To sleep: perchance to dream: ay, there’s the rub – William Shakespeare
Insomnia is characterized by the inability to fall asleep or by waking up during the night and having difficulty going back to sleep. An estimated 10-15% of people suffer from chronic insomnia, which may be associated with difficulty concentrating, memory lapses, fatigue, lethargy, emotional instability, weight gain and low hormone production.
We spend about a third of our lives sleeping and it is not simply some passive thing we do when we are not awake. Sleep is a very active process during which there are numerous hormonal and neurological changes that restore and replenish our system for optimum performance. A good night’s sleep is necessary to rest muscle and brain, solidify memory, reset metabolism, produce hormones, and have a healthy life.
Sleep Cycles
There are 4 sleep cycles and we typically go through 4-6 rounds of sleep cycles each night. Each stage has it’s own special purpose. Early in the night, the cycles tend to have more stage 3 deep sleep. As the night progresses, the duration of REM sleep increases, while deep sleep decreases.
Stage 1 is the lightest, lasting 1-7 minutes, with a slowing of the heart rate, breathing, eye movements and brain waves. Muscles relax and may twitch. This is the transition phase between wakefulness and sleep.
Stage 2 is light, lasting 10-25 minutes, with further slowing of the same systems. Eye movement stops and body temperature drops. This stage is slightly deeper than Stage 1 but still considered light sleep.
Stage 3 is deep sleep, lasting 20-40 minutes, and everything slows to the lowest levels. Also known as slow-wave sleep or delta sleep, where the body repairs and regrows tissues, builds bone and muscle, and strengthens the immune system.
Stage 4 is Rapid Eye Movement (REM) sleep, and lasts 20-40 minutes. Breathing, heart rate and blood pressure increase, while the eyes move rapidly from side to side. This is when we have vivid dreaming, and it’s believed to play a role in memory consolidation and mood regulation. During REM sleep, the brain is very active, but the body is typically paralyzed to prevent acting out dreams.
The Important Role of Light
Light plays a crucial role in regulating the sleep cycle by influencing the body’s circadian rhythm, which is the internal clock that governs the sleep-wake cycle. Melatonin, a sleep promoting hormone produced by the pineal gland, is influenced by light. Melatonin production usually begins to increase in the evening, about 2-3 hours before your regular bedtime. This increase in melatonin levels signals to the body that it is time to start winding down and preparing for sleep. This period is often referred to as the “biological night.” Throughout the night melatonin helps regulate the sleep cycles. Complete darkness and cool temperatures support melatonin production.
Even before you awaken the eyes pick up the dawn light and send signals to the brain that “it’s time to wake up”. As morning arrives melatonin levels begin to drop. At the same time, light stimulates the release of cortisol, a hormone associated with stress and alertness. This is known as the cortisol awakening response (CAR). Light exposure enhances this increase, helping you feel more alert and ready to start the day.
Sleep Influences on Hormones
The pituitary gland, often referred to as the “master gland,” plays a crucial role in regulating various physiological processes by secreting hormones that affect growth, metabolism, and reproduction. During sleep, the pituitary gland is particularly active and influences several critical hormone systems including Growth Hormone, supporting growth, cell repair, and muscle development, especially active during deep sleep; Cortisol, influencing wakefulness and prepares the body for the day; TSH, regulating thyroid hormone and metabolism with a peak in the early morning; Prolactin, supporting reproductive health and immune function; FSH and LH, regulating reproductive health; and ADH which maintains water balance by reducing urine production during sleep.
Sleep apnea is a common condition typically occurring as people start into deeper stages of sleep when the muscles relax the airway closes off. Snoring is a similar process and is often associated with sleep apnea. People with sleep apnea don’t get good deep sleep and as a result often feel lousy. This also explains why sleep apnea is often the cause of low Testosterone in young men.
Sleep Myths
Myth: Cutting just one hour per night out of the sleep cycle won’t make much difference. Nope, adults need about 7-8 hours of sleep per night, on average. Growing teens may need 8-9 hours or more. Running short just one hour can accumulate into a sleep debt that will have effects on motor and cognitive performance.
Myth: People need less sleep, as they get older. In truth, people tend to sleep less as they age due to health problems that cause pain, more fragile sleep with easier disruptions, and less time in deep restful sleep.
Myth: The body can quickly adjust to different sleep schedules. Not so. The body has a biological clock, our “circadian rhythm” that controls our sleep patterns. External cues are mostly the day / night cycle. Quite simply we are designed to sleep when it is dark and be active when it is light. Internal cues from the brain literally signal time to sleep and time to wake.
