Some basic advice on SLEEP
- How do you normally handle sleep issues?
Preliminary surveys are key to early diagnosis to facilitate strategies of treatment. Attached are a few of the surveys I plan to incorporate with patients that may display sleep issues:
- PROMIS Sleep Disturbance and Sleep Related Impairment
- Brain checklist
- Alliance Sleep Questionnaire
- Sleep Quality Assessment (PSQI)
- 3 day detailed dietary food log to determine if there are some dietary triggers to the insomnia
Tests I would run include:
- Dutch hormone test or salivary cortisol
- CBC and CMB, particularly fasting glucose, HbA1C, insulin, hs-CRP, sedimentation rate, homocysteine
- Full iron panel
- Micronutrient test to identify deficiencies that may be promoting sleep dysfunction.
Various interventions include:
Nutritional and lifestyle strategies
- Optimize glucose control. -Dysglycemias such as T2D and sleep disorders often coexist (Khandelwal, Dutta, Chittawar, & Kalra, 2017), which may be due to the disease itself or secondary complications associated with dysglycemia. Both hyperglycemia and hypoglycemia can disrupt sleep. Poor blood sugar can also cause a dysfunction in the metabolism or serotonin and dopamine, both which can influence sleep quality (Bodyecology, 2018).
Strategies include: Avoid sugars and refined grains and replace them with fruits, vegetables, legumes, lean protein, and healthy fats, can help regulate insulin release during meals. Also, a lower carb dinner may promote better sleep. “A significant trend toward worse sleep quality with increasing carbohydrate intake was found. The quality of carbohydrate seemed to be more important than its quantity in mediating this association” (St-Onge, Mikic, & Pietrolungo, 2016). In fact, poor sleepers consumed the highest carbohydrate intake such as confectionary noodles, sugar sweetened beverages. It is also important to stress that skipping meals and irregular eating is also associated with poor sleep quality. A balanced approach is key: too low protein, too high protein, too low carbohydrate, and too high carbohydrate are all associated with poor sleep quality (St-Onge et al., 2016)
- Avoid foods that can contribute to insomnia- food rich in sugar, caffeine, green tea (Zeng et al., 2014).
- Focus on functional foods that promote sleep-such as barley grass powder, whole grains, maca, panax, Lingzhi, asparagus powder, lettuce, cherry, kiwifruits, walnuts, and Schisandra wine (Zeng et al., 2014). “Barley grass powder with higher GABA and calcium, as well as potassium is the most ideal functional food for promoting sleep” (Zeng et al., 2014). Other foods include fatty fish, a good source of vitamin D and omega-3, that is important to regulate serotonin and sleep regulation (St-Onge et al., 2016).
- HIIT training conducted on an empty stomach. HIIT can improve insulin sensitivity (Sogaard et al., 2018). Researchers at the University of Turku demonstrated that short term interval training can positively alter brain glucose metabolism in subjects with insulin resistance (Honkala et al., 2018). Try to avoid exercising right before bed, however, as it may provoke a stress response that can contribute to insomnia.
- Early time restricted feeding- Although it may be difficult to implement, early time restricted feeding consists of eating early in the day that aligns with circadian rhythms (6 hour feeding period before 3pm) has been associated with improved insulin sensitivity, B-cell responsiveness, blood pressure, oxidative stress and appetite, not solely due to weight loss (Sutton et al., 2018).
- Magnesium supplementation– I use a magnesium oil spray that I recommend for folks who may have dysregulated sleep patterns. Magnesium is an essential cofactor for many enzymatic reactions, especially those that are involved in energy metabolism and neurotransmitter synthesis (Abbasi et al., 2012). Aging is a risk factor for magnesium deficiency due to alterations that are common in aging such as increased urine and fecal excretion, reduced intake, reduced intestinal uptake, or drug induced magnesium deficiency (Abbasi et al., 2012). Magnesium plays an essential role as a natural antagonist of NMDA receptor and agonist of GABA and plays a critical role in sleep regulation (Abbasi et al., 2012). Nuts, seeds and beans, whole grains, dark leafy greens, and fish and seafood are the best sources of magnesium in the diet. The study by Abbasi et. al demonstrated that magnesium supplementation was associated with increased quiet sleep and decreased active sleep, as well as an increment in spindle power during non-rapid eye movement (NREM) and a change in delta power in the in the third sleep cycle as well as short wave sleep (SWS) increment (Abbasi et al., 2012). The study also demonstrated that Mg supplementation also resulted in significant decrease in serum cortisol concentrations, particularly in the first half of sleep. Other benefits include lowering blood pressure, increased serum melatonin (Abbasi et al., 2012). Magnesium supplementation is safe. Other forms of magnesium I would use for sleep is either magnesium byglycinate or magnesium citrate. 400-800mg of Magnesium biglycinate has been associated with improvements in sleep quality.
- CBD oil-Preliminary research into cannabis and insomnia suggest that CBD may have a therapeutic potential for insomnia, particularly for REM sleep behavior disorder and excessive daytime sleepiness (Babson, Sottile, & Morabito, 2017). A study in 2017 also revealed a mode of action of CBD on GABA receptors that may help relieve anxiety (Bakas et al., 2017). Small doses of CBD may also stimulate alertness and reduce daytime sleepiness, which can benefit daytime performance and strengthen the consistency of the sleep-wake cycle (Murillo-Rodriguez et al., 2014).
Sleep Hygiene– I retrieved some tips below for better sleep hygiene
- Adults typically require 7 to 7.5 hours of uninterrupted sleep, which is a good target when planning bedtime and awakening times.
- Strive to get to bed by 10:30pm to maximize the therapeutic benefits that occur between 10:30pm and 2:30pm (Noseworthy, n.d.)
- Go to the bed the same time every night
- Keep the room quiet, or utilize white noise that can hep drown out background noise. I use a fan in my room or recommend some apps that you can download that can provide white noise
- Temperature control-the best temperatures for sleep quality is in the low to mid 60’s Fahrenheit, which can help your body thermoregulate during sleep (Tuck, n.d.)
- Dedicate the bed for sleep and sex and nothing else and invest in a comfortable mattress (Tuck, n.d.)
- Limit screen time before going to bed-it is recommended to stop using all electronics about 1 full hour before bed. The blue light can disrupt circadian rhythms. If you absolutely must use electronics (like graduate students do 😊), then there are blue light filtering glasses and apps that you can download to reduce the light coming from the screen to minimize the impact.
- A bedtime routine may be helpful for someone people. Ideas include taking a warm bath, aromatherapy, meditation, deep breathing, reading a book by a soft lamp (Tuck, n.d.)