Sleep and Health

The sleep/wake cycle impacts health in many ways. The hormone melatonin has become more familiar as it now more available over the counter as a supplement that may help with sleep. It may help with getting to sleep – but timing – when it is taken, and how much – not an excess, are important factors, and it may not help with staying asleep. Sleep and wake are very complex processes within the brain and body, with many chemical signals causing activation or inhibition of different areas of the brain which then signal activation or inhibition of body functions. Reviewing all of them is beyond the scope of this post – including just the summary points is my goal.

  • Insomnia seems to be a hyperarousal of the system, both the brain and body remain more metabolically active than within normal sleep causing difficulties falling asleep and then leaving the person lest rested after sleeping because it was never reaching deeper relaxation of the brain’s activity levels. The hyperarousal tends to continue during the day so the person with insomnia may be irritable and not able to concentrate as well but may not feel tired or sleepy as might be expected after missing that many hours of sleep. The risk with ongoing insomnia though is the person is in need of deeper sleep and accidents may be more likely to occur in physical activity or in oversight of details in mental activity, especially when there are multiple demands on attention.
  • The wake/sleep cycle is essential for health for many reasons but the overall point is that different functions of metabolism occur when awake than during sleep, and both are important to overall health. Repair and detoxification, roughly, are the focus of the sleep hours and energy use and activity and learning/creating new connections between brain and nerve cells are the focus of wake hours.
    • Sleep and wake have different specialized genes and proteins for metabolism – what gets made or what gets cleaned up and reused or excreted/detoxified. Wakefulness activates genes that are used in active metabolism, using sugar for energy, and sleep activates genes that are important for using fats for building cell membranes or myelin sheaths around nerve cell connections.
    • Chronic sleeplessness can cause insulin resistance and lead to increased risk for diabetes or metabolic syndrome, whether the sleeplessness was due to inadequate hours of sleep because of a busy schedule, or due to poor sleep quality because of insomnia or other health problems or overuse of caffeine or stimulating lights late at night. More about insulin resistance, Type 2 diabetes and metabolic syndrome is available in a TEDmed video talk about obesity and insulin resistance. A doctor suggests that the approach medical research has taken in looking at obesity as a cause of insulin resistance may be wrong – insulin resistance may lead to obesity. Peter Attia-What If We’re Wrong About Diabetes?, TEDmed.
    • Hypertension, high blood pressure, is also a risk of chronic sleep problems.
    • Add up the problems of reduced myelin sheath production, blood sugar and blood pressure problems, and it is easy to see that long term risks of poor sleep quality may include dementia whether typical forgetfulness type due to loss of connections between brain cells or the loss of brain cells in Alzheimer’s dementia.

Solutions vary depending on the type of sleep problem however general tips for an ideal sleep setting include:

  • A cool room temperature – the body temperature is at its lowest during sleep.
  • Complete darkness – for the pineal gland to make melatonin the use of a light blocking eye mask on long airplane rides may help provide deeper sleep. In the home setting or when traveling cover alarm clock lights or other digital lights during the night and close curtains. Complete light blocking curtains are ideal.
  • Stop using digital screen devices about a half hour to an hour before intended time to try to sleep. Additional tips about electric light: Digital screens are a very bright type of light and blue lens glasses are available for eye protection for anyone who spends many hours per day using laptops or smartphones. The light settings on the device may also offer a dimmer evening setting which may help reduce eyestrain.*
  • Avoid coffee or other caffeine containing stimulants for about four to six hours prior to intended time to try to sleep.
  • Have a regular time to go to sleep and wake up each day. The average person does need about 7 to 8 hours of sleep each night and teenagers and toddlers ideally may need 10 hours of sleep for best cognitive performance and physical health. Lack of sleep for adults seems to negatively affect reasoning and verbal performance more than short term memory. (3)
  • Avoid high fat, hard to digest meals or snacks in the hours prior to intending to try to sleep.
  • A cool compress on the forehead or over the eyes or on top of the head may help relax sooner if insomnia and racing thoughts are a problem or feeling hot and jittery. Reusable gel packs designed for sprained ankles or other sore muscles can be kept in the freezer and then wrapped in a few layers of thin fabric to protect the skin from being overly chilled. The gel pack will eventually lose its coolness but use on the forehead may help slow down the metabolic activity of the brain, which then helps slow down signals to the body to be jittery – 20 to 30 minutes with a cool gel pack may help reach a more relaxed state before the pack is warm. Having several in the freezer could allow you to rotate the warm one with a chilled one if reawakening in the middle of the night is a problem. **
  • If reawakening in the middle of the night is a problem but you are still sleepy, try not to use any bright lights while visiting the bathroom or kitchen, etc. If wide awake, then it is recommended to just get up and do something for a while until feeling sleepy again rather than tossing and turning in bed and getting more anxious or jittery.
  • If reawakening in the middle of the night is consistently happening around 4:00 am then low serotonin levels may be a problem.  (University Health News) Taking the precursor to serotonin, 5HTP or the herbal St John’s Wort, may help provide your body with serotonin.
  • Cognitive Behavioral Therapy for sleep issues has been found to be as or more effective than sleep promoting medications while they are in use, and more effective at long term benefits even after the therapy or medication is no longer in use. Anxiety may be an issue but habits can also affect insomnia, naps and early bed times may disrupt sleep and staying awake during the day, and ideally getting some bright sunshine or full spectrum light during wake hours can help with the body’s 24 hour metabolic patterns. (CBT-I, National Sleep Foundation)

