Count your z’s to better sleep

Sleep may be the single most important factor of health – and one of the least understood. Without rejuvenating sleep, we cannot effectively think, act, or fight diseases. Short or poor quality sleep is linked to obesity, cancer, cardiovascular disease, and diabetes. Up to 90% of adults with depression have trouble with sleep. Yet we rarely give sleep any attention beyond new bedding, alarm clocks, and sleeping pills. Surprisingly, our iPhones may be coming to the rescue.

Tracking sleep cycles on the iPhone

I have recently been testing the iPhone/iPad app called Sleep Cycle, a clever measuring tool for charting your deep or shallow sleep throughout the night. Even better, this little gem wakes us up gently when our cycle returns to lighter sleep – no more blaring alarms that shock us from a deep slumber. By placing the phone under the top sheet near your pillow, it records subtle movements and graphs your sleep cycle by morning. The calculations claim to filter out the more distant movements of your partner. So far, I’m impressed with the results.

This sample graph shows a “normal” night without fits of insomnia or trips to the bathroom. As the manufacturer notes, the first cycle of deep sleep is the most intense, with subsequent phases increasingly less intense. In order to make sense of this, let’s go over some sleep cycle basics.

Sleep cycles 101

It is normal to have 3-5 sleep cycles per night, and one normal cycle includes these stages:

• Stage 1 – drifting off, easily awakened
• Stage 2 – eye movements stop
• Stage 3 + 4 –  slow wave sleep (SWS) or deep sleep, decreases in adolescence and third decade followed by progressive decline*, decreases in depression and with alcohol consumption
• REM (rapid eye movement) – dreams and processing of emotional experiences, more rapid breathing, eye movements, rising blood pressure, possible difficulty regulating body temperature, increased “density” with depression and aging

The deep sleep phase is a critical part of the rejuvenation process. During this phase, the body regenerates muscles and tissues, grows bone, and revives immunity. We cannot be easily awakened in this phase, and there is very little muscle activity. Deep sleep is harder to get as we age.

REM sleep is what we experience when dreaming, and it appears to stimulate parts of the brain used in learning. Scientists believe our dreams are stories we create to connect the fragments of brain activity that occur during this phase. The timing and duration of REM sleep appears closely tied to the previous deep sleep phase, and disruptions can result in depression or bipolar behavior in some individuals. The exact nature of these disruptions is still being studied as an underlying cause of many psychological disorders. In fact, new research supports the idea that popular psychiatric drug lithium works in part by reducing the REM phase and affecting related body functions.

So how can we affect our sleep cycles?

We all know the basic rules about getting consistent sleep, avoiding late night lights or screen activity, and eliminating light and noise distractions in our bedrooms. The University of Maryland Medical Center offers a few more tips for good sleep hygiene. But what if we still have trouble…what else can we do to drift off into a night of bliss?

