Sleep and Your Health
Jacques: Welcome to the Clinician’s Corner from Natural Horizons Wellness Centers, a weekly podcast focused on integrative medicine, healing, nutrition, and exercise. I’m your host, Jacques de Broekert, and I’m here to help you learn new ways to improve your life as we explore treatments and therapies that will lead to a healthier you. Today, here we’ve got Dr. Lucky Bennett again and we are going to talk about sleep. Sleep is a very important part of health, isn’t it?
Dr. Bennett: Absolutely.
Jacques: So I’ve got my perspective on sleep as a mental health therapist and what it means to people. What’s your take on sleep?
Dr. Bennett: My take on sleep is that we don’t do enough to protect our sleep, generally speaking, in this society. We make sleep one of our lowest priorities in many cases and it has a really profound impact on people’s health, physical and mental.
Jacques: Yeah. You know, from a health perspective, from a mental health perspective it’s kind of low on the totem pole because it’s not productive, and that’s kind of what I think we kind of all see it as, is not productive. So perhaps it does take a back seat to everything else. You know, there are a lot of different reasons people don’t sleep. I mean we’ve got, you know, from a therapist’s standpoint, anxiety is one of the bigger ones; the racing thoughts and I didn’t complete my day and I’ve got to get more done, those kind of things. From a naturopathic standpoint I don’t know. What do you see as some of the causes for lack of sleep?
Dr. Bennett: You know, in terms of some of the causes I see them being more often than not, lifestyle driven. So for example, people are staying up way too late. They’re doing way too much stuff in the late hours of the evening and early hours of the night, and that’s disruptive to sleep.
Jacques: We’ve got a lot of reasons for that. I mean television and I mean I was looking at the television the other night and thinking God, there’s like 150 channels I can choose from. Distractions like that; it’s not just reading or chores.
Dr. Bennett: Absolutely. And you’re right, television is a distraction; and our phones and computers and e-readers, although e-readers are better than things like computers and television which produce a lot of very bright light that has an impact on the brain’s production of melatonin. And in terms of giving the body a signal that it’s time for sleep, televisions, computers, anything with a bright little screen on it is going disrupt that signal to the body.
Jacques: So just that light alone can trigger that response.
Dr. Bennett: Absolutely, yeah.
Jacques: Yeah, wow. So to get to the idea of anxiety I think, you know, from when I’m treating people, anxiety is a big driver of racing thoughts, things that interfere with that. And there are a lot of mental health disorders that can be associated with that. You’ve got hypomania, things like that that can [it’s starting, I hate that, cyclothymia, hypomania—trying to come up with the names of these things. Three, two, one.]
From a mental health standpoint there are a lot of reasons that people can have interrupted sleep patterns. I mean we look at hypomania, cyclothymia, different mental disorders that are diagnosable, that are treatable with everything from lithium to any anxiety medications. But aside from that just your average person who doesn’t have that. Mild anxiety can be a real, a real problem as well; and that exposure to light, getting that trigger that, you know, the hormone releases that are deviating away from.
Dr. Bennett: So when you see people who are dealing with anxiety and that’s impacting their sleep do you address that from like a behavioral modification?
Jacques: Sure. And, you know, I’ll bet it’s probably some of the same suggestions you make for people. But simple things like bedtime ritual, is what I call it, and a lot of people who have anxiety they deviate from that bedtime ritual. One of the big offenders is a television or some other type of electronic device, like a computer or television in the bedroom. And so I talk to people about removing the offenders out of their bedroom. The bedroom is called a bed room, which should have a bed in a room, and that’s about it. So I don’t mind people reading at night, but that’s about it. Because the television is—it takes over; it’s a very passive thing and it starts to take over.
It also is a mask for racing thoughts which is a typical thing you see in anxiety. So they’ll be watching television because there’s sound and there’s sight so then they don’t have to think about the fact that they’re having racing thoughts. But all the while in the back of their mind they’re still going over the list of things they didn’t do that day. So there are some behavioral things and we could talk a little bit more about that. But I’m sure that you’ve got some other things that you also typically work with people on besides the behavioral part.
