Sleeping Well in the Age of Stress

Bridget Cassidy Sep 25, 2018

It’s 3:00 a.m. and you’re wide awake.

In six hours you’re going to give the biggest presentation of your career. That is, after you get your kids out of bed, dressed, and off to school. Oh, right. You have to drop your husband at the airport. What else? You start your to-do list. Did you pay your water bill? What about the kids’ camp fees? Did you buy cereal yesterday?

Stop! If only you could nod off. You close your eyes, hoping that action in itself stops the wheels in your brain from turning. Suddenly, you hear a drip of water. Your tired mind turns toward the leaky bathroom faucet.

Drip.

Drip.

Pause. Wait for it.

Drip.

We’ve all been there right? It’s terrible. On the other hand, we know what a big night of sleep can do for you. Our energy levels reset, allowing us to invite new possibilities into our lives. There’s nothing like it, especially when you can get the big sleep every night.

Unfortunately, many of us are not getting enough sleep. The American Sleep Association estimates that as many as 70 million adults in the United States could suffer from some kind of sleep disorder that either shortens the duration of their sleep or makes them wake up unrested.

Sleep deprivation can have several different causes, including health conditions, lifestyle choices, and stress. Stress is a big one. There are now different treatment options based on scientific research available for various sleep disorders. Sleep hygiene, for instance, suggests establishing a bedtime routine and schedule, and adopting other good sleep habits could improve the incidence of sleep disorders like insomnia. Bear in mind, however, that sleep hygiene alone may not be enough to treat such conditions.

We Learned From The Best

We wanted to find out more about the world of sleep and how it regenerates our bodies, as well as the common causes of sleep deprivation and available treatment options. So we spoke to a leading expert in the field of sleep medicine.

Dr. Rohit Budhiraja is an assistant professor of medicine at Harvard Medical School, the director of Brigham and Women's Hospital's sleep clinic, and a faculty member in Division of Sleep and Circadian Disorders and Division of Pulmonary and Critical Care Medicine in Boston, MA.

Budhiraja’s main field of study is sleep apnea and other sleep-related breathing disorders. However, he was able to go over everything from how sleep helps regenerate the body and mind. He also explained how temperature, light, and calming (what he calls TLC) is so important to get a good night’s sleep. “On average, most people need seven or eight hours of sleep,” says Budhiraja.

Let us share what we learned with you, starting with the basics.

Tiger peacefully sleeping in snowfall (source)

What is Sleep?

Animals as small as the honeybee and as large as the blue whale fall asleep every day and perform noticeably better when well-rested. But what exactly causes us to feel sleepy and doze off? And how did most of the animal kingdom evolve the need for sleep in the first place?

Here’s the succinct definition of sleep taken from the Merriam-Webster Medical Dictionary, “...the natural periodic suspension of consciousness during which the powers of the body are restored.”

There is evidence that sleep was handed down to most animals from a common ancestor nearly 700 million years ago. According to a New York Times profile on a 2014 study, “our nightly slumbers evolved from the rise and fall of our tiny oceangoing ancestors, as they swam up to the surface of the sea at twilight and then sank in a sleepy fall through the night.”

There are many reasons why this adaptation evolved. For one, it’s possible that sleep is meant to keep animals inactive at times when they were unlikely to find food and when their predators were most active. Sleep also affords the benefit of repairing and restoring the body, which allows animals to avoid predators more effectively and find food in their waking hours. Take a look at honeybees, which perform a “waggle dance” to tell other bees where food can be found. When bees are sleep-deprived, their dance is not as precise, making it more difficult for other bees to follow their directions.

35.2% of adults 18 and older report sleeping less than 7 hours every night.
- Center for Disease Control (CDC)

“Some historians and researchers believe that, centuries ago, humans followed biphasic or polyphasic schedules,” says Budhiraja. Biphasic sleep is when someone sleeps two separate times during a 24-hour period whereas polyphasic sleep is when someone sleeps multiple times (more than twice) in a 24-hour period. “Industrial Revolution and artificial lighting may have forced people to adopt monophasic schedules.” He went on to clarify that there is little evidence to suggest a polyphasic schedule is a good idea. As for biphasic sleep, there are several countries and cultures which still practice an afternoon nap or ‘siesta’. 

