In this post we are going to explore all things sleep and hopefully after reading this you will appreicate it more and get some more zzz.

What is sleep and why we do it?

Put simply, sleep is a natural physiological process that allows our bodies to rest, promote healing and repair, and replenish our energy for the day ahead. When we sleep, our body goes through different stages of sleep, each phase with its own purpose.

We have evolved to sleep but interestingly there is a theory that maybe we were in a sleep like state and evolved to have wakefulness. Because sleep leaves us in a very vulnerable position unable to defend ourselves, unable to gain resources such as food or reproduce - so you would think that from an evolution perspective we would have got rid of it. But it carries on in many animals so let’s look at sleep closer.

Sleep is when so much repair and regulation occurs. In fact in some stages of sleep our brains are 30% more active than in a wakeful state. They have even found sleep like state in earth worms (some of the oldest living creatures). So sleep has evolved and stuck around showing how important it is.

We spend roughly 1/3 of our lives asleep so it is something that we need to be conscious of. And if we spend 1/3 of our lives doing it, it must be important right?

Stages of Sleep

There are two main stages to sleep REM (rapid eye movement) and non-REM. Non-REM sleep is further broken down in to 4 stages (1-4).

The first stage of sleep is the lightest form of sleep, where our body is still semi-conscious and we can easily be woken up. This is often called Stage 1 sleep. As we progress through stages 2 and 3, our brains emit slow-wave patterns, our heart rate and breathing slow down, and our muscles relax. It is during these stages that our bodies experience recovery from the previous day's activities.

The final stage of sleep is called rapid eye movement sleep or REM. This stage of sleep is vital for cognitive functioning, but it also promotes memory, learning, and creativity. During REM, our brains become active, and our eyes move rapidly back and forth, hence the name.

NON-REM

Stage 1: Light sleep, characterized by slow eye movements and relaxed muscle tone.
Stage 2: A bit deeper, characterized by a decrease in heart rate, and a decrease in breathing.
Stages 3 and 4: The deepest stages of NREM sleep (also known as “slow-wave sleep” or “delta sleep”), in which the brain waves slow down even more, and breathing becomes very slow and steady. This is where a lot of the body repair and healing occurs.

REM

REM on the other hand, is a phase in the sleep cycle that is characterized by the rapid movement of the eyes. It is also called “paradoxical sleep” because many of the processes that are more active during the day have greater activity during REM sleep. This is when we dream and consolidate memories from the day. REM sleep is our emotional regulation- if you don’t get enough REM sleep you are more like to be emotionally volatile and suicidal. REM is when you lay down pathways from learning and helps you find new pathways to do with problems.

The irish proverb “ a good laugh and a long sleep are the two best cures for anything”.

You don’t just stay in one state for slow linearly and stay in a REM state. There is this battle between all the stages of sleep that cycles every 90mins. In the first half of the night get more non-REM sleep than REM in these 90min cycles. Then in the second half of the night we get more REM than non-REM. All stages are critical and you cannot do without one - sleep deprivation can be fatal.

Why Sleep is Important?

According to research, regular and adequate sleep plays a vast number of roles in the maintenance of our body while providing time for rejuvenation of the whole system. During this time, several actions and physiological activities take place in the body, including:

Repair and Healing
- Sleep is an important part of the body's self-healing process. While we are asleep, the body has the chance to repair the wear and tear suffered during the day.
Brain Function
- Sleep plays a key role in cognitive processes such as memory, attention, and decision-making. During sleep, the brain processes vast amounts of information gathered throughout the day.
Hormone Regulation
- Sleep also regulates hormone production, aids growth, and regulates appetite. The body's circadian clock also influences when hormones such as cortisol, melatonin, and growth hormone are released.
Improved mental health:
- Adequate sleep is essential for maintaining good mental health. It helps to regulate mood, reduce stress, and improve cognitive function. Lack of sleep can lead to anxiety, depression, and other mental health issues.
Enhanced physical health:
- Getting enough sleep is important for physical health as well. It helps to maintain a healthy weight, reduces the risk of chronic diseases such as diabetes and heart disease, and boosts the immune system. It is also when muscle repair and growth occurs.
Better productivity:
- When you get enough sleep, you are more alert and focused, and your memory and decision-making skills are improved. This leads to increased productivity and better performance in both work and personal life.
Improved relationships:
- Lack of sleep can lead to irritability and mood swings, which can negatively impact relationships with family, friends, and co-workers. Getting adequate sleep can improve communication, patience, and overall relationship satisfaction.

