A primer for natural treatment of sleep disorders
By Matthew C. Popkin, M.D.
Proper nutrition, regular exercise and getting enough restorative sleep are the most important things you can do to achieve optimal health and wellness. Getting a good night’s sleep is essential for feeling refreshed and energized to face the challenges of the day. Up to 70% of Americans are chronically sleep deprived. This is a common problem that I see in my medical practice on a daily basis and it can be directly or indirectly related to many chronic medical and emotional problems.
Chronic sleep problems wreak havoc with your body’s natural rhythms and diminish the restorative properties that sleep is supposed to provide. The incidence of most chronic diseases including but not limited to diabetes, high blood pressure, heart attacks, obesity, anxiety and depression are all increased due to chronic sleep problems. Our bodies are genetically programmed to follow a regular wake –sleep cycle in order to stay in proper rhythm both mentally and physically. Our bodies need to follow the natural circadian rhythms of darkness and light to ensure that all of our organ systems function optimally. When we deviate from these cycles we disrupt the rhythms that keep us healthy. This leads to both physical and emotional illness and disease.
Sleep is essential because that is when your body’s healing properties repair the damage that occurred from your daily activities.
Your daily metabolism and internal time clock are reset. Your hormones are balanced to be in sync with your brain and vital organs. Your immune system is recharged to prevent infections and cancer. Cellular repair of all organ systems is achieved. Your body is put back in balance. This needs to be done on a daily basis to prevent acute damage from becoming a chronic disease.
The reasons why people develop chronic sleep problems are varied and all too common.
Stress from the day leads to an over active mind at night. The increasing complexities of our home and work lives, the intrusion of technology and the intense need to multi-task to complete our daily objectives all have overburdened our sensitive nervous system to the point that we have disrupted the delicate cycles that keep us in rhythm. We create too much energy during the day which therefore does not get released at night and prevents our systems from shutting down when it is time to sleep. Stress must be minimized during the day so it does not carry over to the night and disrupt your sleep.
Improper diet and lack of nutrition creates a constant inflammatory condition in our bodies that our immune system and free radical fighting systems have to work overtime to correct. This corrective process goes into overdrive which extends into our sleep time thus making it more difficult to achieve fully restorative sleep patterns.
Non-biologic stimulants and drugs such as caffeine, nicotine, certain prescription drugs, stimulating supplements, illicit drugs of abuse and some vitamins and herbs can all cause our bodies to fall out of rhythm. Our bodies make their own natural stimulant hormones and bioactive transmitters to elevate our energy when needed. To keep balance our bodies also make their own counteractive hormones and transmitters to decrease our energy when needed. When we introduce outside chemicals in an effort to alter our body’s natural cycles by either boosting energy or forcing rest we overshoot our normal thresholds and therefore throw off our natural, delicate cycles that our bodies require for balance. This overstimulation and over depression of natural bodily functions leads to what I call “cycle confusion” which causes chronic sleep problems.
Hormone imbalances such as thyroid, adrenal and male-female sex hormones can lead to chronic sleep problems as these hormones have direct and indirect effects on the body’s metabolism and wake-sleep cycles.
Chronic pain and the medications used to treat this pain can have drastic effects on the normal wake-sleep cycle by chronically elevating the body’s “fight or flight” hormones and causing wide fluctuations in the pain centers of the brain which alters other vital neurotransmitters leading to chronic, global neurologic overstimulation.
Natural treatment aims to re-establish our natural rhythms.
Treatment of chronic sleep problems must address the rhythm disturbances that are created and restore these rhythms to natural balance. This means re-establishing the natural circadian rhythm, the natural rhythm of darkness and light, which our bodies are genetically programmed for. This will correct the “cycle confusion” and put the body systems and cycles back in sync with its natural and intended rhythms. This is achieved by addressing the cause of the cycle imbalance and removing or correcting it. I do this with my patients by doing a thorough investigation of their specific problems that lead to neurologic overstimulation and creating a treatment plan that they can become actively engaged in. This leads to greater compliance and ultimately greater success.
