Sleep - It's More Important Than You Think!

By Dr. Patrick Zitt, DC, DNM, MS

America is experiencing a sleep deprivation epidemic.

On average, we are getting 1.5-2 hours less sleep than we did just a mere 50 years ago.

While the majority of health experts agree that adults should clock in 7-9 hours of quality sleep each night, as a society, we are far from that goal. A shocking one-third of Americans do not get even the bare minimum amount of sleep needed to maintain their health.

• 8% get less than 5 hours of sleep each night
• 23% get about 6 hours of sleep
• 5% get 7 hours of sleep (bare minimum, though many may do better with more)
• 7% get 8 hours of sleep
• 8% get 9 hours or more

What makes these statistics worse is that they are based on self-reported sleep times. Studies have shown that self-reported sleep is almost always overestimated, with the grossest overestimations made by those getting the least amount of sleep.

According to the CARDIA Sleep Study

• Those that slept an average of 7 hours over reported by 0.4 hours (they thought they were getting closer to 7 ½ hours)
• Those that slept an average of 5 hours over reported by 1.2 hours (they thought they were getting more than 6 hours)

So, unless you are measuring your sleep objectively with a wearable device (such as a fitness watch or Aura Ring), you are most likely not getting as much sleep as you think you are!

Why are we getting such little shut eye?

There are conditions and circumstances that negatively affect quality and quantity of sleep (not an exhaustive list):

• Pregnancy
• Pain
• Cancer
• Depression or Anxiety
• Sleep apnea
• Restless leg syndrome
• Working the night shift
• Substance abuse
• Medications

If you are struggling to sleep and suffer from any of the above conditions, it is vitally important to address it with the appropriate medical professional.

But honestly? In my experience, a large portion of my patients are lacking sleep due to a lack of effort and planning. When life gets too full and something has to give, sleep is usually the first on the chopping block. 

Overloaded with work? Stay up late.

Want to work out? Wake up early.

Friends going out? Sleep can wait.

One more episode of New Girl? Who even needs sleep….

One can argue that exercise, friendships, leisure time, and work ethic are important components to health and may be worth sacrificing a little sleep for. While no one can objectively say that sleep is more important than any other pillar of health, I firmly believe that getting enough quality sleep should always be a top priority. Read on and I think you’ll agree.

What does sleep actually do for us?

When our cells use energy, they create waste, much of which is toxic. Cells throughout the majority of the body clear this waste through the blood stream throughout the day, but the only time your brain cells can move their waste to your blood is while you sleep. Toxic waste buildup in the brain negatively impacts cellular health, hormones, neurotransmitters and neurons, and inflammation....so, everything.

This is only scratching the surface of why sleep is so vital. The scientific community still has a lot of questions to answer surrounding the mechanisms of how sleep helps us. In other words, we know that sleep is vitally important to our health but are still a little murky on all the reasons why.

How low sleep affects health

Let's look at how routinely getting less than 6 hours of sleep each night increases the risk of several diseases:

• All-cause mortality: 12% increase. By comparison, smoking increases ACM by 20% and obesity increases ACM by 18%).
• Obesity: 55% increase
• Type 2 diabetes: 50% increase
• Type 2 diabetes + Glucose Intolerance: 240% increase (you can develop glucose intolerance within just a few days of short sleep)
• Auto Immunity: 20-81% increase, depending on the condition
• Stroke: 100% increase
• Heart Attack: 100% increase
• Congestive Heart Failure: 67% increase
• Coronary Heart Disease: 48% increase
• Breast Cancer Survival: 46% decrease (sleep hasn't been linked to whether you get cancer but it's been shown to impact how well you can fight it)
• Infectious Disease: Short sleep increases your chances of contracting the common cold and flu.

In addition to directly affecting certain conditions, sleep impacts literally everything because it influences other health factors.

• Five consecutive days of 4 hours of sleep increases calorie consumption by 20%.
• Only one night of 4 hours of sleep increases insulin resistance in healthy adults.
• One night of 3 hours of sleep dysregulates cortisol.
• 6 hours or less of nightly sleep is linked to increase sedentary behavior and screen time.
• Sleep deprivation has been linked to reduced muscle strength during workouts and less efficient workout recovery. 
• Just one night of no sleep raises several inflammatory markers in otherwise healthy young adults. Inflammation can stay elevated for several days after returning to healthy sleep habits.

This means that even if your diet is on point and even if you are diligently exercising, these efforts are being undermined if you're lacking sleep. And if we’re honest, we do not need statistics to tell us that we eat more junk food and laze around more on days when we’re tired.

Getting more (or better) sleep

Now that you know just how influential sleep is to your health, it’s time to take steps to ensure your best sleep!

If you’re struggling to make sleep a priority, consider these tips:

