The Exhaustive Guide To Breaking Exhausting Sleep Cycles

According to The Better Sleep Council, 65% of Americans are losing sleep because of stress, and 16% experience stress-induced insomnia. There is a close connection between stress and sleep, and in the extreme it can feel like a vicious cycle. According to sleep expert Dr. Charles Czeisler, if you're trying to function with less than four hours of sleep for four consecutive nights, you’ll have the same level of problems with thinking and analyzing things properly as if you had been awake for 24 hours—which is equivalent to being legally drunk.

How big is the sleep problem in America?

An estimated 50–70 million U.S. adults have chronic sleep and wakefulness disorders.  The Center for Disease Control and Prevention Morbidity and  Mortality Report (MMWR) published during sleep awareness week in March provided the first estimates of the extensiveness of sleep problems from the first nationwide surveillance of sleep habits of Americans. The results highlight two prevalences of self-reported sleep-related behaviors with potentially dangerous consequences: 37.9% of adults in 12 states reported unintentionally falling asleep during the day at least one day in the preceding 30, and 4.7% reported nodding off or falling asleep while driving during the same period. Also of concern: 35.3% reported getting fewer than seven hours of sleep in a typical 24-hour period. Chronic  stressors is a significant part of the problem. Chronic stress is ongoing stress such as job insecurity, not meeting your numbers, having to witness and care for aging parents, financial strain, deployment of a loved one, personal health problems, or toxic personal relationships.

And this isn't just a personal problem. In a 2010 study by Rosekind and colleagues published in the Journal of Occupational and Environmental Medicine, of 4188 employees at four U.S. corporations, those with insomnia or insufficient sleep had worse productivity, performance, and safety outcomes. Fatigue-related losses in productivity cost an estimated $1,967 per employee each year. Insomnia is characterized by a complaint of difficulty initiating or maintaining sleep, or of non-restorative sleep even when you have adequate opportunity to sleep.

Why Sleep?

Several years ago I considered sleep a luxury, only affordable if i didn’t have a more pressing obligation. Sleep was reserved for discretionary time. Sometimes with all the tasks, demands, and challenges of my family and working rotating shifts in the emergency room, I thought the obvious solution for finding more time in the day was to simply give up sleep time.   

According to Dr. Lawrence Epstein, Faculty at Harvard Medical School, Chief Medical Officer of SleepCenters, and our recent guest on StressRelief Radio, we should spend about one third of our lives sleeping. This isn’t passive. It is not just a "time out." The brain is highly active during sleep. This activity is critical for renewing different aspects of our mental and physical health each day. Think of sleep as the platform for launching your ability to think and do every day. 

There are four major sleep-related factors that affect our ability to think and perform at peak levels.

1. The natural homeostatic drive for sleep. Your body’s natural need for sleep is determined largely by the number of consecutive hours that you been awake. When you been awake for extended periods time the brain takes over sending signals to the body telling it to sleep. In fact, it’s not a want—it’s a need. Sometimes you’re aware of it and you feel drowsy, but other times you are suddenly hit a wall and must respond to an overwhelming need to sleep. This is an intrinsic biologic drive-programming that we all learn to respect. You have experienced it when you are working late to get that report done and suddenly crash.

2.The total amount of sleep over the previous several days. if you get less than five hours of sleep a day for several days a sleep deficit bills up. The problem with sleep deficits—like many others—is that once you are behind, its almost impossible to catch up. When you have a deficit the brain finds it more difficult to function. Did you know that when you learn a new information or skill you need at least eight hours of sleep (including REM sleep) to fully process the information? The necessity of sleep for learning could be due to the fact that sleep increases the production of proteins while reducing the rate at which they are broken down. These proteins are used to regenerate the neurons within the brain. Without them new synapses may not be able to be formed. This can literally limit the amount of information a sleep-deprived individual can maintain.  

3. Circadian rhythm. We all have biological rhythms, known as circadian rhythms, which are controlled by an internal biological clock. This clock affects body temperature, appetite, alertness, etc. as well as sleep timing. Circadian rhythm is influenced by body chemicals and sunlight. For non-shift workers, the human circadian rhythm of alertness is at a natural low point when you are most sleepy between 3:00 AM and 8:00 AM.  The propensity for sleep and wake are regulated by a complex interaction between the accumulated need for sleep (homeostatic drive) and circadian timing.

4.Sleep inertia. Sleep inertia is the grogginess that most of us experience when we first wake up. Why morning coffee? Researchers suggest sleep inertia can often be reversed by activity and noise as well as caffeine. One theory is that sleep inertia is caused by the build-up of adenosine in the brain during REM sleep. Adenosine then binds to receptors, and feelings of tiredness result. Caffeine may block those receptors in the brain. (Okay, now its time for another cup of coffee.)

Do stress and sleep disorders threaten your health?

Stress combined with a lack of sleep can have a devastating effect on your body. People who suffer from insomnia develop a resistance to insulin, which can often lead to higher blood pressure or diabetes. Other risks associated with a lack of sleep include memory loss, weight loss, anxiety, depression, hypertension, and chronic aging. Sleepless nights also raise a person’s cortisol levels, the stress hormone that activates the fight or flight response people get when feeling threatened.