Circadian rhythm.
This is our light and dark driven internal clock. By following these regular patterns of day and night, light and dark, over the course of time our bodies have become dependent on these rhythms to function normally and stay in balance. Every one of our body systems needs to be in sync with the circadian rhythm as well as each other. Imagine a tight rope walker holding a horizontal balance bar with all of these body systems carefully balanced on either side. If just one of these body systems is out of balance it throws all of the other systems out of balance and the body as a whole will therefore be out of balance. Due to our industrialized and overly technical lifestyles we have forced our bodies to live in a cycle that is incongruent with what we are programmed to live in. We have overstressed our body’s natural rhythms by making it function out of sync with the natural circadian rhythm of light and dark. We no longer follow the natural signal from the sun to awaken nor follow the natural signal from darkness to go to sleep.
We now wake with the use of an alarm clock, not a natural internal clock. We go to sleep long after dark usually after a long and stressful day filled with over stimulating activities and chemicals whose effects last long into the night. We work long days in offices utilizing unnatural, artificial lighting and get very little natural light from the sun. Then we go home and bombard our neurologic system at night with TV, video games, computers, home stress, etc. when we need the darkness that the evening brings to trigger the body to produce the sleep hormone melatonin in preparation to sleep. All of this excessive stimulation and light essentially throws our body’s rhythm of nighttime melatonin production out of balance causing us to have difficulty going to sleep. In the evening light is something we need a limited amount of. Too much light and stimulation before bed interferes with the signals to produce Melatonin that regulates our body cycles and rhythms causing chronic sleep problems.
Reestablish your natural circadian rhythm.
The activities of your day and how you transition into the evening and nighttime hours all play a role in how well you sleep. As I explained, our body is affected by the light/dark, day/night circadian rhythm cycle. Here is some information to help you understand how you can reestablish a healthier circadian rhythm from the time you wake up to the time you go to sleep.
How you wake up is important.
Research at the Mayo Clinic found that if you need an alarm clock to wake up, it’s a sign that you’re not sleeping properly. Alarm clocks interrupt the sleep cycle and prevent sleep from completing its natural stages. Dawn simulation devices are much more effective at establishing a healthy sleep cycle by gently rousing you from sleep.
Try to go to sleep and get up at the same time every day.
Sticking to a consistent wake-sleep schedule helps set your body’s internal clock and optimizes the quality of your sleep. Start by setting a realistic bedtime that will work with your lifestyle. Choose a time when you normally feel tired, so that you don’t toss and turn. If you’re getting enough sleep, you should wake up naturally without an alarm. If you need an alarm clock to wake up on time, you may need to set an earlier bedtime.
Take restorative breaks throughout the day.
A few times a day, find a quiet spot somewhere and get comfortable. Take 5-10 minute to focus on your breathing. Take slow, deep breaths and feel yourself relax as you focus all of your attention on your breathing. This will quiet your mind and create a sense of calm throughout your body. This will help decrease the over stimulation of your day and help prevent the carryover of stress into your night.
Let your body feel some natural sunlight on a daily basis.
We are surrounded by artificial light for most of the day and as such lose the benefit of this signal to trigger natural energy. Researchers at Johns Hopkins University found that natural light itself governs our sleeping patterns. As sunlight enters our eyes it interacts with our visual detection elements and stimulates neurotransmitters in the brain that regulates our biological clocks by triggering our neurologic system to release specific chemicals and hormones that control healthy energy production throughout the day. Try to get at least 15-30 minutes of natural sunlight a day.
Exercise.
Exercise affects our daily rhythms by signaling the body to promote deeper and more restorative sleep cycles. You should try to avoid exercising within 2-3 hours before sleep as it may cause overstimulation and make it more difficult to fall asleep. Set a consistent exercise schedule that works for you and stick to it.
Decrease and/or eliminate Caffeine and other stimulants.
