Sleep plays a crucial role in every single physiological process within the human body. Throughout the day, neural, nervous and muscular-skeletal activity produces metabolic waste. During sleep, the body undergoes a recovery process to remove this waste. This removal allows the body and brain to continue to function the following day, and with poor sleep, the ability to function
appropriately and at high performance is impaired. Homeostasis is described as the tendency towards a relatively stable equilibrium between interdependent elements, primarily as maintained by physiological processes. This process is regarded as the most crucial natural regulatory system in the human body with regards to maintaining good health and longevity. Poor sleep impairs our abilities to regulate the nervous system, hormones, and neurotransmitters that are all vital for normal daily functioning and life. Without sleep, it is thought that we would die within a matter of weeks due to dysfunction of the immune system, leaving us vulnerable to even the smallest of infection.
Modern-day society has devalued sleep to such an extent that more than 40% of the UK, Australian, and the USA population are sleep deprived. Over the last 100 years, the average sleep duration has significantly decreased and is now thought to be less than 7 hours. The most likely cause is the invention of the lightbulb, advancements in technology and the push for a 24/7 working society. It is well established that shorter sleep duration and poor sleep quality are strongly associated with BMI, with empirical evidence from systematic reviews and meta-analyses that poor sleep is an independent risk factor for obesity, chronic disease and Alzheimer’s, to name a few. There is an increase in mental health issues, such as depression and anxiety. While social media certainly is playing a significant role, its the addiction to mobile devices and lack of education that is causing people to suffer from sleep-related issues such as insomnia.
Over the last six years, I’ve been working in healthcare clinics both in the UK and Australia as a Sleep scientist. We are seeing more and more individuals with multiple co-morbidities that can be directly associated with their sleep-related issues. Poor sleep is a silent killer, and people do not realise the extent to how inadequate their sleep is until they are struggling with health concerns 20- 30 years down the line. There’s a possibility that these health concerns could have been prevented had they realise and got support with their sleep issues a little earlier. Poor sleep results in increased appetite due to the inability to regulate hunger hormones, a stressful body environment that can lead to muscular atrophy as well as memory and cognitive decrements. Subjective sleepiness is a poor indicator of actual performance due to disruptions in the brain, controlling self-awareness and emotional regulation. As a means of concern and attempt to support those who struggle with sleep, this document is my top five tips for improving sleep, reducing sleep onset time, increasing sleep efficiency and quality. As a scientist, I’ve gone into nitty-gritty details but hope that it’s written in a manner in which you can all understand.
1. BE CONSISTENT IN SLEEP WAKE TIME
The body has a system known as circadian rhythms. A body clock that cycles over roughly 24 hours is controlling our regulatory hormones for sleep, appetite and energy expenditure on a negative feedback loop. The sleep and wake cycle plays a crucial role in the control of its function, and therefore, it’s vitally important to maintain consistency in time we sleep and wake. This clock is controlled by the suprachiasmatic nuclei and is mainly controlled by light and temperature. During the day excitatory neurotransmitters (acetylcholine, glutamate, nitric oxide, dopamine, and Norepinephrine), the chemical messengers in the brain produce awakening states such as energy, alertness, and focus. Throughout the day, energy is utilised in the form of adenosine triphosphate (ATP), and as a by-product of metabolic activity, a chemical called Adenosine builds up in our brains. Adenosine is an inhibitory chemical, and a build-up of Adenosine causes pressure to sleep, by increasing drowsiness. Throughout the day, Adenosine combines with Norepinephrine, and in the presence of Serotonin produces Melatonin. As darkness arrives, Melatonin is released by the pineal gland, decreasing the activity in the brain to help initiate sleep. At this point, there is a more significant shift in balance towards the inhibitory neurotransmitters this slows down neural activity and shuts off the ascending reticular activating system and causes the shift in consciousness to sleep. Melatonin is broken down in the liver to Serotonin, and even potentially DMT that produces are dream states. Throughout the night, a change as a result of adenosine and melatonin metabolism, a shift in neurochemical balance occurs increasing excitation of brain neurons, stimulation of the sympathetic nervous system and the release of cortisol to cause the waking state in the morning.
Even in the absence of light, these circadian rhythms continue to rise and fall roughly on a 24 hours clock. Nonetheless, if your sleep/wake cycles differ each day, our bodies get confused, and the timing of all these hormones and chemicals are disrupted, causing variations in sleep onset, ability to remain asleep and as a result of a lack of energy during the day. These two hormones also play a role in appetite, digestion, and energy expenditure therefore not having consistency in sleep and thus misaligning their release can play havoc with our bodies that lead to all kinds of performance and health decrements.
