Sleep. Most of us don’t get enough and most of us wish we had more. A healthy sleep pattern is absolutely essential to health and preventing chronic disease. Sleep is a time where our body goes through complex biochemical pathways to help repair and regenerate our cells, tissues and organs from the day before. It is a crucial process of the human existence and we would die without it. Most Australian’s get less than 6 hours of sleep a night, however an optimal amount of sleep is said to be 7-9 hours. It is important to distinguish between actual sleep time and the time spent in bed.
Many people get into bed leaving themselves the potential to sleep for 7-9 hours before they have to wake up, however it often takes them too long to fall asleep or they wake up a lot in the night and struggle to fall back asleep. This in turn decreases overall sleep time and quality. Also, some people simply go to bed too late and wake up early in the morning, therefore decreasing their sleep time. Lastly, most people have certain habits around their sleeping patterns that will be discussed below, which lead to poor sleep quality, which is why some people can wake up unrefreshed, despite getting enough sleep time.
The importance of sleep.
Sleep deprivation (i.e. lack of sleep time or lack of quality sleep) is a chronic stressor on the body and effects every organ system as it is a crucial process that helps our bodies tissues repair and regenerate each night after a day of exposures to mental (e.g. work) and physical stressors (e.g. exersize) on the body. Therefore, when we don’t get enough sleep or the quality of our sleep is poor, the body doesn’t repair from the stressors of the day before, which in turn increases inflammation in the body. Chronic inflammation increases the risk of many chronic diseases and health issues, which is why decreased sleep is so tightly correlated with them.
This then causes fatigue, as well as poor mental and physical performance, which I am sure most of you have experienced at some point in your life after a big night out or just constantly not getting enough good quality sleep. This leads to decreased productivity in your life, therefore making you useless to yourself and others.
Decreased sleep time and quality increases the risk of other poor diet and lifestyle habits, as well as effecting a person’s ability to maintain and implement other aspects of a healthy diet and lifestyle.
For example, a lack of sleep can impair the functioning of satiety hormones, as well as increase cravings/intake of high calorie processed foods. This is because impaired sleep causes the brain to fatigue, which then makes the brain crave calorie dense, palatable food. Also, going to bed later increases the amount of time a person is awake for, which in turn increases their eating window. Snacking at night is usually in the form of high calorie foods due to boredom, habit and brain fatigue.
Once a person is fatigued from a lack of sleep, they are less likely to want to exersize, as well as prepare/cook healthy food. Also, their poor diet choices decrease the intake of nutrients to support good health and energy levels, which exacerbates fatigue. This is why decreased sleep time and quality is strongly associated with weight gain.
A lack of sleep also decreases our ability to adequately handle the daily stressors of life. When we are sleep deprived we are more likely to get stressed and react to situations in our environment in a stressful way. This is why impaired sleep is associated with mental health issues. This can further impact our energy levels and also lead to emotional eating of processed foods. A lack of sleep also impairs our immune system due to the increases in cortisol that results from impaired sleep time and quality. This makes us more susceptible to infection.
Lastly, as mentioned, decreased sleep is a major stressor on the body and can chronically elevate stress hormones and inflammation. This is a recipe for developing chronic health issues which are driven by inflammation, such as digestive problems, food intolerances, poor immune function, blood sugar issues, high blood pressure, fatigue, hormonal imbalances, sugar cravings, weight gain or weight loss, brain fog, cognitive issues, anxiety, low moods (depression), skin issues, joint pain, insomnia and changes in appetite.
Sleep is a time where our body can rest and regenerate its cells. Having sustained, good quality sleep allows our main sleep hormone called melatonin to be released in optimum amounts, which helps facilitate repair and regeneration. Melatonin is a potent anti-oxidant, therefore it helps to repair our damaged cells from a day or stressors. It is also a huge part of the immune system, protecting us from infections that may have entered the body during the day.
But why are we not getting enough sleep?
Our circadian rhythm (i.e. our sleep-wake cycle) is governed by two main hormones. Cortisol and melatonin. Cortisol is our get up and go hormone and melatonin is our sleepy hormone. These hormones are released in response to light entering the eye.
When light enters the eye, cortisol is released. When darkness enters the eye, melatonin is released. Cortisol is supposed to be highest in the morning when we wake up, which is when the most light is supposed to enter our eye. As the day progresses and it gets darker, the eyes get exposed to less light, therefore cortisol is supposed to drop off and melatonin begins to increase. These two hormones work in antagonistic pairs. I say “supposed to” because in our modern world, this system is often disrupted in people.
When we were cavemen, we used to sleep and wake with the sunrise and sunset. When the sun would rise, light would enter the eye and cortisol would be released to wake us up. When the sun would set, less light would enter the eye, leading to the release of melatonin, causing us to feel sleepy. The most light we were exposed to at night was a campfire, which was a very gentle yellow light.
