World sleep day is this Friday, 19th March. This years theme is “regular sleep, healthy future”.
Sleep day highlights the importance of sleep as a “pillar” of health, alongside exercise and nutrition. It also encourages everyone to prioritise sleep to improve their overall health and well being.
Sleep should take up around 1/3 of the average persons day. It is as critical to our wellbeing as food, water or shelter. It is both a behavioural phenomenon of disengagement with the environment as well as a period of time where a whole host of complex physiological processes take place. When you first go to sleep, your metabolic rate drops and the depth of your breathing decreases. The volume of air going into and out of your lungs decreases and the carbon dioxide level goes up. Then when you progress into REM (rapid eye movement) sleep, you lose all muscle tone in your skeletal muscles apart from the muscles in your diaphragm and the muscles that move your eyes. So each night when you are dreaming you are immobile.
Most adults function best when they sleep 7-9 hours per night. Almost half of us are sleep deprived…….but not by choice! Sometimes we simply can’t fall asleep or stay asleep due to a range of biological factors and/or lifestyle choices. Lack of sleep can lead to increased fatigue and excessive daytime sleepiness. It can impair your immunity, interfere with your metabolism, muck up your hormones and your mental health.
Regularly sleeping fewer than seven hours per night increases the risk of developing heart disease and diabetes. It is also associated with unhealthy eating habits that can lead to other chronic illnesses. Sleep deprivation can cause impairments in short and long term memory, decision making, attention and reaction time.
If you are sleep deprived you also tend to make more errors at work and drive more dangerously on the road.
Insomnia is defined by a persistent inability to fall asleep or maintain sleep. There is some limited research that shows that insomnia increases with age. Insomnia has substantial negative effects on mental and well as physical health and quality of life.
The burden of sleep disorders is believed to have risen over the last 12 months thanks to Covid- 19. Many circadian rhythms were (and may still be) out of wack because of stress, drinking more alcohol than usual or weight gain. When we drink more we may find that we fall asleep easily but the quality of the sleep is poor.
Sleep loss creates a hormone imbalance in the body that promotes overeating and weight gain. Leptin and ghrelin are hormones that regulate appetite. Without sufficient sleep, the production of these hormones is altered in a way that creates increased feelings of hunger. Lack of sleep also has links with obesity through growth hormone deficiencies and elevated cortisol levels. Insufficient sleep can also impair your metabolism of food.
Restricted sleep duration has also been shown to cause a greater tendency to select high-calorie foods. Calories consumed late at night may increase the risk of weight gain. Furthermore, adults who do not get sufficient sleep tend to exercise less because sleep loss causes sleepiness and fatigue during the day.
When you are overweight, the excessive fat that is present acts to insulate and pad your body. It is easy to recognise this extra fat when it appears as a large stomach, hips and bottom and a fuller face. But excess weight is also added in places that we cannot directly see, such as along our airway and at the base of the tongue. This crowds the airways and causes problems. Especially if it is combined with the added weight pressing from the outside of a larger neck or a large stomach restricting the lung volumes.
When this airway restriction is mild, it leads to snoring. Snoring is simply turbulent or disrupted airflow.
As the airway becomes more crowded and more prone to collapse, the flow of air can completely cease. This will result in pauses in breathing called apnea. This comes from a Greek word that means “without breath.”
There seems to be a bidirectional relationship between pain and sleep. More pain makes sleep worse and poor sleep makes pain worse.
A 2019 study by Ho et al reported that insomnia symptoms, were highly prevalent in individuals presenting with musculoskeletal pain. In this case 71% of people with osteoarthritis, 59% with low back pain and 41% with neck pain reported poor sleep quality, non-restorative sleep, early awakenings and difficultly initiating and maintaining sleep.
This has led to the view of insomnia no longer being the consequence of pain but a parallel condition that requires specific management.
This refers to the science-backed practices — during the day and before bedtime — that help create the ideal conditions for healthy sleep, not just washing your face and cleaning your teeth!
Most research shows that exercise training has a moderately beneficial effect on sleep quality. That is exercise did not change the sleep duration or disturbance but just improved quality of sleep. Most trials have looked at moderate aerobic exercise (such as endurance training, walking and tai chi) performed for 40-60 minutes over 10-16 weeks.
Overall, research shows that participating in a cognitive behavioural therapy (CBT) program can reduce the time spent awake, improve the quality and efficiency of sleep and increase the total time asleep. CBT treatment usually involves efforts to change thinking patterns.
Restful sleep largely depends on having a rested mind, and so the preparation can begin with your mindset…during the day. More often than not, our issues around sleep are rooted in our thinking processes. By gradually training the mind in a specific way — day by day, for a month for example — you gradually create an environment conducive to a good night’s rest.
Meditation has been shown to improve the quality and efficiency of sleep. It also improves how quickly you fall asleep, and how long you can stay awake during the day. Meditating before bed can help you to fall asleep faster; once asleep, you’re likely to sleep more soundly, too.
Headspace for example has a 30-day Sleep course that is designed to be used during the day. You do the course in conjunction with a simple sleep meditation at bedtime. The aim of these courses is to train the mind for long-term, sustainable change. The bedtime meditation then becomes a specific exercise to send you to sleep.
There are many apps available online that can help guide you through sleep mediations.
A guided sleep meditation may include
If you’re experiencing long stretches of any kind of insomnia, it is always a good idea to speak to doctor to rule out any underlying issues behind those sleepless nights.
If medical issues are ruled out, your sleeplessness may be caused by worry, stress, and/or a few poor sleep hygiene habits that you may wish to improve.