Struggling with Insomnia?
Insomnia is one of the most common complaints I see in my practice. Insomnia has many moods and flavors - and for simplicity sake- I’d like to clarify that if you struggle with ANY aspect of sleeping, this is for you.
Many people struggle with being able to fall asleep or turn their brains off after a long day, even though they feel completely exhausted.
Others can’t seem to stay asleep and wake up consistently at the same time every night, unable to fall back asleep.
And some people sleep through the night but simply toss and turn and never feel like they are getting good quality rest.
While the exact presentation of your sleep issues absolutely matters and is very important for me to understand to give more targeted advice, the following information is foundational for optimal sleep- regardless of what your current issues specifically look like.
Let’s back up just a little and talk more broadly about sleep. Sleep is a time of rest for the body and brain. The way that brain waves change during sleep is complex and profound. Being able to sleep requires that our nervous system be able to shift into “rest and digest” or parasympathetic mode- which is a profound over-simplification- but all that really matters for today’s sake. Research also shows that sleep is a time of “clean up” - where powerful antioxidants like Melatonin circulate the body and brain and reduce oxidative damage and repair cellular structure (a great reason why sleep is so important to longevity and healthy aging). Some of you may have also heard that sleep is essential for lymphatic drainage of the brain that helps clean out protein accumulation that has been associated with diseases like Alzheimers.
Needless to say, sleep is important and sleep is complicated. And the function and resilience of our nervous system, and many other systems, directly impact our ability to sleep.
Below I will outline the 7 most important things you should understand or be doing for healthy, optimal sleep. If these things don’t help you, it may be time to seek ouT more personalized care.
1) Inability to fall asleep or stay asleep tells us about the state of our nervous system
If good quality sleep seems elusive to you, I want you to ask yourself what your days look like? Are you stressed out? Running around with NO breaks, pauses or rest from “good morning” to bedtime?
If your brain or body never has time to pause and rest during the day, it may struggle to do so when bedtime comes around.
Being constantly on the go or experiencing high stress daily can wire our nervous system to feel in threat mode (even when you are not conscious of feeling this way)- and because the nervous system is not a light switch, it can be hard to go from sympathetic overdrive (high intensity, work, stress, go-go-go!) to parasympathetic (resting, digesting, sleeping).
I would recommend that you practice TITRATION- the ability to slowly add pause and rest into your days. That can be hard for some folks- which is a sure sign you need it most. Start with resting for 5 minutes, then increase time and frequency as it feels more comfortable.
Resting is physical and mental rest- it is not “meditating” or doom scrolling or zoning out, it is simply being. I like to rest every day by laying down for 5-30 minutes and closing my eyes. Somedays I fall asleep, other days I just lay there.
A healthy nervous system should be easily able to slide back and forth between healthy sympathetic to healthy parasympathetic.
2) How you eat throughout the day and before bedtime impacts sleep and stress hormones
Cue my favorite thing to talk about with patients- BLOOD SUGAR REGULATION!
You may have heard the advice to eat a protein and fat rich snack before bed- which I whole heartedly agree with - but what often gets left out is the fact that how you eat all day long greatly impacts your sleep- from a nutrient perspective, of course- but more specifically from a blood sugar regulation perspective.
Why would you eat a protein rich snack before bed? Sleeping is the only time our bodies go without food for a long period of time- which is healthy and normal. However, some people have less resilience for managing a healthy blood sugar overnight. So what can happen is your blood sugar dips in the middle of the night, say around 2am, and then your body responds by secreting Adrenaline (which release glucose from storage, again a normal response to low blood sugar!) and your blood sugar is fixed, but you jolt out of bed feeling wide awake. Having protein and fat shortly before bedtime will keep your blood sugar more stable through the night to ideally prevent that lovely little spike in Adrenaline.
But here’s the thing, if your blood sugar is dysregulated ALL DAY LONG- other essential hormones involved in sleep are going to be impacted.
Blood sugar dysregulation is a physiological stress - meaning it’s quite hard on the body- whether or not we consciously recognize it as “stressful”. The body has to respond with increased levels of cortisol, our beloved stress hormone. The more cortisol we have, the more that cortisol interferes with our circadian cycles (and of course, our nervous systems.)
Blood sugar regulation is also essential for how our brains produce and secrete neurotransmitters - which are-you guessed it- important for sleep (and mood, and energy and everything else!!)
So if you are someone who
Skips breakfast
Skips lunch
Forgets to eat
Goes all day without eating and then eats a huge meal at dinner
Eats a high carbohydrate diet with minimal proteins and fat
Craves sugar (and eats sugar all day)
Your daily blood sugar dysregulation may be impacting your sleep (and many other things…)
(Note: incase you couldn’t tell, intermittent fasting is something I DO NOT recommend to my female patients, in fact I believe it to be harmful)
I would encourage you to make changes to how you eat throughout the day by making sure you are eating 3 good sized meals at regular intervals, snacking as needed and making sure you are getting at least 20 grams of protein with every meal and plenty of fat rich foods.
3) Lack of internal rhythm or routine is very confusing for our bodies
Consistency is so important when it comes to sleep. Being able to go to sleep and wake up at the same time everyday is essential for healthy sleep. Our bodies thrive on routine and rhythm, If you are someone with irregular work hours or inconsistent habits- sleep is going to be difficult for you. If you have the power to change it- it is imperative you stick to a consistent sleep/wake time (yes, even on the weekends!)
In case you forgot, we are creatures of nature- we evolved living outdoors with no exposure to artificial light until relatively recently.
