Deliberate sleep deprivation has been used for centuries, as both a form of torture and a means for interrogation. If we leave that interesting yet vile factoid aside, sleep is a basic human need, like food, water and breath
Like these other needs, a good night’s sleep is a vital aspect of creating good health and well-being throughout your lifetime. On average, we spend about 30% of our lives asleep. It is the body’s natural rest cycle. Our bodies all require long periods of sleep in order to restore and rejuvenate, to grow muscle, repair tissue, and synthesize hormones.
But what makes you sleep? Answer- The internal body clock
The body clock typically has a 24-hour repeating rhythm (called the circadian rhythm). Two processes interact to control this rhythm. The first is the hunch to sleep that builds with every hour that you are awake. This drive for sleep reaches a peak in the evening, when most people fall asleep.
The second process involves your internal body clock. This clock is in sync with certain cues in the environment. Light, darkness, and other cues help determine when you feel awake and when you feel sleepy (1).
Sleep is a complex and dynamic process that affects how you function and the term ‘Sleep Health’ is often used to encompass all the different aspects of it.
What is Sleep Health?
Sleep health is a multidimensional pattern of sleep-wakefulness, adapted to individual demands that promotes physical and mental well-being. Everyone needs sleep, but its biological purpose remains a mystery. Sleep affects almost every type of tissue and system in the body – from the brain, heart, and lungs, metabolism, immune function and finally to a good mood.
That said, the cumulative effects of sleep disruption and sleep disorders have been associated with a wide range of deleterious health consequences.
However, there is a difference when it comes to sleep deprivation and sleep deficiency.
Sleep deprivation is the condition of not having enough sleep while Sleep deficiency is a relatively broader concept and can lead to physical and mental health problems, injuries, loss of productivity, and even a greater risk of death. An individual is sleep deficient if he/she has one or more of the following:
- You don’t get enough sleep (sleep deprivation)
- You sleep at the wrong time of day (that is, you’re out of sync with your body’s natural clock)
- You have a sleep disorder that prevents you from getting enough sleep or causes poor quality sleep.
Whatever may be the reason, a disrupted sleeping pattern ought to have negative repercussions on your health.
But what can possibly cause this sleep disruption?
Researchers suggest certain risk factors to be reasons behind a disrupted sleep (2).
Some of the important ones are-
Lifestyle factors– Consuming excessive amounts of Caffeine, drinking alcohol, drug abuse, shift work, jet lag
Environmental factors- Excessive noise or light.
Psychosocial factors– Stress, anxiety, worry
Other disorders– Insomnia, Obstructive sleep apnea, Restless leg syndrome, Narcolepsy (a neurological disorder that involves a decreased ability to regulate sleep-wake cycles) cite
Physiological factors– Bruxism (grinding your teeth), talking in sleep or sleepwalking (Somnambulism), hot flashes during Menopause (3).
In addition, in our work at iThrive we have found there are two major factors that lead to impaired sleep.
Adrenals are two glands which produce a variety of hormones. Among those are steroid hormones- Adrenaline and Cortisol. The stress system works on these two hormones. Adrenaline and cortisol do not operate in isolation. They are part of a complex system known as the HPA axis (HPA is short for hypothalamic-pituitary-adrenal axis) which combines parts of the central nervous and endocrine systems.
These hormones are produced in the adrenal glands. The hypothalamus and pituitary gland, located in the brain, monitor their levels and send messages to the adrenal system to adjust the production as a response to stress.
Activation of the HPA results in wakefulness and these hormones (Adrenaline and Cortisol ) and others including corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), are associated with attention and arousal (4)
People with a dysfunctional liver often experience sleep problems as a result of impaired melatonin metabolism. Liver is the main organ responsible for metabolism of melatonin, a hormone that regulates the sleep-wake cycle (5)
Lack of sleep not only affects your quality of life. It can also be dangerous because it increases your chances of having accidents. This makes it important to find out the underlying cause if you are regularly sleeping poorly.
But how much sleep do you need?
Usually, most healthy people are structured for being awake for as long as 16 hours and need an average of 8 hours of sleep per night (6). In spite of this, some people are able to function even after as little as 6 hours of sleep without sleepiness while others cannot perform to their fullest unless they have slept for 10 hours. And, contrary to common myth, the need for sleep does not decline with age but the ability to sleep for six to eight hours at one time may be reduced (7). Nevertheless, sleep needs vary across ages from person- to- person. The National Sleep Foundation along with experts from sleep, anatomy and physiology, as well as pediatrics, neurology, gerontology and gynecology recommended sleep ranges across various age groups (8). A summary of these new recommendations includes
- Newborns (0-3 months): Sleep range is 14-17 hours each day
- Infants (4-11 months): Sleep range is 12-15 hours
- Toddlers (1-2 years): Sleep range is 11-14 hours
- Preschoolers (3-5): Sleep range is 10-13 hours
- School age children (6-13): Sleep range is 9-11 hours
- Teenagers (14-17): Sleep range is 8-10 hours
- Younger adults (18-25): Sleep range is 7-9 hours (new age category)
- Adults (26-64): Sleep range is 7-9 hours
- Older adults (65+): Sleep range is 7-8 hours
Moving ahead, there are complications associated with a disturbed sleeping pattern. Both short-term and long-term impacts have been observed.
Short-term and long term impacts of sleep disruption-
Short-term consequences include increased response to stress, reduced quality of life (QoL), emotional distress, mood disorders, reduced memory and performance and other mental health problems in otherwise healthy people. Individuals with underlying medical conditions may face poor health-related quality of life (9).
Hypertension, dyslipidemia, CVDs, weight-related issues, metabolic syndrome, and T2DM are some of the long-term impacts of sleep disruption.