• Make a bedtime ritual you enjoy. A bedtime ritual is a series of events that prepare your mind and body for sleep. When performed in the same sequence at the same time each night, your brain begins to expect that sleep is coming. The trick is making this routine something you will look forward to and won’t want to put off. Examples of what you might include are a shower or skincare routine, sipping hot tea, reading a non-stimulating book, meditating, journaling, stretching, etc. You can make this as long or as short as you want, as long as it is done every night in sequence followed directly with placing your head on your pillow.
• Invest in good bedding. If you love your bed and can’t wait to cuddle up at night, you’ll be less likely to put off bedtime! Invest in soft and breathable sheets and blankets that make you go “ahhhhhh” when you settle in.  If you find yourself tossing in the night or waking up with a stiff neck or back, consider a different mattress or pillow. It may take some trial and error, so make sure you make your purchase from a company with a favorable return policy.
• Keep the same to the same general sleep times. Studies have shown an increase in obesity risk when bedtime and length of sleep varies by more than 2 hours, even if the total amount of sleep is adequate. And what’s more, falling asleep and waking up become much easier when your brain knows when to expect it (thanks, circadian rhythm). Decide on your preferred wake up time then count backwards 8.5-9 hours (depending on how long it takes you to fall asleep) to get your bedtime. If these times are more than 30 minutes off from your current routine, start shifting your routine in 15 minute increments. And here’s an important but unfortunate truth – you need to keep these same sleep and wake times on the weekends with very few exceptions.
• Treat your bedtime like an appointment you can't miss. In order to keep your bedtime and wakeup time consistent, you have to stop making it negotiable. Just as you cannot be late to work, a workout class, or a dinner reservation, you must tell yourself you cannot be late for bed.
• Set timers to alert you to when you should dim lights, turn off electronics, begin your bedtime routine, get in bed, etc.
• Reward yourself. Make a sticker chart, checklist, or whatever will motivate you. Give yourself gold stars for doing your bedtime ritual, turning off electronics, getting to bed on time, etc. After a week, treat yourself! The reward must be significant enough to be motivating. You must want the reward more than you want to doom scroll social media at night for this to be effective.
• Consider melatonin. Melatonin is a hormone naturally produced in the body that is vital to the regulation of circadian rhythm. While it does not help you stay asleep, taking a low dose right before bed (once electronics are off and lights are dimmed or off) can help you fall asleep when your body otherwise doesn’t feel ready. While long term effects are thought to be minimal, this is best used as a short term solution.

If you’re making an effort to get enough sleep but it still eludes you, consider taking these steps:

• Plan for more time in bed than you think you need. It can take 30-60 minutes to fall asleep. Plus, you may experience wake ups in the night. Plan to be in bed about one hour longer than the amount of total sleep you want to make up for these interruptions.
• Watch your caffeine, nicotine, and alcohol intake. Nicotine is a stimulant that will interfere with sleep, especially for those with insomnia. Alcohol, while a depressant, interferes with blood sugar regulation which negatively impacts quality of sleep through the night. Both of these should be avoided within 3-4 hours of bedtime. I recommend that coffee is avoided after lunch, however this can vary by the individual. Some may need to have one cup at 8am and no more while others may get away with a 3pm cup.
• Do not eat within 2 hours of sleep. As with alcohol, food influences blood sugar levels which can wake you up at night. In addition, while our bodies can digest food while sleeping, it is not as efficient as a process.
• Get plenty of sunshine during the day to regulate your circadian rhythm. Your circadian rhythm is the internal clock that tells you when to be awake and when to sleep (among many other things) and is greatly influenced by light. Light contains various colors of wavelengths. Blue wavelengths are dominant in the morning sun and are stimulating to our brains, telling them to “wake up!” Red wavelengths are dominant in a setting sun and firelight, cuing our brains that night is coming. Expose your eyes to at least 15 minutes of bright morning sun first thing after waking. Indoor lighting is often not bright enough so take your morning coffee on the porch or use a light therapy box while getting ready or exercising. Keep your energy levels up throughout the day by going outside often or working near a window.
• Turn off electronics at least one hour before bed to regulate circadian rhythm. Remember those wonderful blue wavelengths that woke you up and kept you alert during the day? That’s exactly what you don’t want when you’re trying to go to sleep! Televisions, phone screens, and light bulbs are mostly blue light and tell your brain to energize when it should be winding down at night. Dim indoor lights about 2 hours before bed (or use red bulbs). Then, turn your electronics off at least an hour (preferably two) before bedtime. Amber lens glasses (“blue blockers”) are handy for those times when electronics are necessary, as they do block some blue light.
• Ensure your room is as dark as possible. Speaking of light, it may be obvious that sleeping with a light or the tv on can impede sleep. But even a light as innocent as a small LED on a charger may be enough to keep your brain from fully relaxing into sleep. Use electrical or duct tape to cover up any sources of light in your sleep space, no matter how minimal.
• Use a white noise machine to block out noise. Cars outside, the occasional dog bark, a snoring family member, and even electrical frequencies that may not be perceived by your conscious mind can keep your brain awake. These unavoidable sounds can be drowned out by a white noise machine which makes a constant, low level of noise that dims the other noises. If you’re sensitive to frequency noise, opt for one that has an actual fan inside over a machine that loops a prerecorded fan sound.
• Drop the ambient temperature to fall asleep faster. Core body temperature drops when we sleep. Dropping the ambient temperature makes it easier for body temperature to drop, decreasing the amount of time it takes to fall asleep and decreasing middle of the night stirring. While this number may vary from person to person, 65 degrees Fahrenheit is a good starting point.
• Ensure adequate magnesium levels. Known as the relaxation mineral, magnesium relaxes muscles, stimulates melatonin production, and can calm the nervous system. You can get magnesium through your diet by consuming green leafy vegetables, fish, legumes, nuts, seeds, and whole grains. You can also supplement magnesium before bed. While magnesium is generally a very safe supplement, consult your healthcare practitioner to ensure you do not have a condition where it may be contraindicated (such as poor kidney function).
• Check your other lifestyle habits. We have covered how sleep influences diet, exercise, and stress, but these in turn, influence sleep. Eating a nutritious diet, exercising at least 150 minutes per week, and actively lowering your stress level will all have a positive influence on sleep.

These sleep tips and more are included in my Back to Basics 10 Day Challenge. This challenge guides you though the foundational elements of good health in an easy to implement challenge you can do at your own pace.

And lastly, if you have tried all the tips and hacks to get enough quality sleep and it still eludes you, there may be underlying conditions preventing it. Reach out to me for a free consultation so we can discuss how to get you sleeping and feeling your best!