Your Bedroom – A Perfect ‘Sleep Cave’

Remember the ‘Man Cave’ which was popular a few years back? Well, think of creating a ‘cave’ at home to sleep in, because the ideal sleep environment is indeed cave-like. Below is a check-list to work through as you design the perfect sleep environment. You can also see this month’s issue of SHAPE magazine, with tips from designers and yours truly.
http://www.shape.com/lifestyle/mind-and-body/how-give-your-bedroom-better-sleep-makeover

To make a perfect ‘Sleep Cave’:
1. Dark. Should be as dark as a cave, this allows your natural melatonin levels to soar at night and help you sleep.
2. Quiet. Ever sleep in a basement and have a better night’s sleep because it was so quiet? Turn off everything that makes a sound, thus asking for your attention. Do what you can to keep the dog from barking, or his collar from jingling. If there are irregular sounds, a soft white noise machine might be helpful.
3. No electronics. Did a caveman have little lights flashing, or sales texts chirping in the night? Research this last year shows that many people are woken multiple times each week by the phone. Make sure you are not one of these folks by putting your electronics to bed in another room.
4. Comfy. Sleeping surfaces vary widely around the world. What’s most important is that the bed is comfortable for you. Unfortunately bedpartners can prefer different firmness in the mattress. Modify it with extra padding so it’s softer for one, or put a firm board under the mattress so it’s firmer for the other person.
5. Cool. People sleep better when it is cooler than 65, or even cooler at 60 degrees. Adjust both the temperature of the room, and the covers so you aren’t waking up too hot. Many patients tell me they like the bed to be warm when they get into it in the evening, but then get too hot in the night. You can use a heating pad, electric blanket, or hot water bottle to warm the bed beforehand, but then turn it off once you are in bed.
6. Minimal ‘stuff’. Back to those cavemen, they didn’t have so much stuff in their sleeping quarters, did they? Remove all the things from your bedroom that are thought provoking or call for action. You want the bedroom to be a place that you are ‘off-duty’ from the responsibilities of the day.

Although none of these recommendations are high tech, they are based on solid research, and make a huge difference in how well you sleep. Making these changes will be worth it as you get optimal sleep and all its’ daytime benefits!

Understanding Circadian Rhythms at the Molecular Level

We’ve talked in the past about circadian rhythms, how there is a daily rhythm of hormone fluctuations that make us more alert during the day, and more sleepy during the night. There are also changes in organ function by time of day. Shiftworkers’ health suffers for being up and active at a time their body is programmed to sleep.

What we haven’t discussed is how these rhythms are established in the first place. Just this week, there was an article published in Science by Lazar and Feng about the circadian rhythm of fat metabolism in the liver.

During the day, molecules modify the liver DNA to reduce fat production. Those molecules leave during the night (so there are 100 at 5am, as opposed to 15000 at 5pm). With those molecules absent, more fat is produced and stored in the liver. The authors conclude “This leads to a circadian rhythm of metabolism that is important, because disruption of this rhythm leads to fatty liver. This may explain in part why altered circadian rhythms in people who do shift work is associated with metabolic disorders.”

There are molecular changes like this happening in many organ systems, multiplying the effect of being out of sync with the natural light-dark cycle.  As our understanding of circadian physiology develops, we’ll be better able to improve the health of shiftworkers.

Sleep In America Poll – Using Technology

The new Sleep In America Poll came out today, the first day of National Sleep Awareness Week 2011.

This poll was all about our use of technology during the hour before bed, our nightly sleep, and daytime function. Here are some of the highlights:
– 63% say that during the week their sleep needs are not met
– 60% say they have a sleep problem almost every night
– 95% of us use technology during the hour before bed a few nights a week or more
– 20% of 13-29 year olds say they are awoken by a text, phone call or email several nights a week
-22% of 13-18 year olds are clinically sleepy
– About 10% of 13-45 year olds say they drive drowsy 1-2 times a week

Even the light from your TV or laptop is enough to suppress melatonin. During the hour before bed your melatonin should be increasing, allowing you to become sleepy and fall to sleep easily. The time for bright light is in the morning to get energized.

