How's Your Sleep?
Having trouble sleeping?
Insomnia is one of the most common sleep disorders, with as many as one in nine people suffering from it. Women seem to suffer at double the rate as men - and this number increases past the age of 45. True insomnia is an inability to fall asleep, stay asleep, waking up early that is occurring multiple nights a week for more than three months. It can impact how we feel during the day, and is not related to any other medical conditions or medications (which yes, can impact sleep too!). Some of us have trouble falling asleep, others with staying asleep, and some with going back to sleep if they wake up in the night. This experience is different than that of being sleep deprived - which is when we don’t give ourselves enough time for good sleep (at least 7-9 hours in bed)!
So, what systems help us sleep?
Often, when we think of insomnia or sleep issues, we think of our circadian rhythm and the hormone melatonin. Melatonin is degraded by light and helps our body signal to us when we should be more tired. This isn’t the only system that signals to our body to get sleepy. Our homeostatic system also uses a chemical called adenosine to signal to our body it’s time to sleep. Adenosine builds up over the day as we are awake - contributing to making us feel sleepy when we have been awake for a long time. The receptors for adenosine are blocked by caffeine (how coffee and tea work!!) promoting wakefulness. Finally, our central nervous system, which functions via the parasympathetic (rest and digest) and sympathetic nervous system (fight, flight or freeze) contributes to our ability to calm down and relax, drifting off into sleep.
What impacts my sleep?
Factors that impact poor sleep could be physical, psychological, medical, environmental. This includes aging! There is also a genetic component that contributes to some chronic insomnia, and external factors such as bright light, alcohol consumption, the temperature of the room, caffeine, and tobacco. A common trigger for chronic insomnia is often of an emotional nature. These could be concerns, worry, distress and anxiety. These can impact our ability to get to sleep via the central nervous system as well as an activation of the sympathetic nervous system. When our sympathetic nervous system is more dominant (as it is when we are emotionally distressed, worried or upset!) it impacts our bodies and sleep in four different ways.
It activates our threat response, which can raise our body temperature!
When we are in fight or flight, we have increased blood flow, heart rate, brain activation and metabolic rate, as our body is prepped to move or defend itself. We need a slight drop of core temperature in order to initiate sleep - the increased metabolic rate during fight or flight makes this harder!
2. Hormones elevate our cardiac activity!
Cortisol, adrenaline and noradrenaline are front line hormones when we are in a stress response. These three hormones raise our heart rate, and our cardiac activity. We need a calm cardiovascular system to be able to drift off to sleep!
3. Brain activity in emotional and memory regions are ramped UP.
Normally when we are falling asleep, the activity of our hippocampus (memory area of brain), the amygdala (emotional area of our brain) and basic alertness regions of our brain stems is reduced. When we are emotionally distressed, or having trouble sleeping, it has been found that we have a harder time disengaging from a patterns of worry and rumination. Many of us can related to this experience of finally laying down at the end of the day only to have a blank head that can focus on all of our worries and anxieties!
4. When we do fall asleep: the quality isn’t the same.
When we have recently been in fight or flight mode and finally do fall asleep the quality of sleep we get isn’t the same. The electrical impulses of our brain waves are shallower, and we have fragmented sleep cycles that are peppered by brief awakenings that we don’t remember. Often patients don’t function as well during the following day!
What can we do to support good quality sleep?
Sleep hygiene
Sleep hygiene is a term that refers to how conducive our environment and habits are for sleep. We should focus on keeping our room dark, cool, and quiet.
Keep your space dark, cool, and quiet
Using fans, black out curtains and covering up any lights in your space. Use your bed for sleeping and intimacy, not for television and working!
2. Limit screen use before bed
Aim to turn off screens about half an hour before bed (even more time would be better!). Try unwinding with a quiet activity such as reading, crafting, or stretching for this time before bed. Some of our patients use this time to do their skin care routine.
3. Limit caffeine and alcohol
Caffeine inhibits adenosine receptors (adenosine makes us feel sleepy!), and too much can inhibit our ability to fall asleep. Alcohol can also impair our sleep quality, in smaller doses it acts as a stimulant, in larger doses a depressant, and the sleep we get when we have drank alcohol is low quality as it impacts the time we spend in REM sleep.
4. Give yourself enough time
With so many competing priorities (work, social, hobbies, family, friends) sometimes we feel tired as a result of not giving ourselves enough time to rest. Ideally we want to go to bed, and wake up at the same time every day, giving ourselves at least 7-9 hours of sleeping opportunity in our bed!
Manage stress
Managing our stress by practicing habits that encourage the function of our parasympathetic nervous system, having a regular movement practice, participating in reflection exercises and working with professionals, can all help manage our stress.
Activating our parasympathetic nervous system
We can support our parasympathetic nervous system in a few different ways. Deep breathing techniques (such as focusing on taking a deep breath in, holding it for a few seconds and then releasing it, activates our parasympathetic nervous system. Practicing yoga, seeking acupuncture or massage treatments, getting out in nature, reading a book or playing music, watching something funny, or meditation can all be ways that we promote the parasympathetic nervous system.
Movement
Physical activity can support our stress response in a few different ways. Aerobic (cardio) activity, impacts our neurotransmitters, and reduces cortisol and adrenaline levels. It can also encourage endorphins, which make us feel happy and relaxed. Physical activity can also serve as a “moving meditation” whether you are engaged in an exercise class, sport, walk, swim, bike or yoga class. It is specific time where we are focused on our activity, and not our schedules, phones, worries or other stress inducing thoughts.
Reflecting on how we spend our time
Sometimes chronic stress comes as a result of many factors - controllable or uncontrollable - in our lives. We often have patients reflect on activities in their week that are either draining, neutral or energizing to bring awareness to the areas that might be taking a toll. Completing a values and priorities exercise can help us understand what we really care about, and recognize the ways in which we honour those values and spend our time - or don’t. It can be helpful to see areas that we need to focus on more, or are already happily focusing on. While we can’t always make changes right away, understanding areas that drain us, while bringing our attention to what we can control, can help make our weeks feel lighter.
Work with a practitioner
Getting support from practitioners can be incredibly important to manage our stress. Psychotherapists, Nurse Practitioners, and Naturopathic Doctors can help us understand areas in which our thinking patterns, our daily activities, and our overall health may contribute to stress - or be a symptom of other health concerns.