Sleep

Sleep? Wait a minute Dr. Dan, I came here to learn about food and Human nutrition. What does sleep have to do with nutrition?

Sleep has everything to do with Human nutrition. The reason I start with sleep is because it IS that important. Without adequate sleep it is not even possible to have good nutrition. The Human body requires sleep to recover and repair, to create the healthy gut microbiome needed to be able to process nutrients and make the hormones that signal the cells to function. Good sleep is the fundamental key to good health! This point is not stressed enough yet so important that if you don’t start here then just abandon everything else I write about. Yes you read that correct, do not even bother to change anything if you don’t get your sleep optimized!

Good sleep will help you lose weight. Good sleep will help you control anxiety. Good sleep will add years to your life! This is all true. Society often views sleep as “optional” or only for the weak who can’t tough it out. Working long hours is admired and encouraged. The reality is that lack of sleep directly contributes to diseases mental and physical, and is responsible for more highway deaths than drinking and drugs combined. Inadequate sleep is directly responsible for a large percentage of workplace errors including medical errors by my sleep deprived colleagues. Hint, don’t ask your surgeon where they went to medical school, ask them how many hours of sleep they had last night. If you do only one thing for your health, sleep is top of the list.

Poor sleep, defined as chronically less than 6 hours per night makes it impossible to lose body fat. If you restrict calories with poor sleep you will lose muscle mass and make your health much worse. Poor sleep contributes to poor eating by creating the urge to eat more, “the munchies.” Poor sleep imbalances the hormones making it impossible to gain muscle and strength. This may look like your exercise program isn’t working but it is really your body being unable to respond due to lack of nutrition. Poor sleep disrupts the healthy gut microbiome creating cravings for bad eating. Bad sleep helps cause a bad diet. Really bad sleep, less than 5 hours is equivalent to being legally intoxicated. The goal is 8 hours per night and more is better.

Good sleep starts here

Here are some recommendations I've gathered from sleep experts:

