Four Underlying Factors for Quality Sleep

We all know how important sleep is. It plays a central role in our health, emotional well-being and performance at work or school. Yet so many people experience occasional sleeplessness. Did you know that 43% of adults report that stress has caused them to lose sleep in the last month, more than one third of adults use medication or other aids to help with sleep, and the productivity losses of fatigued workers adds up to about $136 billion?^{1, 2, 3} Here are a few of the underlying causes of occasional sleeplessness:

1. Circadian Rhythm
2. Glycemic Regulation
3. Stress
4. Sleep Hygiene

Circadian Rhythm

Circadian rhythms are daily cycles that regulate everything from our body temperature to hormone levels. They’re primarily controlled by the suprachiasmatic nucleus (SCN) in the hypothalamus. The SCN is a tiny region of nerve cells that uses light information from the retina to synchronize internal clocks with the outside world. This helps us sleep when it’s dark and wake when it’s light.⁴ The SCN has two main clocks: a central one that controls sleep and wake cycles, and an external one that’s synchronized with the environment. These two clocks work together to help us fall asleep at night, stay asleep during the night and wake up in the morning. When circadian rhythms are disrupted, it can have serious effects on our health.⁵ Shift workers and jet lag are two common examples of this phenomenon.⁶

Glycemic Regulation

Glycemic fluctuations can significantly impact falling asleep and staying asleep throughout the night.⁷ Blood sugar fluctuations can lead to waking up at night due to impacts on cortisol, which is generally seen as a “stress” hormone. One of the impacts of cortisol is the release of stored blood sugar in response to a fluctuation. When cortisol is elevated, it becomes a challenge to fall asleep or get back to sleep, as it is a hormone that boosts alertness.⁸ The sleep impacts of blood sugar fluctuations are, unfortunately, a feed-forward cycle, which shows that when someone is not sleeping appropriately this can have a further influence on insulin sensitivity and glucose homeostasis.⁹

Stress

Stress is all around us and difficult, if not impossible, to fully remove from modern life. Unfortunately, stress can have a disproportionate effect on sleep, whether this be from the worry that comes along with it, or the hormone and neurotransmitter impacts. As discussed, elevated cortisol doesn’t only impact glycemic regulation, it can also be related to melatonin secretion.¹⁰ Stress results in the activation of the HPA resulting in the release of cortisol, noradrenaline and adrenaline, all of which are excitatory neurotransmitters, important to the waking hours, but very impactful if levels are increased when one is trying to get a good night’s sleep.

Sleep Hygiene

Pursuing the right lifestyle changes and behaviors can have a much bigger impact on sleep quality than one may think. Below is a “punch list” to refer to every day that, when followed appropriately, will promote high-quality, restful sleep.

• No screens for 30-60 min prior to bed – The bright light from screens disrupts our normal sleep-wake schedule.
• Keep the same bedtime and wake-up time – Our body responds well to a fixed schedule, keeping to a regular sleep/wake routine will help your body to stay on track.
• Avoid caffeine and alcohol for 4-6 hours prior to bed– Both have larger deleterious effects on sleep than you realize, either from the obvious response to stimulants or due to the metabolism needs of alcohol.
• Have a pre-sleep routine – Try out some relaxing activities like reading, meditation, stretching or peaceful music.
• Finish exercise at least 2 hours prior to bedtime – You need to relax after exercise, and this can take some time.
• Find the right temperature – The Sleep Foundation suggests a sleeping temperature between 60-67 degrees Fahrenheit as optimal.¹¹
• Improve your sleeping environment – Comfortable bedding, complete darkness and removing distracting noises can go a long way.

Nutrient/Herb Recommendations

Once the primary impact on sleep quality has been determined, it becomes straightforward to prioritize appropriate recommendations, based on the unique needs of the patient. Below is a summary of potential options which can help to support the personalized needs of patients.

Conclusion

Promoting healthy sleep onset is important for and needed by many patients. Having a clear understanding of why a patient is experiencing occasional sleeplessness is the starting point. Once that is identified and prioritized, one can determine the appropriate course of action aligned with both the goals of the patient and the underlying physiology responsible for the patient’s concerns. Check out our latest Sleep Protocol and sleep support formulas!

References

1. American Psychological Association. (2013, January 1). Stress and sleep. Retrieved from: https://www.apa.org/news/press/releases/stress/2013/sleep
2. Maust DT, Solway E, Clark SJ, et al. Am J Geriatr Psychiatry. 2019;27(1):32-41.
3. Ricci JA, Chee E, Lorandeau AL, Berger J. J Occup Environ Med. 2007;49(1):1-10. doi:10.1097/01.jom.0000249782.60321.2a
4. Fukuhara C, Tosini G. Front Biosci. 2003;8:d642–651.
5. Radziuk, J. M. 2013;62(4), 1017-1019.
6. Waterhouse J. J R Soc Med. 1999;92(8):398-40
7. Shoji S, Shoji Y. Nihon Rinsho. Nihon Rinsho. 2009 Aug;67(8):1525-31.
8. Hirotsu C, Tufik S, Andersen ML. Sleep Sci. 2015;8(3):143-152.
9. LeBlanc ES, Smith NX, Nichols GA, et al. BMJ Open Diabetes Res Care. 2018 Dec 26;6(1):e000604.
10. Mohd Azmi NAS, Juliana N, Azmani S, et al. Int J Environ Res Public Health. 2021;18(2):676.
11. The Best Temperature for Sleep. Sleep Foundation. Retrieved from: https://www.sleepfoundation.org/bedroom-environment/best-temperature-for-sleep