Clinical Brief

When sleep is a nightmare, do this…

I was excited to talk about sleep because I’ve suffered from periods of insomnia and I know how frustrating it is to wake up day after day without an adequate dose of shut eye. I go to bed by 10:45 most nights, I don’t eat too late, it’s not due to coffee drinking, or alcohol consumption or medications. I don’t travel, I’m don’t fall asleep to a screen of any kind, and in general I keep a regular, boring schedule. All of those things can keep you from getting night’s sleep, but I’m talking about the inability to fall asleep because my brain won’t turn off. I am very interested in why some people are able to sleep and others have trouble with it.

Research has shown that sleep is one of the most important factors in maintaining our health. A lack of quality sleep causes depression, weight gain, confusion, irritability, inability to focus, poor immune function, decreased body temperature, increased risk of cardiovascular and digestive issues and many other problems. In one animal study, the lifespan of rats which is  usually 2-3 years, was reduced to a mere 5 weeks through REM deprivation.

What is sleep?

Now that we’ve established the importance of sleep, let’s look at what what is. Basically, sleep is a cyclical, lower level of consciousness that consumes roughly one third of our lives. So far research has shown us the the process looks something like this:  

When light hits the back of the retina it stimulates cells that convert photons (light particles) to electrical signals. These electrical signals then stimulate the Suprachiasmatic Nucleus or SCN to send a signal to the pineal gland telling it to increase the release of melatonin. Melatonin acts on cells of the SCN to induce a lower state of consciousness and induce sleep. In addition to propagating the electrical signal to the pineal gland and inducing a lower state of consciousness, the SCN works with adjacent structures in the hypothalamus to initiate anabolic biochemical processes that are important for restoration. Each cell in the SCN appears to be electrically active in a cyclical 25 hour pattern, despite the fact that we operate in a 24 hour circadian cycle. In addition to its direct effect on sleep, melatonin produces a number of effects on the immune system, the reproductive system and the mitochondria in the cells.

What happens during sleep?

It should be apparent the sleep cycle itself is part of a larger cyclical process called the circadian rhythm. The circadian rhythm consists of a wake cycle, in which catabolic chemical reactions dominate, and a sleep cycle in which anabolic processes dominate. Catabolism is the process of biochemical breakdown and oxidation. Anabolism is a biochemical process which results in rebuilding chemical structures which were broken down during catabolism.

The circadian processes direct of number of functions in the body through neurological and hormonal stimulation. Neurotransmitters are categorized as either stimulatory or inhibitory. The stimulatory neurotransmitters dominate during the waking hours and the inhibitory neurotransmitters dominate during sleep. In a similar pattern, hormones that stimulate catabolic processes dominate during the day and those that stimulate anabolic and healing processes dominate during sleep.

So let’s talk briefly about the sleep cycle itself. Sleep proceeds through 5 stages. Stages 1-4 are progressively deeper levels of sleep. During stage 1 sleep is light and our eyes move slowly and muscle activity slows. Theta waves dominate this stage. Stage 2 is a deeper sleep that results in slower brain waves, and reduced eye movement. Snoring happens most often during stage 2. During stage 3 slow delta waves dominate. Stage 4 sleep is associated exclusively with delta waves. Finally we come to REM sleep. REM stands for “rapid eye movement”.  In REM sleep our limbs are partially paralyzed, our eyes move rapidly, our heart rate, blood pressure and rate of respiration increases. REM sleep accounts for 20% of our sleep during the night and lasts about 2 hours in healthy individuals.  We are in stage 2 sleep about 50% of the time and the other stages 30% of the time. When REM sleep is finished we go back to Stage 1 sleep. Healthy individuals proceed through several cycles throughout the night.

Here are some important correlations to note:  Dopamine is closely associated with beta brain waves and dominates during the waking hours of the day helping us with focus and attention. Alpha brain waves are associated with the neurotransmitter Acetylcholine and are present and measurable when we have our eyes closed in activities like meditation and prayer.  GABA is dominant during relaxation and is associated with theta waves. Theta waves are present during progressive stages of sleep up to stage 3.

So why am I bringing this up? Well, we can’t sleep when neurotransmitters are out of balance. If the dopamine and serotonin systems are out of balance or a relative nutritional deficiency exists, we won’t sleep at night or be able to maintain vigilance during the day. If GABA is deficient, we won’t be able to relax when we try to sleep. Serotonin and GABA facilitate the neurochemical reactions that dominate the brain during sleep.  Acetylcholine, Dopamine and norepinephrine facilitate the chemical reactions that dominate during wakefulness. Along with these neurotransmitters, there are cofactors (and many other chemicals we are unaware of) that help facilitate in neurochemical reactions.

The nutrients and cofactors that are important for sleep include the B-vitamins, especially pyridoxine and niacin, zinc, vitamin C, methionine and cysteine, selenium, folate, adenosine and several of the amino acids.

So knowing what we do about circadian rhythms, and sleep cycles, how do we deal with problems associate with sleep? In my clinic I will briefly walk people through the things we’ve talked about above. A thorough history is critical in ruling out many the many causes of sleep problems. We always make sure to mention the concept of sleep hygiene which is basically the use of rules and routines around sleep time. They include but are not limited to:

  1. Relax if possible and no screen time within an hour of bedtime.
  2. No eating within 4 hours of bedtime.
  3. Drink water early in the day and don’t use within 3 hours of bedtime.
  4. Don’t get in bed unless you plan on sleeping or having sex.
  5. Limit or eliminate the use of coffee (or other stimulants) and alcohol if necessary.
  6. Go to bed at the same time each night. (Sundown to sunrise is best)
  7. Exercise if possible before early evening.
  8. Control room temperature.
  9. Keep your room as dark as possible and get up when the sun rises.
  10. Avoid simple carbohydrates and consume vegetables and complex carbohydrate if possible.

In addition to these tips, if insomnia and poor sleep are caused by chronic disease we have to deal with those issues. If poor sleep is due to dietary issues, we need to deal with diet. If these interventions do not fix the problem we assume that neurotransmitter dysfunction or hormone dysregulation are a possibility.  Women with hormone dysregulation, specifically relatively low progesterone, we deal with that.  If we suspect neurotransmitter dysfunction because of history and ruling out other causes, then we supplement with nutrients that help restore adequate function.  

  1. Eliminating the Top Causes of Insomnia – Neurotransmitter Deficiency and Cortisol Excess Julia Ross Townsend Letter Article
  2. Brain Basics – Understanding Sleep,
  3. The Human Suprachiasmatic Nucleus
  4. Srinivasan V1, Pandi-Perumal SR, Trahkt I, Spence DW, Poeggeler B, Hardeland R, Cardinali DP. Melatonin and melatonergic drugs on sleep: possible mechanisms of action.Int J Neurosci. 2009;119(6):821-46. doi: 10.1080/00207450802328607
  5. Braverman, Eric. The Edge Effect


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