How Sleep Works

While the exact mechanism for how sleep happens in humans is still unclear, the broad strokes are these: the hypothalamus generates the circadian rhythm—the inner clock that says we should sleep at night and be awake during the day—and triggers the release of melatonin, a compound that signals to our brain when we should be asleep.

Meanwhile, as our brain works hard during the day, another compound called adenosine is released by astrocytes. Adenosine accumulates in the brain and eventually reaches levels that trigger drowsiness. Melatonin and adenosine work together—and sometimes independently—to make us feel tired and crave sleep. When we’re asleep, adenosine levels decrease while melatonin stays high. When the circadian rhythm says it’s time to wake up, melatonin decreases and we become alert.

Why We Sleep

Memories

We know much more about why humans need sleep than other animals. One of the benefits humans get from sleep is the consolidation of memories. When we’re awake, we’re receiving sensory input from the things we see, hear, feel, and our brain forms connections between what is happening to us in real time and what we remember. According to Budhiraja, when we fall asleep our brains work on reclassifying the information we received during the day and cataloging our memories.

Much like a librarian takes the books in the return cart and places them in the correct shelf, the brain sorts through the events of the day and classifies the information into new areas. Not only does the brain place the information in the correct areas during sleep, it also removes unnecessary information by getting rid of those superfluous neural connections.

The woods are lovely, dark and deep, And I have promises to keep, But neither the woods nor those promises Are as important as some restorative sleep. - Dr. Budhiraja's variation on Robert Frost's poem

Restoration

Another reason we need sleep is to restore our bodies. “During sleep,” says Budhiraja, “our bodies relax and muscle tone decreases.” And when our muscles relax, the damaged tissue regenerates more efficiently. That’s why a good night’s sleep feels so good after an exhausting workout session.

Budhiraja goes on to explain that research points towards REM (rapid-eye-movement) sleep as the stage where much of the muscle recovery and memory consolidation happens. REM sleep—also called Stage R—is characterized by being the stage at which we dream. Typically, REM sleep happens 90 minutes after we first fall asleep.

First, we cycle through non-REM (NREM) stages of sleep—N1, N2, and N3—which bring us deeper and deeper into rest as our brain activity slows down. Once the REM stage is over, the cycle from stage N1 to stage R restarts, in a repetitive process that lasts approximately 90 minutes and happens multiple times per night.

“Your genes decide if you’re a 6-hour sleeper or a 9-hour sleeper,” says Budhiraja. Though doctors do recommend getting between 7 and 8 hours of sleep every night, there is no one-size-fits-all answer.

The body loses its rhythm without a fixed sleep and wake-up schedule.
-Dr. Rohit Budhiraja 

Common Sleep Disorders

Though there are dozens of sleep disorders, as listed by the third edition of the International Classification of Sleep Disorders (ICSD-3), below we will discuss the three most common sleep disorders: insomnia, sleep apnea, and restless leg syndrome.

Insomnia

An individual is said to suffer from insomnia if they have trouble falling asleep or staying asleep throughout the night, if they wake up too early in the morning, or if the sleep they have is non-restorative. Almost 60 million Americans suffer from insomnia every year.

While primary insomnia—that is, insomnia that doesn’t appear to be caused by another disorder—is a problem for many people, in most cases, it is caused by or appears alongside a wide range of conditions, such as depression, heart disease, diabetes, and chronic pain. 

Dr. Rohit Budhiraja with patient

Treatments for Insomnia Bad habits or poor lifestyle choices are some of the main causes of insomnia. Stress, no bedtime routine, irregular work schedules, and side effects from prescription medications can be the primary causes of this sleep disorder.

Sleep Hygiene is a collection of lifestyle changes that can improve sleep. These include: establishing a bedtime routine, eliminating the consumption of caffeine, alcohol, nicotine, and certain foods close to your bedtime, getting regular exercise and losing weight, limiting daytime nap times to 30 minutes, creating a welcoming sleep environment, and getting a lot of natural light during the day. 