A solid night's sleep is essential for cell repair and rejuvenation, bolstering the immune system and aiding overall metabolism. It's no secret that poor sleep translates into poor work performance, disturbed moods, and depression.

All in all, we spend roughly one-third of our lives asleep, with good reason. Sleep deprivation can impair multiple body systems such as endocrine, cardiovascular, immune, and cognitive functions. Though many of us know this all too well, few of us have grasped just how significant undersleeping can be in our lives. Sleep is a natural state of rest that is essential for human well-being. It is a cyclical process that occurs periodically in humans and several other animals. There are two primary types of sleep: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep.

Neurotransmitters and sleep

Adenosine- major sleep molecule- improves quality of sleep and amount of sleep+ REM
Melatonin- regulates circadian rhythm
Serotonin- involved in sleep and precursor for melatonin ( tryptophan is procurer for serotonin).
GABA- inhibit neurotransmitter and makes everything quieter in the brain ( at least 30% lower levels of this in insomniacs)

What Body Systems does Sleep Improve?

Sleep is linked with the repair and healthy function of several body systems. It is essential for building immunity and is vital for cardiovascular health, metabolic, and emotional well-being.

What is normal sleep?

The CDC currently recommends a minimum of 7 hrs sleep
But for most adults 7-8hrs is adequate.
We know children require more sleep and as we age the amount of time we sleep becomes less.
According to the national sleep foundation - duration recommendations :
- 14-17 hours for newborns
- 12-15 hours for infants
- 11-14 hours for toddlers
- 10-13 hours for preschoolers
- 9-11 hours for school-aged children
- 8-10 hours for teenagers.
- 7-9 hours is recommended for young adults and adults
- 7-8 hours of sleep is recommended for older adults.

Anyone who says they sleep 5hrs and are “doing fine” is lying. They have accommodated to the new low normal and just don’t realise how much better they would function with more. It like your glass has frost over it and you don’t realise how har it is to see out of until you clean it.

We know this from the “day light saving experiment” and a number of other studies including those involving sleep apnoea correction.

Adolescents when given 1hr extra sleep by a later schools starting time in the US showed a reduction in car accidents by 70% (number 1 killer of adolescents before suicide).

Your brain is still developing until the age of 15years. A s child u are laying down the maps and highly connecting neurones until age 5. The in adolescent years is when the “pruning” and pathways are made more efficient. This process causes a change in sleep pattern in adolescent compared to children and adults. Where they go to sleep later and get up later.

What happens if we under sleep or don’t get quality sleep?

Reproduction/sex hormones

Young healthy males- when their sleep is reduced to 4-5hrs sleep for 3-4 consecutive nights - testosterone levels drop to those of men 10years their senior! And that impact not only sex drive but performance in a number of areas.
Same happens for women - women get decreased FSH that leads to mensural irregularities and difficulties with conception.

Blood glucose

Sleep helps us regulate blood glucose levels -with less than 6hrs sleep we get a 40% reduction in normal function & become pre-diabetic. To do this otherwise you would need to gain about 10kg of fat overnight to see that kind of effect on blood glucose. Thats how powerful sleeps affect is on blood glucose and metabolism.

