The Sleep Solution: Why Your Sleep is Broken and How to Fix It

by W. Chris Winter

To me, the three main pillars of good health that we can exert some control over are nutrition, exercise, and sleep.

the brain does in fact have a system for removing waste: the glymphatic system.

Scientists discovered that the main waste product the glymphatic system is removing is amyloid beta (Aβ), the protein that accumulates in the brains of Alzheimer’s patients. While that fact itself is fascinating, there’s more: The glymphatic system is 60 percent more productive when we sleep than when we are awake!

One last thing about the glymphatic system: it seems to work better when you sleep on your side.

One behavioral change you can implement right now that could reduce your risk of developing Alzheimer’s disease is to simply sleep on your side.

increased body weight could cause poor sleep, largely related to breathing changes.

Numerous studies have shown sleeping fewer than six hours and staying up past midnight to be linked to obesity. In a 2015 study looking at the habits of over 1 million Chinese subjects, public health researcher Jinwen Zhang found higher levels of obesity in people sleeping fewer than seven hours per night.

Ghrelin is a hormone produced in our gut. Ghrelin acts on our brain to promote hunger, but it also may play a key role in the pleasure associated with eating. Ghrelin makes us crave all of the processed foods on full display at twenty-four-hour convenience stores. Clinical investigator Shahrad Taheri’s 2004 study showed that as sleep duration goes down, ghrelin production goes up, increasing the likelihood of overeating and obesity.

Poor sleep quality can affect levels of the chemical leptin in our body. Leptin, produced by our fat cells, induces the feeling of fullness and puts the brakes on our appetite. When we sleep poorly, leptin levels are reduced, which makes us want to eat more,

after a poor night of sleep, our energy levels are reduced. One compensatory mechanism is for us to eat more in an effort to boost our energy.

With poor sleep come decreased impulse control and greater risk-taking behaviors. These factors could lead to eating poorly

over time, for every hour of sleep an individual lost, he or she gained 2.1 points on their body mass index (BMI).

For individuals who leave sleep-related breathing disturbances untreated, the long-term consequences on the heart are devastating. Heart failure is an inevitable outcome.

For some mental health professionals, the association between depression and insomnia is so strong, they don’t diagnose depression in someone who does not show signs of sleep disruption.

Frequent awakenings during the night, regardless of the cause, may contribute significantly to worsened mood and negative emotions. In his 2015 study, Johns Hopkins researcher Patrick Finan found the effects of interrupted sleep on mood may be more powerful than the effects of reduced sleep.

treatment of sleep apnea can reduce the incidence of depression significantly, dropping it from 73 percent to 4 percent.

My motto is: “Sleep always wins.”15 Sleep is a powerful driver of human behavior.

Many of the patients I’ve treated come to me insisting that their problem is that they “don’t sleep.” They never fall asleep, or they wake up and cannot get back to sleep. Anyone who says this to me is actually suffering, at least in part, from a more fundamental problem: They are sleeping; they just don’t perceive their sleep effectively. In other words, their assertion of not sleeping is just plain wrong. The medical fact is, we all sleep. It’s a primary drive. The body insists on it. So the first thing I need to tell you if you are one of those people who “never sleep” is this: You need to accept one simple fact, or you will be doomed to struggle with your sleep forever. YOU SLEEP.

Stop telling yourself (and others) that you don’t, or can’t, sleep. No matter how dirty your cage is, so to speak, your body will not allow you not to sleep. If you cannot eat or drink, you’re going to die. If you truly can’t sleep, you’re going to die too, probably within a few weeks. I bet your sleeping problems have been going on longer than that and you’re not dead. What does that tell you?

According to Stanford sleep researcher Maurice Ohayon’s 2004 study, all through our life, our sleep need is declining.

In a 2010 study, Kristen Knutson analyzed time diaries kept by research subjects from 1975 to 2006 and concluded that we are not really sleeping less intrinsically, although people do seem to be working more. This study did not seem to support the idea that members of modern society were sleeping drastically less than their counterparts from a generation ago. The other study that seems to cast doubt as to whether we are sleeping less than we did in the past centered around hunter-gatherer cultures and their sleep patterns. In a 2015 study led by researcher Gandhi Yetish, ninety-four adults from the Tsimane (Bolivia), the Hadza (Tanzania), and the San (Namibia) were observed for a combined total of 1,165 days. The results indicated that these individuals were averaging only six hours and twenty-five minutes of sleep per night. This is on the low end of the current average in Western industrial societies.

