c'bella: Sleep
Why is Sleep Important?
Sleep is an essential function that allows the body and mind to recharge, leaving you refreshed and alert when you wake up.
Research has linked getting enough sleep to better concentration, memory, productivity, cognition, calorie regulation, athletic performance, and social and emotional intelligence, as well as a healthier immune system, lower inflammation and risk of heart disease. It also helps prevent depression.
How Much Sleep Does the Body Need?
The appropriate amount of sleep a person needs depends on their age. The National Sleep Foundation recommends a daily sleep allotment for different age groups, visualized in the chart below.
|
Age Group |
Age Range |
Recommended Amount of Sleep per Day |
|
Newborn |
0-3 months |
14-17 hours |
|
Infant |
4-11 months |
12-15 hours |
|
Toddler |
1-2 years |
11-14 hours |
|
Preschool |
3-5 years |
10-13 hours |
|
School-age |
6-13 years |
9-11 hours |
|
Teen |
14-17 years |
8-10 hours |
|
Young Adult |
18-25 years |
7-9 hours |
|
Adult |
26-64 years |
7-9 hours |
|
Older Adult |
65 years or older |
7-8 hours |
Science of Sleep
The body’s sleep cycle is regulated by a circadian rhythm, or internal body clock of sorts that operates on a 24-hour cycle.
A few factors influence the body’s circadian rhythm.
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- Adenosine: Sleep-wake homeostasis, (the balance between sleeping and waking drives), may be linked to an organic compound produced in the brain called adenosine, whose levels increase throughout the day as you become more tired, and then the body breaks down this compound during sleep. Thus, it controls when you feel tired and ready for bed or refreshed and alert.
- Suprachiasmatic nucleus: The brain region known as the hypothalamus (which maintains homeostasis in the body) contains a cluster of cells called the suprachiasmatic nucleus that processes signals when the eyes are exposed to natural or artificial light, helping the brain determine whether it is day or night. As natural light disappears in the evening, the body releases melatonin, which induces drowsiness. When the sun rises in the morning, the body releases cortisol, which promotes energy and alertness.
Once a person falls asleep, the body follows a sleep cycle divided into four stages that repeat cyclically throughout the night until a person wakes up. The first three stages are known as non-rapid eye movement (NREM) sleep, and the final stage is known as rapid eye movement (REM) sleep.
Stage 1 NREM:
Marks the transition between wakefulness and sleep, and consists of light sleep. Muscles relax and heart rate, breathing, and eye movements begin to slow down, as do brain waves, which are more active during wakefulness. Typically lasts several minutes.
Stage 2 NREM:
Characterized by deeper sleep as heart rate and breathing continue slowing down and muscles become more relaxed. Eye movements cease and body temperature decreases. Apart from brief moments of high frequency electrical activity, brain waves also remain slow. Longest of the four stages.
Stage 3 NREM:
Plays an important role in making a person feel refreshed and alert the next day. Heartbeat, breathing, and brain wave activity all reach their lowest levels, and muscles are as relaxed as they will be. Longer than the first stage and decrease in duration throughout the night.
Stage 4 REM:
First REM stage will occur about 90 minutes after falling asleep. Eyes will move back and forth rather quickly under the eyelids. Breathing rate, heart rate, and blood pressure will begin to increase. Dreaming will typically occur during REM sleep, and arms and legs will become paralyzed. The duration of each REM sleep cycle increases as the night progresses. Numerous studies link REM to memory consolidation. The duration of REM will decrease as a person ages, causing them to spend more time in the NREM stages.
For most people, the duration of each cycle lasts about 90-120 minutes. NREM sleep constitutes about 75%-80% of each cycle. A person may also wake up briefly during the night but not remember the next day. These episodes are known as “W” stages.
Effects of Irregular Sleep Patterns and Lack of Sleep
An insufficient amount of sleep can have serious repercussions.
Studies have indicated that sleep deprivation leaves people vulnerable to attention lapses, reduced cognition, delayed reactions, mood shifts, weight gain, and an increased risk of heart disease, stroke, obesity, type 2 diabetes, high blood pressure, poor mental health, and early death..
