Sleeeeeppp

“I never sleep right through the night”

“I’ve always been a restless sleeper”

"I dread 3am"

Anyone who has experienced problems with sleep will attest to the impact it has on quality of life. I estimate 80% of the people I see in clinic suffer from disordered sleep along with other complaints they bring. It’s so common it gets dismissed as normal for them.  So, let’s take a deep dive into the role sleep plays in our lives and how we can get a great night's sleep.

When our quality and quantity of sleep is insufficient our thinking speed slows; our ability to focus, pay attention and take action all suffer. Reaction times are slow and thinking tends to be more confused. Sleep deprived people tend to take more risks and make poor decisions.

Less sleep also affects our mood. A study designed to evaluate the effects of lack of sleep on mood in young adults found sleep deprivation was associated with increased reactions to negative information. Chronic sleep restriction caused changes in the functioning of serotonin similar to that seen in depression.

Evidence is also growing that sleep is a powerful regulator of appetite, energy use, and weight control. When we sleep well there is an upregulation of leptin, a hormone responsible for appetite suppression and a down regulation of ghrelin, the appetite stimulating hormone. So with poor sleep the experience of being more hungry is very real. To be holistic in our approach we need to broaden our treatment of obesity, weight management and diabetes beyond the scope of diet and exercise alone. Sleep is a game changer.

Insomnia even causes our body to upregulate an important inflammatory marker C-reactive protein (CRP). This is related to increases in blood pressure and systemic inflammation. Lack of sleep can also influence the release of adrenal stress hormones such as adrenaline and cortisol!

Circadian Rhythm

You've probably heard of circadian rhythm before. You might even understand the concept. But do you know how to make it work to your advantage? Circadian rhythm is an internal clock, it dictates sleep and wake cycles, controlled by your hypothalamus and its production of melatonin (which makes us sleepy). The circadian rhythm can affect both duration and quality of sleep, along with energy levels and appetite.

This natural rhythm normally reflects the sun's movement around the earth over 24 hours, but a modern lifestyle has thrown that out the window for many. Shift work, jet lag, screens and exciting crime dramas after the kids are in bed all mess with the ability of our hypothalamus to pump out melatonin (the hormone that induces sleep) on demand every evening.

To take control of your circadian rhythm try these basics:

1. Be consistent: We are creatures of habit and respond to rhythm and regularity. If you eat at the same time everyday your body learns to produce digestive secretions in preparation. And you'll probably find your bowels follow suit. If you go to bed with the same routine at the same time, your brain falls into line quickly.

2. Seek out the sun: Expose yourself to natural daylight, early in the day is best. Light is the most important external factor affecting sleep. This helps reinforce the clearest circadian cue.

3. Pimp your night routine: Engage all the senses and create a regular routine at bed time, allowing at least 30 minutes to wind down. A warm shower, a fluffy towel, a nice smelling oil, a low light or candle, calm music. Take advantage of all the cues to let your brain know it can rest soon.

4. Move it: daily exercise, earlier in the day ideally, gives cues to your body that it's daytime now. Not sleep time.

5. Avoid caffeine: When we first wake in the morning our body dispenses a good dose of adrenalin. Enough to get us up and out of bed. Caffeine throughout the day does the same. So if you consistently fake that early wake up, your body gets confused about when day vs night begins. We'll look at this closer below.

6. Limit light before bedtime: Dim the lights. Keep it cosy. And yep, you already know it, the screen in your hands isn't helping. This cannot be underestimated.

7. Avoid a hot cup of tea before bed. Herbal or otherwise. In the late evening our body naturally lowers our core body temperature. Our skin and extremities may feel warmer but our inner temperature cools. Sleep is typically initiated as temperature starts to decline. Drinking hot tea does the opposite. It warms your insides.

8. Eat enough protein in your diet. The precursor to the essential sleep hormone Melatonin is Tryptophan, rich in most dietary forms of protein, plant and animal. Tryptophan breaks down into 5HTP and in turn into Serotonin, then as darkness descends this further breaks down into melatonin.  Try adding a serving of pumpkin seeds, almonds, poultry, cottage cheese. Note, best absorbed when combined with some carbohydrates. 

9. Histamines. That glass of red wine at dinner time. Red wine contains more histamines than white wine. Other high histamine culprits you might not expect are the traditional and trending fermented foods and bone broths! Histamine sends signals to your brain to cause wakefulness, and in those sensitive to histamine, this can be a real problem. 