Create and follow a sleep schedule. First determine your sleep chronotype. We have a circadian body clock that is hardwired into our DNA and cannot be changed. We function best when we align our sleep with our circadian clocks. What feels the most natural to you, do you like to go to sleep early, middle or late evening? About 30-40% of the population naturally fall asleep later in the evening, defined as a few hours past 9 P.M. There is nothing wrong with you, your body clock works from 11:00 P.M. to about 9 A.M. This is the typical teenager body clock. Some adults are hardwired this way and it’s best to honor this. Most people have a body clock that works from 9 P.M. to 6 A.M. Honor this too.
Control your light exposure. Early morning sun helps promote an early bedtime (9 P.M.) while afternoon sun promotes a later time. For people in the late bedtime group, Dr Matthew Walker in his book, Why We Sleep suggests using blue-blocking sunglasses in the morning and then allow full sun exposure in the afternoon. Regardless of group, start dimming the lights about 2-3 hours before your bedtime. If you can change to more yellowish (warmer color temperature) even better. Dr. Andrew Huberman and Roka have teamed up to create Wind Down® glasses to block blue light. I’m going to try them before I recommend them.
Abandon the electronics! Not only the blue light, which can be altered by some apps and adjustments, but the brain stimulation has been shown harmful to sleep. At least 1-2 hours before bedtime all electronic use needs to stop. No television. No computer. No cell phone. No tablets. Pretend it is 1965 and the all 3 TV channels have signed off for the evening. This is not optional. These devices activate parts of the brain needed for alertness, not sleep.
Mentally and physically prepare for sleep. If you follow #3 above then what to do? Now is a great time for gentle range of motion body movements I’ll discuss later. Meditation is another great idea here as is old fashioned reading a book. Yes, those paper things with words on them.
No alcohol or sleeping pills. Both alcohol and sleeping pills are sedatives. They make you feel less alert, sedated, and both harm important components of sleep. Both result in feeling worse the next morning that recycles the perceived need for the sleep aid in the first place. Note if you are on prescription sleeping medications like zolpidem (Ambien®), eszopiclone (Lunesta®) or others please see your doctor before stopping. These medications require care for withdrawal.
Control your food intake. When you enter deep sleep the brain moves blood and spinal fluid around, blood out, spinal fluid in, then reverses. It’s sort of a wash cycle. This happens best in deep sleep which is usually within the first hours of sleep. When we eat a large meal the body is actively digesting which makes deep sleep less likely. The surge in glucose, insulin and cortisol are not helpful. It is best if we do not eat for at least 3 hours before bedtime. Eating before bedtime also contributes to gastroesophageal reflux (GERD) or acid reflux which will also disrupt sleep.
Control your liquids. It’s a good habit to stop drinking liquids along with food to allow the bladder to empty and reduce the need to get up at night. This gets more difficult as we age and the bladder becomes less tolerant. It is also a challenge because the food plan purposely drops insulin levels, and that alone comes with a fluid release. Start your day with a huge water intake and taper as the day turns to evening. More about that in the water section.
Have a comfy, cozy sleeping bed. There are many different types of pillows, mattresses and sheets. You need to experiment with each element. Like your pillow soft, firm, medium? Low, medium, high? Some pillows are adjustable. Same for mattresses; soft, medium, firm, memory foam, springs? Sheets come in cotton, bamboo, silk, and more. Sheets can be silky smooth or have texture (called percale). Ever sleep at a hotel and love the setup? Ask them what they use. Just keep trying until you hit the magic combination for you.
The dark, cool room. Black out the windows if there are any. No lights. No clocks. Nothing distracting. A white noise like an air filtration unit is good, especially to help drown out traffic or other noises outside. Consider a sleep mask if you cannot block the light.
Control your body temperature. While turning down the lights it is also good to slowly turn down the thermostat. A downshift in body temperature is required to fall asleep. A nice hot shower or hot Epsom salt bath just before bed helps temporarily elevate body temperature to help transition into the cooler bed.
Watch your caffeine. We love coffee! There is no doubt caffeine is the number one drug in the World. Caffeine is exceptionally good at temporarily blocking the sleep hormone adenosine. It keeps us in the alert state while its working. It also has a relatively long activity inside the body. Those two cups of coffee you had at 8 A.M. today are about 25mg of caffeine at 9 P.M. tonight, about 1/5th of a cup of coffee or similar to a 5 P.M. espresso shot. Rare individuals process caffeine quickly and can have afternoon cups, but for most of us it is better to have one or two before 8 A.M. if we hope to sleep at 9 P.M. Earlier is even better. Decaffeinated coffee still has caffeine but much less 15-30mg vs 100-120mg for regular. Try a day of decaf only to see if your sleep profile improves.
Optional supplements. Magnesium glycinate is a good nutritional supplement that also aids in sleep. A dose of 400mg an hour before bedtime is reasonable. This can also help stop nocturnal muscle cramps.
Extra credit- sleep tracking. I am a tech nerd and love data and gadgets so I had to try a sleep monitoring app on my phone called Sleep Cycle Sleep Tracker. I like it and use it nightly. It also records snoring which is a good monitor for sleep apnea. I added an Oura Ring® Gen3 as another method. The app and ring track sleep differently and give added insights. There are other devices as well. Regardless of how you choose to track your sleep it is a good idea. The first thing I noticed was how horrible I was sleeping. This motivated me even more to take actions to improve my sleep profile. Tracking your sleep is an effective way to improving it. We can’t fix the problem we don’t know we have.
Prescription Medications. If you believe one or more of your medications might be disturbing your sleep, please discuss this with your doctor. There may be alternate times or ways to take them or possibly change to alternate drugs entirely. Do not make medication changes on your own before consulting the prescribing physician! Seriously, do not change your medications without your doctor’s knowledge. Do not stop, reduce or increase dose, modify in any way from the way prescribed. This must be done in cooperation with your doctor.