Gene expression

A UK study, where people slept for six hours, showed it can dysregulate gene expression. A massive 712 genes were dysfunctioning from the reduced sleep. 50% of those genes were down regulated 50%, where up-regulated. Some of the down regulated genes were responsible for your immune function. Some that were up-regulated involved genes to do with metabolism, Reduced sleep turns up the production of the stress response in the body.

Cancer/Dementia/Alzheimers

In fact one night of poor sleep (for four hours) decreases immune anti-cancer cells response by 70% (NK cells). And with just one night of reduced sleep (4hrs) increased beta amyloid protein in the circulating blood and CSF (cerebro-spinal fluid). Beta amyloid is a key sticky protein that is linked to alzhemier’s and dementias.

Heart disease

Sleeping less than 6hrs a night regularly cause a 200x increased risk or heart disease and heart attack. And a 200-300x increased risk of coronary artery calcification.
Sleep decreased your heart rate, relaxes your blood vessels -think of it like the best blood pressure medication

Weight changes

When you under-sleep and workout your body - the body weight you are trying to loose will not be in the ratio you would like. Of the body weight lost 70% will come from lean muscle mass. The body when under-slept becomes stingy with fat. It will loose muscle as the preference for the fuel source and hold onto fat. Not only this but leptin and ghrelin signalling goes wrong. We end up with more gherlin and less leptin - which make you hungry and you don’t feel full - making it more likely you will overeat.

Mental health

There is not a single psychiatric condition where sleep is not affected. Even your addiction potential is higher if you are a sleep deprived person.
If you are sleep deprived you can develop psychosis and even die (when it is prolonged & continuous).

Why We Don’t Get Adequate Sleep

Several reasons can cause insufficient sleep: work schedules, electronic devices, stress, and medication.

First and foremost, the habit of electronic devices, such as phones and the internet, can also impede good sleep as it arises from their ability to emit an intense wavelength of light, which suppresses the secretion of the hormone melatonin and interferes with circadian rhythm.

What Can We Do to Improve Sleep?

There are several things that you can do to promote healthy and restful sleep, including:

Establish Regular Sleep Patterns:
- Give yourself time to get proper sleep. Prioritize a regular sleep schedule and commit to it.
Establish a Relaxing Sleep Environment:
- Ensure that your sleep zone is dark, cool, and quiet with comfortable mattresses and bedding.
Limit Electronic Usage at Bedtime:
- Immediately before sleep, limit exposure to intense light-emitting devices.
Support Natural Circadian Rhythms:
- Ensure that you have sufficient exposure to bright natural light each day.

Hormones and sleep

During sleep, a number of hormones are released that help regulate various physiological and behavioural processes in the body. Some of the key hormones involved in sleep regulation include:

Melatonin:
- Melatonin is a hormone secreted by the pineal gland that plays a critical role in regulating sleep-wake cycles. Melatonin levels increase in the evening as it gets darker outside, signaling to the brain that it's time to start winding down and preparing for sleep.
Growth hormone:
- Growth hormone is a hormone that is essential for growth and repair of the body's tissues. It is primarily released during deep sleep, particularly during the first few hours of the night.
Cortisol:
- Cortisol is a hormone released by the adrenal glands in response to stress. It follows a diurnal rhythm, with levels being highest in the morning and gradually decreasing throughout the day. However, disruptions to the sleep-wake cycle, such as night-shift work or insomnia, can disrupt this rhythm and lead to abnormal cortisol levels.
Leptin and ghrelin:
- Leptin and ghrelin are hormones that help regulate appetite and metabolism. Leptin levels tend to be higher in people who get adequate sleep, while ghrelin levels tend to be higher in people who are sleep-deprived. This can lead to increased cravings for sugary and high-fat foods, which can contribute to weight gain and other health problems.

Glymphatic System

The glymphatic system is a recently discovered waste clearance system in the brain that is responsible for removing harmful waste products from the brain, harmful proteins, heavy metals and other debris from the central nervous system (CNS), including the brain and spinal cord. It was first identified in 2012 by a team of scientists at the University of Rochester Medical Center.

