Sleep: The Built-In Reboot

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There’s a reason pilots are limited to 8 or 9 hours of flying in a 24-hour cycle: sleep deprivation can make you cognitively impaired the same way drinking too much alcohol can. In extreme cases, it can make one certifiably psychotic.

The first time I ever hallucinated it was smack dab in the middle of a midterm during the first semester of medical school.

I already stood out a fair bit from the crowd given that I started med school in a halo brace after breaking my neck a couple of weeks before the start of freshman year.

So it didn’t help my reputation when in the midst of a quiet classroom among 200 fellow students who were also taking the exam, I started laughing almost uncontrollably, swatting at dancing pink elephants who were singing boisterous incoherent nursery rhymes.

After the test, I hauled ass out of the room so I wouldn’t have to explain to anyone I had just popped onto the set of a Mary Poppins skit. Given that it’s not super easy to hide when you have a halo screwed to your skull, a couple of my friends found me outside and eventually wrangled me to my apartment to get some sleep, finding the whole thing both super funny and fairly concerning.

Turns out I had only gotten 6 hours of sleep in 7 days. Thankfully after getting about 20 hours of straight subterranean sleep, the pink elephants had flown away.

That week’s cocktail:

– About a half gallon of coffee a day
– Solid all-nighters at the local IHOP
– One 30-60 minute nap per day only once vision became too blurry
– Sheer will power laced with crazy pressure to not be one of the 30% that were expected to fail out or quit after the first year

Notably, one of the biggest contradictions in medicine has just recently become corrected as medical school and residency training programs have begun to limit the number of hours per week a trainee can be in the hospital. [It’s generally capped at 80 hours per week now, which is fair compared to the average of our surgical rotations where we walked around like zombies after spending 110-120 hours per week under florescent lights.]

All of this tweaked my interest in sleep medicine and neurology, and it was later galvanized when I was diagnosed with narcolepsy in my 3rd year of school.

Narcolepsy is a sleep disorder that essentially involves uncontrollable sleep attacks at times when it super problematic. It doesn’t look good in class, airport waiting lines or funerals when you crash out, but you can usually get a pass given that people know the med school work routine. However, conk out while assisting in a surgical procedure, on the drive home from the hospital or in the midst of a “we need to have a talk” date… and now you’re in big trouble.

Turns out the combination of not enough sleep, too much fast food and alcohol, buckets of school related stress and too many sports related concussions tipped the scales that triggered the ongoing sleep attacks. Once that all cleaned up and I focused on brain recovery, the nasty nods waned and haven’t returned.

You don’t have to get to the same point I was at to experience the hallmarks of chronic sleep deprivation. If you require coffee to start your day, have trouble remembering your Honey-Do list or you’re just not performing as well as you want, you’re probably not getting enough sleep and it probably has something to do with the following 5 factors.

Top 5 Factors for Normalizing Sleep

I’ve had a fair bit of research in sleep medicine on both sides of the equation, as a physician and a patient.

Sleep as dictated by the circadian rhythm, is vital for organizing all organ function based on the optimally timed function of the “body clock.” Long-term sleep disturbances have been linked to impaired immune function, increased health problems like cardiovascular disease, psychological issues including depression and anxiety, and an overall negative impact on greater lifestyle issues like poor work performance, fatigue and a lousy sense of well-being.

It’s even so crucial to the system that without it, we eventually die, as in the cases of Fatal Familial Insomnia. (Though there is a fascinating story of a Vietnamese man named Ngoc Thai, known for not sleeping for over 40 years and appearing to function quite normally.)

Whatever the style of sleep related disturbance and the severity of the symptoms downstream, in my experience, it comes down to 5 Factors:

  • Constitutionality
  • Productivity
  • Psycho-Endo-Neuro-Immunology
  • Toxicity
  • Hygiene
  • Constitutionality

This has nothing to do with where you’re from or one of the founding documents of our nation.

It has to do with how you genetically function at a cellular level. Some people require less sleep than others, cases in point – Michelangelo, Bill Clinton, Margaret Thatcher and Arnold Schwarzenegger (who is well known for encouraging people to “sleep faster”).

Other people require more sleep in order to feel at their best. If you require sleep nightly for more than 10 hours on average, you can now officially be classified as having prolonged nocturnal sleep time because it’s outside the norm. If that’s what you need, then that’s what you need. Take it and kick ass the other 14 hours or so a day.

Many factors are at play here and entire books have been written on the subject. Several of the main players include: how efficiently the mitochondria (energy power plants of the cell) generate the energy necessary for optimal function, the electro-magnetic architecture of the brain (see Jack Kruse’s stuff on Quantum Sleep), bimodal sleep phase tendencies (some people preferentially sleep in two phases per night with a waking time in the middle – this was actually more of the norm over a hundred years ago before the invention of artificial light), a person’s sensitivity to environmental noises (aka “light sleepers”) and one’s general fortitude at being able to push through sleep deprivation.

Productivity

In todays’ highly competitive, rocket fuel lifestyle success is measured in productivity. “Don’t just sit there, do something,” has been hammered in to us since grade school, and we are all too accustomed to going with the flow and distorting our own biological rhythms. Nutrition, movement and yes, sleep all can get shoved aside in the name of doing and making more.

Interestingly enough, most people significantly improve their daily productivity when they optimize their own personal sleep cycles (on average 7-9 solid hours per night works best for most folks) with a 20-30 minute nap midday as desired. Sleep is one of the most consistent markers of longevity and improves many biologic processes from immune function to memory, thus generating better work performance overall and fewer sick days. Sleep deprivation is even worse on physical performance than taking sleeping pills like Triazolam.

So if you’re one of those Type As whose sleep suffers in the name of productivity, just remember that very few people ever say on their death bed, “I wish I would have worked more.” Only a personal honest inventory can reflect if the gas pedal is getting laid on a bit too much, and if so, then rebalancing the relationship between work and play is necessary.

Psycho-Endo-Neuro-Immunology, PENI

This is the foundational four of the Integrative Medicine approach to optimal function, as it notes the highly interwoven matrix between emotions and thought (P) to the function of hormones (E), the nervous system (N) and the immune system (I). Add an extra “S” system of your choosing (somatic, sensory, social, etc. and you’ll have an even catchier acronym).

Let’s start in order, with the psychological (P) aspect related to neuro-chemistry. This category is related to the underlying deeper issues that drive one’s moment-to-moment thoughts and feelings. Whether they are conscious or not, these associated beliefs, worries, stresses, attitudes, traumas and all the other miscellaneous psychological states directly affect the physiology of the entire body, thus the popularity and ever-growing body of research related to the field of mind-body medicine.

Then we get into the endocrine system (E) dealing with hormones and one in particular, Melatonin. This hormone is produced in the pineal gland of the brain modulates sleep-wake cycles, and is a neuro-protectant, anti-inflammatory and offers anti-oxidant support. Since it is produced from serotonin, you’ll have low melatonin if you have low serotonin.

Other hormones to note are cortisol (the major stress hormone produced by the adrenal glands), progesterone (the dominant female hormone in the second half of the menstrual cycle and one that is also significantly implicated in older men who are grumpy insomniacs) and thyroid hormones (that modulate metabolism). Ideally, full hormone panels are evaluated for anyone experiencing anything sleep related – whether it be chronic insomnia or ongoing sluggishness even when sleeping more than 8 hours a night.

The neurology (N) piece here is related to wiring. Some people have hot wiring and are more dominant in excitatory NTs – neurotransmitters (ex. dopamine, norepinephrine and epinephrine). This can look like anxiety, edginess, heightened startle response… and a hard time getting to sleep or staying asleep.

Other people have cool wiring and greater inhibitory NT dominance (ex. serotonin and GABA) and can lean towards calmness, but also depression. These folks typically do not have as many issues with sleep.

Sleep architecture is another piece of the neurological puzzle here as many people spend too little time in REM sleep (the dream-filled deeper states) with broken periods intermixed or have a sleep phase that is out of time, either too phase delayed or advanced. Sleep disturbance is also related to concussion and traumatic brain injury. This is a huge issue as somewhere between 40-65% of people with a mild TBI have chronic insomnia. Much of this is due to rebalancing neurochemistry and improving chronic inflammation while learning the basics of sleep hygiene (see below).

The immune piece (I) is in an intimately cyclical relationship with inflammation and neurochemistry as well, thus highlighting the nature of the interwoven matrix of these main 4 areas. With chronic inflammation comes imbalances in neurochemistry and hormones leading to disrupted sleep architecture, and with insomnia comes a weakened immune system. A weakened immune system also makes one more prevalent to injury and infection, thus worsening inflammation… and the cycle continues. This is one of the reasons that vitamin D supplementation, which improves immune function, has a secondary benefit in helping to normalize sleep patterns in those who are deficient.

Toxicity

Suffice it to say when you’re overloaded with toxic chemicals, everything gets thrown out of kilter. Sleep is one of the hallmark symptoms people notice. In supervising hundreds of clients through detoxification programs, a consistent relationship is revealed between inflammation and sleep. As inflammation improves, sleep normalizes. For some it happens rather quickly and for most others it happens gradually – over a period of weeks or months. (Note – See previous blog on the Detox Download for more info.)

Sleep Hygiene

The Fifth Factor basically involves up-leveling all the behavioral patterns dealing with sleep and setting out strategies for improving sleep when it’s off. Western culture is still over-exposed to late night technology (especially of the blue light spectrum that keeps the brain stimulated) and therefore, confuses the “body clock” about what time it actually is.

The Tools and Techniques for Better Sleep

If you haven’t already done so, start thinking about your sleep routine — the structure and patterns of your sleep. How consistent is your sleep schedule? What time do you usually go to sleep? What time do you wake up? Do you wake up feeling refreshed?

Keep a Sleep Architecture

Log and begin using it to track the quality of your sleep each day for a couple of weeks. The data you collect during this time will serve as your baseline. Next, as you experiment with different therapies, continue to track your sleep each day, comparing your new scores with your baseline scores to determine whether a particular therapy is effective for you. This is invaluable information to help detect where the potential glitch is in your sleep system and therefore be able to effectively troubleshoot it.

1: Aim for 7-9 Hours of Sleep Per Night

Most people do best when they aim for eight to nine continuous hours of sleep each night, with one or two brief naps (30 minutes or less) during the day as needed. Having trouble getting the sleep you need?

First, take a look at your before-bed habits. Ideally, do not eat anything a minimum of two hours of going to sleep. You should also avoid vigorous exercise, bright lights or watching stimulating, aggressive movies within an hour before bedtime.

2: Avoid Bright Blue Light 2 Hours Before Bed

The bright light exposure piece here is particularly important for those late night TV / computer / cell phone users, as the blue light spectrum is particularly disturbing to the circadian rhythm. The blue light spectrum stimulates the brain (think light therapy boxes), so it stands to reason it would still stimulate the brain at night.

Remember, the circadian rhythms govern the “body clock” and the mechanisms of that clock, so if the clock is off and “can’t tell the right time” then the rest of the body’s mechanisms are going to be off too. This is becoming more and more widely appreciated and is stimulating the movement towards computer accessories such as F.lux that incorporate a blue light reduction filter adjusted to the time of day to lessen blue light exposure at night.

3: Get Your Legs Above Your Head

So, it goes without saying that if you happen to wake up in the middle of the night, definitely try to avoid turning on the lights, as this will stimulate daytime brain function. If you find that you can’t get back to sleep after 30 minutes, get out of bed while keeping any lights you do turn on at the lowest setting.

Opt for a relaxing activity like stretching, journaling or meditation until you feel sleepy enough to return to bed. One great position for calming the sympathetic fight or flight system is lying down with your legs above your head (for example, pointed up a wall). This is a modified inversion pose that’s classically been used in yoga for centuries to ease the nervous system and thus, supporting relaxation.

There are a host of other inversion poses and postures, including bridge pose, lying on an inversion table and my personal favorite — going Batman style, totally upside down with gravity boots hooked into a pull up bar.

Note: start inverting slowly and for brief periods, gradually increasing the angle and slant (if you’re using an inversion table) and adjust to your own tolerance.

4: Use Supplements When Necessary

Calming herbs

Use calming botanicals, in lieu of sleeping pills (which can impair cognitive function and cause daytime drowsiness all by themselves). Take herbs like valerian, chamomile, hops, passionflower, lemon balm or kava kava before. You can find these in many forms, from teas and tinctures to powders and capsules.