Caffeine

Caffeine is a topic that comes up in consultations and warrants some respect for the impact it has on our ability to switch on... and off!  Caffeine is a stimulant and consumption of more than two cups daily is associated with a worsening of sleep disturbance and insomnia. 

Caffeinated drinks and foods such as coffee, tea (green, black, white, matè), chocolate, cacao, energy drinks and cola drinks are often used to improve morning alertness or to maintain energy levels during the day, they are also embedded in our work and social cultures. But caffeine metabolism is relatively slow, typically 6+ hours after consumption. In some it may be more. Volunteers given a morning dose of 200mg of caffeine (equivalent 1-2 double shot coffees) had increased difficulty sleeping the same night, as shown by EEG recordings of sleep patterns.

It is important not to underestimate its effect. A few squares of dark chocolate after dinner can be sufficient to prevent sleep initiation or sustaining sleep. ️

Alcohol

Alcohol has sedative properties and reduces the time it takes to go to sleep. I commonly see in clinic clients use an evening drink or two to wind down from a busy day and help initiate sleep. But hold the pour, alcohol actually prevents deep non-REM and REM sleep so with those couple of glasses to wind down there is now a predominance of lighter non-REM sleep, and more likelihood of waking. Drinking alcohol is thought to potentially lower melatonin levels in the brain. After drinking there is a tendency to awaken after a few hours of sleep and thus any benefit gained from the initial sedative effect is lost because of the detrimental effect on quality of sleep.

Side note: alcohol ingestion in the evening is associated with greater incidence and loudness in males snoring. But I probably didn't need to tell you that. 

Nutritional support

1.    5-Hydroxytryptophan, sounds impressive, or maybe toxic? It's simply the chemical name for a metabolite of tryptophan, an amino acid you get eating protein rich foods. The tryptophan breaks down into 5-HTP (with the right cofactors) and then breaks down in Serotonin (with the right co factors) and then into melatonin (with the right cofactors). See a pattern yet?

Tryptophan 5-HTP Serotonin Melatonin.

So with a direct pathway to some pretty crucial neurotransmitters, (Serotonin and Melatonin) does 5-HTP really work for sleep? Yes (with the right cofactors). And with a few more provisos. Read on.

Here's the run down of what this supplement needs to give you results in bed.  For anything to 'convert' from one thing to another in the body we need enzymes, these enzymes require cofactors. In the case of Tryptophan 5-HTP Serotonin Melatonin we need Vitamins B3 andB6, Vitamin C and Zinc.

Now, if you can get the precursor Tryptophan in your food, why take 5-HTP? I'm always more inclined to prescribe food before pills, and doesn't a regular serve of poached eggs or snacking on pumpkin seeds sound more appealing than another pill bottle in the cupboard?

But here's that proviso. In times of stress ()our body will not convert Tryptophan into 5-HTP, instead it diverts to a conversion to Kynurenine. Kynurenine is a precursor to NAD+. Not a bad thing, in times of stress this will convert food into energy and preserve the integrity of our DNA. All good things, except still no sleep!! So in some cases, there really is a time and place for supplementing 5-HTP (with cofactors ) 

2. This is the most commonly self-prescribed mineral: Magnesium is a cofactor for serotonin synthesis. Remember serotonin converts to melatonin when the sun sets. So sufficient magnesium is essential for feeling good and getting sleep. 

Magnesium due to it's relaxant effect on muscles (Remember: calcium to contract muscle, magnesium to relax muscle) may help to relieve nervous tension and muscular discomfort that impedes sleep. 

I've seen magnesium make a significant difference clinically treating sleep and stress, but the form and quality of magnesium you take is crucial. Some forms cannot be absorbed from the digestive tract, making them an awesome laxative, but not going to help any with sleep!!

3. B vitamins play a pivotal role in the regulation of sleep due to due their involvement in metabolism of serotonin and then in turn melatonin. Without adequate intake of B vitamins the body simply isn't able to manufacture serotonin or melatonin. Read it again, they’re that crucial.

Most important for the synthesis of serotonin are B3 and B6, however these all get put in the category of B vitamins because they work as a team, and supplementing individual B vitamins creates a mess of imbalance. It should also be noted stress and fatigue tend to go hand in hand with sleep disorders. A B complex is also valuable to support the entire body while sleep deprived as it plays critical roles in energy production too.

4. Herbal Medicine has a myriad of options and tailored sleep formulations to help you get quality sleep can be enough to break the cycle of insomnia and retrain the night routine to be what you need it to be. 

As you can see there's a long list of things you can do to help yourself, and there may also be a list of things a practitioner can help with.  The key here is you don't need to give up hope of ever feeling rested again.