The glymphatic system is made up of a network of microscopic channels that run through the brain, allowing cerebrospinal fluid (CSF) to flow through it. This fluid carries away waste products such as beta-amyloid, which is associated with Alzheimer's disease, and tau proteins, which are linked to other forms of dementia.

The glymphatic system works by using a combination of blood vessels and cerebrospinal fluid (CSF) to flush out waste products from the brain. The CSF is a clear, watery liquid that surrounds the brain and spinal cord, providing them with nutrients and cushioning them against shock. This system also has it’s own microbiome and immune system too. called the Glyo dependant lymphatic system. Glyo cells specifically astrocytes regulate the flow of water and lymph. The brain shrinks to about 60% of size at night. Lymph can then flow along arteries and this is how it gets into the brain.

The system works by pumping CSF through the brain at a high rate, which helps to flush out waste products from the interstitial spaces between brain cells. The waste products are then carried away by the blood vessels and eventually eliminated from the body. One of the key components of the glymphatic system is a protein called aquaporin-4, which is found in the cells that form the walls of the blood vessels in the brain. Aquaporin-4 helps to regulate the flow of CSF through the brain and into the interstitial spaces, allowing waste products to be removed efficiently. Astrocytes (immune cells) have N feet aquaporin -4 channels that regulates the flow of lymph and waste removal. As it flows along the brain it needs to exit brain- as we have a skull there would be too much pressure if the fluid stayed there. We don’t want pooling of lymph for this reason and because we don’t want the waste products it’s flushing to stay. We will get neurodegenration and disordered firing if this happens.

The glymphatic system works when we sleep, allowing CSF to flush through the brain at a faster rate than during waking hours. That's why it's important to get a good night's sleep to ensure that the glymphatic system can do its job effectively. During sleep, the brain undergoes a process called the glymphatic clearance cycle, during which the glymphatic system becomes much more active. This allows for more efficient removal of waste products from the brain, helping to prevent the buildup of harmful substances that can lead to neurological disorders. By removing waste products and other debris, it helps to protect the brain and spinal cord from damage and dysfunction, and may even play a role in preventing neurodegenerative diseases such as Alzheimer's and Parkinson’s.

The glymphatic system is also affected by lifestyle factors such as diet and exercise. A healthy diet that is rich in antioxidants and anti-inflammatory compounds can help to support the glymphatic system and improve brain health. Exercise has also been shown to increase the flow of CSF through the glymphatic system, promoting waste clearance.

If you have a history of strep -infections, viral etc in your tonsils -due to the proximity of this tissue to brain- there can be migrated immune cells to brain through the cryptocorn plate. This then causes microglial activation. There is a reservoir of pathogens in tonsils and tonsils help with lymph drainage- think of the tonsils as the “toilet of the brain”. Pans and pandas patients- sometimes need tonsillectomy’s to prevent chronic reinfection and spread of these pathogens.

A lot of heavy metals and certain infections love the brain issues such as lead, aluminium, mercury, & lyme disease. Lead is often stored in the bones and leaches out as we age r when women are breast feeding ( breast feeding is very energy intensive and pulls on all the bodies reserves including the calcium and nutrients stored in bones). Any structural damage to the brain such as TBI (traumatic brain injury) can also affect the flow of lymph with this system.

Animal sleep types - Chronotypes

Dr Michael Breus popularised the discussion of people sleep patterns based on animal chronotypes. There is a quiz online you can do to also tell which animal you are. This is intended to help you learn hoe to optimise activities during the day and what sleep timing may suit you best based on this.

Chinese medicine clock

With Chinese medicine different times of the day are linked to different body systems. This can be useful if you are feeling sleepy or getting symptoms at certain times of the day. Also if you are waking constantly at say 3am this could point that your liver needs more support with detoxification.

