Sleep - It's a third of your life!
Post updated 11/20/20
The "FDA announced it had ordered drugmakers of popular prescription insomnia medications to add "black box" warning labels — the agency’s most prominent warning — to caution patients about their dangers after an investigation found cases of serious injuries, and even death, resulting from various "complex behaviors" tied to the drugs. Those behaviors included sleepwalking, sleep driving, and "engaging in other activities while not fully awake, such as unsafely using a stove," the FDA said."
“A lack of sleep has been associated with an increase in all-cause mortality.” I don’t know what else you need to read about the importance of sleep to be convinced to do something about it!
“It is becoming increasingly apparent that sleep plays an important role in the maintenance, disease prevention, repair, and restoration of both mind and body Sleep deprivation studies in normal subjects demonstrate that a lack of sleep can cause attention and working memory impairment. Moreover, untreated sleep disturbances and sleep disorders such as obstructive sleep apnoe (OSA) can also lead to cognitive impairment. Poor sleep and sleep disorders may present a significant risk factor for the development of dementia.” Reference
As for athletic performance, “Sleep deprivation can have significant effects on athletic performance, especially submaximal, prolonged exercise. Compromised sleep may also influence learning, memory, cognition, pain perception, immunity and inflammation. Furthermore, changes in glucose metabolism and neuroendocrine function as a result of chronic, partial sleep deprivation may result in alterations in carbohydrate metabolism, appetite, food intake and protein synthesis. These factors can ultimately have a negative influence on an athlete’s nutritional, metabolic and endocrine status and hence potentially reduce athletic performance.” Reference
Before we start with suggestions, let's take a sleep history or learn more about your habits.
The first piece of the puzzle is a questionnaire that asks about sleep habits, quality, quantity and more. Below are the most used questionnaires. Pick at least one. My questionnaire is much more detailed and has components of many different scales, indexes and articles. Hopefully by simply answering the questions you gain some insight into your sleep and how to improve it.
Epworth Sleepiness Scale: 8 simple questions
STOP BANG Questionnaire: 8 questions
Berlin Questionnaire: 10 questions
Pittsburg Sleep Quality Index: 20 questions
My Sleep Questionnaire: Long form, lot's of questions, possibly more insights. Still a work in progress.
1. What time do you go to sleep? Start here! Keep your nightly sleep time consistent. Do not vary it by more than 1 hour. This is a HUGE factor in the amount and quality of sleep you get. Listen to Dr. Amy Bender
2. Avoid caffeine in any form (coffee, tea, supplement) after 2:00 pm.
3. Start winding down two hours before bedtime. This includes stopping all electronics (computer, phone, tablets) and shutting off as many lights as you can. If you are a "thinker" like me, write down your "To Do" list before bed.
4. Avoid bright lights at least one hours before bed – try the FLUX software on your computer and try yellow/orange/amber glasses (I use them!) which remove the blue or short-wavelength light which is the most melatonin-suppressive; this is the type of light typically emitted by devices such as televisions, computer screens, and cell phones. The use of these glasses has been studied (Reference) and it works!
5. Sleep in a very dark room. Get black out shades and remove or cover any small lights from electronics (TV, phone, computer, chargers, etc.) which are in your room.
6. Do not eat within 2+ hours of bedtime.
7. Do not work-out within two hours of bedtime.
8. Commit to sleep consistency for 3 weeks. See what happens. Then commit permanently!
9. Commit to a consistent wake time.
10. Get some daylight! Get outside between 10:00 am and 2:00 pm. Don't dismiss this hint. If you do not get daylight for days or weeks in a row, it is a problem. Read this study about the use of light in the ICU and how it affects circadian rhythms.
11. If you take a Vitamin D supplement, take it in the morning, not in the evening.
EMF: ElectroMagnetic Fields. What doe the World Health Organization have to say. Click here. Let's just say that if WHO launched the International EMF Project way back in 1996, there must be a little something to this issue.
12. Turn off the WiFi in your home at night.
13. Cell Phones:
Keep your phone at least 1' -3' away from your body whenever you can
Keep your phone on Airplane Mode whenever you can, especially if you keep it on and near your bed at night.
14. Noise – one of the best things we ever did was to replace the windows in our home. In addition, simply making sure all the buzzing and hissing from electronics and other equipment is shut down is very helpful. Try a White Noise machine. For some, this is extremely helpful, including me!
15. I use Lavender oil in a diffuser at night. This helps and my wife loves it too! Bergamot, sandalwood, cedarwood, yland yland, chamomile, marjoram and many more work as well. Learn more about essential oils!
16. Try additional magnesium. I use spray magnesium (Magnesium Oil), up to 1000 mg per day. Or soak in an Epsom salts bath.
17. My favorite book on sleep is The Effortless Sleep Method by Sasha Stephens.
18. No sleeping drugs (prescription or OTC)! This study in the British Journal of Medicine states:
"Rough order-of-magnitude estimates at the end of the supplemental files suggest that in 2010, hypnotics may have been associated with 320 000 to 507 000 excess deaths in the USA alone."
"Patients with prescriptions for hypnotics had approximately 4.6 times the hazard of dying over an average observation period of 2.5 years as compared to non-users."
"Perhaps the most striking finding was that an increased hazard for death was present even in the lowest tertile of hypnotic use, such that hypnotic drugs were associated with a 3.6-fold increased risk of dying for patients using <18 hypnotic pills per year."
19. Sleep Supplements:
Be careful with melatonin. For me, melatonin makes me feel drugged in the morning. I use a spray product so I can parse the dose both before bed and when I wake up at night. I like two different products which are spray. They both have melatonin, but one has 1.5 mg melatonin per spray, the other has 100 mcg per spray. They each have different micronutrients and herbs in addition to the melatonin. Sleep Support and Renewal: L-theanine, tart cherry (Prunus cerasus) juice, melatonin, lemon balm (Melissa officinalis) leaf extract, chamomile (Matricaria chamomilla), flower extract, valerian (Valeriana officinalis) root extract. Native Rest: Zinc, Selenium, Jujube Fruit, Jamaican Dogwood. I think most people will find the Sleep Support and Renewal most effective. I have also used Primal Force’s Native Rest.
20. Get an App (although this brings back the issue of EMF above)
There are many commercial sleep technologies and the link above reviews them (2020). Fitbit, Oura, and WHOOP were the top rated by these authors.
“When one falls asleep, the body and mind experience different levels of sleep throughout the night.Your sleep cycles consist of REM sleep (Rapid Eye Movement) and NREM (Non Rapid Eye Movement) which cycle consistently in five stages throughout the night.
The beginning stages of sleep prepare your body to shut down.This includes the feeling of dozing off and the ability to be easily awakened by noise or thoughts.The middle stages are a process of light sleep usually lasting anywhere from 10-25 minutes.Deep sleep occurs in the later stages – when activity in the body is low and activity in the brain is very high.REM sleep is the last stage of the sleep cycle where for about 70-90 minutes we are in our deepest sleep.This is also the stage of sleep where we dream – the stage of sleep where one is hard to wake and sometimes can feel disoriented upon awakening. Above all, this is the stage of sleep that from which we do not want to be awakened.
These cycles repeat throughout the night and into the morning. Waking up in the beginning stages of your sleep cycle is important because our bodies aren’t almost entirely shut down.Being awoken in the middle of REM sleep can cause grogginess that has the potential to last throughout the morning and even throughout the day.This explains why sometimes we sleep for eight or nine hours and still feel like we barely got any rest at all.” Reference
I'll pass on the sleeping pills!