Now days, because of technology and artificial light sources, our circadian rhythms undergo disruption. This is because when it becomes dark, we are still exposed to light in our homes and light from our technology devices. This confuses the bodies clock.
At a time when minimal light should be entering the eye, we are exposed to white/blue light from lights in our home and on our devices. This leads to increased production of cortisol and therefore lowered amounts of melatonin.
Continuous light exposure up until bed time via devices and artificial light sources can lead to decreased sleep onset, maintenance and quality due to the increase in cortisol and suppression of melatonin. Some people may still find it easy to fall and stay asleep, despite the light exposure, however we know that the artificial light exposure before bed increases cortisol levels and suppresses melatonin production well into the night. It takes a good few hours for melatonin levels to increase to their normal levels. Also, if a person goes to bed late at night or in the early hours of the morning, it decreases the amount of time that their body will be exposed to complete darkness before the sunrise causes natural light to creep into their room, which penetrates their retina through their closed eyelids.
This leads to an overall net decrease in total melatonin production/exposure throughout sleep (and increased cortisol levels), which can have profound negative health impacts. It can also be a reason as to why some people wake up feeling fatigued and unrefreshed, despite getting 8 hours of sleep.
As mentioned above, melatonin is a master antioxidant hormone and in optimal amounts, it restores and regenerates the body after a day of exposures to environmental factors that damage cells. Without this, the body stays inflamed and un-repaired, causing poor energy levels and it increases the risk of cellular dysfunction and disease. It also decreases the bodies robustness, meaning environmental stressors are more likely to cause damage to the bodies tissues due to impaired cellular function. Chronically high cortisol levels also causes inflammation and oxidative stress in the body, leading to dysfunction and disease. This is why poor sleep habits and decreased sleep is associated with all chronic diseases.
On top of this, it is not uncommon for people to also be very stressed after a day of work, leading to further increases in cortisol levels, as cortisol is a stress hormone. As well, coffee, smoking and alcohol before bed, as well as lack of exercise/movement during the day and poor diet choices can further increase cortisol levels and suppress melatonin levels.
Lastly, when many of us wake up, we sometimes wake up in a dark room or before the sunrises, and go into offices for the day with minimal day light exposure. This also confuses the bodies circadian rhythm as it isn’t fully aware that we are “awake” and that it is day time as there is less natural light entering the eye that has the most profound effect in triggering cortisol. Then some people only leave an office when it is dark outside, and get home and expose themselves to artificial light. This in turn disrupts the circadian rhythm even further because the body never really gets the chance to properly distinguish between night and day due to differences in light exposure.
It is for these reasons as to why shift workers can suffer such negative health effects.
Like everything to do with health, there is no one size fits all.
Researchers recommend getting 7-9 hours of sleep per night. As you can see, 2 hours is quite a large variance, therefore everyone will differ in the amount of sleep they require for optimal functioning. Obviously your sleep amount will differ depending on many factors. For example if you are an athlete or on a day to day basis you need to optimize peak cognitive performance, you may require more sleep. The way you feel based on your sleep time is called sleep satisfaction, and will differ for everyone, depending on how they live their life.
To figure out your optimal sleep time, use a sleep diary. Track the time you go to bed, the time you wake up and estimate the amount of time you were actually asleep for. Then take note of how you feel and perform the next day in your daily life. Do this for at least a week and adjust your sleep and wake times accordingly.
Decreased sleep in children and teenagers is even more damaging than in adults
Since sleep is crucial for optimal physical and neurological development, sleep deprivation in kids and teens is extremely damaging. A lack of sleep in kids and teens are associated with obesity, diabetes, depression, anxiety, attention and behaviour problems, decreased academic performance, increased drug and alcohol use increased and car crashes for those old enough to drive.
A recent study came to a consensus that for every 24 hours, children ages six to 12 years old should sleep nine to 12 hours, and teens ages 13 to 18 years old should sleep eight to 10 hours. Therefore, fewer than nine hours in children or eight hours in teens is considered inadequate. It is estimated that 73% of youth get inadequate sleep with a break down looking something like this:
For middle schoolers:
6 percent got four hours or less
6 percent got five hours
11 percent got six hours
20 percent got seven hours
30 percent got eight hours
27 percent got nine hours or more (adequate sleep)
For high schoolers:
7 percent got four hours or less
13 percent got five hours
23 percent got six hours
30 percent got seven hours
27 percent got eight hours or more (adequate sleep)
Put another way, a whopping 23 percent of middle schoolers and 43 percent of high schoolers get six or fewer hours of sleep per night. And this doesn’t even tell us whether the little sleep they are getting is quality sleep. When we consider these data, is it really any wonder that we have epidemics of childhood obesity, diabetes, and ADHD?
