Sleep and Insomnia

JUST HOW IMPORTANT IS SLEEP? Attitudes about the importance of sleep  have changed as new research has provided information on positive and negative effects of sleep .

I hesitate to discuss the possible ramifications of missing sleep because those who suffer from chronic insomnia can tend to become obsessed enough about the loss of sleep, without also worrying about the effects of this loss. But hopefully additional information can lead to lifestyle changes which will improve sleep.

It is not only the insomniacs who suffer the effects of sleep deprivation.  Some who think they are good sleepers are still not sleeping enough for maximum health & functioning.  With all the demands of modern life, cutting back on sleep can seem like the only answer for creating extra time to “do”.  But the quality and quantity of your sleep directly affects the quality of your waking life.

How many hours of sleep do you need?

The chart below presents the ideal amount of sleep required for different age groups.  Despite the notion that older people have decreased sleep needs, they still need 7.5 – 8 hours nightly.  Because of aches & pains, and other discomforts older people may have trouble sleeping this long at once, so daytime naps can help to compensate.

Average Sleep Needs

Age		Hours
Newborns (0-2 months)		12 – 18
Infants (3 months to 1 year)		14 – 15
Toddlers (1 to 3 years)		12 – 14
Preschoolers (3 to 5 years)		11 – 13
School-aged children (5 to 12 years)		10 – 11
Teens and preteens (12 to 18 years)		8.5 – 10
Adults (18+)		7.5 – 9

The signs of mild sleep deprivation can be subtle and are:

• Needing an alarm clock to wake up on time.
• Relying on the snooze button.
• Having a hard time getting out of bed in the morning.
• Feeling sluggish in the afternoon.
• Getting sleepy in meetings, lectures, or warm rooms.
• Getting drowsy after heavy meals or when driving.
• Needing a nap to get through the day.
• Falling asleep while watching TV or relaxing in the evening
• Feeling the need to sleep in on weekends.

Sleep provides many benefits such as the following:

• Helps repair your body: Damage from stress, pollutants, infection, ultraviolet rays and other harmful exposures in the day can be repaired at night. Extra protein molecules are produced by your body during sleep. These form the building blocks for cells needed to help mend your body at the cellular level. Sleep gives the body a chance to replace chemicals & aging or dead cells, and to repair muscles, and other tissues.  Sleep may also have an effect on strengthening the immune system.
• Helps keep your heart healthy: Your heart and cardiovascular system are constantly under pressure. Tests have shown that people with normal or high blood pressure have a 20-30% reduction in pressure and a 10-20% heart rate reduction while sleeping. Sleep also helps to reduce the inflammation in your body. High levels of “inflammatory markers” are linked to heart attacks, heart disease and strokes.
• Reduces Stress: A good night’s sleep reduces stress & stress hormones in your body.  When you are sleep deficient, your body functions are put on high alert causing an increase in the production of the stress hormones adrenaline,  norepinephrine and cortisol.  An increase in these stress hormones is stimulating and can further impair sleep.
• Improves your memory: When deprived of sleep it is difficult to concentrate. This leads to an inability to organize and archive facts, faces, lessons or even conversations to memory. While you are sleeping a process called memory consolidation occurs, your brain is busy processing your day, making connections between events, and organizing and archiving memories. Sleep allows your brain to better process new experiences and knowledge, increasing your understanding and retention. Brain glycogen levels are replenished during sleep. The glycogen is  stored as a  back up to glucose which is the main brain fuel substance.
• Helps you control body weight & metabolism: One of the lesser known benefits of sleep is that it helps regulate ghrelin and leptin, the hormones that affect and control your appetite.  Leptin is a hormone produced in your fat cells which tells your brain you have had enough to eat.  Sleep deprivation decreases leptin levels so it is harder to feel satisfied after eating.  Ghrelin is a hormone, which stimulates appetite and it is produced in your stomach.  Sleep loss increases Ghrelin levels thus increasing appetite.  Research has shown people who sleep less than seven hours per night are more likely to to be overweight or obese. Studies have shown that when your body is deprived of sleep, the normal hormone balances are interrupted and your appetite increases. Unfortunately this increase does not lead to a craving for fruits and veggies, instead your body longs for food high in calories, fats and carbohydrates! So, if you are interested in controlling or losing weight, be sure to get a good night’s sleep.
• Helps balance hormones & neurochemicals: All endocrine functions have cycles in the body in tune with the circadian rhythm.  Sleep provides important contributions to normal hormone balance & regulation.  Scientists have isolated chemicals in the body, which help to regulate sleep such as melatonin, serotonin, and adenosine.  Serotonin is an important neurotransmitter, which promotes sleep, a balanced mood, emotional health, and feelings of well-being. Seratonin is produced from tryptophan.   Low serotonin in the brain can lead to increased sleep problems, anger, aggression, irritability, obsessions, repetitive thoughts, fear, worry, and depression.  The sleep inducing hormone melatonin is produced from serotonin.