They would be fatigued—they’d describe their body’s energy level as low.

when you are fatigued, get some rest. When you are nodding off, get some sleep.

A word of comfort: Scientific studies have established that if an adult sleeps well, usually six to seven hours will suffice. Many of my patients with sleep problems often feel they need nine hours or more of sleep to feel okay. Imagine asking one hundred adults how much sleep they need to feel their best. Most of the adults who unknowingly have sleep problems answer with unusually high numbers. This is one of the factors that can lead survey analysts and researchers to conclude that the average amount of sleep we all need is eight hours. Six to seven hours is absolutely fine for some people. For adults over the age of sixty-five, as little as five hours could be appropriate according to the 2015 consensus paper by Nathaniel Watson and his colleagues. The hunter-gatherer cultures mentioned in the last chapter were averaging only about six and a half hours of sleep each night and yet they appeared to be quite healthy and well adjusted.

A 2015 study published in the Journal of Neuroscience found that sleep deprivation may impair your ability to properly read facial expressions.

As you’re awake for longer and longer periods of time, more adenosine collects in your brain. Because adenosine induces sleepiness, the longer you’re awake, the more likely you are to be sleepy. This is the chemistry behind sleep being a primary drive.

Caffeine blocks adenosine.

Living people are either awake or asleep.37

One of the most unusual functions of REM sleep may be in the regulation of pain perception. In the past, most individuals have associated pain with poor sleep. Pain Poor Sleep The relationship, when stated in this direction, should not be terribly surprising. When one is in pain, one sleeps poorly.39 Studies have examined the reverse relationship in an effort to see if poor sleep could in fact lead to pain. Poor Sleep Pain In these studies, patients were allowed to sleep in a variety of situations. In multiple studies, sleep conditions that involved REM sleep deprivation were shown to increase the levels of pain experienced by volunteers who were healthy and pain free before the studies.

Beyond the contribution of sleep disturbances to acute pain perception, researchers have also linked sleep disturbances to the development of chronic pain conditions. In a 2015 study, rats who got insufficient sleep before an injury were more likely to suffer from chronic pain than well-rested rats.

Typically, adults spend approximately 25 percent of their night in deep sleep with the majority of deep sleep activity occurring during the first half of the night. This sleep is restorative sleep and makes individuals feel rested (not sleepy) the following day.

Why is deep sleep restorative? Mainly because the time you spend in deep sleep happens to also be the time of greatest growth hormone (GH) production. I know, I know. . . . You’ve finished growing, so you are wondering why growth hormone is important. Basically it does so many things to help your body stay young and healthy, and perform better,

Your sleep is divided into three distinct stages—light sleep, deep sleep, and dream sleep. Dream sleep is also known as REM sleep and is important for memory and mood regulation. A lack of deep sleep can cause sleepiness because it is the most restorative phase of sleep. These three stages in a healthy sleeper should flow in a predictable pattern.

Why did televisions wind up in the bedroom? I don’t have a clue. To me, it’s like a toilet in the family room. Televisions produce loads of light.

Consider the 2014 study showing that subjects continue to mentally sort words from spoken word lists even after they fall asleep.

In a 2014 study by Charles Czeisler, individuals who used e-readers before sleep at night took an average of ten minutes more to fall asleep and had less REM sleep than individuals who read a printed book with indirect light. Any light exposure in the late evening or early night can have a negative impact on your circadian rhythm and sleep, so keep your environment dim at the end of your day for great sleep.

night owls often feel warmer later at night than morning types.

Memory foam pillows often provide excellent orthopedic support of the neck and spine, but like their mattress counterparts, they often trap heat so individuals sensitive to being hot at night may not like them.

If you wake up before your alarm goes off, just remind yourself that it’s still time to sleep. That’s the only thing that matters.

A 2015 Preventive Medicine study showed that individuals, and in particular men, seemed to sleep better when they were exposed to green spaces and nature.

It’s important to communicate effectively here, or feelings can get hurt quickly. I believe that everyone has a right to sleep well. If only one canteen is taken on a hike, most couples would share the water inside. It would be unthinkable for one partner to drink it all, leaving the other with nothing. Why should sleep be any different? Why should one partner be allowed to deprive another of something that in many ways is just as important as water or food?

Think of it this way: As with most things we consume to “help us sleep,” alcohol produces sedation, not necessarily sleep. With all of this bad publicity, it’s amazing that alcohol remains the number one sleep aid in this country.