*Modern laptops or smartphones emit bluelight which may inhibit sleep. (1) Wearing blue light blocking glasses in the evening for any screen time may help reduce the effect. It has been found helpful to prevent sleep difficulties to wear them during the three hours prior to trying to go to sleep. The blue light blocking glasses are not needed for use throughout the day however. Eyestrain from a long day working with a light screen may cause dry itchy eyes and eyedrops for moisture and taking occasional breaks may help prevent that problem. Read more: (2).

**The tip about keeping gel packs in the freezer for use as a cold compress for the forehead that I mentioned for insomnia in the last post is something that I have found helpful in the past for migraines. I tried it recently for insomnia after learning in the course about sleep and neurobiology that a “biothermal device” had been found helpful in sleep lab studies for patients with insomnia. (Sleep, Neurobiology, Medicine and Societycoursera.org)

The drawing suggested they had an electric blanket type compress size cooling device that laid over the forehead and slightly over the ear area, so a little bigger than a gel pack designed for sprained ankles. However a gel pack for sprained ankles is already at stores and electric cooling biothermal devices are not yet available to my knowledge. The point – my trial use with a freezer gel pack for insomnia was very helpful at slowing my thoughts and helping my body reach a relaxed state fairly quickly. I didn’t immediately go to sleep but it did seem to help. I’ve tried it several times now and one night got another out of the freezer when I was awake but sleepy in the middle of the night. 

Environmental cues and genetic differences can effect sleep patterns. (Sleep, Neurobiology, Medicine and Society, coursera.org) (How Nature and Nurture Shape the Sleeping Brainnature.com)

There is more on this topic however this is an overview of the importance of sleep.

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

  1. Dustin Eves, Do Computer Screens Emit UV Light? techwalla.com, https://www.techwalla.com/articles/do-computer-screens-emit-uv-light
  2. Do Blue Light Blocking Glasses Really Work? 2018, nymag.com,     http://nymag.com/strategist/article/blue-light-blocking-glasses-work.html
  3. Conor J Wild, Emily S Nichols, Michael E Battista, Bobby Stojanoski, Adrian M Owen; Dissociable effects of self-reported daily sleep duration on high-level cognitive abilities, Sleep, , zsy182, https://doi.org/10.1093/sleep/zsy182

Translational Research – translating research into patient guidance

“The answer is 17 years, what is the question: understanding time lags in translational research” – Morris, et al, 2011 (1)

It takes far too long for research findings to be ‘translated’ into health messages or techniques that reach the patient in need of health care guidance – 17 years on average according to the review of research study by Morris et al (2011). The team’s conclusion is that translational research is in need of further study but with more well defined terms and types of measurements so research by different teams can be compared. Twenty three studies were reviewed but the research parameters were diverse and not readily comparable. (1)

As a person with training and experience as a health care professional I followed general recommendations for general health and weight loss for many years but they didn’t help and I kept getting more sick with problems that didn’t show up on lab tests. Being told regularly that my symptoms must therefore be psychosomatic (mentally based) and that I should see a talk therapist did lead me to spending time with talk therapists and it helped somewhat but I kept getting more sick.

