Adequate sleep is as essential to our wellbeing as a healthy diet, exercise, and stress management, but unfortunately for many it is difficult to achieve. A recent survey by the National Sleep Foundation shows that sleep difficulties occur for 75% of us at least a few nights per week. This is alarming because our long-term health depends on the regeneration that occurs during sleep.
When we sleep our body regenerates its supply growth hormone, the “anti-aging hormone.” This nightly ritual serves to stimulate tissue regeneration, liver cleansing, muscle building, the breakdown of fat stores, and the normalization of blood sugar levels. When your sleep cycle is interrupted, so too is your body’s production of growth hormone. Chronic sleep loss also alters our immune system function, putting us at higher risk for colds, flus and maybe even cancer. People with sleep difficulties also tend to suffer from fatigue, weight gain, high blood pressure, decreased concentration, and irritability.
So why do we have so much difficulty sleeping? The truth of the matter is that there are many (by some counts, over 60) different potential underlying causes to an individual’s sleep disturbance. Determining the cause can be complicated, but with a thorough history, physical exam, and the help of functional medicine testing the cause can typically be determined and addressed. Our motto should be: Rather than medicate the symptom, let’s get to the bottom of the problem.
One of the best tools I have found for resolving sleep difficulties is sleep-specific neurotransmitter and hormone testing. Many neurotransmitters (the chemical signals in our brain) and hormones are necessary at certain levels to achieve sleep, and imbalances in any one of these may lead to sleep disturbance.
For example, serotonin is one of the most important neurotransmitters for sleep because it is needed to initiate sleep. So, for those having difficulty falling asleep, a serotonin deficiency may be the culprit. Therefore using natural supplements such as tryptophan or 5-HTP (both of which are building blocks of serotonin molecules) can increase serotonin and as a result improve sleep.
Serotonin is just one of the many neurotransmitters that affect sleep, however. Generally, your body’s neurotransmitters can be lumped into two categories: inhibitory and excitatory. Inhibitory neurotransmitters tend to relax the nervous system, therefore promoting sleep, and excitatory neurotransmitters have the opposite effect. Having either a deficiency of the inhibitory neurotransmitters or an excess of the excitatory ones can prevent sleep. Therefore, measuring the exact balance of these neurotransmitters can be extremely helpful in determining the most effective natural therapies for an individual.
For example, if someone is deficient in an inhibitory neurotransmitter such as GABA, we can use natural supplements to increase GABA levels. Alternatively, if testing shows an excess of certain excitatory neurotransmitters, we can use nutrients such as L-theanine to help block their production. Because these tests are achieved through simple urine collections, the levels can be tested at the time of sleep disturbance; allowing us to determine the precise imbalances occurring at the time of sleep difficulties.
Another important component of sleep is a hormone called cortisol, which is produced by our adrenal glands. When your body is functioning well, cortisol is produced in a rhythmic fashion in which levels are highest in the morning, decrease through out the course of the day, and are lowest at night to allow for sleep. When your body is under chronic stress - be it physical, mental or emotional stress - the adrenal glands may begin to dysfunction in such a way that results in low daytime and high nighttime cortisol production. This flipped pattern causes us to feel sleepy during the day and sleepless during the night.
Through simple saliva tests we can measure cortisol levels throughout the day to determine if this disturbed pattern may be a cause of an individual’s sleep difficulties. The pattern can then be corrected through the use of adrenal support during the day (i.e. adaptogenic herbs, glandular therapies, and B vitamins), and supplements (i.e. phosphytidylserine) to decrease cortisol during the evening.
Of course another essential hormone involved in sleep is melatonin. Melatonin maintains the body’s circadian rhythm, our internal clock that affects when we fall asleep and when we wake up. Melatonin production can be affected by age, seasonal affective disorder, jet lag, night shift work, menopause, and number of other factors. One such factor, light exposure, is a common cause of melatonin imbalance, and yet is easily remedied. Being exposed to bright light in the evening or too little light during the day can disrupt the body’s normal melatonin cycles. These cycles can be reset by taking melatonin supplements in the evening combined with light therapy in the morning.
I have highlighted a few of the most common physiological causes for sleep disturbance, but of course there are many other factors that could be involved in any individual case. Conditions such as blood sugar dysregulation, anxiety, hyperthyroid, restless leg, pain, reproductive hormone imbalance, and sleep apnea could all be underlying causes of insomnia. Rather than take a sleeping pill that masks the symptom, by working with a naturopathic physician you can get to the underlying cause of sleep issues. Resolving sleep issues, you not only get better sleep but also improve your overall health.
As a parting thought, I’d like to outline some of the simple lifestyle changes you can make, no matter what the cause of your sleep disturbance, to start on your way to a good night’s sleep.
Maintain consistent sleep and wake times. Do not push yourself to stay up past the initial signs of sleepiness. This can stimulate epinephrine production, causing more difficulty getting to sleep later.
Develop a bedtime routine to relax and prepare your body for sleep. This could include a warm bath (possibly adding Epsom salt or lavender oil to relax the body further), meditation, gentle stretching or yoga, or deep breathing exercises.
Reserve the bed for sleep only. Do not read, watch TV, eat, or worry in bed. Solve daily dilemmas outside of the bedroom. If you find that you’ve been lying awake in bed for 15-20 minutes, get out of bed. Do something mundane until you feel sleepy, and then go back to bed. Repeat this as often as needed.
Create a quiet, cool, dark and comfortable sleeping environment. The bedroom should be clutter-free and have as little ambient light as possible. Electronic devices such as clocks, stereos, and TVs emit electromagnetic radiation and light that can disrupt sleep. Try removing these from the bedroom to create an atmosphere of complete darkness.
Exercise regularly. Exercising during the day decreases the time it takes to fall sleep and increases the amount of deep sleep obtained.
Get exposure to sunlight early in the morning to encourage a strong circadian rhythm. As I mentioned earlier, the hormone melatonin is suppressed in light and secreted in darkness. So we want to suppress it during the day and maximize it at night. If you are indoors all day you may want to get a full-spectrum light to keep in your home or office space to help suppress melatonin during the day.
If you tend to wake during the early hours of the morning, have a small protein snack just before bed to ensure consistent blood sugar levels throughout the night.
Avoid all TV and computer work for at least an hour before bed. Both of these are stimulating to the nervous system and will delay sleep onset.
Avoid stimulants, especially in the afternoon and evening. The stimulating effects of caffeine can last up to 10 hours, and that from nicotine for several hours. Alcohol, although it is a depressant, will result in fragmented and light sleep during the night.
Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment.