makIng 2021 our year for better sleep

Happy New Year, VegMichigan community! 

I hope your holidays were safe and as healthy as possible, and were filled with joyful moments despite the challenges we faced in 2020. My holiday was low key this year, but it was still very nice to have some down time and fun at home. 

Now that we’ve started this brand new year, we get a clean slate! Many people out there are still feeling the effects of 2020 but I hope this year is a new beginning for us all with better things ahead. I also hope this will be your healthiest year yet. At the end of each year, I try to take time to reflect and set intentions for what I hope to achieve in the upcoming year. I write down some big and small goals for myself. I think about things that have been going well and some things I would like to improve upon. I also write down any improvements I want to make in regards to my health. I believe that writing down our intentions is a good first step toward bringing goals to reality. 

One significant, health-related goal on my list this year is to find out how I can get better sleep. I should start by saying that I am usually not a very good sleeper. I feel that the older I get, the more I am starting to notice the effects of poor sleep. Harvard University advises us that chronic poor sleep can have profoundly negative consequences on our long term health. I have already started to actively work on this. I have been trying to learn more about why sleep is so important and how I can improve mine. I know I am definitely not the only one in this boat because I see patients all the time who also struggle to get quality sleep. So, I wanted to share what I am learning for myself with all of you this month. Let’s kick off 2021 by discussing a very important topic in lifestyle medicine: How can we achieve our best sleep possible?

what Is sleep, anyway?

Sleep is one of the most interesting things about the human body. It’s one phenomena where scientists haven’t discovered all the answers yet, but as we learn more about sleep we are finding out just how important it is. Sleep is controlled by neurotransmitters, or chemicals in the body that send signals throughout our nervous system. Serotonin and norepinephrine are examples of such neurotransmitters, and they help control our sleep cycles within the brain. These and other similar neurotransmitters help regulate our circadian rhythm and the signals tell neurons when to turn on into wakefulness and off into sleep at various times during our sleep-wake cycle. 

The biological reasons for why we require sleep still aren’t completely understood. However, advances in research have shown that sleep has numerous helpful roles throughout the body. Beyond serving a restorative role and allowing our bodies a chance to rest and recharge, sleep is thought to be important for cognitive functioning, neuron repair, and processing and consolidation of memories. Sleep is also thought to be involved in cardiovascular protection and repair, immune system function, and the regulation of our metabolism. Studies have shown that people who chronically do not get enough sleep tend to have higher rates of high blood pressure and heart disease. People with Type 2 Diabetes who suffer from insomnia have been shown to have worse glucose control. Poor sleep can contribute to obesity as well, and can disrupt hormone functions that regulate our hunger and satiety. 

Sleep occurs in stages, and there are essentially five different stages that we cycle through during a typical night’s rest. These stages are divided into REM and non-REM sleep. Stage 1 sleep is when we drift back and forth between being awake and asleep. We can be easily woken during this time. Muscle and eye movements start to slow down, although many people do experience jerking muscle movements or even a sensation of falling during this stage of sleep, which is normal. Stage 2 is light sleep. Our heart rate and breathing rate decreases slightly, brain waves slow down, and eye movements stop during this time. Stage 3 and 4 are similar and are considered our deep sleep stages. People have a difficult time waking up suddenly from these stages and will typically feel somewhat groggy. Stages 1-4 are considered non-REM sleep. The last stage of the sleep cycle is REM sleep. During REM, we have rapid, involuntary eye movements. This is the stage when most of our dreams occur, and our body stops moving temporarily which prevents us from acting out our dreams. During a normal sleep, these 5 stages repeat themselves over and over throughout the night. 

I recently had an opportunity to take an at-home sleep study. I mostly just wanted to do it as an experiment to learn more about how at-home sleep studies work for my patients. What I learned about myself in the end was not surprising, but also somewhat concerning. I took the study over 2 nights and wore a sensor on my index finger throughout the duration of each night. I learned that although I usually allow myself about 8 hours of total sleep time, I only averaged about 4.5 – 5.5 hours of actual sleep each night. What happened to the other 3-4 hours? It was most likely spent in stage 1, “in and out of sleep” and tossing and turning. No wonder I so often feel tired during the day.

why are we not sleepIng?