I knew I was physically sick, not just mentally making myself sick from stress or anxiety because I wasn’t always stressed or anxious and had always had some minor but chronic health problems as a child. So I eventually gave up on the standard not-helping-much answers and instead paid closer attention to my daily routine and dietary choices and slowly stopped doing any of the things that seemed to make me feel worse the next day. With the pay attention method I got somewhat better. Fibromyalgia and chronic fatigue symptoms were improved. Iodine supplements helped me with weight loss and a low dose antibiotic protocol developed for an autoimmune type of condition helped relieve my severe migraine problem.

Prescriptions can be quick and easy answers but they don’t always work, sometimes makes things worse, can delay trying other strategies that might work better – and can be expensive in insurance co-pays or be an out of pocket self pay expense. Health needs adequate sleep, with black out curtains and no lights, not even a digital alarm clock – keep it in a bedside table drawer or cover it with a towel. Even a little light at night can interfere with our production of melatonin and it helps with a variety of health needs throughout the body.

Health requires regular stretching and exercise that works out the heart and lungs and builds the other muscles somewhat. To maintain bone density requires weight bearing exercise – lifting weights in a warehouse or digging in a garden or in a gymnasium. Having the freedom to read text documents on your laptop while standing and using hand weights can multitask physical fitness needs with work or school needs. Varying positions and going for short walks occasionally is healthier than any type of job that requires too much of the same motions or having to stay in the same position for long periods of time.

Standing desks that can easily transition to a sitting desk can be as simple as a couple boxes under your laptop. Standing can allow some leg and arm stretches and then the boxes can be removed for some time spent sitting to type more intensively. Eight full hours in either position might be more of a health risk than being able to switch between the two options. (2)

Health requires all of the nutrients and additional fiber and antioxidants and other phytonutrients that aren’t considered essential in the same way vitamins are but may be necessary for more optimal health.

If it is reasonable to want to prevent measles or chickenpox, or other infectious diseases, then it seems reasonable to want to prevent age related degenerative disease by providing the body more of what it needs to remove toxins and rebuild tissue as it wears out. Even brain cells are replaced with new ones  – our entire body is not the same body that we had as a newborn. We are regularly removing old cells and growing new ones.

All truths are easy to understand once they are discovered. The point is to discover them. ~ Galileo

And the point of translational research is to improve the process of translating research findings into effective strategies for patient care. If research is still in early stages it may not be safe for all patients, finding out how to identify which patients it might help would then be a necessary step before translating the findings into patient education messages or health care protocols. How to guides ideally will always include safety warnings about which patients the health messages might harm if they were to use or be ineffective for their use.

As an individual it is good to know your rights as a patient and to seek health care professionals that take the time to listen. As a patient seeking a second opinion may be helpful and it can be helpful to write down your symptoms and mood changes, your daily diet or sleep habits, and any other routine habits in order to look back occasionally to see if any patterns show up in what is helping or not helping you feel better. We all need to remember that we are the ones living our lives and that makes us the ones in charge of taking care of our own health as best as we can.

It can take three weeks or more to build a habit and that suggests the reverse is likely true – and keeping a written tally sheet about the habit you want to change can help stay on track and help show where you may be veering off track. For more guidance, see Changing Habits, The Learning Center, University of North Carolina. (3)

Your Health Insurance agent is not your mother (probably), and in the current system large bills can lead to more profit for health insurance companies – so watch out for your  own budget by taking care of exercise, diet, and sleep habits and send your Health Insurance agent a nice card at the holidays instead of having them on speed dial for questions about your enormous co-pays. Insurance is nice but 10 or 20% of an enormous bill is still more than most of us have in the bank or can easily borrow. (4)

Bankruptcy due to health care costs has become too common – stay out of bankruptcy court by spending more time on daily health care habits – the research is fairly conclusive regarding the basics –

