This week we are joined by Dr. Sydne Ford about a super important topic – SLEEP! Sleep is the crux of staying well and insufficient sleep is linked to numerous diseases. I did a recent podcast called Sleep For Life you can check out to supplement this post!
Don’t you feel and function better when you are well rested? Despite sleep being something we have done naturally since birth, it can be quite frustrating, as many people have difficulties with falling and/or staying asleep, for various reasons.
Insomnia and Stress
Over the past few weeks, I have seen an increase in the number of patients in my clinic, who have told me that they are having trouble sleeping. This is not a chronic issue for them, yet it started since the coming of the COVID-19 pandemic. Has this happened to you as well? Or maybe you’ve been battling chronic insomnia? You are not alone. It is estimated that around 30-40% of Americans suffer from insomnia. Lack of refreshing sleep can lead to increased irritability, daytime fatigue, anxiety, depression, concentration difficulties, and problems remembering and learning.
Risks of Sleep Deprivation
If that doesn’t give you cause for concern, chronic sleep deprivation is also associated with increased mortality risk and chronic illnesses such as diabetes, obesity, high blood pressure and heart disease.
If you need one more reason on why we should care about getting a good night’s rest, then look no further. In the midst of the current pandemic, many people are asking what we can do for our immune system. We can get the recommended 7-9 hours of sleep, because sleep affects our immune system! Sleep deprivation can decrease production of our protective cytokines, which are needed to fight infection. Studies show that you may have a decreased immune response to vaccines with lack of sleep, you may be more susceptible to the common cold caused by viruses, and it’s also harder to recover if/when you do get sick with a virus or bacteria.
Sleep terms are often thrown around and it’s important for us define these. Here are some brief definitions:
- Acute Insomnia-short term, lasts days to weeks. This is often caused by increased stress (e.g. changes at work, home life, current events or other traumatic events)
- Chronic insomnia-lasts for a month or longer. May be primary insomnia or caused by underlying issues.
- Primary Insomnia-This is a disorder that is not caused by an underlying medical problem, medication or other substances. It can, however, be triggered by chronic stress and emotional issues.
- Secondary insomnia-This is a disorder that is caused by underlying problems such as:
- Metabolic/hormonal disorders
- Illegal substances
- Lung/breathing disorders (like sleep apnea)
- GI issues
- Chronic pain.
It is extremely important to address and treat these problems first, if they are the root cause of your insomnia. Therefore, if you have sleep issues and feel that you’ve done everything right, it is important that you see your doctor for a proper evaluation.
Positive Changes for Health
So what can we do with this information? Firstly, let’s get back to the basics and I will give you some tips that you can implement tonight. These are things that I have even had to remind myself to practice because I’d gotten away from it…because…life. The tips that I’m going to share may sound boring, they may sound childish, but they can be very effective.
You need a bedtime!
You probably remember as a kid, your mom told you to go to bed at a certain time. For those of you with kids of your own, you are likely put them down the same time every night. Children need to be on a routine so that they can get used to falling asleep.
Well guess what? It’s the same thing with adults! No matter the age, our bodies like to be on a routine. So let’s set a bed time now. Whatever time you usually wake up in the morning, set your bedtime for 7-9 hours before that. Also remember, our bodies want to be on a cycle where we go to sleep and wake up at the same time everyday. Once you have that time in mind, stick to it! Try not to negotiate with yourself because you want to continue binge watching the new Netflix series.
The Wind Down
Not be confused with “wine down” as alcohol before bed usually leads to worse sleep. Start winding down an hour before your bedtime and have a ritual where you read something calming (not the news), take a bath or shower, dim the lights and/or drink herbal tea. Once that bedtime hits, lights off, TV off, phone off.
It is best if you can avoid electronics an hour before bedtime but I realize this is difficult. Be aware, however, that the blue light from electronic devices will activate your brain, where you still think it’s day time, and suppress your natural production of melatonin. Try to put your phone down.
BONUS – Same rules apply if you wake up in the middle of the night. No phone (unless you’re turning on a meditation or guided imagery app to fall back asleep) and no TV. External noise other than white noise may also be a distraction.
The bed is only for the 3 Ss–Sleep, Sex and rest when you’re Sick. If you don’t fall asleep after 20 minutes, don’t grab your phone, don’t turn on the TV. Get out of the bed! Go do something else, something non-invigorating and relaxing, until you get sleepy. And then go back to bed.
Waking up in the middle of the night?
I enjoy mindfulness meditation and breath-counting meditation to help with both falling asleep and falling back asleep. My favorite guided imagery and meditations to recommend are Headspace, which is subscription-based and Kaiser, which is free. There are also online structured sleep programs such as Cleveland Clinic’s Go! To Sleep program. Your doctor may also refer you to a professional who can provide cognitive behavioral therapy (CBT) to target your thoughts and actions that may disrupt your sleep or treat any underlying anxiety or depression that could be causing insomnia.
Moderate-intensity exercise may be helpful. It’s free, it’s low risk. Plus, we know that physical activity has numerous other benefits. So do it! This recent post by Dr. Stiff shows the shared benefits of sleep and exercise.
Over-the-counter (OTC) treatments?
You want to be cautious with this -OTC medications and supplements are not benign, even if natural. OTC medications that are touted as non-habit forming are in fact, habit forming. They often contain the active ingredients diphenhydramine (glorified Benadryl) or doxylamine, which is in the same family as the prescribed hydroxyzine. Yes, this medication causes drowsiness, so is very attractive to use as a sleep aid.
Tolerance can occur, meaning your body will require an increased dose. Long term use is also associated with increased risk of dementia and can cause many side effects for older adults such as constipation, hallucinations, confusion, urinary retention, and heart rate changes. Always inform your doctor if you are taking any OTC treatments.
Even if you’ve been prescribed a medication or supplement for insomnia, good sleep hygiene is still a must. Talk to your doctor about weaning it back as much as possible. Few doctors actually want their patients to be taking any habit-forming drug.
The Bottom Line
Limit caffeine, try to quit smoking , move regularly and try to avoid alcohol before bed if you’re having sleep issues.
We’ve all heard the phrase “I’ll sleep when I’m dead”
No. Sleep for your health. Sleep for your life. Sleep right now.
Stay tuned for part 2 next week. We’ll dive deep into a review of common supplements and how food can also affect your sleep.
Dr. Sydne Ford, MD is a board-certified Family Medicine physician at the Emory at Acworth clinic in Georgia. She works with patients of all ages, starting as early as newborns. She is passionate about supporting women’s health, adolescent medicine, and health disparities. At the core of her work, is her desire to get to the root cause of disease and prevent, reverse, or manage chronic diseases using mind-body medicine, nutrition, and movement. She is currently pursuing further training through The Institute for Functional Medicine. She can be found on Instagram at @thehippiedoc.