The first domino to tumble in the insidious fall from the graces of good health is often the consistent lack of deep restorative sleep. Insomnia is one of the most common complaints I hear in my practice. If left unchecked, sleep difficulties inevitably begin a negative spiral down a path of increasingly severe health problems. Insomnia begets fatigue, weight gain, irritability, ADD, depression, brain fog, fibromyalgia, cognitive impairment, memory loss, impaired judgment, hallucinations, impaired immune function, increased type 2 diabetes, increased risk of heart disease, tremors, and many more serious health problems. Likewise, it is unusual to find a patient suffering from conditions such as fatigue or fibromyalgia who also don’t also experience a chronic lack of quality sleep.
As an ER doctor for 20 years I worked more than my share of night shifts, and I have paid my insomnia dues first-hand ever since. Bless the men and women who staff our hospitals, nursing homes, factories, and other shift work enterprises, who are going to work for their long night’s work just as we are climbing into our cozy beds for a good night’s sleep. Back during my night shift days, I must have heard it a thousand times, “Jim you look tired today.” Duh! I had a right to be tired; I had been up all night. Day shift people just don’t understand night shift people, and visa versa. Finally, after many years in denial, I realized that I was slowly taking years off my life by cheating my body of mother nature’s most potent medicine: a good night’s sleep. Shortly thereafter, I weaned my self out of the ER, into a “wellness medicine” practice, and into a wellness lifestyle. More and more, I try to practice what I preach, and now I sleep in my own bed every night. Just like an ex-smoker who becomes overly indignant about those around him who light up, I have since become a crusader for a night of deep restorative sleep.
When a patient comes in with fatigue, brain fog, or many of the other conditions of chronic disease, one of the first questions I ask them is “how are you sleeping?” More often than not the patient’s response will reflect problems with chronic insomnia. The patterns can vary. Sometimes it is difficulty getting to sleep. Many others get to sleep just fine, only to awaken at 2:00 in the morning. Often they can’t get back to sleep, which makes for a long and fatigued day at work the next day. Occasionally, I’ll find that a patient may get to sleep and sleep through the night, but may never wake up feeling rested and refreshed. Each of these patterns represents their own diagnostic challenges and therapeutic approaches.
Why do we sleep? In our busy lives, it seems like a total waste of time. We spend about a third of our lives sleeping! That adds up to about 25 years in the sack conked out. How the need for sleep evolved over time remains a hot topic of research. However, we do know this much: sleep is absolutely necessary for physical, mental, and emotional health, and even for life itself.
In the old days, sleep patterns were matched with the circadian rhythms of the earth. The sun went down, and it got dark. This triggered our melatonin to go up and our cortisol levels to go down, and thus we became sleepy. However, the electric light bulb changed the paradigm. With artificial electric light, we control our day and night light. Our eyes, brains, and bodies can’t distinguish between daylight and electric night light. Many people have totally lost touch with the rhythms of nature. Studies show that these people have more depression, more ADD, more heart attacks, more illness in general, and they die younger.
Sleep labs to the rescue! Sleep medicine has mushroomed in the past decade. Everybody’s trying to get in the game. Sleep labs are popping up all over the country. However, in my humble experience, many sleep labs have become a laundering service for the sellers of C-pap machines. Certainly sleep apnea is an important part of the equation. Without a doubt, it is under-diagnosed and undertreated. Many patients do get excellent relief from C-pap therapy. I’ve known some who claim that it has saved their life. However, it represents only a small part of the overall insomnia problem. The sleep labs often leave many important questions unanswered.
The beginning of the road back to restorative sleep begins with the understanding and practice of “sleep hygiene.” Contrary to implications from the word “hygiene” this has nothing to do with cleaning up anything. Instead it involves the consistent practice of setting the conditions optimally for a good night’s sleep. I like to tell my patients to take a “mini-vacation” before bed. Turn off the TV, and the computer. Turn on some “white noise” like a fan. Turn the lights down a bit. Do things that you find relaxing, such as reading a book. Better yet, read one of my old articles. That’s bound to put you right to sleep!
As I consider therapy, when possible I like to figure out the cause of the problem. That way I can treat the root cause. With proper testing, I often find that imbalances in estrogen, progesterone, cortisol, thyroid, and neurotransmitters are the culprit. Similarly, low melatonin, or elevated cortisol levels at night may contribute to the problem. Correcting the root cause can bring about dramatic relief in some patients.
Sometimes we must resort to empirical treatments. Finding the right sleep medication is like trying on shoes. The shoes that fit Cinderella did not fit her sisters at all. Similarly, the very supplement that helps one patient “sleep like a baby” may cause the next patient to stay up all night. I prefer to try natural supplements, such as melatonin, valerian, 5HTP, GABA, and other herbal remedies first. I find that about 75% of my patients respond well to these remedies. If these supplements are not working, then I may resort to sleep medications. In this case however, patients and providers must be careful not to choose a medication that promotes sleep, but never allows the patient to get into a Stage 4 REM deep restorative sleep.
A final category of potentially helpful therapeutic measures includes such modalities as acupuncture, hypnosis, neurofeedback, biofeedback, and CES (cranial electrical stimulation). I have found these therapies to be quite helpful for some patients.
In summary, sleep is a vital aspect of your foundation of wellness. If you are not getting a deep restorative sleep, it will eventually take its toll on your health. Work with your health care provider, and at the end of the day, adopt a “whatever it takes” policy toward getting a good night’s sleep. You cannot achieve true wellness, without getting a consistently good restorative sleep.