Dr. Bennett: Absolutely. I work really hard to get people to go to bed and wake up at the same time every day. If you have to be awake for work at 4:30 or 5:00 in the morning and you’re going to bed the night before at 9 or 9:30 Monday through Friday, and then Saturday and Sunday you’re staying up until 2 or 3:00 in the morning, or even just, you know, 10 or 11, that’s a pretty big difference from your normal…
Jacques: Or the other end of it where they’re sleeping in, because now they’re sleep deprived and they’re going to try to make up for it, and you can’t do it that way, can you?
Dr. Bennett: No. It is absolutely your best bet to go to bed and wake up at the same time every single day, regardless of whether or not you have to be at work or whatever your commitments are. And so really guarding that period of time when you need to be asleep, you know, when you need to be asleep.
Jacques: It’s really funny too because you have children and I have children. It’s really funny when we have children and—your child is not old enough to have gone through this but I have had a couple that are—it’s really funny as parents we say okay, it’s bedtime, it’s 8:30. And we tell them, you know, and we try to get that consistency because what happens when you don’t—total chaos. You have total chaos in your house if that child is up until 9:30 and they normally go to bed at 8:30 you’ve got a crabby, screaming kid that night or the next day. But yet as adults we don’t follow that same process. It’s just, it’s really bizarre, you know?
Dr. Bennett: Yeah. We have a little bit better ability to control our impulses so when we’re overtired we don’t necessarily act out in the same way that children and babies do. We still are overtired; we still have that same effect. You know, it decreases our ability to speak well. It decreases our ability to think well, to multi-task; to do things like drive our car safely. I was reading somewhere that for every hour you’re missing sleep that’s like having a glass of wine or a bottle of beer and hitting the road.
Jacques: The National Highway Safety Council did a study, it was about a year ago, and they were doing it on truck drivers to see the effects of sleep deprivation; and they’re trying to make sure the truck drivers are enforcing the requirement that they don’t drive over 10 or 12 hours in a day, I think. And yeah, the effects of sleep deprivation were the equivalent of drinking, incognizant of psychomotor skills. Yeah, shocking.
Dr. Bennett: Yeah. So, you know if you would not get behind the wheel after having an alcoholic, after having had an alcoholic beverage, think twice about getting behind the wheel if you’re sleep deprived. It’s a big deal. The other areas where I see lack of sleep playing a big role is in weight gain or inability to lose weight. When our sleep cycles are disrupted it affects the balance of cortizol and growth hormone in the body so our tissues don’t have a chance to repair.
Jacques: When we, when we’re not sleeping we have a lot of hormonal issues that kind of start to kick in. It’s that survival thing that goes on in the body and so we do have that fat retention and the breakdown of tissue in the body that occurs because of that; correct, right?
Dr. Bennett: Absolutely. Another area where I see it having an effect is in women’s hormone cycle and their reproductive hormone. And I’ve seen correcting sleep patterns regulates irregular cycles in a matter of a month or two, doing nothing else, just looking at sleep.
Jacques: Going back to a regular sleep pattern.
Dr. Bennett: Yeah. And it’s pretty impressive when that happens and that’s actually been well documented in animal models as well, and it’s something that they use in breeding programs in zoos. It’s not, you know, this isn’t anything new; it’s just we’re not applying it to ourselves.
Jacques: With sleep patterns I would look at as I’m listening to somebody tell me about their lives in my therapy practice, they’re having problems with relationships, they can’t—they’re not doing well at work. And they don’t have any of the other issues but they are definitely sleep-deprived or they’ve got sleep apnea. Trying to get them to engage in a regular sleeping pattern is one thing, but I mean what’s your perspective on how long it takes to regain on that debt? It’s a sleep debt.
Dr. Bennett: It is a sleep debt.
Jacques: Can you do it in a night?
Dr. Bennett: No, absolutely not.
Jacques: Two nights, maybe three?
Dr. Bennett: No. And there is a little bit of debate about whether or not you can actually fully make up that sleep debt. But any step that you can take towards repaying that debt even a little bit is going to benefit you in the long run and in the short run. But it does take time to let your body fall back into those normal circadian rhythms, get used to that. And you’ll find generally, I see people really noticing a difference over the course of a month or two or three. And when we’re really able to address the reasons why they’re either not falling asleep or they’re waking up in the middle of the night then it gets just that much easier for them to start to sleep regularly and sleep easily and sleep well.
Jacques: You said a month or two or three. So you’re talking about a month or two or three of regular sleep that they would need, whether it was eight or nine or ten hours.
Dr. Bennett: Well ideally, for the rest of their lives.
Jacques: Right. But I mean in the process of trying to regain some normalcy, it’s like months; we’re not talking days or weeks, hours or a little catnap here or there.
Dr. Bennett: Nope.
Jacques: Let’s talk about hypomania, for example. People who are hypomanic they almost seem like they’re on the verge of being out of control. They’re very productive, sometimes overly productive. They’re very easy, it’s very easy for them to improvise through things, quick thinking, a lot of creativity; the kind of things that you would see in manic or bipolar disorder. But it’s not, because they’re not quite as extreme as that so they can function very well in their normal lives. They do have racing thoughts but they also—they’re also being productive, whereas the person who is bipolar or is in a manic phase is not going to be productive. There’s just gibberish; you know, they’re not sleeping for three days and there’s just gibberish. They also tend to fall into the problems of not being able to sleep. So accurately, an accurate diagnosis from a mental health perspective is very important because medications can help. And we look at trying to stabilize those behaviors through things like lithium, the anti-anxiety medications which, of course, is not a natural kind of thing, but…
Dr. Bennett: But we have our approaches for that too. We’re getting different means to the same end.
Jacques: Right. And again, the key point there is to stabilize so they can kind of re-engage in that. Now aside from those issues you’ve got all kinds of things like relationship issues, you know. We are both parents of new infants. We’re not sleeping a whole lot.
Dr. Bennett: No, we are not.
Jacques: What’s the answer for that? I don’t have one. Do you have one?
Dr. Bennett: I don’t. I just have to believe in my heart of hearts that there is an inborn protection for new mothers to get through this period of sleep deprivation.
Jacques: But that’s not going to help me, I’m a new father.
Dr. Bennett: Sorry. But yeah, we are tired and I think part of having a young baby at home is starting to teach that baby how to sleep. That’s a learned skill and sometimes babies aren’t real happy about it so there are different approaches to doing that. But it’s just as important to teach them to sleep as it is to teach them that they need to be in their car seat when they’re in the car because that’s what’s best for them, it’s in their best interest. And you’re setting up really good habits for a lifetime.
Jacques: Yeah. There was some research done, the APA just published this last year, that showed that the mood of a mother at bedtime, the caring, the loving kind of nurturing environment that’s created by a mother at bedtime, is one of the larger predictors of sleeping through the night for a child. And we’re talking about, we’re not talking necessarily about newborns but infants, toddlers; and so the mood—and again, I’ll go back to the concept that I was talking about, the bedtime ritual, that you have a healthy bedtime ritual. And you used a very interesting term there, you said protect, protect your sleep. That study showed that if a mother is anxious or upset or there’s a lot of turmoil in the house at the time, bedtime, what those children learn to do is they learn to not sleep. It affects them in their teenage years because they pick that up as a habit, and it causes those anxious thoughts.
Dr. Bennett: That’s very interesting.
Jacques: I thought it was really kind of interesting, yeah.
Dr. Bennett: So these are my recommendations to help people start getting to sleep better. We already talked about going to bed and waking up at the same time every single day. We talked about turning off the TV, the computer, the iPad, the phone, the Blackberry, those bright sources of light. I like to see people in bed by 11 to 12:00 at the latest. And that has to do with the body’s normal levels of cortizol and growth hormone as they just normally fluctuate over a 24-hour period. When you’re up past 12:00 then those hormone levels start to get a little out of whack or a lot out of whack, and that leads to things like nighttime snacking. Cortizol in and of itself will contribute to holding onto weight around the middle, so when those hormone levels are disrupted because you’re up past when your body thinks you should be up, that’s problematic.
Jacques: You know, in one of the obesity journals they did a research piece about the types of foods people choose when they do that. We used to think oh a snack; I’m just going to get some chips or something like that. That actually is not something that’s a choice; you’re driven to do that. Carbohydrate eating is normally done at night. We used to think it was behavioral; it’s not. It’s the body is telling you to eat carbohydrates.
Dr. Bennett: And the reason that’s happening is because as we sleep our blood sugar is slowly falling, falling, falling, falling, falling. So we call breakfast, you know, breakfast is called breakfast because we’re breaking that fast, that overnight fast. So if you’re awake and you are aware, maybe not consciously you are, but your body is telling you that your blood sugar is falling, you’re driven to go to carbohydrate, to go to sugar, to get that readily available source of energy.
So one of the ways that I tell people to counteract that is to have a high protein snack right before bed, you know, 20, 30 minutes before they crawl into bed. That might be some plain yogurt if you tolerate dairy well; that might be a handful or almonds or walnuts; that might be a piece of chicken or fish or turkey. Just something that’s going to let their blood sugar stay stable a little while longer. Because one of the reasons people wake up in the middle of the night is that they’re hungry, their blood sugar is low. They don’t necessarily identify that as the reason that they’re awake because we don’t associate 2 or 3:00 in the morning with being hungry; they just know they’re awake and they’re not feeling great because they’re awake. So that can certainly help.
Also, sleeping in total darkness, I mean complete darkness; like if you open your eyes you shouldn’t be able to see your hand in front of your face. Sometimes that’s not easy to accomplish in your entire room so I’ll actually recommend that people sleep with a sleep mask over their eyes, or get a headband or a scarf to tie around their eyes so that there really is no light signal coming into the brain through the eyes.
So those are sort of my top shelf recommendations for helping people get back on track with good sleep.
Jacques: From my perspective I look at other things. Drinking alcohol, taking any kind of medications that you’ve missed the timing on that should be taken in the morning rather than at night. If you’re over-stimulated, if you’re watching a movie for example that is, you know, it’s one of those high drama kind of things, you’re getting yourself kind of revved up, you’re getting a little bit of that adrenalin release and that makes it hard to sleep. A little bit of light exercise before you go to bed is actually recommended.
Dr. Bennett: Yoga, stretching, walking, yeah.
Jacques: Right. Thirty, you know, an hour to 30 minutes or so before you go to bed can be good. Over-exercising before you go to bed is not going to help you, it’s just going to make it worse; but like I said, removing electronic devices. Our brain does not just go dead when we go to sleep. It’s still awake and alert. It goes into a process that allows us to shut down a lot of functions but that’s why alarm clocks work. The alarm clock goes off, we hear it, we wake up. Things like television can interfere with our ability to sleep. When we dream we’re not dreaming in the deepest part of sleep; we’re actually dreaming when we’re the closest to being awake. When you’re at that point you’re actually getting sound input and so you can—I don’t know if you’ve ever had this happen—but something’s on around you and you’re dreaming but you’re dreaming what you’re hearing.
Dr. Bennett: Gets incorporated, yeah.
Jacques: Right. Trying to figure out ways to shut off all that input is very important. You know, from a behavioral standpoint, being able to get yourself at a place where you’re not processing over and over and over repetitively what’s going on from that day or into the next day will help you relax and sleep. And you want to look for those triggers. And as a behaviorist what I try to help people identify are the triggers that cause lack of sleep.
Dr. Bennett: You raise a good question with that. It’s not something that I encounter frequently in my practice but certainly increased amounts of sleep, too much sleep, is a signal for things like depression, and that needs to be addressed as well.
Jacques: Yeah. And sleep can be linked to so many things. But I look, as a mental health professional, that’s one of the top two or three or four things I look at is what’s your sleep pattern. Are you sleeping? Are you sleeping too much or you’re not sleeping enough? Because it has a direct effect on behavior and cognitive abilities and your mood, different things like that. So too much sleep for me is a prime indicator of depression or anxiety, or something else that is going on. So are there any natural products that people could use to enhance their ability to fall asleep?
Dr. Bennett: There are. There are herbs like valerian. There are substances like melatonin. You can find sleepy time teas at most grocery stores and certainly at health food stores. And they’re all really useful tools. They’re not the solution. So I am comfortable with and often encourage people to utilize these tools while we’re working on correcting the behavioral issues around bedtime, around sleep, making sure that blood sugar issues are worked out and they’re turning off the television, etc. So they’re useful tools but they shouldn’t be the solution; they shouldn’t be the crutch.
Jacques: So there are some other things that you can use besides over-the-counter medications, things we’ve suggested previously. You had one suggestion, I think we were talking about earlier today, was about progressive medi—what was it?
Dr. Bennett: Progressive relaxation and guided meditation.
Jacques: Okay. Progressive relaxation, let’s talk about that one.
Dr. Bennett: Yeah. So progressive relaxation simply involves starting at your feet, clenching your feet, holding tension there for a few seconds and then let it go. Then you work up to your calves, you work up to your thighs, the buttocks, the abdominal muscles, the back muscles, the fists and the arms, and the shoulders, the neck, and then finally the face; just holding tension in these areas for a few seconds and consciously letting that tension go.
Jacques: In clinical terms we call it a somatic response when we have stress. So you have these somatic responses of tension. We don’t even realize we’re doing it, you know.
Dr. Bennett: Exactly.
Jacques: Some people do it in their stomach, some people in their back, some people in their head, they get headaches. And there’s different, you know, there’s a different response to it. So what you try to do then is to eliminate those, right?
Dr. Bennett: Yeah.
Jacques: Okay. And then the other one you named was…
Dr. Bennett: Guided meditation. And you can find lots of tracks on iTunes, you can go to the library; a lot of places like Borders or New Age stores, or health food stores even sometimes will have CDs that have tracks where basically a voice—and usually there’s music behind it as well—a voice guides you through the meditation that basically takes you into sleep. And it’s a very nice way again, of letting go of the tension, the stress that’s being held in the tissues of your body from the day so that you can transition into a more peaceful sleep.
Jacques: Sleep is very important to us. I think we underestimate the impact of lack of sleep in our society. We’re starting to see it more and more, but I think that it’s something we really should look at addressing if we want to look at our overall health. And the incidences of cardiovascular events, cancer, can really be connected to sleep deprivation.
Dr. Bennett: It’s huge in chronic disease, huge.
Jacques: Big problem, big problem. Especially for new parents when we’re suffering with our newborns. Hopefully, that will end soon for us both. But thanks for coming in and talking to us about this. We really enjoyed it.
Dr. Bennett: Absolutely. Protect your sleep.
Jacques: Protect that sleep.
Thanks for dropping by, Dr. Bennett, for another informative session here at the Clinician’s Corner, a weekly podcast that’s brought to you by the Natural Horizons Wellness Centers as an information source to improve your health and wellbeing. And if you have any questions about your health or health concerns that you may have, you can contact us at Natural Horizons Wellness Centers through our information on this podcast, or through our website at naturalhorizonswellnesscenters.com, and we look forward to you joining us again for the Clinician’s Corner.