Caffeine is a powerful stimulant that has deleterious effects on your body’s sleep hormones. Its effects can last several hours and can interfere with your circadian rhythm. Many things contain caffeine other than just coffee and tea. Caffeine is in soda and other drinks, herbal teas, chocolate and some medications especially those for migraine headaches. Even decaffeinated coffee has a little caffeine in it.
Clean up your diet.
Try to eliminate all pre-prepared foods, sugars, high fructose corn syrup, gluten and processed foods such as white bread, rice and pasta. Remember the phrase “The whiter the bread the quicker you’re dead”. Try to decrease your consumption of dairy as well. These are pro-inflammatory foods that cause the body’s anti- inflammatory mechanisms to work in overdrive to decrease the oxidative stress and free radical damage that is created by these foods. This metabolic stress can affect your sleep cycles leading to chronic sleep problems.
Eat based on your biology.
Your digestive system works best at mid-day so try to eat your biggest meal at lunchtime and keep your dinners light. Your body slows its metabolism as the day progresses to prepare your body for sleep. Don’t eat large meals before going to sleep as your body will be stressed trying to digest those calories while you are sleeping and have to work to store those calories because you won’t need them during sleep. This leads to obesity which worsens the wake-sleep cycle.
Be smart about napping.
Napping is a good way to recharge and make up for lost sleep hours but limit them to 15 to 20 minutes. If needed, try to nap in the early afternoon and avoid napping in the evening.
Fight after-dinner drowsiness.
If you find yourself getting sleepy way before your bedtime, do something mildly stimulating to avoid falling asleep such as going for a walk, calling a friend, or getting clothes ready for the next day. Try not to over stimulate which may push your sleep time later which in turn affects your wake time. If you give in to the drowsiness and take an evening nap you may not be able to fall asleep or if you do you may wake in the middle of the night.
Be careful of stimulant medications or supplements.
Certain medications can cause sedation and some cause activation. Don’t take diuretic medications (water pills) before bed as you will be awakened by the urge to urinate which will interrupt your sleep. Be mindful of when you take your medications. Talk with your doctor and pharmacist about your medications and make sure you are taking them at the appropriate time of the day.
Properly transition from daytime to evening to bedtime.
You should prepare your body for sleep by creating the right cycle triggers. It takes time for your body to produce the sleep neurotransmitters, especially Melatonin, that is needed by the brain to allow you to sleep. Reduce all types of stimulation in the evening before going to bed to start the process. Set a routine to wind down and prepare your sleep environment. An example would be locking up the house, preparing your clothes for the next day, washing up and brushing your teeth, etc. as preparation for going to bed.
Create a technology sundown.
An hour or two before you plan to go to sleep, stop sitting in front of your computer and switch off all other electronic devices that are over stimulating your nervous system and inhibiting the production of your sleep hormones.
Prepare your home for sleep.
Dim the lights an hour or more before going to bed. This will create a sundown effect on your brain and cause the production of sleep hormones. Eliminate loud sounds such as TV or music.
Use relaxation techniques.
As I stated earlier, stress is one of the most common causes of sleep problems. Use the breathing technique I described earlier to focus your attention on your breathing and take your mind off of the work day. Power down your mind just as you power down your computer. Use breathing exercises, meditation or anything possible to redirect your thoughts towards calming your mind and body. This will decrease the stress hormones and allow you to sleep more soundly.
Create a Regular Routine.
Going to bed around the same time everyday is the best way to establish good sleep hygiene. The body’s ability to regulate its internal clock for healthy sleep patterns depends on consistency. A regular sleep rhythm reminds the brain to release wake and sleep hormones on a regular basis. Deviations in daily sleep patterns disrupt bodily rhythms and throw you out of sync with your normal wake- sleep cycle. This ultimately affects our overall health and wellness.
Avoid sleeping in even on weekends or nights you’ve stayed up late.
It can be tempting to sleep in on weekends, but even a couple hour difference in wake time disrupts your internal clock. The more your weekday/weekend sleep schedules differ, the worse the jetlag-like symptoms you’ll experience. If you need to make up for a late night, opt for a daytime nap rather than sleeping in. This strategy allows you to pay off your sleep debt without disturbing your natural wake-sleep rhythm.