Sleeping in a ‘Cave’

Think about what a cave is like . . . dark, cool, quiet, and did I say dark? For the best sleep, a cave-like bedroom is ideal.

People sleep best in a cool room, no warmer than 65 degrees. Keep bedcovers in light layers that can easily be adjusted so you avoid getting too hot.

Keep the room quiet. If there are intermittent sounds you just can’t avoid, then use a soft sound machine through the night.

Dark makes all the difference in sleep. Melatonin which is so important for falling asleep is suppressed by light. Unfortunately in most urban settings there is so much light polution that it’s difficult to make the bedroom dark. Use black out shades to block outside light, then turn off all nightlights and electronic LEDs in the bedroom.

Making these simple changes to the bedroom can make a real improvement in your sleep.

Timing Light Therapy and Melatonin Supplements

It’s been fun to talk with people suffering from Delayed Sleep Phase over the last couple days.  There’s been some questions about shifting sleep phase using light therapy and melatonin supplements.  The timing of these therapies depends on whether you want to delay sleep, ie. make it begin later, or advance sleep, making it occur earlier.  Once you know that, then you use the Phase Response Curve to see when to use these therapies.

A word of warning:  The correct timing is crucial, so it is best to work with a sleep professional if you want to shift your sleep phase.  If you use light or melatonin therapy at the wrong time you can cause problems by shifting your circadian rhythm the wrong direction.

Follow this link to the Phase Response Curve on Wikipedia: http://en.wikipedia.org/wiki/File:PRC-Light%2BMel.png

On the horizontal axis you see time, and the sleep period written in.  On the vertical axis you see hours of phase advance on the top, and hours of phase delay on the bottom.  Bright light is represented by dark purple, melatonin by green.  Note that the light curve goes both higher and lower than the melatonin, that is because a much larger phase shift can be achieved with light.

Let’s look at an example.  Say an adult is unable to sleep until 2am, but must get up for work at 7am.  Getting 5 hours of sleep each night is not enought for her.  She would like to sleep from 11pm to 7am, but is just not sleepy.  Using the Phase Response Curve, she begins using light therapy each morning when she gets up for the day.  She also takes some melatonin 6 hours before bed.   These combined therapies allow her to feel sleepy at 11pm, and fall to sleep easily.  Now she can get a full night’s sleep, and all the benefits of sufficient sleep.

Tart Cherry Juice for Insomnia?

A couple weeks ago a pilot study was published looking into tart cherry juice for insomnia. Here’s a few details:

15 older adults who have chronic insomnia but are otherwise healthy drank the cherry juice blend twice a day for 2 weeks. They kept a sleep diary during this time and during another 2 week time.

The results showed that on the cherry juice they had less time awake in the middle of the night. Tart cherry juice contains naturally occuring melatonin, which is thought to be responsible of the effect. The authors state that this was a mild effect, and that cognitive-behavioral therapy and pharmaceuticals have a larger effect on insomnia.

So what’s our conclusion? At this point in time, you could try tart cherry juice, but if you have significant insomnia, other treatment methods will be more successful.

Zeitgeibers

What is a zeitgeiber???

The word ‘zeitgeiber’ comes from the German language, and means ‘time giver.’ Zeitgeibers are clues in the external world that help keep our internal body clock in sync with the 24 hour day/night rhythm. This word is used a lot in the field of chronobiology.

The most meaningful zeitgeiber is light, as it impacts melatonin, which in turn sets our circadian rhythm. Other zeitgeibers include meal times, exercise times, and social activities. When your zeitgeibers happen at close to the same time each day, you will be more firmly in sync with the 24 day/night rhythm. This can pay off in sleeping well, and being fully alert during the day!

Is it Insomnia or Delayed Sleep Phase?

Insomnia is an inability to fall asleep easily or stay asleep throughout the night. Delayed Sleep Phase is when a person is on a later schedule than the norm. The tricky thing is that Delayed Sleep Phase can masquerade as insomnia, because it can also cause difficulty falling asleep.

In Delayed Sleep Phase the circadian rhythm is pushed later, so the person doesn’t get sleepy until later than the norm. So if he tries to go to sleep at a normal time, he lies awake in bed, and experiences insomnia. However, if he goes to bed later when he feels sleepy he will have no sleep problem.