  • ideally at least 30-60 minutes of exercise 3-5 times per week,
  • drink plenty of water for thirst
  • and eat 5-9 servings of vegetables/whole fruit per day, get adequate protein, whole grains and essential omega 3 fatty acids without too much saturated and trans fats each day. Trying to include a serving of fatty fish three times per week can be a source of omega 3 fatty acids or vegetarian sources include walnuts, hemp seed kernels or ground flax seeds. Including a serving of beans, nuts and seeds on most days may increase the amount of magnesium and other important trace nutrients in the daily/weekly diet.
  • Six hours of sleep seems to be a minimum need for most people and more than eight hours on a regular basis may be too much or a sign of health or depression problems in adults once they are out of the teen years, (teens may benefit from ten hours of sleep per day, (6)). Short naps during the day can be a healthful activity and may increase work productivity, 20-30 minutes may be ideal. Longer naps may lead to waking up groggy instead of refreshed. (5)
  • Social activity and other relaxing hobbies also seem to be helpful for health.

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes. Thanks./

  1. Zoë Slote Morris, Steven Wooding, and Jonathan Grant,

    The answer is 17 years, what is the question: understanding time lags in translational research., J R Soc Med. 2011 Dec; 104(12): 510–520. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241518/

  2. Robert H. Shmerling, MD, The Truth Behind Standing Desks, Sept. 23, 2016, Harvard Health Blog, Harvard Health Publishing, health.harvard.edu,  https://www.health.harvard.edu/blog/the-truth-behind-standing-desks-2016092310264?utm_campaign=shareaholic&utm_medium=twitter&utm_source=socialnetwork
  3. Changing Habits, The Learning Center, University of North Carolina, https://learningcenter.unc.edu/tips-and-tools/changing-habits/
  4. Why Your Health Insurer Doesn’t Care About Your Big Bills, propublica.org, https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills
  5. Napping, sleepfoundation.org, https://sleepfoundation.org/sleep-topics/napping
  6. See Chapter Two: The Lost Hour, Po Bronson and Ashley Merryman, NurtureShock: New Thinking About Children, Twelve, Hatchette Book Group, New York, 2009 http://www.nurtureshock.com/

Additional references for more information on translational medicine:

Excerpt from a post about my own genetic screening (Genetic Screening can give guidance about potential medication adverse reactions, 2018):

Additional reference for further discussion of the advances in the use of genetic screenings for medication risk is available in a book that is already slightly dated with the rapid advances in technology but as a starting point it is helpful for an overview on the history of technological advances in the area of medical care: The Creative Destruction of Medicine: How the Digital Revolution will Create Better Health Care, by Eric Topol, M.D., 2013. Basic Books. ISBN: 978-0465061839. (1) (“Book Review…,” and summary, by Jung A Kim, RN, PhD, PubMed_2)

One of the pioneers in personal genetic screening was Esther Dyson, a venture capitalist. She quoted a colleague regarding why she agreed to be one of the first ten participants in the Personal Genome Project:

“You would no more take a drug without knowing the relevant data from your genome than you would get a blood transfusion without knowing your blood type.” [128] (1)

The future of individualized health care will include genetic screening for everyone and what isn’t addressed in the book by cardiologist and translational research specialist Eric Topol, M.D. is the use of genetic screening for individualized nutrition guidance. In addition to discovering what medications may work better or be more dangerous for an individual genetic screening can target which types of exercise or diet plans may be more or less beneficial and which nutrients may need to be restricted or supplemented more than the average guidance.

My previous genetic screening was for fewer genes but which were chosen as most commonly a problem for children on the autism spectrum – I had 11 of the 30 and the guidance led to supplements and diet changes that have helped me feel better and have better mood stability – Methylation Cycle Defects – in me, Genetic Screening “For Research Purposes Only” – at this stage it is a legal phrase as genetic screening is not considered consistent enough for use as a diagnostic tool, but my personal health is of significant interest to me.

  1. Eric Topol, M.D,, The Creative Destruction of Medicine: How the Digital Revolution will Create Better Health Care, 2013. Basic Books. ISBN: 978-0465061839.  (1) Chapter 5, Biology: Sequencing the Genome, page 117: [128]
  2. Jung A Kim, RN, PhD, Book Review: The Creative Destruction of Medicine: How the Digital Revolution will Create Better Health CareHealth Inform Res. 2013 Sep; 19(3): 229–231.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810531/ PubMed_2)

[128] Esther Dyson, “Full Disclosure,” Wall Street Journal, July 25, 2007, A15.