Alcohol promotes amnesia. Another criterion many people have for achieving a good night of sleep is having no memory of what happens between falling asleep and waking up. Alcohol can help with this.

It should be noted that some studies report an increase in deep sleep associated with alcohol, typically during the first half of the night. While this is disputed, what’s not disputed is the mess alcohol makes of the second half of your night as the alcohol is metabolized.

Well, when it comes to food, the National Sleep Foundation feels it best not to eat any of it within two to three hours of bedtime.

People always blame the tryptophan in the turkey, but in reality it’s the carbohydrate bomb you dropped in your stomach that does the trick. Eating that massive amount of sweet potatoes with sugar-coated walnuts, stuffing, cranberry sauce, and pecan pie creates a sudden surge in your blood sugar and a spike in insulin levels that promote a feeling of sleepiness. In 2007, research by Chin Moi Chow from the University of Sydney showed conclusively that a high-glycemic-index meal consumed four hours before sleep resulted in a significantly shorter time to fall asleep than a low-glycemic-index meal. Take your cue from the holiday when you need a midnight snack. Look for dried fruit, cereal, or bananas. High-glycemic-index foods produce sleepiness, so if food must be consumed at night, these are good choices. Other foods that are good choices for sleep contain high amounts of melatonin. These foods include walnuts and tart cherries

(dried or juice). Foods high in tryptophan are sleep promoting because tryptophan is the building block of melatonin. Game meat like elk and chickpeas are high in tryptophan content. Finally, foods high in magnesium (almonds) and calcium (milk, kale) can help promote relaxation and sleep. When it comes to sleep promotion, hot chamomile tea or passionflower tea can also be helpful.56 Sweeten the tea with honey, itself sleep promoting, for an added kick. Avoid proteins that can often promote the synthesis of dopamine, a wake-promoting neurotransmitter.

With vigorous physical exercise reserved for the morning, try incorporating some relaxing exercises or meditation before bed. Many of my patients “run the list.” Their minds are whirring with activity throughout the day, and it’s often hard to turn off the to-do list at bedtime. So try this: get a notebook and before getting in bed, write down the things on your mind. Practice restricting this writing to an hour-long period in the evening. At any point during this designated hour, you may write things down in your notebook that are on your mind. You do not need to write continuously. Once the hour is over, put the notebook away. You are no longer allowed to think about things you have to do. There’s enough on your list already. This may take some practice! It’s a very disciplined practice. Some people find it helpful to not just put the list away, but visualize putting all their intentions and obligations into a box and using a big key to lock it for the night. That kind of visualization can be a useful thing to think about after you lie down to help you fall into sleep. For those of you with a worry so huge that it cannot be ignored, go ahead and write it down. It’s not that big of a deal. The worst-case scenario is that you’ll awaken, turn on a dim light, write it down, and struggle to fall back to sleep. Oh well, at least you won’t miss your tax filing deadline tomorrow! A trick for these situations is to keep an unusual (and unbreakable) object on your nightstand. Perh...

WANT TO TURN THE PROCESS of quieting your mind into a futuristic video game on your iPhone? Muse (www.choosemuse.com) is a small biofeedback device that wirelessly connects to your phone. Muse detects your brain waves and can convert them into the sound of the ocean. By using the device, you can “hear” the activity level of your brain and practice calming it down. The more you calm your brain, the quieter the ocean becomes. By practicing this skill, you’ll be able to expertly shut your brain off as soon as you get into bed. One useful component to the bedtime routine is a hot shower, or preferably a hot bath. While cooler environmental temperatures typically result in a higher-quality sleep, vigorously heating the body via bathing before sleep has been shown to improve sleep quality, most likely because of the cooling and body heat release that follows. Therefore, a hot bath about an hour before you hit your cool, comfy bed can be very helpful for difficult sleepers.

Exercise in the morning, preferably in bright light. Consistent breakfast timing with the meal heavy on wake-promoting protein. Consistent lunch timing. Finish dinner at least three hours before bedtime. If you have to snack after that, have a handful of nuts or a few pieces of dried fruit. Not too much. Reduce your environmental lighting around the time the sun is going down. Turn off lights or use dimmer switches. Spend an hour after dinner jotting things down on your to-do list. Put the list away after sixty minutes. Brush your teeth. Take a warm bath. Do some light exercise or meditation. Breathe deeply. Read a print book until you feel sleepy.