Sleep apnoea

If when you breathing is affected during sleep essentially causing a lack of oxygenation to reach your brain and this causes you to either wake up frequently from seep, mouth breath, snore etc. It is often linked with obesity and other ling conditions such as COPD.

Long term it has detrimental affects on your health by not having adequate oxygen supply to the brain. Sleep apnoea patients when given a CPAP machine (continuous positive airway pressure machine) to make sure they are getting oxygen into their lugs during sleep. A study showed a 50% compliance rate with the CPAP. Those on the CPAP and compliant pushed the onset of alzheimers back by 10-15yrs compared to the non-compliant group. If we don’t have enough oxygen and aren’t maintaining sleep we loose the capacity for neurogenesis when asleep.

What about naps?

Polyphasic sleep- or sleep with regular gaps such as awake for 4hrs and asleep for 2hrs has not been shown to be beneficial. We are not designed to sleep in this way it doesn’t allow us to get to deep sleep adequately or cycle properly into REM.

There is support for “siesta” style sleeping with a nap in the afternoon. Research that was done in Greece showed when they stopped this practice the incidence of heart attacks rose over the 5years it was in place and this law has since been revoked- to allow the practice to continue.

The trouble with having multiple little naps is it stops the “ sleep pressure” or tiredness building that will lead you to have quality and easy onset sleep later. Its like having a snack before dinner- you aren’t as hungry when dinner does around. We want to stop this so we can fall asleep easily. We need that build up of adenosine that makes us fee sleepy and to not release the pressure so to speak.

What can we do?

Sleep hygiene strategies

There are so many different resources out there for sleep hygiene such as black out curtains, eye masks, chilli pads to go on your mattress ( to keep core temperature low), weighted blankets etc.

The premise being we want it to be a cool, dark, quiet environment for sleep. We need a core body temperature drop of 1 degree Celsius and it seems 18 degrees Celsius is optimal for air temperature.

Sleep hygiene can also mean the routine at which you sleep. Having a set routine is key to train your body when it needs to get up and when it needs to rest and that can include things you like to do before hand to wind down into sleep.

Stimulus control

Exercise is a great way to ensure that you can wind down into sleep later in the day Those who regularly exercise have better sleep patterns and report less insomnia. So exercise isa way of controlling stimulation in the body.

But other stimulus control is avoiding tv, or screens late at night, because they keep your brain active and the light itself doesn’t let your body know that it's time to sleep.

Light restriction- we are a dark deprived society in this era- we need darkness in order to stimulate melatonin release. Don’t just stay away from blue light but the hour before bed dim the lights in the house as well.

But in the first half of the day we need sunlight at least 40mins of sunshine to slow down melatonin to make us feel more alert.

Sleep restriction

Try not to nap and try to stick to the same sleep and wake times. Even if you didn’t get a good night sleep try to still get up at the same time and not sleep in even on weekends.

Cognitive therapy/Relaxation techniques

Most insomnia is caused by anxiety. So anything that can help that racing mind settle and become in control of our thoughts will help us with sleep. Meditation is a great way to help us settle the mind and get the mind and body back in alignment.

Other considerations

If you feel groggy in the morning it might be that the lymphatic system isn’t cleaning properly and we may need binders for heavy metals if suspected (with melatonin). EMF have been shown to increase the excretion of melatonin (in urine) and disrupts our circadian rhythm.

Some people feel better improving the lymph drainage by raising the head of your bed. 5 degree angle or by cranial compression -rhythmic compression can do before bed before going to sleep.

There are also devices now that can track your sleep - but we don’t want to get obsessive there is now a condition call orthosomnia- where people become so obsessed about tracking and their sleep that affects their sleep giving them insomnia.

