Episode #8: Use Sleep to Transform Your Health (May 24, 2019)

Dr Stefanski breaks down all the latest research on why we sleep and how to get the best night's sleep without resorting to sleeping pills. She discusses the following:

  • How sleep restores brain health and helps prevent cancer and diabetes. 

  • How much sleep you really need.

  • How alarm clocks damage your creativity. 

  • Why we need more REM sleep (and dreaming!) than other mammals. 

  • How sleeping pills destroy your sleep and your long term health. 

  • Why teenagers are impossible to get out of bed. 

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**Episode Transcript**

Hello there, this is Dr Jessica Stefanski on the Let’s Talk Hormones Podcast. This is episode #8 and today we’re talking about sleep, possibly the greatest health therapy on planet earth!  

I am building on some recent episodes of the podcast that focused on adrenal health and intermittent fasting. In both of these I talked a bit about sleep and I really wanted to do an episode focused solely on sleep and talk about all that we know from recent research that’s been done explaining a bit more about why we sleep and why it’s so important to get a good quality and quantity of sleep. I also want to talk about the issue with sleeping pills and why they are harmful to good sleep. 

So today we’re going to answer the following questions: 

  • Why is Sleep important?

  • What does healthy sleep look like?

  • What are the steps that you can take to have a better night’s sleep?

  • What’s the deal with sleeping pills? 

Why is sleep important?

Sleep is one of the top determinants of health. Some would argue it’s THE top determinant of health.  We don’t know all the functions of sleep but we know a lot and we know that not getting enough sleep is correlated with an increased risk of diabetes, Alzheimer’s, and early death. Driving without getting enough sleep is like driving drunk and we have more accidents caused by drowsy driving than we do drunk driving. 

For some time, it was considered rather fashionable to not sleep. Like if you were a successful, you got by on 5, 6, 7 hours of sleep; definitely less than 8 hours. 

I remember being in medical school and going to a lecture of a very famous doctor and author who is doing a lot of good in the world and he claimed that he only slept like 4 hours per night because he has too much to do, sleep was down on his list of priorities. Now that might have been a bit of exaggeration but talking to a group of hundreds of impressionable students and basically saying that sleep gets in the way of the real work of life is the kind of message that a lot of people have gotten in the modern world. 

But I will argue that this kind of thinking is counterproductive, can lead to serious health problems. The reality is that sleep is possibly the greatest health treatment available to you and you’re probably not taking full advantage of it. 

Some specific health benefits of sleep

Sleep helps balances blood sugar and insulin and helps control body weight and appetite. I’ve definitely had this experience of not sleeping enough and then overeating the next day.  It resets our immune system and helps us fight off infections and recover from illness. I’m sure you feel this when you get sick, the big thing most of us want to do is go straight to bed. And this is the best thing you can do.  Sleep drives good gut health and a healthy microbiome It helps us stay pain free and restores the health of our muscles, bones and joints It is important for cardiovascular health and blood pressure, it can help prevent stroke and heart attacks. 

Sleep is vital for brain health. It helps our brains stay healthy and good sleep is absolutely necessary to prevent all sorts of neurological issues including dementia. It helps prevent anxiety and depression. There is a type of cleansing that goes on overnight during sleep as the brain tidies up, gets rid of damaged cells, makes new neural connections, consolidates memories and helps you integrate experiences. That’s why for the students out there, it’s always better to extend your studying for a test over several days rather than trying to cram it all in over one day or late night study session. Your brain needs time to process and consolidate those memories and it can ONLY do that during sleep. And actually it’s important to sleep well the night before you study as well. 

From a hormonal perspective, sleep resets our hormone systems and for example, a good night’s sleep allows the rise of growth hormone which is arguably one of the most important hormones we have. Good growth hormone release is what allows us to build and maintain lean muscle mass which keeps us health, keeps insulin balanced, drives other hormone systems. 

What does healthy sleep look like? 

Melatonin is released from the pineal gland in the brain, and the message it sends is “it’s dark outside and it’s time to start winding down”  Then as morning approaches, and light starts to filter in through your eyelids, the melatonin drops and this allows you to begin the process of waking up.  Your body temperature drops to it’s lowest point at about 12-2am. 

Healthy sleep is all about patterns and following your body’s internal 24 hour clock, also known as a circadian rhythm. You should be getting an average of 8 or more hours of sleep. May be a bit more or a bit less, but for most people, around 8 hours or more seems to be optimal. 

You should have enough sleep that you can wake-up without an alarm. If you’re waking with an alarm, you’re disrupting your sleep cycle. This will cause problems in the short term and in the long term. 

Research has shown that there are morning people and evening people and this is at least partially driven by genetics. Whether you think you are a morning person or an evening person, this doesn’t excuse poor sleep habits. For example, if you’re staying up late looking at your phone or computer or watching tv, drinking alcohol every night, this is going to affect your ability to get to bed, stay asleep and wake up at a decent hour. 

Sleep is made up of REM and NREM sleep.  Research has shown that we typically go through ninety minute cycles of sleep and we go back and forth between the 2 types of sleep in these 90 minute cycles. We have more NREM sleep earlier in the night and more REM sleep later in the night. Both have unique benefits and both are necessary. NREM seems to be more about cleaning up neural connections in the brain and REM seems to be about integrating your experiences, emotions and creativity. We have much more REM sleep than all other animals, seems to be necessary for our big complex brains. 

The steps you can take to create an amazing night’s sleep. 

1.Developing a healthy sleep pattern: Getting to sleep and waking up at a regular time. Ideally you could base your waking time on sunrise and work back from there but that’s not going to work for everyone. 

