Let’s Talk Sleep


- Issues falling asleep

- Troubles staying asleep

- Waking feeling groggy & unrefreshed


Does this sound like your life experience?


I see these forms of sleep disturbance commonly in my practice, even more frequently since the onset of the pandemic. There are many biological & psychological factors that play into how we sleep, but generally speaking we should be able to achieve 7+ hours of quality sleep nightly. Any fewer than 6-hours of sleep nightly can result in physical impacts of sleep deprivation that can impair how we function the following day.(1)


According to the CDC, approximately 1/3 of adults get fewer than the suggested hours of sleep nightly, which can put your body at higher risk of chronic disease down the road.(2) What a great opportunity for preventative medicine!


I love helping people achieve better sleep, so let’s dive into how naturopathic medicine can help!


Basics of Sleep Biology:


Sleep is regulated by what is called our circadian rhythm. It’s an intricate balance of hormones and neurotransmitters that respond to our environmental cues such as daylight & routine to make us sleepy.


Once asleep, we cycle through 4-key phases approximately 6-9 times in a night: N1 (aka “light sleep”), N2 (aka “the preparation phase”), N3 (aka “deep sleep repair”), and finally rapid eye movement (aka “REM sleep”). All are needed in order to wake feeling refreshed.


During the preparation phase, information is sifted and processed for storage during the day. N3 allows you to repair damaged muscle tissues from exercise and stores factual information you learned. During REM sleep, the body is essentially paralyzed and this is where dreaming and emotional memory storage happens.(3)

 

Although sleep can respond to a disturbance in any system of the body, the key systems I see implicated in poor sleep are the endocrine (or hormonal), nervous, digestive, and immune systems.

 

Addressing Hormone Imbalance:


When we think of sleep issues, melatonin is often the hormone that comes to mind first. It is a key player in regulating our circadian rhythm, but so is cortisol.

Cortisol is our “stress hormone” that is produced as a result of our fight or flight response. Cortisol and melatonin have an inverse relationship with each other, which means as cortisol goes down at night, melatonin levels go up. If melatonin doesn’t work for someone and they find that they are having ruminating thoughts or anxiousness at night, often I look to elevated cortisol as a culprit.(4)


Other hormones such as progesterone, thyroid hormone and insulin can also play a role in how we sleep. Progesterone has a “relaxing” effect on the nervous system and when it is deficient, sleep may be hard to initiate and maintain. In cases of both high and low levels of thyroid hormone, one may have issues falling and staying asleep. Insulin is our “sugar regulator”, and in cases where insulin is not responding properly to sugars we eat (aka insulin resistance), drops in blood sugar levels at night can cause one to wake mid sleep.


Addressing the Nervous System:


The nervous system regulates our neurotransmitters and responds to both physical and psychological stressors.


Neurotransmitters are chemicals our body makes to send signals through the nervous system. Those that cause the nerves to fire or get excited include epinephrine, norepinephrine, acetylcholine, glutamate and histamine. When these molecules are insufficiently unopposed, you can imagine that your system will struggle to relax and sleep. We also make neurotransmitters that act like brake pedals to oppose those that are excitatory, such as GABA, serotonin, and dopamine. Therefore, GABA and 5-HTP can often be useful in helping promote sleepiness.


Certain electrolytes or minerals are also needed to relax these nerves, such as magnesium, calcium, iron, and zinc.


Addressing the Digestive System:


The digestive system is implicated two-fold when it comes to sleep.


Firstly, if you are not digesting your foods properly, abdominal discomfort due to acid reflux (i.e. GERD), indigestion, flatulence, abdominal bloating, constipation, etc. can be quite disruptive to a good night’s sleep. Along those lines, histamine intolerance can contribute to poor sleep onset for some of those who have sensitivities to foods or food allergies as histamine is a stimulating and excitatory neurotransmitter.


Secondly, nutrient deficiencies as a result of poor digestion can have impacts on the nervous system that prevent muscle relaxation and promote anxiety. These nutrients include magnesium, calcium, iron, zinc, Vitamin D, and Vitamin B12.

 

Testing:

Tests I often consider when getting to the root of sleep disturbance include:

- Routine Testing: CBC, CMP, Glucose, CRP/ESR

- Hormone Testing: cortisol rhythm, DHEA, progesterone & estrogen, insulin

- Nutrient Testing: Iron, zinc, Vitamin B12, Vitamin D, RBC Magnesium

- Other Testing: IgG Food sensitivity

 

Management:

When it comes to sleep support, I always start by addressing the diet and lifestyle. If these fundamentals are not met, we may not see the improvements you are hoping for.


Lifestyle:

Because sleep is cyclical and routine dependent, ensuring a consistent pre-sleep regimen is essential. Key sleep hygiene recommendations will include keeping consistent sleep-wake times, keeping your bedroom quiet and dark, avoiding screens 60-minutes prior to bedtime and avoiding large meals the 2-hours prior to sleep.(5)


Other lifestyle factors that can impact sleep include movement, taking time in nature & stress management! Any movement is better than none when it comes to sleep, so I encourage you to find a way to move each day that feels good!


Diet:

Both what and when we eat are important! In general, eating consistent meals throughout the day vs. grazing has been shown to result in longer sleep times.

  • Carbohydrates can help promote neurotransmitter (i.e. serotonin) production which can help you fall asleep. Consider adding a serving of complex carbohydrates to a meal 2-4 hours before bedtime (i.e. quinoa, long grain brown rice, sweet potato, etc.)

  • Protein provides building blocks for neurotransmitter production and muscle repair while sleeping. Studies show that when it is eaten in sufficient quantities and consistently throughout the day (i.e. at each meal), overall sleep quality improves.(6,7,8)

Botanicals:

I love harnessing herbal medicines to improve sleep. It depends on what system we are working to address, but common herbs used to promote sleep onset include lavender, skullcap, valerian, ashwaghanda, chamomile, lemon balm, tart cherry, hops, and passionflower.(4,9,10)


Supplements:

We can’t always get everything we need from the diet or lifestyle so I find that melatonin, l-theanine, GABA, magnesium, iron, zinc and calcium supplements can often help if your body needs added support!(4,11,12,13)

 

If you are interested in learning more, please feel free to schedule a free 10-minute discovery call to see if naturopathic medicine is a fit for you!


Disclaimer | this information is meant for educational purposes only, and should not be used as a replacement for professional medical advice.

 

References:

  1. https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html

  2. https://www.cdc.gov/sleep/data_statistics.html & https://www.sleepfoundation.org/how-sleep-works/sleep-facts-statistics

  3. https://www.ncbi.nlm.nih.gov/books/NBK526132/

  4. https://www.naturalmedicinejournal.com/journal/2010-06/role-cortisol-sleep

  5. https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html

  6. https://www.sleepfoundation.org/nutrition

  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675071

  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520871/

  9. Hoffmann, D. Medical Herbalism: The Science and Practice of Herbal Medicine. Published 2003.

  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035468/

  11. https://pubmed.ncbi.nlm.nih.gov/21226679/

  12. Neumann SN, Li JJ, Yuan XD, et al. Anemia and insomnia: a cross-sectional study and meta-analysis. Chinese Medical Journal. 2021;134(6):675-681.

  13. https://journals.sagepub.com/doi/pdf/10.1177/2165079917734880



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