• Prevent and treat sleep apnea – With this condition, breathing is interrupted, oxygen reduces in the body, and the person comes out of deep sleep to recover. My previous report discussed how nasal obstructions (such as chronic congestion) and mouth breathing can lead to snoring and sleep apnea. Some form of sleep apnea is estimated in 20% of the population, though 80-90% of cases go undiagnosed. Treat underlying sinus problems by identifying and avoiding triggers such as dust, mold, or food allergies.
• Change your pillows – Speaking of allergies, pillows harbor bacteria, fungus, and dust mites that can affect your health and sleep. Some pillows can be washed in hot soapy water to reduce these pathogens, and hypo-allergenic covers can also reduce our exposure.
• Warm up the skin – One study found that tiny increases in skin temperature (with a special thermostat) helped elderly patients almost double their deep sleep and prevent early morning waking. Take an extra minute to add that extra blanket or warm socks on colder nights.
• Encourage drop in body temperature – Start high, aim low. Studies suggest a “rapid decline in core body temperature increases the likelihood of sleep initiation and may facilitate an entry into the deeper stages of sleep.” Exercise performed 3-4 hours before bed or a warm bath right before bed may raise the body temperature to help fall asleep faster and deeper. So why would raising skin temperature or initial body temperature help when we need to drop our temperature to sleep? Details are unclear, but the changes seem to trigger the body into down-regulation.
• Exercise to sleep – Regular exercise appears to help improve sleep in multiple ways, increasing heart health, weight control, social interaction, and synchrony with our circadian rhythms. Exercise can also reduce our dependencies on medications and harmful addictive substances, further supporting quality sleep. Exercise stimulates growth hormones, prolactin, and TH2 immune responses which promote regulation of body functions and immunity. Multiple studies showed that exercise performed shortly before sleep may actually improve sleep, despite common beliefs.
• Check for hormone imbalances – Growth hormone deficiency is linked to sleep disorders. In women, progesterone plays a role in sedating and reducing REM, and estrogen appears to increase REM. Correspondingly, ovulating women naturally experience more stage 2 sleep and reduced REM sleep near the mid-luteal phase. Sleep challenges are prevalent in postpartum and menopausal women due to hormone changes, and progesterone may be helpful in certain circumstances.
• Wake up with bright light therapy – Multiple studies support the use of bright light therapy in regulating sleep-wake cycles and subsequent symptoms of depression. Recent studies on older, depressed patients showed that exposure to bright light in the early morning (7500 lux) improved mood, increased sleep efficiency and increased the rise in evening melatonin. Melatonin is a natural hormone produced by the body to induce sleeping based on our internal clock, and levels get out of balance with jet lag, aging, and poor sleep hygiene. While some people prefer a 10,000 lux full-spectrum light for increasing energy levels, Philips makes a less intense LED-based blue light that appears to have the same effect with shorter exposure. I have successfully used the Philips goLITE BLU Light Therapy Device on dark winter mornings to wake up easily without caffeine or cold showers.
• Avoid artificial light after dark, and try candles – Exposure to any artificial light at night alters the sleep-wake cycle, though we are particularly sensitive to blue light. My own experiments with a lighted candle (in a safe location) have helped me go to sleep quickly and deeply every time.
• Increase melatonin naturally – While melatonin supplements are available over-the-counter, there is little evidence to support its safety in the long-term. The Mayo Clinic states that melatonin is generally considered safe for daily use (5 mg) up to two years. (Read the precautions carefully.) I have previously used and recommended melatonin spray that allows for smaller dosing over a short period of time to normalize sleep schedules. New research revealed a natural source of melatonin in tart cherry juice. In fact, consumption of tart cherry juice improved sleep duration and quality in healthy men and women!
• Try psychotherapy –  Dependency upon sleeping pills can be financially and psychologically frustrating, with no end in sight. Insomnia can now being treated with Cognitive Behavioral Therapy for Insomnia. The crux of this treatment is sleep restriction, forcing the body to get sleepy at bedtime. It is also important to avoid use of the bedroom outside of sleeping or preparing to sleep.
• Reduce bodily pain – One study showed that 35% of subjects with pain reported sleep disturbance compared to 13.5% without pain. Natural pain relievers or anti-inflammatories include capsaicin (in chili peppers), arnica, curcumin (turmeric), and fish oil. I have also experienced pain relief with low-level laser therapy, a painless treatment for pain and inflammation.
• Avoid the late night munchies – A small study showed that “higher food intake close to the sleeping period is associated with negative aspects of sleep patterns in healthy individuals, especially in women.” Food digestion is also slowed during sleep which may cause discomfort during the night and prevent restful sleep. Further studies are needed to determine what types of food make the biggest difference. University of Maryland Medical Center recommends avoiding caffeine, alcohol, and heavy, spicy or sugary foods 4-6 hours before bedtime.
• Try sleeping alone – This may be the most effective method I’ve tried, though certainly not my favorite! Many couples choose to sleep separately for a solid night’s sleep. When a partner has poor health, pain or sleep disturbances, sleep quality can be reduced dramatically. Research showed 32% of patients whose partners had poor health had sleep disturbance compared to 13% of patients whose partners had excellent health. Women seem more sleep-sensitive to their partner than men. Bed sharing is a health issue for children as well, as one China study pointed out an increased risk of sleep problems where children share a bed with one or two parents. Brain and body development can be adversely affected, though it is not clear how the results may differ between families and cultures.

New directions in controlling sleep

A very exciting study showed that carefully applied slow wave (deep sleep) deprivation actually improved major depression symptoms in subjects. Sounds were played while patients were experiencing deep sleep – softly enough to prevent waking while also preventing deep sleep. This deprivation also increased REM sleep. The following days were most revealing, as patients experienced recovery or rebound sleep with increased slow wave sleep. Rebound sleep is our natural response to sleep deprivation, though studies on animals imply that we’re unable to fully recover. Gene expression is altered with sleep deprivation, affecting our inflammation response, metabolism, circadian rhythms, and much more. Aging may also blunt our recovery.

Until we have established new methods of altering sleep, most of us can start by figuring out our sleep cycles with iPhone apps like Sleep Cycle. A product called LARK offers a silent vibrating alarm and sleep coaching advice. However, the LARK iPhone/iPad app works only with the LARK wristband that starts at $99. The monitoring system is numerical rather than graphical, and the customer ratings are far less than Sleep Cycle.

An innovative company called Zeo sells a variety of sleep performance products that assist with sleep and sleep monitoring. Their $99 Zeo Sleep Manager links a headband sensor to an iPhone app with gentle waking similar to Sleep Cycle. There are no reviews for the app, but it appears to present both numerical and graphical sleep cycle information with some useful comparisons to lifestyle factors like caffeine.

Ultimately, we will benefit immensely from a thorough awareness of our sleep cycles and how we can control them to feel pleasant, refreshed and alert throughout the day. We glimpsing this dawning revolution in personal digitized health, often termed Quantified Self. People are starting to work together in online communities to gather, share, and analyze their health data faster than brick-and-mortar laboratories can set up their microscopes.

I have only one question as we approach a new era in health and sleep science…what is it going to take to pull me away from my glowing WordPress document at 11:30 at night?