Just because sleep provides many benefits does not mean that sleep beyond the required amount will be beneficial.  In fact excess as well as insufficient sleep can be detrimental to your health.

Sleep consists of a series of distinct cycles and stages which are needed to restore and refresh your body and mind. Each stage of sleep in the sleep cycle offers specific benefits.  Helpguide.org has offered the following graph to show the actual sleep cycles:
During the night, your sleep pattern moves back and forth between   the more alert (stages 1-2), Non-REM deep restorative sleep (stage 3-4) and REM sleep.  REM sleep is dream sleep as dreams occur at that time whether or not you remember them.  The non-REM deep sleep is a time of physical repair & rebuilding, while the REM sleep is a time of mental recovery and consolidation. Thus deep sleep renews the body and REM sleep renews the mind. Together, the stages of REM and non-REM sleep form a complete sleep cycle that repeats until you awaken.  As the hours of sleep progress the REM sleep becomes more frequent and lasts longer.

Getting good, restorative sleep requires more than just spending enough hours in bed.  The time spent in each stage of sleep also matters. A normal adult spends approximately 50 percent of total sleep time in stage 2 sleep, 20 percent in REM sleep, and 30 percent in the remaining stages, including deep sleep.

REM (Rapid Eye Movement) sleep is reached about 70 to 90 minutes after falling asleep.  In REM Sleep: Dreaming occurs, the eyes move rapidly, breathing is shallow, the heart rate and blood pressure increase and the arm and leg muscles are paralyzed. During REM sleep, your brain consolidates and processes the information you’ve learned during the day, forms neural connections that strengthen learning and memory, and replenishes its supply of neurotransmitters, including feel-good chemicals such as serotonin and dopamine that boost your mood during the day.

Try sleeping an extra 30 minutes to an hour in the morning to get more mind and mood-boosting REM sleep. This is the time when REM sleep stages are longer. If you aren’t getting enough deep sleep, your body will try to make it up first, at the expense of REM sleep. So by improving your overall sleep and hours of sleep, you will also increase your REM sleep.

Many sleeping pills and other medicines disturb the REM sleep cycle.  Some sleep meds claim not to interfer with REM.  These and natural sleep aids will be discussed in the last installation of our sleep series.

Poor sleep can impair quality of life & impair many areas of functioning.  Sleep deprivation has a wide range of negative effects beyond daytime drowsiness.

The short-term effects of sleep deprivation include:

• Impaired glucose tolerance & increased insulin resistance even in healthy research subjects.
• Fatigue, lethargy, and lack of motivation
• Moodiness and irritability
• Restlessness
• Reduced creativity and problem-solving skills
• Increased sensitivity to stress, and difficulty coping with stress
• Reduced immunity; frequent colds and infections
• Concentration and memory problems
• Reduction in communication skills
• Weight gain
• Impaired coordination, decreased vigilance and alertness with increased risk of errors & accidents
• Reduction in decision making ability
• Tension headaches

The long term effects of chronic sleep deprivation are more problematic and may include:

• Poor quality of life
• Worries about sleep, obsessive
• Increased stress with increased hypothalamic pituitary adrenal axis activity causing an increased state of arousal & hypervigilance
• Mental impairment
• Obesity
• Injury from accidents
• Attention Deficit Disorder (ADD)
• Anxiety disorders and depression, other mood disorders
• Long term sleep disturbance in children may lead to neuronal & cognitive loss.
• Increased risk of diabetes, heart disease, and other health problems
• An increased incidence of hypertension
• Increased heart attack & heart failure risk
• Heart failure
• Increased stroke risk.

