A good night’s sleep can not only help someone feel well-rested and refreshed upon waking up, but is important for both healing and potentially preventing a plethora of health concerns. Since the invention of the lightbulb, generally speaking, we have been able to metaphorically burn the midnight oil such as in working longer hours. This is also symbolic of our culture where there is more pride in “doing” and “going,” rather than trusting we can also truly be human “beings.” A good night’s sleep can look different for everyone; however, it is important to consider and address any combination of the potential causes of sleep related issues, from physical, to emotional and even to more esoteric considerations.
Sleep is divided into rapid-eye movement (REM) and non-REM, with four stages that make up the latter. It’s in non-REM that we can achieve our deepest sleep, and in around 90 minutes or so after falling asleep REM occurs shortly after. REM accounts for most of our dreams.1 However, it’s in both of these states that our body has the chance to actually synthesize ideas and information from the day, take what it needs, and make room for what’s not truly needed. In fact, consider how many times we may decide to “sleep on it” before making a final decision. A proper night’s sleep certainly helps our focus and confidence.
Generally, it is recommended that adults get about seven to nine hours of sleep (kids and teens usually require more), going to bed around 10 to 11p.m. and waking up within that range. In fact, only a few (around 5 percent) actually have “night owl” genes in their DNA where going to bed past midnight truly does work. This gene is called Cry1 (can show up on 23&me), which surpasses a variety of genes implicated in circadian rhythm.2 On the contrary, even though people can adjust their circadian rhythm such as in the case of graveyard workers, there have been clinical reports indicating that they can also have slower healing time, perhaps if they do not have this gene and they are literally going against nature’s rhythm and their own body’s inherent wisdom.
Sleep & Health
In the majority of cycles people are familiar with, there are many different hormones that are created throughout the night. In addition, as our minds reset, our body gets the chance to heal and clean up (e.g., healing after a tough workout) thanks to our immune system. For example, deep sleep facilitates growth hormone release, an important hormone in regulating blood sugar, insulin and hunger levels (especially leptin—satiating and ghrelin—hunger-inducing).3
Thyroid hormones and sex hormones (e.g., estrogen, progesterone, testosterone) are also produced during the night, all involved with factors such as weight concerns, heart disease, hormone-related concerns, gut health, fatigue, mood concerns and other metabolic related issues. In fact, studies have shown that long-term night-shift workers may be at increased risk for hormone related cancers (e.g., breast cancer, prostate cancer) due to mistimed hormone production, especially of progesterone and testosterone.4
Melatonin, produced in both the gut (from serotonin) and pineal gland, is one of our most potent endogenous antioxidants, with prime production at around 11 p.m. In this case, it not only helps us go to sleep, but it also contributes to our overall health status. Cortisol, our stress hormone, gets produced in the early morning hours and helps to wake us up. Then, it drops quite a bit around the afternoon, then steadily declines as melatonin prepares to induce sleep. While we need stress to survive, more often than not we’re having peaks and troughs at the wrong times, either not making enough or making too much. An imbalance of cortisol can also create imbalanced hormones, blood sugar dysregulation and many of the other concerns listed above. As these flows of physiological mechanisms and sleep get disrupted, they can, in turn, affect each other. Therefore, both a lifestyle plan and therapy may provide answers that address all of the patients concerns, but they should also be educated on prevention of these issues.
People may also report vivid or recurring dreams, or that they may not be able to remember their dreams. Oneirology, the study of dreams, dates as far back as Sigmund Freud and Carl Jung, who believed dreams were part of the subconscious, and has been discussed over many hundreds of years. A conclusion to a uniform exact meaning still remains elusive, as this can lead to skepticism and apprehension. However, there are many dreams that tend to represent what’s going on in someone’s life, though it can also require some mindfulness of the dreamer themselves to face what’s going on in their own life, especially if it’s an issue they’ve been putting aside. Further, how they feel when they wake up or during the dream can also be important in deciphering its meaning. They can keep a pen and pad by their bed to write it down if they wake up in the middle of the night, keeping in mind how they feel as they’re writing it, and then it can always be addressed and considered after they wake.