If you continue to suffer from insomnia, other treatments include cognitive therapy such as light therapy or relaxation techniques. Finally, prescription or over-the-counter sleep medications can help you get to sleep but may also bring on other side effects.

One in three over 30 year olds have sleep apnea.

– Dr. Rohit Budhiraja

Sleep Apnea

Budhiraja then discussed sleep apnea. About one in three people over the age of 30 may have some degree of sleep apnea, with 13% of men and 6% of women having moderate to severe sleep-disordered breathing. “During an apnea episode, the muscles at the back of the throat and the tongue block the airway, causing the sleeper to stop breathing for seconds at a time,” says Budhiraja.

The Division of Sleep Medicine at Harvard Medical School reports obstructive sleep apnea, which is the most common type of sleep apnea, raises your heart rate and increases your blood pressure, putting stress on your heart.

One of the most notable symptoms of OSA is snoring. “It’s extremely rare for this condition to be fatal,”says Budhiraja. However, OSA is related to a host of other issues, such as high blood pressure, obesity, diabetes, heart attacks, stroke, increased traffic accidents, depression, anxiety, and, of course, insomnia. Treating sleep apnea, affirms Budhiraja, can alleviate the symptoms of depression and anxiety.

Treatments for OSA The treatments for mild cases of sleep apnea focus more on making lifestyle changes that may be interrupting your sleep. These include losing weight (if you are obese or overweight), exercising on a regular basis, reducing alcohol consumption (if not stopping altogether), and quitting smoking. Other suggested treatments include changing your sleep position and using a nasal decongestant or allergy medication. The most common treatment for severe OSA is continuous positive airway pressure (CPAP) therapy, prescribed by your physician. The CPAP machine facilitates the constant flow of air into your throat so your airway remains open while you sleep.

Restless Leg Syndrome

The third sleep disorder is Restless Leg Syndrome (RLS) that frequently disrupts sleep and affects 2-15% of the population. Sufferers describe an unpleasant and sometimes painful tingling or cramping sensation in the legs when resting or falling asleep at night. Moving the legs alleviates the symptoms but they quickly return when the movement stops.

The pain and discomfort often keeps people from sleeping at night. Researchers are still investigating what causes RLS, but there may be a link to iron deficiency, diabetes, high blood pressure, and ADHD, among other conditions. “Some types of antidepressants may also cause RLS,” says Budhiraja. 

Treatments for RLS 

Budhiraja recommends massaging your legs, taking a warm bath or shower, and doing light exercise and stretching to relieve the symptoms. More strenuous exercise, however, can worsen RLS symptoms and sleep quality, and should be avoided within 5-6 hours of bedtime. He also recommends making certain lifestyle changes including the elimination of caffeine, alcohol, and smoking cigarettes from your daily routine.

There are prescription medications available to treat RLS. One class of such medications are dopamine agonists that mimic the neurotransmitter, dopamine, in the brain. 

I Can't Sleep (source)

Sleep Deprivation in Adults

In 2014, the Centers of Disease Control and Prevention (CDC) classified sleep deprivation as an epidemic in the United States with more than 70 million adults currently suffering from the condition. That’s one third of the U.S. adult population.

Groups with the highest percentage of sleep deprivation are Native Hawaiians/Pacific Islanders at 46.3% and Blacks at 45.8% then Asians at 37.5%, Hispanics at 34.5%, and Whites at 33.4%.

- CDC

Sleep deprivation can affect all aspects of our lives, and some effects are much more serious than simply nodding off at work or being irritable. For one, there is evidence that losing sleep regularly is associated with chronic conditions like heart disease, diabetes, and high blood pressure.

According to the CDC, heart attack, coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease (COPD), cancer, arthritis, depression, chronic kidney disease, and diabetes occurrences were higher in U.S. adults who suffer from sleep deprivation or what CDC calls “Short Sleep Duration,” which is less than 7 hours of sleep per night.

