Get to the root cause of insomnia
By Dr. Martin Gleixner, MSc, ND
Fatigue is the most common symptom seen in my practice.
Improving sleep is a great starting point to help people gain energy. But the notion of sleeping a full eight hours is often seen as luxurious. Adding an afternoon nap may even seem a little sinful. Our cultural mentality involves working too hard (and at times playing too hard), often at the expense of rest and relaxation.
In this column, let's explore how to obtain a more restorative sleep.
A full night of restful sleep heals the body by reducing inflammation and balancing the hormonal and nervous system. Correcting insomnia, therefore, is an excellent adjunctive tool in treating any chronic disease. More specifically, in addition to increasing daytime energy levels, improving sleep is effective to enhance memory, assist in weight loss, and reduce the risk for depression, anxiety and cardiovascular disease.
How do you know if you are getting enough sleep?
- If you need an alarm to wake up, you are not getting enough sleep.
- If you need coffee or other stimulants (e.g. Redbull) to get you going in the morning and/or get you through your afternoon, you are not getting enough sleep.
- If you frequently feel tired, run down, burnt out, irritable, impatient or have memory issues or trouble concentrating, you may be not getting enough sleep.
Sleep medications can be helpful during a temporary period of insomnia. But, sleep aids can prevent the body from entering the deeper phases of sleep (i.e. delta sleep), even though your eyes are closed and you are unconscious for the whole night. Waking up groggy and non-refreshed can commonly occur since the apparent night of sleep did not reduce inflammation or heal the body in ways that sleep usually provides. Most pharmaceutical options create dependency and often have withdrawal effects.
Try as many of the following techniques below as possible. Circle ones that you are interested in and try one this week.
Find the cause:
The most important way to improve sleep is to first figure out what is keeping you up. Work with your medical doctor or naturopathic doctor to investigate why. The timing of impaired sleep provides good clues.
In my practice, patients usually fall into one or more of the following categories:
- those who just can't fall asleep
- those who wake up many times during the night
- those who wake up at a specific time each night, surprisingly common is between 1-3 am or between 2-4 am.
- those who wake up early and can't fall back asleep.
The hormonal balance between cortisol, growth hormone and melatonin is a very important consideration. Cortisol, for example, is normally lowest at bedtime, enabling our body and mind to shut down for the night. But prolonged periods of stress during the day, eating late, arguing with your spouse, watching an intense movie, overdoing mentally challenging work, or exercising too late can all cause raised cortisol levels leading to insomnia.
Other causes may include an overactive bladder, muscle or bone pain, excess caffeine consumption, medication side-effects, leg cramps or restless legs, an over-agitated nervous system (which can include repetitive/excess thoughts or vivid dreams), low blood sugar levels, night sweats, and other hormonal imbalance.
Many of these can be corrected with the proper recommendations & treatments when needed.
Ask yourself a few key questions to help problem solve:
- What is keeping you up so late at night? Are you doing anything useful or productive?
- What usually wakes you up during the night?
- What stops you from falling asleep or going back to sleep if you wake during the night?
- Do you feel safe in your bed? In your home?
- Is your bed and pillow comfortable?
- Is the room cool, is the air fresh, are you warm enough in bed?
- Is your bedroom completely dark? And quiet?
- Is your bedroom peaceful and relaxing?
- How many electronic devices are in your bedroom? Can they go somewhere else?
- Are partners or pets keeping you up, or waking you up?
- Did you get enough exercise that day?
- Are you relaxed or stressed? Overworking during the day?
- Are you eating dinner too late? Have indigestion during the night? Or going to bed hungry?
Address the basics:
Find ways to keep your room quiet.
Keep the temperature in the bedroom no higher than 21°C. Allow fresh air in your bed room by running your air-exchanger during the winter and opening your window for 30 minutes before you go to bed during the summer.
Avoid drinking any fluids within two hours of going to bed if you are prone to getting up to urinate at night.
Work with your medical doctor to reduce or avoid drugs (both prescription and over-the-counter) with side-effects that affect sleep.
Decrease or avoid caffeine, especially later in the day. Unless you are very sensitive, most people can tolerate 1-2 cups of organic coffee first thing in the morning without it interfering with sleep. If you feel jittery after only 1 cup, replace your coffee with a green tea or a decaffeinated herbal tea. Do not drink Redbull or other equivalent drink stimulants.
Limit screen time (iPads, TVs, etc.) before bed mainly because their viewing content (such as vivid shows, depressing media clips or captivating Facebook posts) is often so captivating that you end up staying up much later or cannot fall asleep. For some people watching a relaxing TV show (e.g. comedy) before bed can help de-stress.