Fortunately, there are a number of tests available to help discern physiological and other organic causes of sleep disturbances, such as through blood, urine and saliva. Blood tests are great for different markers of blood sugar and insulin resistance (e.g. insulin, glucose), and thyroid panel. Saliva and urine can be great tests to get a sense of someone’s rhythm throughout the day by a few different snapshots in time, as it measures the free (active) version of cortisol. These vials can also be utilized in the middle of the night to further understand their hormone levels at night. Sex hormones, melatonin, creatinine and neurotransmitters, for example, can also be addressed through these tests as well.
Another consideration is structural issues, such as in the case sometimes of obesity, which can cause pressure on the throat and trigger snoring. There can also be underlying bone or other densities that can affect someone’s sleep quality (if they have a partner can ask them if they report anything about the one in question). Other physical exams and tests may be warranted to either diagnose or rule out any other contributing factors (e.g. pain, nerve issues, posture), and have a look at the person’s overall general health.
General sleep lifestyle habits include turning off electronics at least a half hour before bedtime, getting to bed before 11 p.m., and even going to bed with a mind that is at ease and a sense of completion to literally rest easy. However, often a last minute phone call or email can trigger a sense of urgency that leads to a cascade of other issues being taken care of well past when the person intended to fall asleep. These stressors can not only disrupt sleep, but also disrupt a person’s sense of well-being over time, both emotionally and physically. As soon as there are “not enough hours in the day,” sleep may be the first to suffer. In these cases, education around not just the importance of sleep, but perhaps emphasizing how sleep can aid in better choices, more efficacious decisions and allowing time for family, hobbies, and to make peace within their life. It is as if they’re still “doing” while sleeping, but it’s a very different definition than one they’re used to believing.
In addition to habits before bedtime (some people like rituals such as baths, journaling, reading), regular exercise and movement helps with blood sugar and food cravings, weight concerns, heart disease and prevention and improvement of many other concerns. Including time away from their work in a different environment can also bring new ideas.
Nutrition & Diet
Sleep disturbance can be physiological, emotional, encompass more esoteric meanings, have structural origin, or clues to other issues, yet sometimes can be as simple as urination during the night from drinking too much water right before bed (or a contributing factor). Discuss a schedule in which they can drink water earlier in the day, only leaving a glass or two at night.
Food allergies and intolerances are also incredibly common, as something as vague as “not sleeping right” may not only be from someone eating foods that don’t quite agree with their system, or the wrong time of day for them (some may do better with protein at night, some better with carbohydrates, for example). Digestion and energy from the meal are usually sustained over three to four hours (may be different for people who intermittent fast), so eating too close or too much before bedtime can wake someone up in the middle of the night because the body didn’t understand it was time for bedtime and wants energy. A diet diary with a comment section for sleep, perhaps over the course of a week, can help practitioners find patterns in common or different foods, energy levels, sleep quality and any other concerns the person may have.
Nutritionally, caffeine, alcohol and sugar (e.g. starchy carbohydrates, desserts) have been known to disrupt sleep and cortisol levels due to a wider range of energy levels (commonly known afterwards as a “crash”). So even if the person sleeps, they may not be getting quality sleep going through all the cycles. Also consider the amount of starchy versus non-starchy carbohydrates (e.g. vegetables), protein and fats, as clinically I’ve seen more vegetables and an increase in protein levels make for better energy levels throughout the day, as well as more restful sleep.
The time they wake up during the night can be important as well, as in Chinese medicine waking up between 1 to 3 a.m. generally signifies liver/blood sugar, yet can also encompass hormone and/or thyroid issues (also part of this physiology), cholesterol, detoxification, and any other concern they have that may include the liver. 3:30 a.m., as well as 4:30 to 5 a.m. is also another general wake-up call, literally, as we tend to be our most lucid at these times so there may be something on their mind that they’re not giving proper attention to during waking hours. This can also mean to consider lung and breathing quality (especially as we tend to practice shallow breathing much more than those calming, deep belly breaths), or if there’s some sort of grief or sadness on their mind.
