A lack of adequate sleep has reached epic proportions in the UK.
- A reported 70% (7 out of 10) of British people do not get the 7-9 hours recommended for adults (1, 2). The average Briton gets 6.5 hours sleep per night.
- Just over a quarter (27%) of Britons say that they sleep poorly or very poorly.
- Almost half (47%) of Britons report that stress or worry keeps them awake at night.
- 43% of respondents report that daytime sleepiness interferes with their normal daytime activities.
More and more people are turning to medication to help them sleep. Nearly a third (31%) of people have taken medication to help them sleep, with 15.3 million prescriptions and a whopping £50 million spent on sleeping pills (3). This is of particular concern because a recent study demonstrated that sleeping pill use was associated with a greater than 4x risk of death (4).
A lack of sleep is expensive too. Insufficient sleep costs the UK economy 200,000 work days a year, to the tune of £30 billion per year.
What may be the biggest concern is that sleep problems are getting worse, and not better. The number of people sleeping just 5-6 hours per night has risen by nearly 25%. As a society, there is an overarching work ethic that tends to value activity and productivity much more than rest and recuperation. However, your body still recognises the importance of sleep. So perhaps all of this is not a surprise. I used to frequently burn the candle at both ends, thinking that I was being more productive and that sleep was for lazy people. How wrong I was…
Health problems associated with a lack of sleep
A lack of sleep has been associated with a number of very serious health conditions:
- Heart disease (5).
- Stroke (5).
- Sudden death (5).
- Diabetes (6).
- Hypertension (high blood pressure) (7).
- Overall increased risk of death (8).
- Obesity (9).
- DNA damage and ageing (10).
This list is continuing to grow. Inadequate sleep also affects our ability to:
- Think clearly – sleep deprivation affects short-term memory, long-term memory and working memory (which deals with immediate conscious perceptual and linguistic processing).
- Control our emotions.
- Handle stress.
- Maintain a healthy immune system.
- Metabolise glucose and increases our appetite (11).
Poor sleep is associated with a wide range of psychiatric disorders too, including depression and anxiety.
The problem may involve how we “wind down”
Resting and relaxing for the majority of people involves watching TV, browsing the internet, or engaging with their phone or tablet. However, these activities are not restful for the brain (and hence the body). The blue light emitted from electronic devices is at the peak frequency to disrupt the release of the “sleep hormone” melatonin. Decreases in melatonin production in humans and animals are known to be caused by environmental lighting, especially short-wavelength lighting (between 470 and 525 nm).
The hormone melatonin is secreted by the pineal gland naturally at night time and delivers information to the body about the daily cycle of light and darkness. The organisation of other functions of the body could depend on this melatonin signal, for instance immune function, antioxidative defence mechanisms, blood clotting and glucose regulation (12). This may be why you’re more likely to get a cold or flu after a few nights of sleeping poorly.
Another issue is that most of us run around like headless chickens all day, and then wonder why we can’t fall asleep immediately when we go to bed. If our body and mind has been running in overdrive all day, we cannot just switch our nervous and endocrine systems off in a few minutes. This may be part of the reason that we are becoming increasingly reliant on sleeping pills, despite the problems associated with them.
However, there is a point where the lack of sleep may outweigh the risks or side effects from sleeping tablets. There may be a short-term role for sleeping tablets if all natural and non-drug methods have failed (of which there are many – see later).
People who claim to be “night owls”
Good friends of mine have told me that they are naturally night owls. I even used to say this myself once upon a time. This is not natural. Throughout history, our bodies have evolved with sleep patterns that are synchronised with the day-night cycle.
Getting a second wind of energy late in the day may be a sign of a disrupted circadian rhythm. Normal cortisol release is higher in the morning and tapers off throughout the day and into the evening. This rhythm of release is what gives us energy in the morning and allows us to feel sleepy at night. In people who are experiencing chronic stress, this normal rhythm can become disrupted. They can have a low cortisol in the morning and a high cortisol level at night. This also known as HPA axis dysfunction.
When treating “night owls” for HPA axis dysfunction, one of the first things they report is feeling tired at night, which is good!
How to improve your sleep
Reduce your exposure to artificial light
As I mentioned above, light from electronic devices can disrupt sleep tremendously. One study showed that the blue light emitted from alarm clocks and other digital devices suppresses melatonin production in a dose-dependent manner. The more you use them, the worse the effects! But it is not just electronic devices that contain this disruptive spectrum of blue light. All artificial light contains the spectrum of blue light that disrupts our circadian rhythm and sleep (13).
