As a therapist, I am CONSTANTLY asking my clients about their sleep because not many people understand the truly massive impact that sleep has on our overall well-being. It is the very first place I start with anyone who is dealing with mental health symptoms. Without this solid foundation, I don't think it's possible to truly regulate ourselves and make changes in our lives. This month I asked Dr. Shawn, DC, ATC, to share again his wisdom about how the physical impacts the mental (and vice versa).
Riddle me this.
We spend ⅓ of our life doing it.
We never regret having enough of it.
We feel great when we prioritize it and struggle when it takes a back seat.
It may also be the most significant modifiable variable across ALL health domains.
If you haven't guessed by now, I am talking about sleep. Sleep is often taken for granted, which is unfortunate because sleep may be our secret weapon against many of our most common mental and physical complaints.
Now don't get me wrong, sleep is a very complex, physiological process. Sleep requires a complex cascade of hormonal, environmental, and psychological steps to be effective. Sleep can be divided into four stages; N1, N2, N3, and REM. The stages get separated into REM and non-REM (nREM), which consist of N1, N2, and N3. nREM can go even further, which breaks down into deep sleep (N3) and light sleep (N1 & N2).
N1. The first stage of sleep. When we first lay down for bed, this is the transition between wakefulness and sleep.
N2. The second stage of sleep. This stage is where we spend most of our time during the night. This stage is called light sleep, and when we wake up in N2, we tend to be more alert and ready to go.
N3. The third stage of sleep, this stage is called deep sleep. During this stage, our body repairs itself, mainly in our muscles, bones, and tendons. If you have ever woken up from sleep or nap and found yourself wondering what year it was, you woke up during deep sleep.
REM. The final stage of sleep stands for rapid eye movement. During this stage of sleep, dreaming occurs, and this is when our brain and nervous system repair itself.
During the night, you will go through all of these stages. Depending on how long you sleep, you may enter these stages once or multiple times throughout the night. We start off the night in N1, this stage would last about 15 minutes in an ideal world. Next, we enter N2 for roughly 45 minutes. N3 then follows and lasts around 45 minutes as well. This process is considered one sleep cycle. If you add up the times for this process, it ends up being around 90 minutes. This process will then repeat itself once or twice more, bringing us to 4-4.5 hours of sleep during the night spent in deep sleep. During the last half of the night, we will enter N2, as usual, but instead of going into N3, we will now transition into REM sleep. This new cycle will then repeat itself once or twice more, adding up to an additional 4-4.5 hours getting us in the ballpark of the standard 8 hours most people should shoot for. So during an eight-hour night of sleep, you will have gone through five sleep cycles. 5% of your sleep time will have been in N1, 45% will be in N2, and 25% will be in both N3 and REM.
Now, let’s cover what sleep does. Every stage will have different effects on the body. N1 doesn’t do anything to the body; it is merely a transition stage. N2 is when the brain processes external information—this information processing starts the formation of memories. N3 finishes the formation of memories and is vital for repairing the body. Wound healing, protein synthesis, production of cytokines (to reduce inflammation), muscle, bone, and tendon growth occur during deep sleep. Lastly, REM sleep does for the brain what N3 does for the body. Emotional processing, memory consolidation (the storage/deletion of memories), neuroplasticity (formation of neural pathways), and repair all occur during REM sleep. If we lack REM sleep, this is where we see many of the mental symptoms associated with poor sleep. Brain fog, fatigue, difficulty concentrating, and poor memory are all associated with a lack of REM sleep.
Let's talk about how it affects you when you don't sleep enough. We need to get one thing straight first: you are going to have bad nights of sleep. Cognitive, physical, and emotional abilities do not become compromised after one night of rough sleep. Your ability to think, move, and feel should be just fine. You may feel like you have lower energy, have the urge to nap, and possibly some increased hunger cues, but you should not be experiencing symptoms that impact your overall ability to function.
Multiple nights of poor sleep, insomnia, or chronic sleep deprivation, is when we start to see problems arise. The brain and body struggle to repair themselves, and certain hormones (cortisol, melatonin, ghrelin, leptin) can become dysregulated. This impacts our mood fluctuations, we feel exhausted, have more hunger cravings, and it's harder to fall asleep, stay asleep, and feel rested in the morning. This storm can make us more susceptible to illness, injury, and a host of mental health disorders, including anxiety and depression. When this cycle begins to repeat itself night after night, illness, injury, and mental health disorders can become more difficult to manage and as a result make it harder to get the quality sleep that we need. It's like a snowball rolling downhill getting bigger and bigger with each inch it moves.
Improving sleep is one of the easiest, most straightforward, and most cost-effective lifestyle modifications you can do with the highest payoff. Sleep is more important for the quality and quantity of life than diet and exercise are. When talking with people about sleep, the first place I encourage people to start with is creating a consistent schedule. This is because of the circadian rhythm. This is essentially the internal clock within the body. It is responsible. for our sleep/wake, hunger, and hormonal signals. Sleep is an intricate process triggered by the release of certain hormones (melatonin) at certain times of the day. The release of your hormones in the evening is determined by the release of another hormone (cortisol) in the morning. This cycle is part of our circadian rhythm. Setting our internal clock is the first step to better sleep.
It is recommended to get about 8 hours of sleep every night, and the best place to start with a sleep schedule is the time we wake up. Your wake-up time should be a set time (for example 6:00 a.m.) that works best within your schedule 4-5 days per week. You can still sleep in on weekends, but to make the schedule effective, you need to be waking up at the same time more days than not in a week. When your wake-up time is determined, it's simple enough to count back 7.5 - 8 hours to find your bedtime window (10:00 p.m. - 10:30 p.m.). Your bedtime can have some wiggle room because of the variability of sleep cycles. You should start to see some improvement within the first week of implementing a consistent sleep schedule. If you want or have to stay up late on occasion, move your bedtime window by an hour and a half, or one sleep cycle, (11:30 p.m.-12:00 a.m.) while still trying to wake up at the same time as your predetermined wake time. We want to stay within our sleep cycles as best as possible because that is vital for waking up with energy.
Once you have your schedule set, the following tips will help you to fall asleep or stay asleep. Don't skip over setting a schedule and thinking jumping right to these will be effective. These tips only help when the foundation has a solid schedule.
Let’s start with tips for falling asleep.
The first one is winding down. Many people watch TV, look at their phones, or play video games at the end of their days. Popular media blames blue light for keeping us awake, but, in my opinion, this is not as bad as it appears. The reality is that these activities are stimulating for the brain and a stimulated brain will take a while to fall asleep. The wind-down period is meant to be a time before lying down when we don’t participate in stimulating activities. These activities can include reading a book, taking a hot shower, doing skincare routines, cleaning the kitchen, getting things ready for the next day, stretching, foam rolling, or whatever you can do to slow down your mind and body. There will be individual variance of course. Some people will need less wind-down time, and some will require more. Start with 10 minutes and add more time if you need it until finding the right fit for you.
Of course, we can't overlook the impact that nutrition and hydration can have on sleep.
What you eat before bed can affect your sleep, especially if you eat too close to bed. If your food isn’t digested, you have a higher chance of experiencing acid reflux during the night. Acid reflux can wake even the deepest sleepers. If possible, try not to eat 2 hours before your bedtime window. I'm sure it's also no surprise to anyone that alcohol and caffeine can also significantly impact sleep. Limit alcohol as best you can, and try to avoid caffeine 12 hours before bedtime (yes, 12 hours). Be conscious of your water (and other liquid) consumption as well. If you consume too much liquid right before bed, you must either wake up to relieve yourself or wet the bed. The choice is yours.
Lastly, we can manipulate light, sound, and temperature to prevent random events from waking us up. Blackout curtains or blinds will help to keep the room dark. White noise machines will drown out any extraneous sounds. A colder room (63-67 degrees) is more conducive to sleep than a warmer one. These measures will minimize outside interference from waking us up during sleep. Everyone has their own needs when it comes to sleep so take these tips as starting points and modify them to fit your needs.
Sleep is vital for our health. We spend ⅓ of our life doing it. The body would not devote that much time to something if it weren’t critical, yet so many people neglect it or overlook the substantial impact it has on our daily functioning. Let’s stop saying we will sleep when we are dead and start sleeping better today so we can enjoy the time we have before us.
To learn more from Dr. Shawn Halliday, DC, ATC you can find him on Facebook, Instagram, or connect with him via email at drhalliday@lifequestchiro.com
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