Turn the clock away from view. It will only add to your worry when constantly staring at it...2 a.m....3 a.m... 4:30 a.m...
Check your bedroom for electro-magnetic radiation. EMR comes from alarm clocks, electric blankets, cellphones, TVs, and computers. These can disrupt the pineal gland and the production of melatonin and serotonin.
Recognize that insomnia is a 24-hour issue:
What you do in the evenings/nighttime will affect your sleep, but health changes during the day can also significantly improve sleep at night:
Aim for routine. Try to go to bed and wake up at the same time every day as this helps balance hormone levels and helps establish your internal clock.
Get outside during the day, and aim to lower stress levels. Long work hours (especially if stressful or very intense) can upset your circadian rhythm and cause insomnia.
Eat 3 balanced meals, and make sure to include sufficient protein with your breakfast.
Be sure your dinner includes adequate slow-releasing carbs (e.g. cooked rice/quinoa, starchy veggies) and at least some good fats & quality protein. With such a complete meal, it is ideal to avoid snacking in the evenings. Your digestive system needs time to rest/heal during the night. Some people do best however with a light healthy snack before bed.
Avoid overeating and avoid foods that your body has trouble digesting (e.g. desserts after supper), particularly after supper and in the evening.
Avoid excess alcohol as it can cause nightweats and may keep you from falling into the deeper stages of sleep, where the body does most of its healing.
Avoid foods that you may be sensitive to:
Food intolerances may affect sleep by causing excess congestion (one cause of sleep apnea), gastrointestinal upset, and gas, among others.
If you are prone to indigestion at night, avoid eating before bed. Sugars and grains are especially important to avoid before bed as it can raise blood sugar and inhibit falling sleep. Blood sugar may then drop too low (hypoglycemia), causing you to wake up during the night.
Get to bed as early as possible:
Our bodily systems, particularly the adrenals (i.e. glands that pump out hormones in response to stress), do most of their recharging during the hours of 9 p.m. and midnight. In a physiological sense, the notion that ‘every hour of sleep before midnight is worth double’ is quite accurate.
As to what constitutes 'enough' sleep, it's different for everyone but eight hours appears to the norm. Some people require more than 8 hours, especially those who are already exhausted or those with demanding jobs. Ask yourself, what time would you go to bed, if there was no TV or computer in your home? Or if there was no electricity in your home? This time would likely be much earlier than your actual bedtime! Aiming for a 10 p.m. to 6:30 a.m. sleep is a good target.
Daily exercise improves sleep quality:
Just by slightly increasing your exercise level, you can help yourself get to sleep quicker at night and sleep more soundly. Intense exercise earlier in the day can be very favorable in helping your sleep. Avoid intense exercise in the late evening as this can have the opposite effect.
Mellow out for an hour or so before bedtime and save your worries for another time:
Worrying about bills, health, or loved ones before bed is not conducive to sleep. Rather, take an hour of quiet time before you try to sleep.
Taking a hot bath, shower or sauna before bed raises body temperature, which facilitates sleep. Alternatively, read or talk about pleasant things at bedtime. Try playing a soothing and relaxation CD before bed. If you feel stressed in the evenings, simply taking deep 10 slow, deep breaths can help reset your nervous system.
Take a nap if you feel sleepy:
Weekends are excellent opportunities. Parents should aim to lie down when their children do. Short naps during the day can shorten the lag time to enter deep sleep during the night. Set a limit of 20-30 minutes to avoid going into deeper phases of sleep that can leave you groggy.
Exercise caution in using it, and only as a last resort, as it is a powerful hormone (talk to your Naturopathic Doctor). Ideally it is best to increase levels naturally by adopting many of the guidelines described herein or adopting an alternative treatment that facilitates your own bodies production of melatonin.
Sleep in complete darkness, but get some sunlight during the day:
Exposure to sunlight in the daytime (along with full spectrum fluorescent bulbs in the winter) helps your sleep at night. First morning light exposures are especially important. Aiming for absolute complete darkness at night increases melatonin at night; one should get blackout drapes so no light is coming in from the outside during the night. If light hits the eyes at night, it disrupts the pineal glands production of melatonin. If you get up in the middle of the night, use as little light as possible.
Keep your bed for sleeping (...and the other thing):
Watching TV or doing work in bed can make it harder to relax.
Addressing the root cause(s) of insomnia and adopting the recommended sleep-promoting tips that suit you is paramount.
Choose whatever way works best for you.
Published by Dr. Gleixner on Wednesday June 24th, 2009 in Times & Transcript with updates in 2017.
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