A sleep disorder is any difficulty relating to sleep, including: Falling asleep at inappropriate times, difficulty falling or staying asleep, abnormal behaviors associated with sleep, and excessive total sleep time.

Although there are more than 100 identified different disorders of sleeping and waking identified, they can be grouped in four main categories:

• Insomnia
• Hypersomnia – excessive sleeping
• Obstructive and central sleep apnea.  This is a potentially serious sleep disorder in which breathing repeatedly stops and starts during sleep. It occurs when the throat muscles intermittently relax and block the airway during sleep. Sleep apnea interferes with both sleep & oxygen supply to the body.
• Periodic LImb Movement Disorder (PLMD)

Signs and symptoms of obstructive sleep apnea may include:

• Often sleeping on back, & may be helped by sleeping on side
• More commonly affects older &/or overweight people
• Excessive daytime sleepiness (hypersomnia)
• Loud snoring – 10% of snorers have sleep apnea
• Observed episodes of breathing cessation during sleep
• Abrupt awakenings accompanied by shortness of breath
• Awakening with a dry mouth or sore throat
• Morning headache
• Frequent urination at night
• Difficulty staying asleep (insomnia)

If sleep apnea is suspected, one needs to be evaluated in a sleep study clinic.  If confirmed, there are specific treatments for this.

Periodic limb movement disorder (PLMD) also called Nocturnal Myoclonus or Restless Leg Syndrome is repetitive cramping or jerking of the legs during sleep.  PLMD can occur at any age, but like many sleep disorders it is more common in middle-aged and older people.  Periodic limb movement disorder can be primary or secondary. Primary PLMD has no known cause, it has been linked to abnormalities in regulation of nerves traveling from the brain to the limbs, but the exact nature of these abnormalities is not known.

The two most common symptoms of PLMD are:

• Poor sleep and daytime sleepiness
• Leg movements involving one or both limbs, Typically the knee, ankle, and big toe joints all bend as part of the movements.  The movements vary from slight to strenuous and wild kicking and thrashing.  The movements last about 2 seconds (and thus are much slower than the leg jerks of myoclonus).  The movements are rhythmic and repetitive and occur every 20-40 seconds.

Secondary PLMD has many different underlying medical causes, including the following:

• Calcium, magnesium, potassium or zinc deficiencies
• Iron deficiency
• Vitamin B12, B5, Folic acid deficiency see my newsletter on  vitamin B12/folic acid  for more information.
• Diabetes mellitus
• Anxiety, stress, and worry
• Physical discomfort, aches & pains
• Gastrointestinal discomfort
• Physical illness
• Depression
• Mania

This newsletter is primarily focusing on insomnia, which is defined as difficulty falling asleep, staying asleep, or both, even with adequate opportunity and time to sleep. Insomnia may be due to poor quality or decreased quantity of sleep.

Insomnia falls into four categories:

• Psychophysiological insomnia: a condition in which stress caused by the insomnia makes it even harder to fall asleep
• Delayed sleep phase syndrome: your internal clock is constantly out of synch with the “accepted” day/night phases; for example, patients feel best if they can sleep from 4 AM to noon
• Hypnotic-dependent sleep disorder: insomnia that occurs when you stop or become tolerant to certain types of sleep medications
• Stimulant-dependent sleep disorder: insomnia that occurs when you stop or become dependent on certain types of stimulants.

Sleep depends upon precise chemical messengers produced in the body & brain.  Many things can interfere with the production & balance of those chemical messengers.