Recently, John Hopkins published an infographic with four categories of effects of sleep deprivation. They are: weight, health, brain effects, and safety. For instance, did you know the risk of developing Type 2 diabetes is three times as high for those who are chronically sleep deprived?

Health & Weight

Some study findings show that lack of sleep doubled the risk of death from all causes including cardiovascular disease.

You are also more at risk for obesity due to the hormonal imbalance introduced by sleep deprivation. You crave sweet, salty, and starchy foods because you have higher levels of the hunger hormone ghrelin and lower levels of leptin, the appetite-control hormone. Sleep deprivation can also affect your brain. You have a 33% higher risk for dementia if you suffer from lack of sleep.

Safety

Sleeplessness is also connected to other severe consequences. It is estimated that drowsy driving causes 1,550 deaths and 40,000 injuries annually in the United States.

There is even evidence that sleep deprivation may make you less empathetic.

Lack of Sleep in Kids and Young Adults

The Little One is Tired

According to the Children’s Sleep Apnea Association, an estimated 1 to 4% of children suffer from sleep apnea, including kids between the ages of 2 and 8 years old. It is a common belief that children will eventually grow out of pediatric sleep disorders, but new evidence suggests that may not be the case. Studies have shown sleep apnea is linked to childhood obesity, attention-deficit hyperactivity disorder (ADHD), and cognitive functioning ability.

Some mommy bloggers made suggestions on how to establish and keep an ongoing bedtime routine with your youngsters. Most bloggers agree you should stick with a nightly schedule and sleep hygiene routine that includes taking a bath, brushing teeth, cleaning the bedroom, and dimming the lights.

We start our routine at 7:30 pm. I don’t like to rush them, so I try to get them to relax and wind down at least an hour before the desired bedtime...my kids take a bath or shower, have a snack (no chocolate or sweets!), brush their teeth, read, and then it’s time for me or Dad to tuck them in.
- Jeannette Kaplun, Mommy Blogger at Hispana Global and mother of two.

Sleepless in School

The recommended amount of sleep for high school and college students is 8-10 hours per night, with anything from 8½ (short sleep duration) to 11 hours considered appropriate. According to the CDC, nearly 69% of high school students sleep less than 8 hours a night, with an astounding 76.6% of seniors not getting enough sleep.

Additionally, up to 60% of college students do not get enough sleep on a regular basis.

Another study found that sleep-deprived students were more likely to engage in unhealthy behavior such as drinking, fast driving, and getting into physical fights. Sleep deprivation is also a good predictor of poor academic and athletic performance and drowsy driving.

College students who experienced even one additional night of poor sleep per week were more likely to drop a course (10%) and see a drop in their cumulative GPA (by 0.02). Sleep deprivation ranked the same if not higher than other factors that negatively affect academic success including binge drinking and drug use.

To get better sleep, it is recommended that high school and college students make the following changes:

• Set and stick to a bedtime routine and sleep schedule
  

• Practice sleep hygiene
  

• Create a peaceful sleep environment
  

• Eliminate caffeine three hours before bedtime
  

• Avoid using mobile devices, computer, or tv 1-2 hours before going to sleep
  

• Don’t go to bed hungry, instead eat a small snack
  

• Avoid working out right before bedtime
  

• Meditate or practice light yoga to relax
  

Other age groups affected by sleep loss include the elderly and people with certain diseases including Parkinson’s disease, Alzheimer’s disease, and dementia. Aging can affect our sleep patterns due to a number of factors including hormonal changes associated with aging and the increased likelihood of taking more medications and experiencing side effects. It is recommended that you work with your primary care physician to determine the best course of treatment.

Sleep graph (source)

Work Productivity Takes A Hit

The average U.S. worker loses 11 days of productivity per year due to insomnia. That’s $2,280 per year. The total loss is a whopping $63.2 billion per year. What this could mean for you is missing out on a promotion or a superior performance review.

Unfortunately, our corporate culture only contributes to this by promoting the idea that sleep is not a required commodity. In other words, we think sleep is a luxury saved for vacations and weekends, not something we need for proper health.