Best Time to Awaken
The best stage in the sleep cycle to wake up is during the lighter stages 1 and 2 of sleep. Waking up during these stages typically makes it easier to feel refreshed and alert compared to waking up during deeper stages of sleep or REM sleep. Waking up during these lighter stages usually feels quite natural since the body and mind are not yet fully immersed in sleep. Waking up from deep sleep can cause grogginess and confusion, often referred to as sleep inertia. Waking up from REM sleep can also lead to grogginess and disorientation.
Insomnia Treatments
After trying drug after drug for insomnia, most people find they either don’t help, cause unpleasant side effects, or they wind up hooked on a sedative-hypnotic tranquilizer. The typical prescription medications never truly solve the sleep issue. By targeting the underlying causes of insomnia we can not only treat it more naturally but also restore the normal sleep cycle.
First off, proper sleep habits or “sleep hygiene” are basics that need addressed. A few tips include setting the alarm for the same time every day, going to sleep at the same time, keeping the bedroom absolutely dark and quiet, and keeping the temperature cool. Avoid stimulating activity and excess light late in the evening. Eat dinner at least 2-3 hours prior to bedtime. Cut out caffeine after lunch and avoid too much alcohol.
Melatonin naturally declines with aging. Taking 1 to 3mg at bedtime, regularly, will help many sleep better. Get a good brand, preferably “micronized” for better absorption. My favorite is a 3mg under-the-tongue tablet from Douglas Labs. For some people higher doses in the 10-20mg range work better.
Menopause and female hormone imbalances are very common causes of insomnia. Aside from the proverbial night sweats causing poor sleep, many women suffer from low progesterone, which leads to estrogen dominance and an over-stimulated brain causing not just insomnia, but anxiety, agitation, and irritability typical of PMS. Men too, have disrupted sleep associated with falling testosterone levels.
Perhaps the greatest hormonal sleep disturber is the stress hormone called cortisol. While necessary for many positive health functions, chronic elevations of cortisol wreak havoc with sleep cycles. Cortisol is our “daytime” hormone, reaching its peak about 30 minutes after awakening and slowly returning to a low level prior to bedtime, which allows melatonin to rise and orchestrate a healthy sleep cycle.
Cortisol induced insomnia leads to the classic “wired but tired” feeling at bedtime – feeing exhausted but unable to sleep. Mind racing, patients will clean house, read, or watch TV until they finally just drop from sheer exhaustion. They may awaken during the night with a startle or shock, feeling agitated or hyper-vigilant, and have a tough time returning to sleep.
For the high-cortisol insomniacs we must tackle the cortisol problem. Dietary changes include eating protein with every meal, not skipping breakfast, cutting out sugar and high glycemic foods, and increasing adrenal supporting foods such as fresh fruits and veggies. We usually use supplements that nurture and modulate the stress response, including holy basil and magnolia bark. Cortisol lowering nutrients such as phosphatidylserine, whey peptides from milk and an herbal called Relora-Plex are effective in knocking out high cortisol. Lifestyle changes are often part of the cure and include stress management, mediation, yoga, and bodywork such as acupuncture.
A second type of insomnia is the serotonin / melatonin deficiency. These patients are “night-owls” having a hard time getting to sleep and then having restless sleep with premature awakening. They often have mood disturbances such as depression or anxiety, obsessive thoughts, perfectionism, or emotional mood swings. Winter “blues” may be present as well as a dislike of hot weather. Afternoon or evening cravings for sugar, carbohydrates, alcohol or marijuana are also common.
Tryptophan or its derivative 5-HTP can be taken to support serotonin production, which in turn will increase melatonin. These supplements may be taken during the day for helping mood, or just in the evening. We add melatonin only when the tryptophan alone does not do the job.
The last insomnia type we recognize is GABA deficiency. Calming and balancing to other excitatory neurotransmitters, GABA is the key to a calm and relaxed brain. A patient with GABA deficiency is often stressed and burned out, tense and unable to relax or loosen up. They are the patients who have responded well to drugs such as Xanax or Ambien. For these patients taking GABA prior to bedtime is usually helpful. Taurine is an amino acid that will activate GABA receptors and boost its effects.
While there are many simple, safe, and effective remedies to help with sleep, there is an art to the dosing and timing of supplements. Seek guidance from a practitioner who is well versed in the use of these natural supplements. And again, it is critical to diagnose underlying medical issues that disturb sleep, such as sleep apnea, restless leg syndrome, or hormone imbalances. Sweet dreams!
List of Sleep Supplements and Dosing
Author
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call (970) 245-6911 for an appointment or more information.