Studies have also suggested that people can develop a tolerance of sorts to chronic sleep deprivation. Even though their brains and bodies experience adverse effects due to lack of sleep, they may not even be aware of these deficiencies because less sleep feels normal to them.
Causes for Irregular Sleep Patterns
Sleep disturbances can be caused by many factors raging from the mundane to the medical.
Everyday Causes:
Long work schedules, day-to-day stressors, a disruptive bedroom environment, exposure to bright light/loud noises, etc. can all contribute to sleep disturbances without indicating a deeper underlying cause, and can often be mitigated by making logistical and lifestyle changes.
However, often there IS a deeper cause.
Sleep Disorders:
- Insomnia
- Being unable to fall asleep and stay asleep.
- Most common sleep disorder.
- Sleep Apnea
- A breathing disorder in which a person stops breathing for 10 seconds or more during sleep.
- Restless Leg Syndrome (RLS)
- A tingling or prickling sensation in the legs, along with a powerful urge to move them.
- Hypersomnia
- Being unable to stay awake during the day.
- This includes narcolepsy, which causes extreme daytime sleepiness.
- Circadian Rhythm Disorders
- Problems with the sleep-wake cycle, making a person unable to sleep and wake at the right times.
- Parasomnia
- Acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating.
Signs that someone may have a sleep disorder may include:
- It regularly takes them 30 minutes or more to fall asleep
- They regularly wake up several times each night and have difficulty falling back asleep, or they wake up too early in the morning
- They often feel sleepy during the day, take frequent naps, or fall asleep at the wrong times during the day
- Their bed partner says they snore loudly, snort, gasp, make choking sounds, or stop breathing for short periods during sleep
- They have creeping, tingling, or crawling feelings in their arms or legs that are relieved by moving or massaging them, especially while falling asleep or dozing
- They have episodes of sudden muscle weakness when they are angry or fearful, or when they laugh
- They feel as though they cannot move when they first wake up
Mental Health Conditions:
- Panic Attacks
- Panic attacks often strike at night, and because of this many scientists believe they are biologically based.
- Sleep-related panic attacks occur in stage N2 (light sleep) and stage N3 (deep sleep), which are free of psychological triggers.
- Depression
- Almost 90% of people with depression experience insomnia.
- Waking up too early in the morning is a hallmark of depression, and some people have difficulty falling asleep or get fitful sleep throughout the whole night.
- In dysthymia (chronic, low-grade depression), insomnia may be the most prominent symptom.
- Studies have shown that people with depression spend less time in slow-wave sleep and may enter REM sleep more quickly at the beginning of the night.
- Bipolar Disorder
- Disturbed sleep is a prominent feature of bipolar disorder.
- Sleep loss may exacerbate or induce manic symptoms or temporarily alleviate depression.
- During a manic episode, a person may not sleep at all for several days. Such occurrences are often followed by a “crash” during which the person spends most of the next few days in bed.
- Thyroid Disease
- An overactive thyroid gland overstimulates the nervous system, making it difficult to fall asleep and causing night sweats.
- Breathing problems
- Schizophrenia
- People with schizophrenia sleep very little in the early, most severe stages of an episode.
- Between episodes, their sleep patterns are likely to improve, although many people with schizophrenia rarely attain a normal amount of deep sleep.
Chronic Physical Conditions:
- Heartburn
- Can often worsen when a person lies down because of the backup of stomach acid into the esophagus.
- Can be prevented by abstaining from heavy or fatty foods, by elevating the upper body using under-mattress wedges or blocks, or by taking over-the-counter or prescription medications.
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- Diabetes
- People with diabetes whose blood sugar levels are not well controlled may experience sleep problems due to night sweats, a frequent need to urinate, or symptoms of hypoglycemia. If diabetes has damaged nerves in the legs, nighttime movements or pain may also disturb sleep.
- Musculoskeletal Disorders
- Diabetes
- Arthritis pain can make it difficult for people to fall asleep and resettle when they shift positions. In addition, treatment with steroids frequently causes insomnia.
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- People with fibromyalgia are likely to wake in the morning feeling fatigued and as stiff and achy as a person with arthritis.
- Kidney Disease
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- Kidney disease can cause waste products to build up in the blood and can result in insomnia or symptoms of restless leg syndrome.