A few companies have begun to pay attention to the field of sleep medicine and recent research that has shown the negative effects of poor sleep on employee health, work productivity, and ballooning insurance costs. A recently Fatigue Cost Calculator developed by Brigham and Women’s Hospital for the National Safety Council can provide estimates of the cost of poor sleep health for an employer. Google, Goldman Sachs, and Johnson & Johnson, to name a few, are some of these companies.

At Google, for instance, sleep experts have been invited to the company's locations to share information with employees regarding sleep deprivation, jet lag, and the restorative power of deep sleep.

Light is the enemy of sleep.
- Dr. Budhiraja

More From The Best

Budhiraja says that sleep works to regenerate our bodies including our brains and our muscles. The brain progresses through different stages of sleep every 90 minutes or so: light sleep, deep sleep, and REM stage, which is the dream phase of sleep.

“During sleep, muscle tone goes down,” says Budhiraja. “Relaxation of muscle is even greater during the dream stage of sleep.” He explains that many areas of the brain also relax during the sleep and the rate of brain metabolism decreases, except in REM phase, where the brain activity and energy use may be even higher than when awake. REM and non-REM sleep may be responsible for different aspects of memory consolidation.

A Little TLC

Based on his research, Budhiraja recommends you make three lifestyle changes scientifically proven to improve your sleep. He calls it TLC or temperature, light, and calming your mind to get better sleep.

The cooler your body, the better sleep you can get.
-Dr. Budhiraja

First, there is temperature. When you go to sleep, you do not want your room too warm or too cold. The ideal room temperature to promote better sleep is between 65 and 70 degrees.

Light is another factor proven to affect sleep. If there is too much light in your bedroom, especially artificial light, it can stop the production of melatonin in your brain, the hormone related to sleep. “Light is the enemy of sleep,” says Budhiraja. Cellphones and other mobile devices are blue light sources and major disruptors of sleep. “Smartphones are shown to decrease sleep by up to half an hour.” Budhiraja suggests putting your phone down one to two hours before you go to bed.

Calming your mind completes the treatment trio and is also something we can control, although it may be difficult for some to do. Meditating or deep breathing before going to sleep has been found to decrease anxiety and depression. In fact, studies report meditation is associated with decreased activity in the default mode network or DMN, which is a part of the brain related to mind wandering and thinking about the self.  

Source: RNIB (source)

Finally, not having a regular sleep routine, i.e., going to bed at the same time each night, can throw off your sleep pattern. Our bodies naturally start increasing melatonin a few hours before our scheduled bedtime. If you keep changing that time, you can affect your body’s natural sleep hormone production.

Medication and Treatments

Holistic

Some popular holistic supplements include melatonin, valerian root, and herbal teas such as chamomile tea. According to Budhiraja, melatonin is likely the most studied sleep supplement. As a sleep hormone produced naturally in the body, it tells the brain when it’s time to fall asleep. The dosage is up for debate—over the counter pills are usually available in 1mg or 3mg or higher doses—starting at a lower dose and increasing the dose if needed is a good idea. Melatonin is considered to be a fairly well-tolerated sleep treatment; however, it is not a cure-all for sleep disorders and may only be effective for certain individuals. It is more likely to be effective in individuals who have delayed sleep phase syndrome- a condition in which people fall asleep late and wake up late. It can be also effective in preventing or treating jet lag.

Other alternative solutions include making the bedroom as dark as possible and/ or the addition of a white noise machine to your sleep routine. It is estimated that nearly 75% of Americans said that a quiet room is important to getting good sleep. Lastly, there is taking your grandmother’s age-old advice: drink a warm cup of milk before going to bed.

Cognitive behavioral therapy for insomnia (CBT-I) is a very effective therapy where a psychologist or another trained professional can help you identify and address your thoughts and behaviors that may be contributing to poor sleep. It even can be delivered through online programs.

Over-The-Counter

Over-the-counter medications include diphenhydramine (Benadryl, Aleve PM, etc.) or doxylamine succinate (Unisom). These sleep aids have side effects including drowsiness and leaving you feeling groggy the next day. Furthermore, the body can quickly develop tolerance to some of these medications.