Follow these tips to avoid light exposure:
- Try to avoid using electronic devices for 2 hours before going to bed.
- Use low level or mood lighting for your home when it is dark.
- Use blackout shades to block the effects of street lights.
- Place a cover over your digital alarm clock or get an analogue one.
- If this is difficult to achieve, you can use a sleep eye mask, but some research suggests that we can sense light through our skin through proteins called cryptochromes (14).
Invest in a good bed
You spend about a third of your life sleeping. So, if you can afford it, you should invest in a good quality bed and mattress. Comfort is paramount when getting a good night’s sleep.
Don’t be too warm at night
The National Sleep Foundation suggested bedroom temperature should be between 15.5 and 19.4 degrees Celsius for optimal sleep
Optimise your diet
Many nutritional factors, such as intake of vegetables, caffeine, and some vitamins and minerals, could modify melatonin production (albeit with less intensity than light). Overall, foods can modulate the levels of melatonin. This can be by promoting the synthesis of melatonin by impacting the availability of its precursor, tryptophan, as well getting the right vitamins and minerals which are needed as co-factors and activators in the synthesis of melatonin.
Go to bed earlier
You may have heard of the saying “an hour before midnight is worth two hours after”. There may be some truth in this. When you fall asleep, you go through 3 stages of non-REM (NREM) sleep followed by a stage of REM sleep. You normally go through 5-6 cycles of this in a good night’s sleep. It is the deep stage 3 NREM that is the regenerative, restorative stage and when the body repairs itself. Brainwaves during REM sleep (when we dream) are similar to those during wakefulness or drowsiness.
The ratio of NREM to REM sleep during sleep cycles changes throughout the night. In the early part of the night, the majority of those cycles are composed of deep NREM sleep (stage 3) and very little REM sleep. In the second half of the night (i.e. 3am – 7am) this shifts so the cycles have more REM sleep as well as the lighter stages of NREM sleep (from which we can be easily woken).
People who exercise five to six times per week are the least likely to take medication to help them sleep (12%, compared to a national average of 17%) and are less likely to visit their GP for help with sleep. (5%, compared to an average of 10%). Those who don’t take regular exercise are more likely to sleep badly:
- 11% of those who exercise less than once every six months sleep very poorly most nights, compared with,
- 32% of those who exercise daily who say they sleep very well most nights.
This is in addition to the host of other benefits of exercise.
Manage your stress
In view of ways that stress and anxiety impact your sleep, it makes sense to tackle these factors rather than just patch the symptoms with sleeping tablets. In addition to all the health problems associated with stress, the lack of sleep associated with this could make matters worse, by entering a vicious cycle of a stress causing a lack of sleep, which leads to further physiological stress. If your cortisol rhythm is disrupted, none of the earlier mentioned sleep tips may be able to help you, despite your best efforts.
I do not like to make any general recommendations about which supplements and nutrients can help with sleep problems. This is because the decision about what to take depends on what the underlying cause of the problem is in the first place and coexisting health conditions. Some causes of sleep disruption just require lifestyle changes, whereas others will require very specific nutrient supplementation.
Having said that though, magnesium is usually a safe choice. Most people are deficient in it (15) and it is safe at daily doses up to 800 mg. It is relatively cheap and can be purchased easily. However, it can stimulate bowel movements, which might surprise you if you are not expecting it! You also have to be careful, as some preparations are better absorbed than others.
A lot of people have started using melatonin as a sleep supplement recently. I would only recommend it for short-term emergency use, such as during travel to help with time zone adjustment. As melatonin is a hormone, any supplementation of it may disrupt the natural production of it.
Sleep is so critical to our overall health. I truly believe that lack of sleep and stress are two of the largest threats to optimal health today. If you’ve read my webpages and other blog posts, you know how much value I ascribe to proper nutrition. However, it’s often easier for most people to change their diet than it is to institute lifestyle changes that will help improve their sleep and manage their stress. My final point is that despite exercising, eating a perfect diet and using all the right supplements, if you are not sleeping well and managing your stress, your health can still suffer. In this modern age, not only are we losing the value of rest, we are losing the ability to do it properly. You cannot be healthy without adequate sleep. Full stop.
4. Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJOpen 2012; 2: e000850. http://dx.doi.org/10.1136/bmjopen-2012-000850
5. Robert Wolk, Apoor S. Gami, Arturo Garcia-Touchard, Virend K. Somers. Sleep and Cardiovascular Disease. Current Problems in Cardiology, Volume 30, Issue 12, 2005, Pages 625-662
6. N.T. Ayas, D.P. White, W.K. Al-Delaimy, et al. A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care, 26 (2003), pp. 380-384.
7. P. Lusardi, A. Mugellini, P. Preti, et al. Effects of a restricted sleep regimen on ambulatory blood pressure monitoring in normotensive subjects. Am J Hypertens, 9 (1996), pp. 503-505.
8. M. Kojima, K. Wakai, T. Kawamura, et al. Sleep patterns and total mortality: a 12-year follow-up study in Japan. J Epidemiol, 10 (2000), pp. 87-93.
9. R.D. Vorona, M.P. Winn, T.W. Babineau, et al. Overweight and obese patients in a primary care population report less sleep than patients with a normal body mass index. Arch Intern Med, 165 (2005), pp. 25-30.
10. Judith E.Carrolla, Steven W.Coleac, Teresa E.Seeman, Elizabeth C.Breen, TuffWitarama, Jesusa M.G.Arevalo, Jeffrey Ma, Michael R.Irwin. Partial sleep deprivation activates the DNA damage response (DDR) and the senescence-associated secretory phenotype (SASP) in aged adult humans. Brain, Behavior and Immunity. Volume 51, January 2016, Pages 223-229.
11. Karine Spiegel, Esra Tasali, Rachel Leproult & Eve Van Cauter. Effects of poor and short sleep on glucose metabolism and obesity risk. Nature Reviews Endocrinology volume 5, pages 253–261 (2009)
12. Claustrat B1, Brun J, Chazot G. The basic physiology and pathophysiology of melatonin. Sleep Med Rev. 2005 Feb;9(1):11-24.
13. Joshua J. Gooley, Kyle Chamberlain, Kurt A. Smith, Sat Bir S. Khalsa, Shantha M. W. Rajaratnam, Eliza Van Reen, Jamie M. Zeitzer, Charles A. Czeisler, Steven W. Lockley, Exposure to Room Light before Bedtime Suppresses Melatonin Onset and Shortens Melatonin Duration in Humans, The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 3, 1 March 2011, Pages E463–E472, https://doi.org/10.1210/jc.2010-2098
14. Hoang N, Schleicher E, Kacprzak S, Bouly JP, Picot M, et al. (2008) Human and Drosophila Cryptochromes Are Light Activated by Flavin Photoreduction in Living Cells . PLOS Biology 6(7): e160. https://doi.org/10.1371/journal.pbio.0060160
15. Broadley, M., & White, P. (2010). Eats roots and leaves. Can edible horticultural crops address dietary calcium, magnesium and potassium deficiencies? Proceedings of the Nutrition Society, 69(4), 601-612. DOI: https://doi.org/10.1017/S0029665110001588
Asim is a medical doctor (Consultant Anaesthetist) with 18 years experience in the NHS. He currently specialises in providing anaesthesia for Hepato-pancreato-biliary (liver, pancreas and bile duct) procedures and Liver transplantation. In his current post, he is part of a cohesive team of highly skilled multidisciplinary clinicians, forming the largest liver transplant unit in Europe. Hepato-pancreato-biliary anaesthesia comprises 30 per of the work that he undertakes. The remaining 70 per cent is split across many different specialties, such as anaesthesia for Vascular, Renal, General, Urological, ENT and Emergency surgery, amongst many.
Asim has undergone an extensive Functional Medicine Certification programme, with over 1000 hours of training at the Kresser Institute, run by Chris Kresser M.S., L.Ac, who is the co-director of the California Center for Functional Medicine and founder of Kresser Institute. The ADAPT (Advanced Diagnostics and Personalised Treatment) programme is one of the first and only training programmes to fully integrate functional medicine with the better questions and new insights of an ancestral, evolutionary perspective. Asim is also a member of the Institute of Functional Medicine (IFM). As a hospital Consultant and a Functional Medicine practitioner, he has learnt how to effectively combine his knowledge and skills to treat of a range of health issues.