A special health risk exists for the more than 22 million Americans, or 14% of the working population. Over the past few decades, our society has become increasingly dependent on shift workers to meet the demands of globalization and a 24-hour society.  Drs. Hartenbaum and Zee in the Journal of Occupational and Environmental Medicine outlined the unique problem of sleep and shift work in their paper, Shift Work and Sleep: Optimizing Health, Safety, and Performance.  Shift work is a necessary part of professional life for many workers in health care, food service, retail, transportation, manufacturing, and public safety industries. Shift workers are significantly more likely than non-shift workers to sleep less than 6 hours on work days, work more hours on average each week, and drive drowsy at least once a month. Shift workers have poorer overall health than non-shift workers.

What can you do about your personal sleep-stress cycle?

First, don't forget that stress is often attributed to the way you interpret or perceives a situation. In that regard, changing the way you think about a certain problem can also reduce the stress you feel. Next, realize stress is inevitable,  but how you deal with it can be altered. In fact, I propose you identify, label and embrace the stressors associated with your 3P’s ( purpose, priorities, passions). This is the approach I advocate in my book, Optimal Stress: Living in Your BestStress Zone (John Wiley 2010). Don’t let family or work overwhelm you. 

To begin your sleep cycle first you must slow down and relax. This is the true key to breaking the stress cycle. Stop. Pause. Consider writing down things  that are bothering you. Then, step outside the box and look at what’s stressing you as an outsider. Brainstorm some possible solutions to your problems to put you more at ease before bedtime. It can help you solve those problems you end up worrying over for hours before you actually fall asleep. Learn and develop a ritual to wind down and relax. Relaxation is not the same as counting sheep. Relaxation is a biological response which is the opposite of the stress response. It must be consciously triggered. There are many ways to do this. Relaxation tactics that work to assist with sleeping when you are in bed include listening to relaxing music,deep breathing, progressive muscular relaxation, and mediation or prayer.

What about ‘natural’ sleep aides to help you relax?

Melatonin

You probably already known about melatonin. Melatonin  also known chemically as N-acetyl-5-methoxytryptamine, is a naturally occurring compound found in animals, plants and microbes. For us humans, it’s the hormone your brain’s pineal gland produces at night, when it’s dark and your body needs rest. Known as the "hormone of darkness" So melatonin helps your body know the difference between day and night helps your circadian timing and sleep cycles.

Melatonin reduces the time it takes to fall asleep. Taken 30 to 90 minutes before bedtime, melatonin supplementation acts as a mild hypnotic. It causes melatonin levels in the blood to rise earlier than the brain's own production accomplishes. This usage is now common in sleep and relaxation drinks.

The Mayo Clinic graded melatonin’s effectiveness  and also provides information about dosing and safety—as do numerous other resources like the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).

As always its best to check with your doctor before trying any new medication. 

Valerian

Stephanie Ross from Drexel University College of Nursing in Holistic Nursing Practice provided an excellent review of Valerian as a sleep aide. Valerian has a long-established history of use both as a mild sedative and as a sleep aid in Western Europe. Galen first recorded valerian's sleep-promoting properties in 2 AD. Today, Valerian (Valeriana officinalis) root extract is an approved over-the-counter medicine in Germany, Switzerland, Belgium, Italy, and France for the treatment of stress and nervous tension, disturbed sleep patterns, and anxiety states. Consult with your health care provider about using Valerian. Caution: Valerian is contraindicated during pregnancy and lactation and in children younger than 3 years. Although valerian does not appear to cause residual morning sleepiness, it should not be taken before driving or operating machinery because it may impair judgment.Valerian should not be taken with alcohol and sedative drugs.

Finally, here are recommendations for a good night's sleep from Dr. Lawrence Epstein, Chief Medical Officer of SleepCenters and faculty at Harvard University. He discussed these with me recently on StressReliefRadio. A complete list of his recommendations and more information can also be found here

  • Stay away from caffeine, nicotine and alcohol at least 4-6 hours before bed. Caffeine and nicotine are stimulants that interfere with your ability to fall asleep, and stay asleep. Coffee, tea, soft drinks, hot cocoa, chocolate and some over-the-counter medicines contain caffeine. Cigarettes, cigars, and some drugs contain nicotine. Although alcohol may help you fall asleep, it significantly interferes with the quality of your sleep and often makes you wake up more in the second half of the night.
  • Only use your bed for the three "S" activities .The bed should be for sleep, sickness, and intimacy only. It is best to leave all other activities for elsewhere. Refrain from using your bed for watching TV, paying bills, eating, doing paperwork, computer work, or prolonged reading. Let your body "know" what the bed is for.
  • Do not watch the clock. Many people who are having difficulty sleeping check the clock to see how long it is taking to fall asleep, how long they have been asleep, or how much longer they have left to sleep. This can be a source of frustration and should be avoided.
  • Use sunlight to set your biological clock. When you get up in the morning, get exposure to bright light, preferably sunlight. Light signals that it is morning and you should wake up. Getting 15 minutes of sunlight exposure in the morning can make your entire day better and brighter! Sleep is not an option! Your health, happiness, productivity and even safety depend on how well you meet your body’s need for rest and sleep quality. Consider sleep habits as important as your diet and exercise.

[Image: FLickr user Meredith_Farmer]

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