This is fundamentally confusing to our brains and bodies.
The closer we live to natures light/dark cycles- the better our sleep will become. Some ideas to incorporate that in a reasonable way…
Expose yourself to early morning light and late evening light. (Sunrise and sunset) Now you don’t need to sit outside and stare at the sun for some unreasonable amount of time, but simply getting out loosely in this time frame - maybe for a walk- or even a few deep breaths of fresh air- can be helpful- even if the skies are grey (hello PNW!!)
Keep lights dim in your home in the dark hours and avoid blue lights or UV lights. We all know the recommendation to avoid screens before bed- but if sleep is really a problem- you may need to avoid screens in all the dark hours. Since that isn’t super realistic in the PNW this time of year (it’s dark at 4pm) - can you switch your phone to a red light filter or wear blue light blocking glasses for your last few hours of work?
Spend time in nature every single day.
4) Nutrient depletion, chronic stress or many other imbalances can contribute to poor sleep
Dysfunctional stress hormone levels, thyroid issues, mineral imbalance and so many other specific issues can be contributing to your sleep. If you have never worked with a holistic, Naturopathic Doctor before, I highly recommend seeking out their care to address your sleep issues.
Sleep issues can be so complex and multi-factorial- and often times- a sign that something deeper is out of balance. Our core philosophy as Naturopathic Doctors is to treat the ROOT CAUSE- not provide band-aid solutions.
5) Consider the idea that your brain and body may be wired for biphasic sleeping
Have you heard of biphasic sleeping? It’s pretty fascinating. In today’s world, we believe we are made to be monophasic sleepers- which means we (try to) sleep for one continuous long chunk of time. However, research (and history) suggests that not too long ago, most humans were biphasic sleepers - meaning they slept in two separate and shorter time chunks. Our ancestors would go to sleep early, wake up in the middle of the night to tend fires or children or animals, and then go back to sleep until sunrise. Makes some sense, right?
Now, research also shows we need at least one 5 hour un-fragmented chunk of sleep for optimal brain function and closer to 8-9 hours total sleep every night. So, remember that.
But if you are consistently waking up after a 5 hour chunk of sleep, knowing you need more, but definitely can’t fall back asleep right away, consider that your brain is actually not abnormal.
Now of course, many issues can also contribute to this same presentation of insomnia, so don’t immediately write it off if you’ve made no changes to improve your sleep hygiene and overall health.
But it’s interesting to know that for some people, this just may be a physiologic normal and you may need to adjust your lifestyle to accommodate it.
What would that look like?
Consider you fall asleep with your children around bedtime at 7:30 or 8 pm. You sleep until 1am and then wake up wide awake. You get up and do some light cleaning (in dim lights) or do some gentle yoga, or read a book for an hour or 2, then you go back to bed around 3am and sleep until the kids wake up at 7am.
In this example, you got 1) 5 hour chunk of uninterrupted sleep and 2) a total of 9 hours of sleep. You likely will wake feeling very rested.
Obviously that is a big change to what most of us want sleep to look like, but interesting to know about and consider, right?!
6) Understanding sleep pressure
Last, but definitely not least. Understanding the idea of sleep pressure is essential for understanding how your day-to-day life and nighttime routine impacts your sleep quality.
Throughout the day, as you do things that “challenge” your system- like exercise, or social connection, or using your brain at work- your brain secretes a little amino acid into a closed system called Adenosine. This Adenosine builds up in this closed system (in your brain) throughout the day- and the more you do- the more that Adenosine builds up.
Turns out, the build up of that Adenosine creates a sense of pressure in the brain which triggers the sense of sleepiness. Like the sleepiness when you can’t keep your eyes open. This is very different then other sleep hormones like Melatonin. A build up of Adenosine creates what we call “sleep pressure” and causes sleepiness, allowing us to more easily sink into the parasympathetic sleep state.
Here’s the important part- as soon as you fall asleep, a valve in that closed system opens up and the pressure is released- allowing the adenosine to drain out of that system that was creating pressure, causing sleepiness.
So, if you fall asleep on the couch, and then wake up 30 minutes later to head upstairs to bed, you have LOST that sleep pressure and may have a hard time falling asleep, or sleeping soundly.
I recommend that when you fall asleep, the intention is that it is for good and you are really ready for bed before letting yourself doze off.
7) Some basic sleep hygiene things everyone should know…
Some of these things go without saying, but I would hate for you to miss out on good sleep by ignoring one of them.
First thing is, similar to point #3 above, our bodies like routine. Have the same “wind down” routine everynight to notify your body- “hey, we are getting ready for bed, you know what to do”.
Second thing is, obviously, restrict caffeine during the day. You should really be avoiding all caffeine after 11am especially if sleep is a struggle for you. It doesn’t matter if falling asleep is easy for you but you wake up at 2am, caffeine is STILL impacting your crappy sleep.
Lastly, set the tone in your bedroom. Make sure it is quite, dark and cool. Ideal temperature is 60-64 degrees. Animals sleeping in bed with you is lovely and cute, but disruptive to your sleep cycles. White noise can be hugely beneficial. The bed and bedroom should be for sleep and sex- no working in the bed or bedroom. Your brain should know- this is a place of rest. Avoiding a clock in the room is helpful so you don’t get trapped by middle of the night math problems - “I only have 4 more hours left to sleep!!!”
Oofta. That’s is a really comprehensive list of things to consider as you’re working on improving sleep. I urge you to prioritize as much of these as possible to get sustainable improvements to your sleep.