I spent this weekend at the National Fibromyalgia Conference at Chichester, where I was one of the guest speakers.
The focus of my talk was on sleep. People with fibromyalgia often suffer with very poor sleep quality. Furthermore, chronic sleep deprivation causes all of the symptoms of fibromyalgia, so it is not clear which comes first, the sleep problems causing the generalised pain and fatigue, or the other way round.
However, you don’t need to have fibromyalgia to benefit from improvements in sleep quality. What I am going to lay out here is the central importance of good sleep in health:
Along with diet, sleep quality is perhaps the most significant health factor within your control. Overlook it at your peril!
Sleep, Stress and Health
Sleep is more important to health than many people realise, yet it remains a scientific mystery.
Whilst it is not clear why organisms need sleep, it is certain that a lack of sleep is detrimental to health. Its importance is underscored by the fact that it is a highly conserved evolutionary trait: virtually all organisms either sleep or cycle between more then less active phases. Even some bacteria have internal clocks [ref] and diurnal activity.
The image above illustrates the broad variety of effects caused by sleep deprivation. It is sobering to realise just how many organ systems inadequate sleep can disrupt.
‘Sleep deprivation’ may sound extreme and suggest the negative effects only apply if you miss a whole night’s sleep, or are regularly awake most of the night. However, even small reductions in sleep can be significant.
A study in 2004 involving 25 healthy young subjects, restricted sleep to six hours per night for 1 week. All subjects felt sleepy in the daytime, performed worse on psychomotor tests, and had raised inflammatory marker IL-6. In addition males had raised TNF, (another inflammation marker) and cortisol was disrupted too (more so in males) which is a cardinal sign of inflammatory processes at work and a key stress hormone.
Disrupted sleep affects the endocrine system, leading to raised stress hormones. For example, shift workers, whose natural sleep patterns are disrupted by their work pattern, have changes in melatonin, cortisol, ghrelin, and leptin, and are at increased risk of insulin resistance, diabetes and obesity [ref]. The reverse is also true: increased stress levels results in poor sleep – a vicious cycle that can be hard to break.
Sleep deprivation can affect appetite and meal regularity. In fact, disturbed sleep alone can result in an additional daily energy intake of around 350–500 kcal primarily derived from snacks [ref] Hence predisposition to weight gain.
There is evidence that sleep clears away neurotoxic waste products from the brain which accumulate during the day. [ref]
Knowing all this it seems crazy that we voluntarily mess with our sleep patterns, so next time you are thinking about burning the midnight oil or staying out partying it is worth remembering:
“humans are the only creature to voluntarily change their period of activity to nonhabitual times, forcing misalignment between activity phases and biological rhythms.” [ref]
Improving your sleep habits
Good sleep hygiene includes keeping regular meal and bed times, and sleeping in a dark, cool and quiet room. A relaxing evening bath, avoidance of computer screens and 60bpm music can help sleep.
Before resorting to any medication – including herbal varieties – it is always worth working on improving your sleep habits.
Diurnal rhythms are generated by an internal biological clock that is synchronized to the 24-h day by environmental cues, primarily the light:dark cycle.
Getting back to your body-clock’s natural rhythm should be a first step to improved sleep.
- Avoid screens late at night – the blue light from mobile and computer screens is associated with the daytime ‘wake’ signal. Use software such as flux to make your screen redden after dark. Red light in the evening (think sunsets and open fires) helps the body clock register approaching sleep. Oh, and no TVs in the bedroom!
- 60 bps music – listening to music with a rhythm close to 60 beats per minute near bedtime helps get your brain into sleep mode. To get a taste try Albatross by Fleetwood Mac then google 60bpm music and build a playlist you like.
- Dark & quiet bedroom – install back out blinds, tape over electronic standby lights and turn gadgets off. Try using ear plugs if it’s not silent in your room.
- Cool but comfortable– bedrooms should be cooler than the rest of the house, as the drop in body temperature stimulates sleep. Use several thin layers to control the temperature so you are comfortable. Your body aims for its own night time set point, which is lower than your day time body temperature – adjust room temperature and bed covers to help it.
- Hot evening bath – hot baths an hour or so before bed can be relaxing in their own right, but the fall in body temperature when you get out can signal it’s time to sleep. This effect seems to get stronger as we age.
“It is suggested that a rapid decline in core body temperature increases the likelihood of sleep initiation and may facilitate an entry into the deeper stages of sleep.” [ref]
- No distractions – ban pets from the bedroom; ensure emails and phones are on silent from an hour before bed.
- Establish a routine – Regular bed times are important in their own right, but the routines leading up to sleep help train the body too.
- Avoid night time eating – over night you are meant to be fasting. The digestive system expects to be ‘off’ – don’t confuse it by eating in the night.
“We have shown… impaired glucose and lipid tolerance if a single test meal was consumed between 00:00-02:00 h (night shift) compared with 12:00-14:00 h (day shift).”[ref]
- Go to bed and get up at the same time each day – such regularity suits this helps your body clock know what’s going on
- Avoid oversleeping – Aim for seven to eight hours sleep each night. A recent meta analysis by Professor Franco Cappuccio’s of Warwick University looked at sleep duration and fatal stroke. His team report a U shaped association with an increased risk of fatal stroke amongst regular short sleepers (less than 6 hours) and regular long sleepers (greater than 8 hours). The increased risk was greatest among the long sleepers. [ref]
- Avoid late night alcohol and caffeine after 4pm – More than one glass of wine may interfere with sleep. A ‘Night Cap’ may help you fall asleep, but actually reduces the overall quality of sleep [ref]. According to a recent study, the caffeine in one cup of strong coffee taken 6 hours before bed adversely affects sleep, reducing sleep duration by an average of 1 hour [ref].
Keeping it regular
This cute (but serious) little graphic comes from a paper called Nutrients, Clock Genes, and Chrononutrition [ref]. The paper explains how regular meals and sleep patterns help maintain strong circadian clocks (central and peripheral), maintaining appropriate hormonal rhythms which promote healthy metabolic functioning (left image). However, nocturnal eating, skipping breakfast and variable sleep patterns lead to a weakening of the circadian rhythm contributing to metabolic disorders. (Right hand)
The authors explain “Because the circadian system organizes whole energy homeostasis, including food intake, fat accumulation, and caloric expenditure, the disruption of circadian clocks leads to metabolic disorders.”
They caution against skipping breakfast as “Breakfast is usually the most effective meal to determine the phase of the liver clock in studies of mice that mimic human eating patterns, because breakfast is consumed after the longest starvation during the day. Thus, late dinners or midnight snacks alter the starvation period and remarkably alter the phase of peripheral clocks” [ref]
These metabolic clocks allow the metabolism to preempt activities, ramping up (or winding down) hormones and enzyme production in advance of expected waking, sleeping, eating or fasting. Messing them about just isn’t fair! Establishing regular meal times and bedtimes, and avoiding night time eating can only help with sleep problems and health in general.
What if its still not working?
If you have tried to get the above tips and you are still not sleeping well then it may be time to see the herbalist. In my next post I’m going to write about some of the herbal tools available for resolving sleep problems.
Sleep & Health – Part 2: Herbal treatment – coming soon!