Some of you reading this may be suffering from poor sleeping patterns or your kids may be not getting enough sleep, but don’t stress, here are some extremely, pharmaceutical free, handy tips to help you or your child’s sleeping patterns back on track!
1) Increase sunlight exposure during the day: Day light exposure during the day allows your body to know it is awake and cortisol levels should be high. As mentioned above many of us may wake up and go to work in the dark, or commute to work in closed vehicles. If we work in an office, we may spend most of our day in there until it is time to go home when the sun is already going down and daylight is fading. This can confuse our internal body clock, as the body never really gets the chance to see full midday light, hence it never really knew if it is day or night.
Getting daily daylight exposure could involve doing activities outside, working outside or sitting close to a window throughout the day. If possible, expose your eyes to daylight for a minimum of 30 minutes per day and do not wear sun glasses when outside. For those of you who work in an office, maybe you can take your lunch break outside to ensure you get 30 minutes of daylight exposure.
Regardless of your activities throughout the day, one way to ensure an optimal cortisol response first thing in the morning (especially in daylight savings), is to wake up and go outside for a few minutes before you get ready for the day. This tries to replicate our behaviour as cavemen where we would wake up with the sun rise.
Furthermore, like adults, kids need exposure to bright blue light during the day to help entrain their circadian rhythms. If they attend school during the day, make sure they are getting exposure to sunlight before or after school, or ideally at lunchtime, when the sun is highest.
2) Decrease artificial light exposure 45 minutes before bed: This is usually in the form of phones, computers and T.V’s, which may be hard to implement with kids. Make a house rule that there are no devices allowed in the bedroom at nighttime and set a “media curfew” elsewhere in the house (i.e. no devices after a certain time). Evening technology use is associated with poor-quality sleep and shorter sleep duration among youth. If teens must use devices to complete homework in the evenings, be sure that they have blue-blocking applications like F.lux set up on their computers and/or that they wear blue-blocking glasses. Adults can do this too if they must do work on their laptop. If possible, you can also dim the lights in your house or use candles.
Artificial light exposure emits light onto your retina and makes your body think it is daytime, therefore it releases hormones like cortisol, which is our get up and go hormone. Cortisol should be highest in the morning when we are exposed to daylight and then slowly taper off into the evening as the sunsets and it becomes dark. Darkness then hits our eyes and stimulates the release of melatonin, which is our sleep hormone.
But when we are exposed to artificial light at night, our bodies get confused between night and day, causing chronically high cortisol levels, as well as keeping our body in an “awake” state for longer. This in turn decreases the time of being in a “sleep state” where all the amazing benefits of sleep can occur such as regeneration of cells in the body. This also decreases melatonin, therefore decreasing sleep onset, feelings of sleepiness and the duration of sleep. Furthermore, blue light exposure can even decrease the quality and “restfulness” of our sleep, making us wake up feeling unrefreshed due to a lack of regeneration. Lastly, chronically high cortisol levels predispose us to many other issues associated with increased cortisol. Such as weight gain, fatigue and increasing the risk of chronic disease.
Also, a lack of exposure to direct day light during the day, increases our sensitivity to artificial light at night, which is even more of a reason to get as much sunlight/ day light as possible, because lets face it, in the world we live in, it is hard for people to not use these electronic devices when they get home from a long day. Some people also require these devices for business or school purposes. Keeping the devices as far as possible from your face will decrease the intensity of the light hitting your retina.
Lastly, the variability of light exposure and the variability in the intensity of the light exposure has a profound impact on our circadian rhythm. Although our hunter-gatherer ancestors used to stay awake after the sun had set, they were exposed to a consistent amount of light in the form of fire. However, in our modern world, we are exposed to a huge variability of different light sources.
3) Sip on some tea before bed: Lavender, lemon balm or chamomile tea are good options to help induce sleep and relaxation. These herbs have relaxing effects on the nervous system that allows you to wind down, de-stress and induce relaxation.
4) Ensure yours and your child’s room is dark and cool in temperature: Cover any sources of artificial light (e.g. alarm clock) and turn phones on night mode if they are in the room. Even the smallest amount of light through our eyelids can disrupt our circadian rhythm. Using night masks can help mitigate the effects of a room that is not optimally dark, especially if there is street lights that may be preventing your room from being dark. Eye masks also disallow light to enter the eye through your eyelids. Therefore this ensures that melatonin levels stay as high as possible, right up until you wake up naturally or wake up with an alarm, despite the morning daylight creeping into your room through your window shades. Once you take off your eye mask, and expose yourself to daylight, a natural surge of cortisol will be released to wake you up. Eye masks can also be really helpful if you have a late night as it will keep out light exposure from your eyes right up until you wake up with your alarm.
Lastly, our bodies sleep best in cooler conditions as our core temperatures drop in the evening. Therefore the outside environment needs to stay consistent with the internal one.