Evidence also suggests that sleep disruption may increase the risk of certain cancers and may also worsen the symptoms of some gastrointestinal disorders.
However, too much sleep — as well as not enough sleep — raises your risk of chronic diseases. Yes you heard it right, excessive sleep can also lead to negative health impacts.
Sleeping too much — 10 hours or more — can harm your health. It may be a sign of underlying health problems, according to a study by the Center for Disease Control and Prevention (CDC) published by the American Academy of Sleep Medicine. Findings include:
- Too much sleep — as well as not enough sleep — raises the risk of chronic diseases, such as coronary heart disease, diabetes, anxiety and obesity in adults (aged 45 years and older).
- Sleeping too much puts you at greater risk of coronary heart disease, stroke and diabetes than sleeping too little.
- Sleeping more than seven or eight hours a night, and feeling tired the next day, could indicate you have a health problem.
Also, excessive daytime sleepiness (EDS) in people suffering from sleep apnea is linked with insulin resistance, irrespective of the person being obese (10).
Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night’s sleep, you might have sleep apnea. The main types of sleep apnea are: Obstructive sleep apnea, the more common form that occurs when throat muscles relax.
Apart from these various consequences related to excessive sleepiness and sleep deprivation, what makes a good night’s sleep so necessary and important?
Let’s find out why,
Importance of good sleep
A good sleep serves a multitude of purposes that are important for your health. Some important ones are-
- The first purpose of sleep is ‘taking out the trash’ from your brain
Everyday our brain accumulates metabolic waste while performing its normal activities. During sleep our brain cells shrink by 60% making a way for the glymphatic system, i.e., the brain’s waste removal system to “take out the trash” comfortably (11). The result is you wake up with a clear mind feeling refreshed. That’s one importance of a good night’s sleep.
- The second purpose of sleep is memory consolidation
The timing of your sleep is very crucial. Proper amount of sleep is essential for memory consolidation (12), meaning maintaining and strengthening all your long- term memories. Inadequate or a fragmented sleep can hinder your ability to form both concrete memories (facts and figures) and emotional memories.
- Ultimately, Sleep is paramount for metabolic health.
Studies have shown that when you sleep for just 5.5 hours or so every night instead of 8-8.5 hours, a higher proportion of energy burn comes from carbs and protein and comparatively less from fats(13). The result? You become prone to fat gain and muscle loss. Moreover, insufficient or abnormal sleep cycles can increase your risk of diabetes and heart disease.
Tips for a good night’s sleep-
Sleep hygiene is a variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness. Good sleep hygiene is characterized by personal satisfaction and appropriate timing, adequate duration, high efficiency, and sustained alertness during waking hours (14).
One of the most important sleep hygiene practices is to spend an appropriate amount of time asleep in bed, not too little or too excessive. Other good sleep hygiene practices include:
- Daytime naps to no more than 30 minutes
Napping does not make up for inadequate nighttime sleep. However, a short nap of 20-30 minutes can help to improve mood, alertness and performance.
- Staying away from stimulants such as alcohol, caffeine and nicotine before bedtime
As mentioned, these stimulate and awaken our brain, making it difficult to fall asleep. If you are dependent on caffeine then make sure your last cup of coffee is no later than 2 pm, so that your body has an opportunity to clear out the caffeine before its bedtime.
- Exercising to promote good quality sleep
As little as 10 minutes of aerobic exercise, such as walking or cycling, can drastically improve nighttime sleep quality. For the best night’s sleep, most people should avoid strenuous workouts close to bedtime.
- Steering clear of food that can be disruptive right before sleep
Heavy foods like fatty or fried meals, spicy dishes, citrus fruits and carbonated drinks can trigger indigestion for some people. When this occurs close to bedtime, it can lead to painful heartburn that disrupts sleep.
- Ensuring adequate exposure to natural light
Exposure to sunlight during the day, as well as darkness at night, helps to maintain a healthy sleep-wake cycle.
- Establishing a regular relaxing bedtime routine
A regular nightly routine helps the body recognize that it is bedtime. This could include taking a warm shower or bath, reading a book, or light stretches. When possible, try to avoid emotionally upsetting conversations and activities before sleeping.
- Ensure that the sleep environment is pleasant
Mattress and pillows should be comfortable.Bright light, cell phone and TV screens can make it difficult to fall asleep, so turn those lights off or adjust them when possible. Avoid watching something that disturbs your mind which would further make sleeping difficult. Consider using blackout curtains, eye shades and ear plugs that can help you fall asleep.
- Most importantly fix any liver and adrenal dysfunction you might have
Stress is the primary cause of adrenal dysfunction which might be a reason behind your sleeplessness. Also, compromised liver health, overtime, can lead to sleep problems as a result of the toxins. Harmful substances and byproducts cannot be flushed out of the body when the liver is not functioning properly, as a result, these toxins circulate in the blood causing sleep disturbances.
- Switch to yellow lights
When receptors in our eyes are hit with bright light for an extended period of time, they send a message to the brain saying it is time to be awake. The brain, in turn, stops secreting a hormone called melatonin, which makes people sleepy and helps regulate the internal sleep clock and switching to yellow light prevents this.
In addition, by positioning ourselves in front of electronic devices that project quite a bit of blue light into the evening and night hours, we’re receiving strong signals to be active at a time when our internal clock is trying to help us wind down, and it is a good idea to install blue light filters on all your electronic devices. Blue light filters prevent melatonin imbalance and allow for the natural sleep rhythm to build up.
If you have any sleep issues and you are not able to figure out the underlying cause, feel free to call iThrive and we would be happy to help.
- Van Dongen & Dinges, Principles & Practice of Sleep Medicine, 2000