Please! I Need Some ZZZZZZZZZ’S!
By Stan M. Gardner, M.D.
“Retire to thy bed early, that ye be not weary. Rise early, that your mind may be invigorated.”1
Recently a colleague of mine confided that his wife was plagued with a challenge that is common today: insomnia. As his wife became older, she noticed that it was increasingly difficult to let her mind and body relax into sleep. The difficulty worsened as she began to panic about not being rested sufficiently to function the following day. And the cycle continues, as she joins the ranks of countless thousands, even millions, who suffer with this problem. Is there an answer? Or are there many answers, and we need to figure out which answers apply to us? Let’s explore some information.
This article will not be a textbook on sleep disorders, but an emphasis and awareness of the importance of good sleep habits and basic principles for a sleep-smart lifestyle. It can be both a contributing cause to dis-ease or be an effect of illness, pain or medication use.
Although the whole arena of why we need sleep and the implications of poor sleep are not well studied and understood, there are a few clear relationships between lack of sleep and lack of health.
1. Adults who sleep about eight hours per night live longer than those that sleep longer (9-10 hours) or considerably less (4 hours or less) per night.
2. Sleep deprivation affects the immune system, resulting in a greater number of infections.
3. Tissue repair, including protein synthesis and fat breakdown for energy, takes place in deep sleep because of growth hormone release at that time.
4. Although sleep does not create better moods, vitality or mental sharpness, sleep can erase the poor mood, lack of vigor or mental dullness induced by sleep deprivation.2
There are three principles that must be understood in order to appreciate sleep, drowsiness and awake states: Sleep Debt, Our Biological Clock, and Environmental Stimulation.
Sleep Debt
Sleep debt is the number of hours a person is missing from his/her sleep need. Let’s say I need eight hours of sleep to perform optimally. If I get 6 hours of sleep per night during the weeknights, I am 7 hours sleep deprived by the end of the work week. By sleeping 10 hours per night on the weekend, I gain 4 hours on the sleep debt, which means I start the next week 2 hours sleep deprived. After maintaining the schedule for one month, I am now 10 hours sleep deprived. Hence, at the end of the year of early morning seminary, there is much greater sleeping in class, although the nature and degree of commitment in the students has not changed.
Perhaps the most important reason to understand sleep debt and drowsiness is in relation to driving. The day after the institution of daylight savings time (with the loss of one hour of sleep), there is a 7-8% increase in automobile accidents. Once a person falls asleep at the wheel, there is no guarantee it will only be for a short time, as the sleep state is no longer under conscious control.
Our daughter is a junior in massage therapy school, and her course of study includes extremely rigorous training in anatomy and physiology. She is at the top of her class. One morning after a full week of chronic sleep deprivation, she was scheduled for an exam. I had grilled her extensively on the subjects for the test and she knew the material backwards and forwards. But when the exam was placed in front of her eyes, she couldn’t focus on the questions. She knew she knew the answers, but they eluded her because of her lack of sleep the previous week. She scored the lowest percent that she had received in her entire course. And you can bet she now places a high priority on getting adequate rest!
Biological Clock
Our biological clock synchronizes a vast array of biochemical events that determine our cycles of sleep and wakefulness. Even under the burden of sleep deprivation, this internal clock triggers wakefulness at preset times, typically in the morning with decelerating wakefulness in the mid afternoon and full wakefulness in the evening. Although the biological clock appears to only influence wakefulness, the lack of wakefulness coupled with darkness that triggers release of melatonin from the pineal glands permits us to get to sleep.
Environmental Stimulation
The symphonic interplay of sleep debt and our biological clock, intertwined with the amount of environmental stimulants, determines if we can stay awake in the middle of the night or we can sleep in the middle of the morning. If we are driving home in the middle of the night, relying heavily on environmental stimulation (music, air blowing, singing, eating, slapping the face) to stay awake, we must not relax the stimulation three blocks from home, or we risk falling asleep.
You Have Options
Let’s talk about options for a sleep-smart lifestyle:
1. Establish a regular bedtime (early if you don’t want to be weary!) and wake time (early if you want your mind to be invigorated!)
2. Avoid stimulation such as television, caffeine, or exercise immediately prior to bedtime
3. Consume your evening meal more than three hours before retiring
4. Find relaxing rituals before bedtime that work for you, such as a hot bath, reading, praying
5. Clear the air with your spouse
6. Create a bedroom environment conducive to sleep: quiet, dark, comfortable temperature and comfortable mattress (not too soft) and bedding
7. Put a high priority on sleep
Aids in Sleep
There are a number of different preparations that have been successful in helping people with their sleeping challenges:
1. Melatonin is the hormone secreted by the pineal gland that induces sleep or permits us to enter into the sleep state. When given for sleep, it only seems to be effective when melatonin levels are low in that individual.3
2. Seratonin appears to have an effect on sleep. The seratonin precursors 5-Hydroxytryptophan (5-HTP) and Tryptophan both have been shown to help sleep. All of my experience is with 5 HTP, which increases REM (rapid eye movement) sleep, the most important part of sleep. It also increases the deep stages of sleep without increasing sleeping time.4
3. Calcium and magnesium are minerals that cause relaxation. (Magnesium is also a cofactor for serotonin synthesis). Epsom salt baths can be a very effective soporific.
4. There are a number of calming herbs that help induce sleep. Two have been well studied: Valeriana oficinalis (Valerian) at 450-900 mg doses5 and Passiflora incarnata (passion flower).6
5. Many individuals who have suffered from insomnia have found that the problem disappears when they sleep on a magnetic mattress. Some companies or salespeople will allow customers to try one before buying to see if it will help their sleep.
6. “White noise” can be played in the background, and is helpful to some. Some white noise machines can adapt the sounds, so that they can sound like a peaceful ocean or other sleep-friendly noise.
Last but not least is the place of relaxation in the sleep process. There are various breathing techniques, relaxation of specific muscle groups, massage or self-help energy work that have been helpful for various people. And let your thoughts be relaxing, gentle, peaceful thoughts, while you breathe more and more deeply, and feel yourself getting very, very sleepy. . . . . . . . . . zzzzzzzzzzzz.
1 Doctrine and Covenants 88:124.
2 A fine treatise on all this information is presented in the 450 page book, The Promise of Sleep by William C. Dement, M.D. by Dell Publishing.
3 Nave R, Peled R, Lave P. Melatonin improves evening napping. Eur J Pharmacol 1995; 275; 213-216.
4 Soulairac A, Lambinet H. Effect of 5-Hydroxytryptophan, a serotonin precursor, on sleep disorders. Am Med Psychol 1977; 1: 792-798.
5 Balderer G, Borbely AA. Effect of valerian on human sleep. Psychopharmacol 1985; 87:406-409.
6 Embodden W. Narcotic plants. New York, NY: Collier Books. 1980.