Avoid television or any other visual device during these times of waking up, or if need be, record thoughts on a device or have a pad and pen nearby. Even if it doesn’t feel significant, sometimes the release of something from one’s body is enough to encourage them to go back to sleep.
Sleep trackers have had mixed reviews with users, as many times it just tells them what they know (e.g. not getting enough or good sleep), yet doesn’t offer these many different reasons or solutions to their now ongoing issue. It also won’t mention if they know they want to get to bed earlier. In that case, have them move back increments by about 15 minutes per week so their body can adjust (15 minutes one week, 30 minutes the next week, etc.).
Supplements are meant to supplement, not replace, an unhealthful lifestyle, including sleep quality and any other underlying concerns. Just as medications can help people sleep, so can supplements, yet there can become a dependency on either whether it’s neurochemical or behavioral (or both). A common fear among patients, especially around supplements is whether they have to take it forever, or whether it stops working or does not work at all; so, reassuring the patient can help instill so much of what’s listed above to potentially wean off or know they can have it as a ‘just in case’ can be incrementally more satisfying and motivating as they then tend to have more trust both in their body and the healing process itself.
Personally, one of my favorites is magnesium glycinate (neurotransmitter that helps calm an anxious mind without GI [gastrointestinal] related effects) in the evening, or even a ritual of an Epsom salt bath before bedtime so they can reflect on the day, dream, and just be. Hawthorn is another favorite, as it also helps calm the system, as well as emotionally nourish the heart to conversely receive (the opposite of constantly doing and going) and therefore relax. A blend of essential fatty acids can help with inflammation, food cravings, hormone levels, gut health and heart disease. I sometimes recommend this in the evening (depending on the person’s lifestyle) also due to its mood balancing effects.
Sleep is crucial to our health and survival, yet ironically we are in a society that values everything else other than sleep. The treatments and lifestyle changes are numerous, and a way to consider is what’s their biggest obstacle to cure. We are so much more than our physical bodies, and when sleep disturbances enter into the realm of dreams and other ideologies, it’s just as important to consider these as well even if they don’t fit the stereotypical view of medicine or standard of care. While anything can easily be fixed or adjusted, it is often the long-term sustainable results and trust in one’s body that people are after, and that too lends itself to where they can achieve a state where they can truly let go.
1 Purves D, Augustine GJ, Fitzpatrick D, et al., editors. Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates; 2001. Stages of Sleep. www.ncbi.nlm.nih.gov/books/NBK10996/.
2 Greenwood, V. Having this gene may make some people night owls. Scientific American. Retrieved 11/3/2020. www.scientificamerican.com/article/having-this-gene-may-make-some-people-night-owls/.
3 Leproult, R., & Van Cauter, E. (2010). Role of sleep and sleep loss in hormonal release and metabolism. Endocrine Development, 17, 11–21. https://doi.org/10.1159/000262524.
4 Papantoniou, K. (2015). Increased and mistimed sex hormone production in night shift workers. Cancer Epidemiology, Biomarkers, & Prevention. 24(5):854-863. Retrieved 11/3/2020. https://cebp.aacrjournals.org/content/24/5/854.
Dr. Serena Goldstein is a naturopathic doctor in both New York, NY and San Francisco, CA (currently virtual only), who helps guide patients to trust and understand their body’s signs and signals so they can expand their knowledge and become partners on their health journey. Dr. Goldstein utilizes conventional and natural medicine, psychology, ancient medicine and intuition to discover patterns in their health and life that bring order to chaos. She treats all concerns (even the ones patients are not sure about mentioning!), with a plan they will find fun and exciting.