Try to get to sleep and wake up within 30 minutes of each other every day of the week. Even if you fail to get to sleep early enough, attempt to get up the same time the following day because we are more able to control when we get up than when we sleep. This shall allow for the incremental rise in Adenosine and a feeling of sleepiness at the appropriate time the following night.
2. FOLLOW THE SUN
Evolutionists believe that sleep was an adaptive process. A mechanism to help animals that cannot see in the dark survive during the night. Those that we’re able to remain quiet, reduced body temperature and stay immobile for long periods in darkness, were more likely to survive attacks from those movement and heat-seeking predators that came out during the night. Over millions of years, this adaptive mechanism became sleep and was controlled by the sun.
Nowadays because of the invention of the lightbulb (thanks to Thomas Edison), it’s hard to replicate natural light in the household. However, we can follow it. If the sun is down outside, don’t sit indoors under bright lights up until bedtime. Start to dim your lights or use lamps as the sunsets. This action allows for the release of that sleep hormone — Melatonin. Melatonin should peak around midnight. For most of western society, midnight classed as bedtime, especially in the UK who are renowned for watching TV until late at night. Having bright lights, especially blue light, enters your eyes, activates the ganglion cells at the back off the eye, increasing excitatory chemicals in the brain and delays the release of Melatonin. Such action shifts the Melatonin peak to later in the night, making it more difficult to initiates sleep. Bright lights such as LED bulbs, screen and televisions can shift Melatonin anywhere between 30–90 minutes later making it difficult to sleep, leading to frustration and concern about the inability to sleep and may result in insomnia.
Candlelight does not affect Melatonin and therefore if possible, should be the significant light used in the bedroom. A common mistake most people make is that they turn their leading bathroom light on to brush their teeth or remove their makeup before sleeping. Bright light can disrupt the sleep pattern and cause a delay in sleep initiation and even disrupt sleep maintenance. Late night snack from the fridge, be careful not to spend too much time looking around. For those who have to work late on their laptops for whatever reason, I recommend getting a pair of blue light glasses. These glasses filter out blue light, and the technology is improving all the time. They have been proven to help prevent delays in Melatonin release.
If you wake up prior to sunrise and struggle with sleepiness in the morning, or from seasonal affective disorder (Won’t occur in Australia) then using a blue light lamp can be beneficial to get you going, however, it is recommended that as soon as you can get outside and into natural sunlight then you should. For those of you living in a country that doesn’t get much light in the winter such as the UK or the Scandinavian countries I recommend using SAD light for therapy that can be found here — https://www.amazon.com/Philips-goLITE-BLU-Therapy-Device/dp/B001I45XL8
3. BAN TECHNOLOGY FROM THE ROOM
We have already discussed the reason why we need to avoid bright lights before sleep, so that should provide enough evidence to leave the phones and laptops outside the bedroom; however, there is another point we need to discuss from more of a psychological aspect.
Sleep is a behaviour, not an action. We can pick and choose our actions, but we need to stick to our evolutionary behaviours because let’s face it — the body cannot evolve as fast as technology. Sleep behaviour is the ability to accept that it’s the end of the day and switch off. It is a stepwise shift to unconsciousness. In NREM stage 3 sleep, our deepest sleep, it’s tough to wake someone up. If you have technology such as a phone or laptop in the bedroom, you are not fully accepting that it’s the end of the day and it’s time to shut off.
Although no one likes to think about it, we are all addicted to our phones. How often during the day do we reach for the phones to check emails, texts or social media? They are programmed that way. These companies have done the research, worked with the psychologists and neurologists to ensure that they are as addictive as possible. They are programmed to make sure we receive a considerable dopamine hit that gives a short-lived burst of pleasure, an addictive source of excitation that we seek as we go along in our casual and mundane lives. Dopamine is one of those excitatory messengers that makes us feel alert and awake. Not ideal for the sleep situation. This wouldn’t be a problem if we could just put our phones down and not think about them, however, the way they are programmed even the anticipation of not knowing if you have an email, like or new followers causes an influx of excitation and therefore having phones in the bedroom, subconscious effects on our ability to switch off. Placing your phone in the lounge room is acceptance. It means that you’re taking the right steps to have your time to recover and remove yourself from the rat race that is work, and daily living to get some rest.
Social media has shortened our attention span and has been linked to an increase in ADHD. It also stimulates thoughts and makes it difficult to focus and relax — the conditions required to get to sleep. If you can try to avoid using technology an hour before sleeping, and leave the phone and the laptop out the room. This behaviour is a commitment to say that your day is over and that you are prepared to leave everything till the morning to sort out. Which we all can do if we made that commitment to our health, fitness and next-day performance.