Keep your bedroom as dark as possible.
Our brain needs total darkness for proper production of the sleep hormone Melatonin. If your bedroom is not dark when you go to sleep, it interferes with the production of Melatonin and disrupts your circadian rhythm. Light disrupts your pineal gland’s production of sleep hormones, disturbing your sleep rhythms. Eliminate all sources of light if possible including glowing indicator lights, alarm clocks, cell phones, cordless phones or answering machines, etc. Use dark black out shades or drapes on the windows if they are exposed to light. The easiest thing to do is wear an eye mask. Problem solved.
Keep the bedroom cool.
Lowering ambient temperature sends a feedback signal to the sleep center of the brain signaling that it’s nighttime, and that it needs to release more Melatonin and other sleep neurotransmitters. During the summer set air conditioners to 68-74 degrees depending on preference and use a floor fan or ceiling fan to create a breeze.
Eliminate noise.
If noise is a problem try using earplugs, a “white noise” device or a fan to cover up the surrounding sounds.
Do not become dependent on sleeping pills for sleep.
Sleeping pills do not resolve the underlying causes of sleep problems. Long-term use of sleeping pills is problematic regardless of whether it is prescribed by a doctor or taken over the counter. They can be addictive and potentially dangerous. If you have relying on sleeping aids to get proper sleep ask your doctor to formulate a plan to eliminate them.
Don’t use alcohol to fall asleep.
Alcohol has a sedative effect and as such many people use it for sleep. Alcohol has an initial sleep inducing effect however it can impair sleep during the later stages of sleep which decreases the overall sleep quality.
Natural sleep-promoting supplements.
Some supplements or herbs have a beneficial effect on sleep. Magnesium, 5- HTP, chamomile, valerian root and Melatonin can be helpful. Be careful of these supplements and their potential interactions with any prescription medications you may be taking for another condition.
Don’t make the process of going to sleep too difficult.
Try not to make the act of going to sleep an anxiety provoking event. Sometimes just thinking about sleep affects your ability to fall asleep. We often create a vicious cycle of worrying about sleep which leads to anxiety that worsens sleep problems. If you find yourself unable to sleep don’t make matters worse by stressing over it. Instead, get out of bed for a few minutes, reset your thinking to a calming mode and try to relax. Focus on your breathing, not on the fact that you can’t fall asleep. Then return to bed, do your breathing exercises and try again. Focus on your breathing, in and out, and feel yourself relax and fall asleep.
Fixing any problem is a process and sleep problems are no different. Don’t expect to be an expert right away. Find out the causes of why you are not sleeping well and make a plan to correct them. Too much stress, not the right sleep environment, too many stimulants during the day, improper diet, too much light in the room, too much ambient noise, too warm, too inconsistent of a sleep regimen, etc. Learn how to reduce your anxiety over your sleep problems by understanding the causes of why you are not sleeping well. Then work to correct the problems. Follow all of the sleep tips above from the beginning of your day to the time your head hits the pillow. Most people have many things to correct that they never realized were affecting their sleep. Once these corrections are made the vast majority of people should be able to correct their sleep problems over time. Productive days lend themselves towards restful nights. Sleep well and goodnight.
Matthew C. Popkin, M.D.
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Matthew C. Popkin, M.D. is a nationally recognized expert in the fields of Internal Medicine as well as Integrative and Functional Medicine. He is a practicing physician and founder of Popkin Integrative Medicine, a medical practice dedicated to the prevention of disease and the promotion of health and wellness using a fully integrative approach. Here he focuses his 18 years of experience adding his personal brand of caring and compassion to help thousands of people achieve optimal health and wellness.
To bring his Popkin Integrative Medicine brand to a wider audience, Dr. Popkin created a company called i-Medical Consulting which utilizes an online, virtual video training platform to teach other physicians how to deliver health and wellness services to their patients using his caring and compassionate integrative approach.