Prescription Medication

Finally, there are prescription medications. According to Budhiraja, medications should generally be your last resort in seeking help to get better sleep, and if used, should usually be used over short-term. They can cause several side effects- drowsiness, dizziness, diarrhea, grogginess or feeling as if drugged. In addition, after taking some of these medicines, people may get up out of bed while not being fully awake and do an activity that they do not know they are doing- including driving. The next morning, they may not remember that they did anything during the night. “The body can also develop tolerance to these medications, requiring progressively increasing doses or more potent medicines,” he says.

Image: (source)

Before Turning Off the Lights

Most of us have faced a sleepless night or two in our lifetimes. We’ve laid awake and listened to a leaky faucet go drip, drip, drip into the wee hours of the night. Worse, we are one of the 70 million people in the United States who suffer from a lack of sleep or who have a sleep disorder.

We’re tired new parents, or college students cramming for an exam, or a software engineer who works 60 hours or more a week, or are getting older and are finding it harder to sleep.

Seventy million: that’s more than a third of the population across the nation.

Scientific studies have proven the health ramifications of sleep deprivation and what it does to our bodies, minds, and everyday lives. It is an epidemic that not only affects us as adults but is also affecting our nation’s kids.

We can take countermeasures to get more and better sleep, steps that have been proven to work by scientific studies. We can give ourselves some TLC to promote better sleep, which can, in turn, restore us to our full capacity. Because really, don’t we just want our best sleep every night, especially in this age of high stress? We want that great sleep where we wake up refreshed and ready to take on the day.

Co-Authors: Scott Smith, Community Editor, and Mayra Paris, Associate Editor

https://www.consumersadvocate.org/features/better-sleep-health-habit

Cannot sleep due to stress? Here is the cure

September 5, 2017

Science Daily/University of Tsukuba

Everyone empirically knows that stressful events certainly affect sound sleep. Scientists have found that the active component rich in sugarcane and other natural products may ameliorate stress and help having sound sleep.

In today's world ever-changing environment, demanding job works and socio-economic factors enforces sleep deprivation in human population. Sleep deprivation induces tremendous amount of stress, and stress itself is one of the major factors responsible for sleep loss or difficulty in falling into sleep. Currently available sleeping pills does not address stress component and often have severe side effects. Sleep loss is also associated with certain other diseases including obesity, cardiovascular diseases, depression, anxiety, mania deficits etc.

The research group led by Mahesh K. Kaushik and Yoshihiro Urade of the International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, found that octacosanol reduces stress and restores stress-affected sleep back to normal.

Octacosanol is abundantly present in various everyday foods such as sugarcane (thin whitish layer on surface), rice bran, wheat germ oil, bee wax etc. The crude extract is policosanol, where octacosanol is the major constituent. Policosanol and octacosanol have already been used in humans for various other medical conditions.

In the current study, authors made an advancement and investigated the effect of octacosanol on sleep regulation in mildly stressed mice by oral administration. Octacosanol reduced corticosterone level in blood plasma, which is a stress marker. The octacosanol-administered mice also showed normal sleep, which was previously disturbed due to stress. They therefore claim that the octacosanol mitigates stress in mice and restores stress-affected sleep to normal in mice. The sleep induced by octacosanol was similar to natural sleep and physiological in nature. However, authors also claimed that octacosanol does not affect sleep in normal animals. These results clearly demonstrated that octacosanol is an active compound that has potential to reduce stress and to increase sleep, and it could potentially be useful for the therapy of insomnia caused by stress. Octacosanol can be considered safe for human use as a therapy, because it is a food-based compound and believed to show no side effects.

Octacosanol/policosanol supplements are used by humans for functions such as lipid metabolism, cholesterol lowering or to provide strength. However, well-planned clinical studies need to be carried out to confirm its effect on humans for its stress-mitigation and sleep-inducing potentials. "Future studies include the identification of target brain area of octacosanol, its BBB permeability, and the mechanism via which octacosanol lowers stress," Kaushik says.

https://www.sciencedaily.com/releases/2017/09/170905111357.htm