is the most rejuvenating and restorative sleep stage.
The benefits of deep sleep include growth hormone secretion, which is necessary for building bone and muscle and strengthening the immune system, and for our total brain health. Our central nervous system has the glymphatics system to remove waste and it is only active to remove toxic proteins when we are in deep sleep. Reduced deep sleep has been linked to neurodegenerative diseases.
REM sleep is marked by rapid eye movements and muscle inactivity (with the exception of the extraocular muscles and the diaphragm). This is the stage associated with vivid dreaming and accounts for 18-23% of sleep. While we dream we consolidate memories, learning and creativity. The REM cycles get longer throughout the night lasting from 10 minutes to 1 hour and is the last stage of sleep. If you wake up in the middle of a dream, you know you were in REM sleep.
People with narcolepsy will have REM early in their sleep pattern instead of towards the end. And obstructive sleep apnea sleep disturbance tends to occur during REM phase.
Sleep and our Lifecycle
Sleep changes over the course of our lifetime. Babies aged 0-3 months old start sleep directly in the REM phase before they have developed their circadian rhythm. Teenagers have a higher percentage of deep sleep. Sleep architecture begins to change in middle age.
As we age, our circadian rhythms of temperature, melatonin and cortisol diminish. As a result our percentage of deep sleep reduces, our REM stage decreases, and the percentage of light sleep increases. Our circadian regulation of sleep and wakefulness weaken and we experience increased involuntary waking up. As a result, reduced growth hormone and dopamine levels occur with healthy aging.
The incidence of sleep disorders increases both with normal aging and then even further with neurodegenerative disease including dementia, Parkinson’s disease, Lewy body dementia, and Alzheimer’s disease. Those with mild cognitive impairment have more noticeable changes in deep slow wave sleep, circadian rhythm disruption and REM sleep. Parkinson’s dementia with Lewy bodies is preceded by REM behavior disorder, characterized by muscle movement during REM sleep resulting in hand twitching or thrashing about.
Insomnia and its causes
Insomnia is the most common sleep problem in adults 60 and older. Insomnia includes taking a long time to fall asleep, waking up in the night, waking up early and not being able to fall back asleep, feeling sleepy during the day, and not being able to fall asleep.
There are many factors that impact sleep and can cause insomnia including:
Stress - Increased stress means increased cortisol, the steroid hormone that has an opposing rhythm to melatonin in our circadian rhythm. Elevated cortisol can disrupt our circadian rhythm and therefore sleep.
Hypoglycemia - If you wake up in the middle of the night, it could be due to a spike in cortisol caused by low blood sugar. If this is you, eat a small snack that is high fat with a protein about an hour before going to sleep.
Hot temperatures - Our body expects the temperature to drop at night, so keep your bedroom cool.
Blue light exposure - Blue light - like the sky! — has wavelengths of 450 nm. This blue wavelength decreases melatonin and disrupts your circadian rhythm. Be sure to block blue light from LED bulbs, TV screens and your phone by shutting off electronics and shifting light to yellow toned low watt lighting.
Caffeine - During the day our cells generate energy which creates the byproduct of adenosine. Adenosine builds up in the brain and contributes to our feeling sleepy at night. Caffeine blocks the adenosine receptors, which is one of the ways it helps you wake up in the morning.
Alcohol - We think that one glass of wine helps us sleep but when it metabolizes it actually causes sleep disturbances, especially in the REM phase, which shortens sleep.
Lack of oxygen caused by sleep apnea results in insomnia. People with sleep apnea tend to have REM earlier in their sleep pattern instead of towards the end.
Movement disorders like restless leg syndrome.
Being a night shift worker disrupts your circadian rhythm.
Medications such as barbiturates and other anti-epileptic drugs, beta antagonists, monoamine oxidase inhibitors, selective serotonin re-uptake inhibitors, tricyclic antidepressants, and stimulants also delay or suppress REM sleep.
Establishing great sleep hygiene
Establishing a solid sleep routine and good sleep hygiene is the most effective approach to helping the body maintain a healthy and consistent circadian rhythm. Aim to go to sleep at the same time each night even on the weekend to keep your circadian rhythm in check. Establish good sleep hygiene by incorporating lifestyle changes that help you wind down before going to sleep.
Your sleep routine can include:
✓ Hydrotherapy - Take a hot bath/shower 1-2 hours before going to sleep has been shown to improve deep sleep.
✓ Blue blocker glasses - If you can’t turn off the screen 3 hours before sleep, use glasses that block blue light to ensure melatonin secretion is not suppressed.
✓ Eat a low carb/high fat dinner several hours before your bedtime. Glucose oxidation from carbohydrates suppresses slow wave sleep.
✓ True darkness - Ensure your sleep environment is pitch black. Sunlight and blue light reduce melatonin.
✓ Pink noise played during the first 90 minutes of sleep has been found to slow brain oscillations and increase sleep. Check out the free app Simply Noise.
If you are following a good solid sleep routine and still struggle with insomnia, sometimes our body needs a bit of help.
Supplements to support good sleep include:
✓ Melatonin - Melatonin decreases as we age so it is especially helpful for age-related insomnia. It also helps with insomnia due to depression, autism, or epilepsy and to help patients withdraw from benzodiazepine therapy.
✓ GABA - GABA is our main inhibitory neurotransmitter of the CNS. Barbituate and benzodiazepine medications target the GABA receptor. In my clinical experience patients love GABA because it doesn’t leave them feeling drowsy in the morning.
✓ Glycine - Glycine is an amino acid that binds to NMDA receptors in the suprachiasmatic nucleus in the brain that regulates our circadian rhythm. It is inhibitory and helps to lower body temperature thereby increasing sleep.
✓ Magnesium - Magnesium is a mineral that catalyzes more than 300 enzyme reactions in the body. It improves sleep by activating GABA.
✓ Tryptophan - Tryptophan is the amino acid found in turkey that is blamed for post Thanksgiving feast naps. Tryptophan is the precursor to serotonin, which is the precursor to melatonin. Studies show it has the best results when taken together with B6 and B3. Do not take Tryptophan if you are on any MAOI medication.
✓ Valerian root, Valeriana officinalis - This slightly stinky root helps you fall asleep faster and improves sleep quality by affecting GABA receptors. It can have a paradoxical effect of energizing some people.
✓ Hops, Humulus lupulus - Yes, the same hops that make beer also activate the GABA receptor. I love Hops together with Valerian and Passiflora as a sleep aid for helping patients stay asleep.
✓ Passionflower, Passiflora incarnata - This beautiful flower is excellent for quelling cyclical, ruminating thoughts that can deter falling asleep. Take as a solid extract or together with Valerian and Hops.
✓ Magnolia, Magnolia grandiflora - Magnolia has the compound honokiol that activates GABA receptors and reduces cortisol. Magnolia is also a great immune help against viruses so would be useful for insomnia related to viral infections.
Here's to your good night's sleep!
Medical Disclaimer: The information on DrTaraTranguch.com, and related blogs and emails, is provided for informational purposes only and is not intended to replace consultation with a qualified health care professional. It is not intended as medical advice and does not create a doctor-patient relationship between you and Dr. Tranguch. It is not intended for use in diagnosing or treating a health problem or disease, or prescribing treatment. Please consult your physician or healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or beginning any treatment for any health problem. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.