If that can include a nap, even better. Many people benefit from a nap. Not everyone, but it has been found that in traditional societies, napping is very common. And this is especially true in warmer weather or in warmer times of the year. 

For shift workers or people that have to work at night, for example medical professionals, emergency responders, truck drivers, pilots, it’s best to limit your shift work if possible. We know that for example nurses who work at night are at greater risk of breast cancer. For the good of your health, try to limit working when you should be sleeping. 

2.Wake up without an alarm. If you’re waking with an alarm, your sleep is getting disrupted. But maybe you say, ‘if I don’t set an alarm, I’ll be late for work’. If this is the case, try to get more sleep earlier in the evening. 

If you’re setting an alarm to get up an exercise? Just stop it. Please. It’s not worth it. You’re going to get more bang for your buck sleeping more hours than you are disrupting that sleep to exercise. Try to find another time during the day to exercise or get to bed earlier and see if you can wake up naturally after 8 hours of solid sleep. 

3.Managing light exposure at night. This means no bright light, no blue light, particularly the kind from screens like tv, your phone or computer. If there is light pollution, for example a street light or other lights that come into your bedroom, you may want to consider black out curtains. There are glasses that will filter out blue light, you can wear those in the evening. Some people will replace certain lights in their house or even in their fridge with orange lights so that they aren’t exposed to a blast of light that could shut down melatonin production. 

4.Create a bedroom cocoon. You are spending 1/3 of your life in the bedroom, so invest in good sheets, good mattress, good pillows. Keep the room cool which helps with sleep. Keep electronics, tv, computers out of the bedroom. 

5.Avoid excessive caffeine, especially later in the day. Some people need to avoid it altogether. Caffeine is a stimulant and it can artificially keep you from feeling sleepy. The half life of caffeine is 5-7 hours. That means that if you drink coffee in the morning at 9 am, half of the caffeine from that body is cleared from your body 5-7 hours later, that would be 1-3pm. Then the rest is cleared over the remaining hours. But some people, like me for example, are genetically slow caffeine metabolizers, that means that it takes me longer than others to clear caffeine. This has to do with certain enzymes in the liver that process caffeine. So some people can drink a coffee at 2pm and have no trouble sleeping, For me, coffee later in the day will often cause insomnia. So I have to avoid excessive caffeine intake and definitely limit it later in the day. 

Coffee, tea, chocolate, energy drinks, medications like headache remedies are all common sources of caffeine. And remember that decaf coffee is not caffeine-free. 

What is the deal with sleeping pills? Sleeping pills like Ambien or Lunesta are sedatives, similar to alcohol. That means that they essentially deaden brain function. And the problem is that even though they can be effective at knocking you out at night, the sleep you get is not quality sleep and they actually prevent your brain from going through all the necessary stages of sleep, particularly the deepest stages of NREM sleep. So even though you may be sleeping, you are sleep deprived and your brain will suffer as a result. You’ll probably feel groggy, forgetful and not as energetic the day after using sleeping pills. You might rely on caffeine to wake up which can then disrupt sleep the following night. They’ve been shown to actually worsen your memory and research shows that people who use sleeping pills are putting themselves at greater risk of serious health problems. You’re more likely to get an infection, which is a reflection of your immune function, more likely to be in a serious car accident, more like to develop cancer. Sleeping pills can actually change your brain and you can develop a sort of dependance on them, so if you don’t take them you’ll lie wide awake. I strongly recommend never taking sleeping pills, you are getting such a minor short term benefit for a big long term problems. Get to the underlying issue of your sleep problems instead. 

Melatonin can be helpful. It can just help give your brain the signal that it needs to start winding down. You can start very low, like 0.5mg. Long term most people shouldn’t need to talk it every night but it can be helpful to have on standby. It’s also a potent antioxidant. If you’re traveling across time zones, melatonin can be a great tool to help your body adjust. 
You can also use botanicals like valerian, passionflower, California poppy. Jamaican dogwood can be good if you have any aches and pain that keep you from sleeping. These herbs won’t knock you out like sleeping pills do. You can also take magnesium which is a smooth muscle relaxer and glycine which is a very calming amino acid. Many people are deficient in these 2 substances so these can be nice additions to your bedtime routine.

What are some of the common issues?

Difficulty falling asleep: Look at your light exposure (esp blue light) at night for example, tv/screen time, stimulants like caffeine, cortisol rhythm disruption/adrenal issues. Sleep problems in perimenopause in your 40s and early 50s or worsening sleep near your period can be due to low progesterone relative to estrogen. 

Difficulty staying asleep: Consider blood sugar drops in the middle of the night, cortisol issues, alcohol intake, sleep disorder like sleep apnea, hormonal issues like perimenopause can cause low progesterone and this can affect sleep quality.

Teenagers have a different sleep cycle, if your teen has difficulty getting up in the AM, there is actually a biological reason for that, so don’t blame it on them or assume they are lazy.  Their sleep cycle is slightly offset compared with adults and children, so it is natural for them to stay up late and get up later. Unfortunately the school systems don’t seem to recognize this fact and teenagers are forced to get out of bed early to go to school.

Sleep apnea is something to consider if you are having poor quality sleep or feel groggy during the day. If you snore, gasp for air or stop breathing for periods of time at night, sleep apnea should be considered. I typically send people for a sleep study to get a diagnosis. You may need a C-PAP machine and I know those aren’t a favorite of many people, but it’s so important to make sure that you’re getting enough air at night.

Thanks so much for listening. I hope you have a great nights sleep tonight. And I’ll talk to you next week.