5) Leave enough time for you to get your optimal amount of sleep: Leave enough time for you to fall asleep and still get the required amount of sleep you need. This doesn’t mean going to bed at 1am and waking up at 9am, which is still 8 hours of sleep. Try go to bed before 11pm as the more sleep you get before 12am, the more restful it is. This will increase your energy and cognition the next day, trust me! The whole night owl thing is a myth. Go to bed earlier and wake up earlier, leaving more time in your day to be productive in a well rested sate.
Lastly, for all the new parents with young kids, if you know your child will wake up in the middle of the night, make sure you go to bed earlier so you can still get a decent amount of sleep throughout the night. Prioritise your sleep as it allows you to function at your best each day!
6) Go to bed at a consistent time and wake up at a consistent time: In order to establish healthy sleeping patterns, making some form of bed and wake up time routine will help get your body into a consistent rhythm. For adults, make sure your bed time is absolutely no later than 11pm. In saying that, depending on what your schedule is like the next day, make sure your bed and wake time is consistent based on your weekly schedule. The bed time and wake time should be at least 7 to 8 hours apart and bed time should be no later than 11pm. Obviously the occasional late night is fine on the weekends; just make sure you get back into routine the next night.
Furthermore, for kids, parent-set bedtimes have been associated with improved sleep duration and better daytime functioning in teens. If your child isn’t sleepy, encourage them to at least get into bed and read or write a journal next to red or orange light. Children thrive on routines, so having a pattern of low-key activities that repeat every night can help them relax and start to feel sleepy.
7) Take a hot bath before bed: A hot bath raises your core temperature, therefore your blood vessels dilate and blood moves to your peripheries, away from your internal organs. Then when you get out the bath, your body wants to get rid of the heat and hence you have a drop in core body temperature, which is why you feel drowsy after a hot bath because lower body temperatures are required for sleep and your core body temperature naturally drops at night.
8) Eat a protein and carb rich meal before bed: Carbs increase serotonin (a neurotransmitter) in the brain, which helps stimulate sleep and relaxation. Make sure your carb sources are from whole foods. Also, eating a carb rich meal before bed will help keep your blood glucose levels stable throughout the night. If blood sugar drops during the night, it is seen as a stressor to the body because glucose is the brains preferred energy fuel. Therefore, stress hormones are released to bring blood glucose up to normal levels. The release of stress hormones can wake you up. This tends to happen in people with pre-exisitng blood sugar imbalances.
Moreover, eating a high protein meal before bed can have a blood sugar stabilising effect, leading to decreased blood sugar swings in the night. The meal should occur earlier in the night in order to leave enough time for digestion. Going to bed with a full stomach can sometimes impair sleep.
9) Go camping for 4-5 days: Sleeping and rising with the sun is an extremely effective way to reset your circadian rhythm and get your hormones that govern sleep, back into balance. This allows your body to function the way it was genetically designed, to sleep and wake according tot he sun.
10) 400-600mg per day of magnesium biglycinate: Most of us are deficient in this crucial nutrient due to many reasons beyond this post. Through various mechanisms, magnesium helps relax the nervous system to help promote a state of calm that promotes sleep onset. Magnesium is suitable for kids and is commonly deficient. 200-400mg is a therapeutic dose for a child below 12. Above 12 years old, 400-600mg is adequate.
11) Lavender: Supplementing with 80-160g of lavender extract has been shown in clinical trials to decrease insomnia and decrease sleep latency. Also, burning lavender oil in your room and inhaling the essential oils for 30 mins prior to sleeping, has been shown to help with sleep.
It should be noted that lavender appears to have remarkable synergism with lemon balm in regards to acting through the GABA receptors, and the combination may lead to better sleep. This is currently unexplored in humans, and the potential withdrawal symptoms of the combination also unexplored.
12) Melatonin: The standard dosage for melatonin is a 3mg. Although, supplements of melatonin can be bought, and since some people feel that 500mcg (0.5mg) is better it may be prudent to buy lower doses of melatonin and take multiple pills to see what dose works best for you.
Melatonin is the reference drug for insomnia or needlessly long sleep latency. It will allow you to fall asleep, but does not necessarily enhance sleep quality. It is important to note that melatonin supplementation does not decrease endogenous melatonin production, it does not lose effect over long term use and there is no withdrawal dependence. This makes it very safe, however it is not recommended to be used in kids unless under the supervision of a health professional.
13) Avoid stimulants such as coffee and alcohol. These substances can interact with hormones and neurotransmitters in the brain that regulate sleep. The abuse of caffeine in teens is highly concerning.
Children and adolescents are one of the fastest-growing populations of caffeine users, with an estimated 70 percent increase in the number of teens using caffeine in the past 30 years. There is no evidence for a benefit of caffeine in children and adolescents, and at least one animal study suggests that it could interfere with sleep and brain maturation.