4. BE CONSCIOUS OF CAFFEINE AND ALCOHOL INTAKE
90% of American’s caffeinated drinks, with an average person consuming an average of 300mg, 250mg, and 170mg daily in the USA, UK, and Australia respectively. Caffeine is naturally occurring in coffee (40mg) and is added to many beverages in more significant amounts as caffeine drinks. Feel tired, drink caffeine, need to work out — take pre-workout. There may be benefits to consuming caffeine; however, does this outweigh the importance of sleep?
Caffeine works against sleep in two way.
- It’s a stimulant. It activates the sympathetic nervous system by increasing dopamine in the same way that other addictive substances do. This part of the nervous system is the fight or flight system and works by increasing the release of Corticotrophin Releasing Factor and ACTH via the Hypothalamic Pituitary Adrenal axis releasing cortisol; increased heart rate, blood pressure, and alertness. Not ideal for sleep initiation and quality.
2. Caffeine also blocks the effect of Adenosine, the sleep pressure neurochemical I was referring to earlier. It works by antagonising the adenosine receptors changing their shape. Therefore Adenosine no longer fits its receptor, and inhibits the action of Adenosine reducing drowsiness, increasing alertness and even preventing melatonin production.
Caffeine has a half-life of roughly 5 hours meaning that if you consume coffee at 5 pm, at 10 pm half of it remains in your system and even the smallest amount less 30mg is enough to affect sleep. My advice is not to consume caffeine in large amounts post 3 pm if you are looking at getting a 10 pm bedtime. Therefore that pre-workout you decide to take while may improve your focus and energy in the gym, it going to impact sleep and you’ll find the recovery is much more valuable. After all, sleep is the most anabolic process the body goes through.
Despite its reputation, alcohol is problematic when it comes to sleep. It has been renowned for its ability to help people get to sleep and is often referred to as a nightcap; however, alcohol is a toxin, and that is broken down by the liver. Sleep reduces hepatic activity, and therefore, the liver finds it’s difficult to break down and remove alcohol during sleep. Alcohol fragments sleep, meaning that rather than getting regular solid blocks of NREM and REM sleep, your brain jumps in and out of sleep stages, and wakefulness reducing sleep quality and therefore, efficiency. Poor sleep quality has similar effects on the body that sleep deprivation does and you shall feel much less rested in the morning.
5. CREATE A SLEEP ENVIRONMENT
Can you honestly look at your room and say that it looks like an environment that you wish to sleep in? Having an untidy room can unconsciously make our brain stay active as if we have the stuff to do. We were all taught by our parents to keep a tidy room; it demonstrates the organisation around the rest of our lives. If your brain does not settle, you’ll struggle to get to sleep. Have fresh, clean sheets, a quality mattress, and pillows suited to your preferred sleeping positions. Side sleepers tend to need more pillows with a harder cushion than those who sleep on their back or front.
Ensure that the room is as dark as you can get it, invest in some decent curtains or blinds and try to avoid having bedrooms at the front of the house near the roads and outdoor lights if possible. Use an eye mask if needed. The ideal sleeping temperature is 20 degrees Celsius. The core body temperature needs to drop by 1 degrees Celsius to initiate sleep, and if your room warms, then the body will mistake this for sun temperature and the circadian rhythms will start to shift towards wakefulness.
Reduce the noise as much as possible. Double glazing on your windows, if your house is on the main road. If you build a house, make sure the rooms are away from living areas, kitchens and busy areas. Have agreed to bedtimes for the household or at least get your housemates to turn the television down or even use earplugs if necessary.
Finally, make a routine. Psychologically we can form habits and processes if they are in a series. Make the commitments to forming a sleep routine. That could be making a chamomile tea, sitting down for ten minutes in silence or filling out a journal, brushing your teeth in dim light and then tucking yourself into bed. These step by step processes shall form a psychological process in which sleep is initiated each night. If you find yourself not sleepy, take a break from the bedroom. You do not want to associate the bedroom with non-sleeping; that room is for sex and sleeps only. When people build a negative sleep association with their bed and bedroom, it can lead to sleep issues. Therefore it’s essential to only go to bed when sleepy unless you’re planning some fun time.
In summary, we need to educate our society about the importance of sleep. Parents play an essential role in creating the correct sleep behaviour and should focus on consistency, avoidance of technology in the bedroom and creating the right sleep environment. People with sleep issues should be conscious of their caffeine and alcohol intake. However, please remember if you are struggling with sleep, then making such changes in this document are guaranteed to help. That said, you need to follow them all. Changing one is like deleting your ex from social media without deleting their number. You may not speak for a while, but eventually, you’re going to slip back into bad habits and start chatting again. Changing one habit isn’t enough to create the behavioural change you need to improve your sleep health. If you make these changes and continue to struggle, please contact me for further support.