Melatonin

Secreted by the pineal gland, melatonin regulates our sleep-wake cycles. When given to TBI patients (which is a large contingency of the clients I work with), melatonin has been shown to boost their daytime alertness, improve sleep quality and duration and help them fall asleep faster.Most people know of it as a sleep hormone that’s produced in the brain and helps circadian cycles, and it is also an under-appreciated hormone, brain and immune support agent for global benefits. It acts as a neuro-protectant, anti-inflammatory and anti-oxidant support. It is not however, a magic bullet and doesn’t work for many people.It’s not considered a “hypnotic” in that is doesn’t “put” one to sleep. It acts more like a sleep cycle modulator and facilitates the return to a more optimal sleep architecture. Melatonin supplements are inexpensive and widely available. Sublingual forms are best and ideally taken at the same time each night 30-60 minutes before sleep time.

Magnesium

Although magnesium is prevalent in nuts, seeds, leafy greens and chocolate, many people are deficient in this essential nutrient.Inexpensive and easy to find, supplemental magnesium is often used to relax muscles, reduce anxiety and help promote sleep. There are different forms of magnesium: chelate, glycinate, orotate, threonate, carbonate, chelate, citrate, chloride, sulfate and lactate.For our purposes, the orotate form is important given its ability to create RNA and DNA, as well as its ability to penetrate the cell membrane to be delivered to the mitochondria and nucleus. Magnesium’s threonate form is even more applicable for brain restoration given its unique up-leveled absorption into the brain and its enhanced ability to activate nerve channels involved in synaptic plasticity. Use of the threonate form in the sub-acute recovery phase after injury is also warranted given its vital role in proper nervous system, energy metabolism, cardiovascular health, protein synthesis and much more.
Other thoughts

The amino acids 5-HTP and tryptophan help build serotonin and assist in regulating healthy sleep cycles. Zinc, vitamin B6 and iron (especially in women still having their menstrual cycles and who experience restless legs) have also been used to support sleep. Lastly, many people are significantly low in a variety of trace minerals and often benefit from using a quarter teaspoon of Himalayan crystal salt or Sea salt in warm water before bed.

[Note: give your physician or primary treatment provider a heads up that you’re taking or starting new supplements so they can help ensure there is no negative interaction.]

5. Try Floatation Therapy

I’m a floatation therapy geek and absolutely love this modality for treating a massively wide variety of ailments, and yes, sleep is among them. It helps to normalize the neuro-endocrine system connection, improves inflammation and pain and drops people into greater states of parasympathetic support for rest, healing and relaxation. (See my previous blog on floatation therapy.)

References

Trudeau and Bunney, Sleep Improves Memory: the effects of sleep in long term memory of early adolescents. PLOS journal. Aug 7, 2012.

Lange, et al., Sleep Enhances the Antibody Response in Hepatitis A Vaccinations. Journal of Psychosomatic Medicine. Sept/Oct 2003.

Mougin, et al., Effects of Sleep Disturbance on Subsequent Physical Performance. European Journal of Applied Physiology. 1991, 63. 77-82.

Fullagar, et al., Sleep and Athletic Performance: The Effects of Sleep Loss on Exercise Performance, and Physiologic and Cognitive Responses to Exercise. Journal of Sports Medicine, 2015, 45. 161-186.

Kemp S, Biswas R, Neumann V, Coughlan A. The value of melatonin for sleep disorders occurring post-head injury: a pilot RCT. Brain Inj. 2004;18(9):911-919. doi:10.1080/02699050410001671892.

Naseem, M. and Parvez, S. Role of Melatonin in traumatic brain injury and spinal cord injury. Scientific World Journal 2014;2014:586270. doi: 10.1155/2014/586270. Epub 2014 Dec 21.

Rao, V. et al. Does acute TBI-related sleep disturbance predict subsequent neuropsychiatric disturbance? Brain Inj. 2014;28(1):20-6. doi: 10.3109/02699052.2013.847210.

Lin, L. et al. Melatonin in Alzheimer’s Disease. Int J Mol Sci. 2013 Jul 12;14(7):14575-93. doi: 10.3390/ijms140714575.

Classen, HG. Magnesium orotate—experimental and clinical evidence. Rom J Intern Med. 2004;42(3):491-501.

Slutsky, Inna et al. Enhancement of learning and memory by elevating brain magnesium. Neuron. 2010 Jan 28; 65(2):165-177.

Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Outcomes in Military Personnel. 2011. The National Academies Press. Chapter 12 Magnesium. pg 157.

 

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