- Nocturia
- The need to frequently get up to urinate during the night is a common cause of sleep loss, especially among older adults.
- It may be a product of age or a byproduct of kidney disease, heart disease, UTI, diabetes, enlarged prostate, liver failure, multiple sclerosis, and sleep apnea, or medications. It can also be caused by excessive fluid intake.
- Thyroid Disease
- An overactive thyroid gland overstimulates the nervous system, making it difficult to fall asleep and causing night sweats.
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- Breathing problems
- Circadian-related changes in the tone of the muscles surrounding the airways can cause the airways to constrict during the night, raising the potential for nocturnal asthma attacks.
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- The use of steroids or other medications can also have a stimulating effect that makes falling asleep difficult.
- People who have emphysema or bronchitis may also have difficulty falling asleep and staying asleep due to excess sputum production, shortness of breath, and coughing.
Neurological Disorders:
- Dementia
- Alzheimer’s Disease and other forms of dementia may disrupt sleep regulation and other brain functions due to wandering, disorientation, and agitation during the evening and night.
- Parkinson’s Disease
- Most people with Parkinson’s Disease have insomnia. Physically getting in and out of bed can be a struggle, and the disease often disrupts sleep.
- Some arousals are from the tremors and movements caused by the disorder, and others seem to result from the disorder itself. As a result, daytime sleepiness is common.
- Epilepsy
- People with epilepsy are twice as likely to suffer from insomnia. Brain wave disturbances that cause seizures can also cause deficits in slow-wave sleep or REM sleep.
Medications:
Home Remedies
Daily Routine Changes:
- Establishing a realistic bedtime and sticking to it every night, even on the weekends.
- Maintaining comfortable temperature settings and low light levels in the bedroom.
- Making sure the sleeping environment is physically comfortable.
- Limit screen time or abstain altogether for at least 30 minutes before bedtime.
- Abstain from caffeine, alcohol, and large meals in the hours leading up to bedtime.
- Refrain from using tobacco at any time of day or night.
- Exercise during the day (can help a person wind down in the evening and prepare for bed).
Mindfulness Meditation:
Meditation has numerous health benefits that go hand-in-hand with a healthy lifestyle that promotes good sleep. It reduces stress, improves concentration, and boosts immunity. Studies have also indicated that a regular meditation practice significantly improved insomnia and overall sleep patterns.
Yoga:
Yoga alleviates stress, improves physical functioning, and boosts mental focus. It has also been shown to have a positive effect on sleep.
Massage:
Studies have indicated that massage therapy can benefit people with insomnia by improving sleep quality and daytime dysfunction, as well as reducing feelings of pain, anxiety, and depression.
Magnesium:
Magnesium is a naturally-occurring mineral that can help muscles relax and relieve stress. Studies have shown that taking magnesium daily (400 mg for men, and 300mg for women) can decrease symptoms of insomnia and can improve sleep patterns. However, magnesium supplements should NOT be taken constantly – there should be periodic breaks. Please consult a doctor with any questions or concerns.
Lavender Oil:
Lavender can be used to improve mood, reduce pain, and promote sleep. Studies have indicated that taking lavender oil capsules can be beneficial in improving sleep patterns in people with depression when taken with an antidepressant. They were also shown to lower levels of anxiety, which would also allow for better sleep.
Melatonin:
Taking external melatonin to supplement the melatonin produced by the body can help a person fall asleep more quickly, and it can also significantly improve sleep patterns in those with insomnia. The results were shown to persist even 7-14 days after taking melatonin.
CBD:
Early studies indicate that high doses of CBD may help support sleep by decreasing cortisol levels (high levels are associated with nighttime wakefulness and also with higher levels of anxiety). An FDA-approved CBD-based medication called Epidiolex has also been used to treat rare and severe forms of epilepsy, a disorder which also causes irregular sleep.
SOURCES
Esther M. Blessing, Maria M. Steenkamp, Jorge Manzaneras, Charles R. Marmar. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neuropathics, 2015. DOI: 10.1007/s13311-015-0387-1
Scott Shannon, Nicole Lewis, Heather Lee, Shannon Hughes. Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente Journal, 2019. DOI: 10.7812/TPP/18-041