What could be some reasons why myself and so many others struggle to acquire enough sleep? There are many different factors that affect our sleep quality. Sleep hygiene is a big one. This means our typical lifestyle habits before bedtime and includes things like activity before bed, our sleep environment, the temperature, what we wear to sleep, our sleep schedule, and screen time. Emotional factors like stress, anxiety, and worry are also keeping many of us up at night, especially over the last several months. There are other factors like diet, alcohol, smoking, and sleep apnea that can affect how we sleep as well. I have been making some adjustments of my own and noticing which factors impact how I sleep. Let’s discuss these things, so you can make some tweaks of your own if you are interested in getting better sleep:

1. Optimize Your Sleep Environment: Make sure your sleep environment supports a good night’s rest. Try to avoid potentially stressful tasks (like work) in your bedroom, as blending work and sleep environments together can trigger stress and anxiety at bedtime. Make sure the temperature is optimal for you. Evaluate where you sleep and look for potential disruptions, such as blinking lights, repetitive noises, phone notifications, or even a snoring partner. Try to utilize tools such as fans, white noise machines or apps, blackout curtains, eye shades, or ear plugs to keep things like this from waking you up. Make sure your mattress is comfortable for you.

2. Make sure your clothing is comfortable: One thing I have discovered about myself is that loose fitting shirts that twist around me at night definitely cause me to lose sleep. So I am working on figuring out which types of pajamas work best for me.

3. Avoid daytime naps: if possible and try to stick to a consistent bedtime and wake up time as much as you can.

4. Limit or avoid alcohol consumption: Many people, myself included, enjoy a glass of wine or a nightcap before bed sometimes. Alcohol can definitely affect sleep as well, and can even contribute to sleep apnea because alcohol can relax the structure of the oropharynx (back of the throat). If you are not sleeping well, try to abstain from having alcohol or at least from having it right before bed, to see if your sleep patterns improve.

5. Work on stress reduction: If stress and anxiety is keeping you awake at night, try to do something before bed that relieves stress. You can try a mindfulness activity, journaling, coloring, meditation, deep breathing, or anything else that eases your mind from stress and worry.

6. Regular physical activity is important for sleep as well: Even 20-30 minutes of light exercise daily can have a major impact on sleep quality. Studies have suggested that exercising right before bed can have negative effects on sleep, so it may be better to schedule it earlier in the day if you can.

7. Evaluate your diet: A healthy diet can improve sleep as well. It is important to shift away from foods that are known to keep us awake and try other foods that are easier to digest and also trigger the release of hormones that help promote sleep. John Hopkins Medicine suggests that spicy foods, heavy meals, and fried foods, and sugar-rich foods can all affect sleep quality. We all know that caffeine affects sleep as well, so avoiding it later in the day can be helpful. This also includes foods that contain caffeine, such as chocolate and cocoa. Lighter meals or whole grain foods, such as toast, oatmeal, or a small handful of nuts, are good options if you are hungry before bed. Very high protein foods are generally not advised before bed because they require a higher amount of digestion and can disrupt sleep. Cured or processed meats and cheeses can also stimulate the release of Tyramine, which leads to the release of norepinephrine, which is a neurotransmitter that stimulates the brain.

8. Keep track of what works: Keep a sleep journal by your bed or on your phone. I am working on this myself and identifying interesting things that seem to be helping me. Make note of whether you had good or poor sleep and what your evening activities were, what you ate and drank, and what your sleep hygiene was like. Try to tease out some things that are helping (or not helping) you sleep better.

If all else faIls, seek help

If you’ve tried all of these suggestions and you are still not sleeping well, I recommend consulting with your primary care doctor for help. My preference as a doctor is to make sure my patients have optimized all of the above factors before starting sleep medications, but sometimes they are necessary. You may also need to see a sleep specialist or have testing done to evaluate your sleep patterns further. Your doctor can work out a plan with you that helps you achieve more quality sleep.

Hopefully these suggestions help us all to achieve our best sleep possible. As we go forward into 2021, I am looking forward to diving deeper and discussing other aspects of lifestyle medicine that are so important for our health. Stay warm, stay healthy, and I’ll catch you all next month!