Recently I saw an adult woman who had delayed sleep phase, but who had been diagnosed with insomnia and treated with sleeping pills. One of the clues that she had Delayed Sleep Phase is that she said ” I am never sleepy at bedtime.” We shifted her circadian rhythm earlier, using light therapy and precisely timed melatonin.

Within 6 weeks she was sleeping well through the night, without the sleeping pill she’d previously taken.  Her last comment to me was “Now there’s nothing for me to do but keep on sleeping.”

To learn more about Naturopathic Sleep Medicine and Dr. Catherine Darley please go to www.naturalsleepmedicine.net.  Sleep Well, Naturally.

Tryptophan for sleep: Truth or Turkey?

Many stories abound about how the tryptophan in turkey or a glass of milk before bed will help you sleep.  Is this true or not?  Let’s look at the information.

Tryptophan is an amino acid found in foods.  Many amino acids combine to make a protein.  These proteins are then digested and broken down into the amino acids.  Amino acids are carried by the blood throughout the body.  When we think about sleep, the important organ is the brain.  There is a “blood-brain barrier,”  which substances in the blood need to be transported across.  Tryptophan uses the same transporter as several other amino acids.  If those amino acids are in the blood at the same time, they will compete with tryptophan, so less tryptophan will cross into the brain.

Why is tryptophan relevant to sleep?

Several of the neurotransmitters (brain chemicals) of sleep rely on tryptophan for their production.  Among these are serotonin and melatonin.  Melatonin has been discussed in other blog posts here.  Increasing tryptophan by taking tryptophan supplements does help treat insomnia.  These supplements provide higher doses of tryptophan than can be found in food.  Cottage cheese has the most tryptophan per serving, at 400mg tryptophan in 1 cup.  A 3oz serving of turkey provides 283mg of trytophan, and 1 cup of milk 110mg.

Does the tryptophan in our Thanksgiving turkey help sleep?

Thinking about the tryptophan basics we first discussed above, the tryptophan in turkey probably doesn’t help you sleep.  This is because there are other amino acids in the turkey, some of which may compete with tryptophan to be taken into the brain.  That said, enjoy the sleepy reverie that often follows the Thanksgiving feast!

Melatonin, the Sleep Hormone

You have probably heard of melatonin, one of our bodies’ endogenous hormones. Today we’ll talk about natural melatonin cycles, how melatonin relates to health, and also how melatonin is taken as a supplement.

Your Natural Melatonin Cycle
Melatonin is a hormone produced by the pineal gland. It also acts as a neurotransmitter. In dim light conditions melatonin levels will start to rise about 2 hours before your habitual bedtime, and peak about 2 hours afterwards. This increase is partly responsible for tired feelings before bedtime. It will decline during the night and be at very low levels during the day. Melatonin is suppressed by bright light, such as sunshine.

People who are either “larks” or “owls,” have a melatonin rhythm that is different from the norm. This causes them either to get sleepy much earlier in the day – “larks”, or much later than usual – “owls.” An example is found during puberty in teenagers whose melatonin rhythm shifts later, causing their sleep and wake times to shift later.

Uses of Melatonin
Melatonin can be taken as a supplement to improve sleep. In the past, higher doses (5-10mg) were used like a pharmaceutical drug, and some people experienced a hang-over effect the next morning. Newer research has shown that much lower doses (.3-3mg), which are in line with the levels naturally found in the body, are just as effective.

– Precisely timed melatonin can be used to shift the habitual sleep time for those people who are “owls” or “larks.” Exposure to bright light can also be used to shift sleep times as it will suppress melatonin.
– Melatonin can be used by travelers to reduce jet-lag symptoms. It is especially effective when used in combination with a well-thought out sleep schedule, bright light exposure and limiting light with sunglasses.
– Melatonin can be a gentle aid in promoting sleep for those who have sleep onset insomnia. There are also time-released formulas for people who have difficulty staying asleep through the night.

You can always take advantage of your endogenous melatonin rhythm by going to bed at approximately the same time each night, and getting bright light exposure in the morning. This is one way to naturally keep your sleep healthy!