Diet considerations

Caffeine

Try not to have caffeine late in the day. Caffeine even if you are a fast metaboliser (process it quickly) it can decrease the amount of REM sleep you get even if you fall asleep easily. The Half- life of caffeine is 5-6hrs and it can decrease deep sleep quality by 20% . How do you know if you are a fast or slow metaboliser and have this polymorph? You can get testing however an easy way to know if when you have coffee do you feel wired and jittery even after 1 cup? Or can you have multiple and not feel much happen at all? If you are the jittery one you are more likely to be the slow metaboliser and if you don’t feel anytime the fast metaboliser. It just means your liver process it differently. The caveat being that you haven’t having excessive caffeine here.

Alcohol

Alcohol increases the frequency you wake at night. As you detoxify the alcohol it causes a “rubber band” reflect that causes you to awaken. Thus is because it stimulate stress hormones to be release or the SNS system. Alcohol itself is a depressant/sedative but doesn’t match normal sleep brain waves. So the idea of a “night cap” may not be being you get the quality sleep you are looking for even though it does sedate you.

Protein

Amino acids are good to have before bed (cysteine and adenosine) assist with sleep.

Banana contains tryptophan (see pathway above) and this is why the old recommendation of say warm milk ( ie protein) before bed was said to assist.

Other high tryptophan foods are:

Banana, turkey, fish, eggs, seeds, meat, seafood, kiwi fruit, yogurt, milk, legumes

Sugar

We want more stable blood glucose levels and not give ourselves a “spike” before bed- as this can be stimulatory and stimulate stress hormone release. Sugar is a stimulant If the blood glucose levels go too low we can get rebound hyperglycaemia during the night again it can cause stress hormone release.

Meal timing

Having a large meal late at night can also affect sleep so we want to have a lighter meal or not eat too close to bed time.

Melatonin rich foods

Melatonin is important to help us feel sleep and get to sleep and stay asleep.

Melatonin rich foods include:

Corn, rice, wheat, barley, oats, olives, tomatoes, dairy, walnuts.

Essential fatty acids

Essential fatty acids- eicosanoid is required for sleep and neural membrane function. The pineal gland is high in poly-unsaturated fatty acids especially arachadoinic acid and DHA. If the ratio between omega 3 and 6 is out it can also affect sleep.

Gut health

We want a heathy working gut as the majority of our serotonin is made in the gut- serotonin ( see picture above is the precursor for melatonin. So if you have gut issues it can affect your sleep for this reason ie the microbiome is out of balance.

Supplments/herbs

Melatonin

Regulates the timing of your sleep & helps you fall asleep, but it doesn’t help as much in the quantity or quality of your sleep. It is great short term but we don’t want to give excess melatonin to the body all the time. otherwise your body will shut down the natural melatonin production. Melatonin at 0.3mg-5mg can be used but over 5mg is not going to give additional benefits.

Tryptophan

Tryptophan -5-HTP is a precursor for serotonin and thus melatonin. 200mg at 9pm and 400mg at 11 pm in a small study showed an increase in REM sleep.

Magnesium/ B vitamins/Zinc/ essential fatty acid

Cofactors for a number of reactions for sleep and neural signalling.

Collagen

Of note- some people feel after taking collagen/gelatin find that their sleep can be affected.

Herbal remedies

Herbal sedative/hypnotics are much more gentle than pharmaceuticals ones. They don’t seem to have the “hangover” or “knock out “ effect that pharmaceuticals demonstrate. They also take about 2 weeks to see affect but some people report noticing improvement straight away.

Hypnotics induce drowsiness/sleep
Sedatives decrease nervous system activity and nervous tension
But other herbal products such as nervines, anxiolytics, adaptogens, analgesics are also useful for sleep.

Hypnotics like: Valerian, Hops and Chaste tree -improve sleep by modulating the circadian rhythm.

Whereas the reduce excitability/tension:

Sedatives- California poppy, Zizyphus, Valerian, Vervain, Passionflower, Hops
Anxiolytics- Passionflower, Lavender, Kava
Nervines- St Johns Wort, Oats, Skullcap, Damiana

Improving stress response: