Getting a Good Night’s Sleep, Part 1

Insomnia is a common problem suffered by millions of people that can have significant ramifications for health.  Because of this I’ll be writing a series of discussions about insomnia, its many possible causes and options for relief.  In future posts, I’ll continue to discuss some causes of insomnia that are often not considered especially from the Western medical perspective.  I’ll also go into more detail about how insomnia is viewed from the perspective of Chinese Medicine.
However, it’s worth noting that Chinese Medicine has always included sleep patterns as an indicator of overall health.  In fact, one of the “10 questions” that make up the system of Chinese Medical diagnosis includes detailed questioning about the quality of sleep.  Western medicine is also now seeing the connection between sleep quality and health.  Researchers have identified strong links between poor sleep and problems such as depression, heart disease, obesity, musculoskeletal pain, and diabetes, just to name a few.
For me, good sleep can be seen as one of four legs of a stool that provides a solid foundation out of which good health can be maintained or achieved; the other three being nutrition, physical activity, and management of environmental influences (these will be dealt with in other posts).   I don’t mean to imply that if the above is addressed, one will never get sick or that current health issues will magically disappear.  Rather, these four legs will permit the body to more fully access its own resources to remain healthy or feel better.  Strengthening these resources will help to protect the body from illness, and, in instances where illness is already present, allow a person to better cope with the illness or minimize its impact.
Treatment with acupuncture can significantly improve sleep, even for people with mild symptoms of sleep disturbance.  Regardless of the chief complaint, improved sleep seems to be a common secondary benefit of acupuncture.  This is most likely due to the fact that, from the perspective of Chinese Medicine, illness is seen as a pattern of inter-connected signs and symptoms, inseparable from the whole; change one element and a shift occurs in the entire system. Think of it like having a rock in your shoe.  To relieve the pain of the rock digging into your foot when you walk, you may put more weight on your other foot, which may result in pain in that foot.  There may also be back pain from walking unevenly, increased irritability leading to headaches, and, you guessed it . . . insomnia.  By removing the rock, several other related health issues may also resolve.
Insomnia can manifest in different ways, such as difficulty in falling asleep, difficulty in staying asleep, or waking too early without being fully rested; sometimes a combination of the three.  The causes of insomnia are not always clear, either since it may result from any number of factors that can include emotional distress, unknown physical issues, diet, or environmental influences.
One significant factor affecting sleep that is receiving attention these days is cortisol.  Cortisol is a hormone produced in the adrenal glands (those little glands sitting on top of the kidneys) and is often referred to as our stress hormone.  Besides its natural ebb and flow throughout the day and night, levels of cortisol also go up when we are under stress.  For good sleepers, cortisol will slowly decline throughout the day until it reaches its lowest point at bed time, allowing us to get to sleep easily.  Levels of cortisol will then slowly rise throughout the night in preparation for waking, and will spike rapidly just before we wake up to give us that final boost out of bed.  However, for poor sleepers, these levels may be too high in the evening, interrupting our ability to fall, or stay, asleep, and is most likely attributable to stress.
However, it’s important define what is meant by stress.  For most of us, when we talk about stress, we are referring to external circumstances that lead to a negative emotional response on our part (“My boss is stressing me out!”).  Remember learning about homeostasis in school? It described the way the body maintains balance or equilibrium.  For example, homeostasis is what allows us to maintain a stable body temperature even though we might be in a very hot or cold environment.
So while emotional stress certainly plays a part in affecting our cortisol levels, anything that may upset our equilibrium can also lead to stress and, therefore, impact cortisol levels.  Diet, activity level throughout the day, environmental triggers such as various pollutants, etc. can all lead to physical and emotional stress.  That’s why the topics of sleep can’t be completely separated from talking about the other three legs of the stool I mentioned above, and will make up the content of future posts.
But for the purposes of this discussion, I want to provide some simple tips that may improve sleep for those who are looking for some relief now.  Obviously, these may not be quick fixes, so give them time to work.  Additionally, for those who are suffering from long term severe insomnia, it’s essential that you speak with your doctor and discuss being seen by a sleep specialist in addition to anything suggested here.  You can also check out the National Sleep Foundation for more information about sleep clinics and other support services at http://www.sleepfoundation.org.
Here are some recommendations for a better night’s sleep:
  1. Make bedtime a routine. Develop a set of behaviors that prepares your mind and body for sleep, including maintaining a consistent bedtime every night.  Your body needs a chance to “power down” and variable sleep times adds stress to the body.
  2. Timing is also important. The best and deepest sleep occurs between 10pm and 2am.  Failing to reach this deep sleep may result in waking up after 2am, when sleep is more superficial.  It’s actually ideal to get to sleep before, or close to, 10pm.  Otherwise, you may “override” the sleep trigger and find it more difficult to get to sleep.
  3. Darkness is key. Melatonin, a hormone that regulates wakefulness and drowsiness is affected by light, which inhibits its release.  So any bedroom light could be sabotaging your sleep.  Make sure to block out as much light as possible.  Even a nightlight or LCD display on an alarm clock can have an effect.
  4. Avoid television and computers before bed. Television and computer screens use light from the blue end of the spectrum.  Blue light, like sunlight, is stimulating and will not promote sleep.  You can counteract some of this stimulating blue light by placing an orange light bulb in a lamp in your bedroom and turning it on about 20 minutes before bed.
  5. Avoid too many liquids before bed. Keeping hydrated is important, but downing large quantities of water before bed can result in repeated visits to the bathroom throughout the night.  Definitely avoid liquids such as caffeine, soda, and alcohol close to bed time.
  6. Minimize distractions. Try using a white noise machine, or even adding ear plugs to minimize noises that might wake you up or make it difficult to sleep.  The goal is not to completely cut off the outside world, but to mask those “jarring” noises that can snap you out of a sound sleep.
  7. Try a good foot soak. Grab a basin of warm (not hot) water.  Epsom salt is enough, but if you want, add some lavender oil or other soothing scent (avoid stimulating scents such as citrus).
  8. Think positive. This may sound corny, but as mentioned, stress increases cortisol levels.  If you are spending your evenings focused on the person that cut you off, or watching the latest disaster on the evening news sleep is not going come easily.  Rather, spend your time doing something you enjoy, meditating, or playing a board game.
  9. Manage your meal times. Trying to digest a large meal can make it difficult to sleep.  Eat your dinner earlier in the evening (by 6pm) and if you feel “snackish” before bed, have something light, preferably a good source of plant protein or good quality carbohydrate snacks, such as chia seeds or quinoa, which will keep you sated throughout the night.  Definitely avoid sugar, including high sugar fruits (like bananas).
  10. Be active during the day. Studies show that people who are more active during the day sleep better at night.
  11. Avoid Hot showers or vigorous activity. Hot water can be stimulating, so switch to tepid/warm water for that evening shower.  Don’t start a workout routine before bed either!
  12. Supplements may be an option. There are several natural products that are commonly used to help with sleep.  These include Melatonin, Valerian Root and L-tryptophan, all available in most health food stores.  Make sure to speak to a healthcare practitioner who understands these supplements and their effects, as they may not be recommended for certain people who have illnesses such as depression or for people on certain medications.  Also, because dosages can be challenging with supplements, a knowledgeable practitioner can work with you to get the best outcomes.

About Joseph Oppedisano, L.Ac.

Joe has earned his Masters of Acupuncture from an accredited college of Oriental Medicine and passed all national licensing exams to become a licensed acupuncturist in the State of New York.
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