Some other factors contributing to insomnia include:

• Grief
• Jet lag
• Excess sugar
• Fruit & fruit juice in the evening
• Diet drinks sweetened by the stimulating Nutrasweet (aspartame).  Saccharin or Stevia sweeteners are not stimulating.
• Heavy meals near bedtime.
• Irregular sleep patterns & hours
• Counterproductive sleep habits: too early bedtimes or excessive time spent awake in bed. Engaging in stimulating &/or stressful activities at night.
• Poor sleeping environment such as excessive noise or light
• Caffeine, alcohol or other drugs. Alcohol may help you fall asleep, but will disrupt your sleep later in the night.
• Heavy smoking
• Daytime napping
• Working night shifts-as getting quality deep sleep in the daytime is difficult
• Anxiety, stress, and worry
• Physical discomfort, aches & pains
• Gastrointestestinal discomfort
• Physical illness
• Depression
• ManiaAnxiety

The following list of medical conditions can also trigger insomnia:

• Blood sugar instability
• Indigestion or acid reflux disease
• Chronic pain syndrome
• Chronic fatigue syndrome/ Fibromyalgia
• Congestive heart failure
• Night time angina (chest pain) from heart disease
• Chronic obstructive pulmonary disease(COPD)
• Nocturnal asthma (asthma with night time breathing symptoms)
• A genetic predisposition to insomnia.  Twin studies suggest genetic factors impact sleep.  In another study 35% of those being evaluated for sleep disorders had a positive family history of sleep disturbance.  It was not clear whether the sleep patterns were from genes or learned behaviors.
• Degenerative diseases, such as Parkinson’s & Alzheimer’s (Often insomnia is the deciding factor for nursing home placement.)
• Brain tumors, strokes or trauma to the brain.

Certain medications can interfere with your ability to sleep properly. Such as the following:

• Antidepressants: Sleep distrurbances are usually a part of depression & treating the depression can help the sleep distrurbance.  However some antidepressants are helpful for sleep & some are more stimulating.  If you are taking antidepressants & still have insomnia, you may need to switch to one of the more sleep promoting antidepressants or try changing the time of day you take your medicine.
• Dilantin (an anti seizure drug)
• Most diet drugs
• Sympathomimetic stimulants: are intense central nervous system stimulants.  Such as: The amphetamines (Dextroamphetamine or Dexedrine), Methoylphenidate (Ritalin), Pemoline (Cylert),  Methamphetamine (Desoxyn)
• Antiarrhythmics: are used to treat heart rhythm problems and may cause daytime fatigue leading to sleep difficulties at night.  These medications include: Procainamide or Procanbid, Quinidine or Cardioquin, etc,  Disopyramide or Norpace
• Decongestants: Found in cold & allergy remedies
• Beta-blockers:  are medications used to treat high blood pressure, arrhythmias, and angina. These drugs can promote insomnia, awakenings in the night, and nightmares.  This include: Propranolol & Metoprolol.
• Caffeine containing medications: such asover-the-counter painkillers and appetite suppressants. Because it stimulates the nervous system, it can induce insomnia. Caffeine blocks the action of adenosine a substance that promotes drowsiness.  Although the direct effects of caffeine gradually diminish ,  in some people it may linger for six or seven hours or even longer.
• Cough medicine and medications containing alcohol
• Theophylline which is used to treat asthma & other respiratory problems, this respiratory stimulant is chemically related to caffeine. Many people who use it require doses that are high enough to disrupt sleep.
• Clonidine is used to treat hypertension and occasionally to curb nicotine cravings in people who are quitting smoking.  It acts on nerve cells that respond to the neurotransmitter norepinephrine and can cause daytime drowsiness and fatigue. it also may interfere with REM sleep. Although some people report no problems with clonidine,  others report restlessness, early morning awakening, and nightmare
• Nicotine patches deliver small doses of nicotine into the bloodstream around the clock.  People who use them may suffer insomnia or experience disturbing dreams.
• Corticosteroids steroids such as prednisone are used to suppress inflammation and asthma, can cause daytime jitters and nighttime insomnia.
• Diuretics which rid the body of excess sodium and water,  they can interfere with sleep by inducing urination throughout the night. A common side effect of some diuretics is potassium deficiency, which can cause painful nocturnal cramping of calf muscles during sleep.

We have found the best approach to insomnia that seems to work no matter what the problem may be: MELATONIN by NDI – Adult Dosage: chew 1 tablet 1 hours before bed.  If you feel further help is needed you can add:CHAMOMILE-SCULLCAP EXTRACT – 2 OZ by NDI – Adult Dosage: Follow label on the bottle.