Quality Sleep & Sleep Hygeine
How do we obtain quality sleep? What is quality sleep? Quality sleep is a term to describe sleep that is restorative to overall health and well-being. It refers to optimal time and duration of sleep. There is a difference between research studies about the length of time we need to sleep. For babies who tend to sleep sixteen to eighteen hours, school aged children and teens on average need nine and a half hours and adults seven to nine hours. There are many factors that affect whether or not you had a night of quality sleep. How long it takes you to fall asleep, it should take you less than thirty minutes. The number of times you awake during the night should be once or not at all. The number of minutes it takes you to fall back to sleep if you wake up, should be less than twenty minutes. It is known that everyone needs sleep, however, several researchers agree there is still more to discover about sleep. “Sleep is an important part of your daily routine-you spend about one-third of your time doing it. Quality sleep -- and getting enough of it at the right times -- is as essential to survival as food and water. Without sleep, you can’t form or maintain the pathways in your brain that let you learn and create new memories, and it’s harder to concentrate and respond quickly” (National Institute of Neurological Disorders and Stroke, 2019).
Traditional Chinese Medicine: Organ Clock:
Traditional Chinese Medicine has developed a clock (see Appendix) that shows when each organ recuperates. This clock is sometimes referred to as an organ clock, body clock or meridian clock, it is based on a 24 hour cycle. In Chinese medicine, energy, also known as qi or vital force, moves through the body’s meridians and organs in a 24 hour cycle. Every two hours the energy or qi is strongest within a particular organ and its functions of our body. “Chinese Medicine’s 24 hour body clock is divided into 12 separate two-hour intervals. During each interval our Qi moves through the body, landing in a specific organ meridian...When one organ is at its peak energy, the organ at the opposite side of the clock, 12 hours away, is at its lowest function.” (OrganOlivia, 1)
According to Chinese medicine it is also important what time we sleep. The deepest part of sleep is during the first third of the night, it is the most restorative part of sleep. It is during these hours that the stress hormone cortisol is reduced. The parasympathetic nervous system increases which allows us to rest completely and get out of the fight or flight responses that consume our waking hours. “A bedtime of 10:30 pm (at the latest) is advised so that you are asleep by 11pm when the Liver and Gallbladder start to regulate qi, process emotions, balance hormones and detoxify the body. According to Chinese medicine, the window from 11 pm - 3 am, which correlates to the Liver and Gallbladder is most important in terms of maintaining health.” (Turning Pointe Acupuncture, 3) A lack of sleep at this time can cause difficulty in alertness throughout the day. It is also important to note that in Chinese medicine the body, mind and emotions are inseparable. Which means if there is disharmony in the emotional state it is tied to the physical body. If you wake in the night at the same time every night it may indicate an imbalance in the organ associated to that time.
According to the organ clock 11pm - 1am is the time of the Gallbladder. The gallbladder is a small sac that is attached to the underside of the liver. The gallbladder stores and excretes bile (which aids in digestion) along with being strongly tied to the liver. The emotions of the gallbladder are indecisiveness, lack of courage and resentment. An imbalance may also show signs of weak tendons or tendonitis.
1am - 3am is the time of the Liver. The liver detoxifies and processes emotions each night. It is essential and performs over 5000 functions. The Liver is the largest gland located in the mid and right upper abdominal cavity tucked under the rib cage, it has two main lobes, the main lobe is on the right side with a smaller lobe on the left side. The emotions of the liver are anger and irritability. Imbalances in the liver may present as high blood pressure, migraine headaches, and explosive outburst of anger.
3am - 5am is the time of the Lungs. The lungs are a part of the respiratory system; it is during this time that they detoxify. The lungs are located in the pleural cavities, they are cone shaped organs and occupy most of the thoracic cavity. The right lung has three lobes and the left has two lobes. The emotions of the lungs are sadness and grief. An imbalance may present as shortness of breath, sweating easily, shallow breathing, fatigue, cough, frequent cold or flu, allergies and asthma.
5am - 7am is the time of the Large Intestine. It is a good time to wake up, release bowels and remove toxins from the previous day. The large intestines, also referred to as the colon, are approximately five feet in length. The large intestine has a close relationship with the lungs, which makes it equally affected by grief, worry and sadness. An imbalance can present as colitis, constipation, diarrhea, diverticulitis and food allergies.
7am - 9am is the time of the Stomach. The stomach is located in the upper left part of the abdominal cavity under the diaphragm. Eating your largest meal of the day during this time is beneficial as this is when the stomach is at its strongest. It receives food from the esophagus, and plays an important role in digestion. The emotion of the stomach is worry. Imbalance can present as bad breath, bleeding gums, weak muscles, underdeveloped muscles, muscles that cramp or tire easily and craving sweets.
9am - 11am is the time of the Spleen which is closely related to the stomach. It is located on the left upper quadrant of the abdominal cavity. It is believed that the spleen converts food to qi. The emotions of the spleen are low self-esteem, worry and pensiveness. Signs of imbalance may present as fatigue, memory issues, poor appetite, bloating, paleness, poor hair and nails.
11am - 1pm is the time of the Heart. The heart's primary function is to pump blood to the body and provide the body with vital nutrients and oxygen. The heart sits in the thoracic cavity, with two thirds on the left side and one third on the right of the midline. The emotions of the heart are joy and sadness. The king of all the organs, the other organs will sacrifice their energy to ensure that the heart maintains its balance. Imbalance can present as insomnia, heart palpitations, irregular heart-beat, excessive dreaming, poor memory and concentration and dizziness.
1pm - 3pm is the time of the Small Intestines. The small intestine is called small due to its diameter being smaller than that of the large intestines. The average length is twenty feet. It is located in the central lower abdominal cavity. The small intestine is where digestion and assimilation is completed. The emotions of the small intestines are abandonment and vulnerability. Imbalances can present as indigestion, pain and bloating.
3pm - 5pm is the time of the Bladder. The bladder functions as a temporary reservoir for urine. Moderately full it can hold 500mL or 1 pint.
5pm - 7pm is the time of the Kidneys. The kidneys are located high on the posterior (back) wall of the abdominal cavity. They are the most important organ in the excretory waste. The kidneys cleanse the blood of waste, help regulate volume and composition and aid in regulation of the body fluids pH. The emotions of the kidneys is fear. Imbalances can present as frequent urination, incontinence, vertigo, night sweats, dry mouth, poor short-term memory, low back pain, sore and weak knees, ringing in the ears, hearing loss, hair turning grey prematurely, hearing loss, hair loss and osteoporosis.
7pm - 9pm is the time of the Pericardium and Circulation. The pericardium is a sling-like structure that supports the heart, and attaches the heart to surrounding structures. This is the time that nutrients are carried to the capillaries.
9pm - 11pm is the time of the Triple Burner or Triple Heater. It is not an organ, it is related to the endocrine and lymphatic systems. It is when the body is adjusting homeostasis and replenishing enzymes. The emotions are guilt and confusion. Imbalances may present as adrenal fatigue, swollen lymph nodes and fibromyalgia. It is recommended to sleep at this time so the body can conserve energy.
The Brain and Sleep:
The brain has numerous functions relating to falling asleep and staying asleep. Not only are different structures of the brain involved there are also many complex electrical, hormonal and chemical reactions that transpire during sleep. Sleep is an intricate process that affects how we function every day. In an article by the National Institute of Neurological Disorders and Stroke the author states “Sleep is important to a number of brain functions, including how nerve cells (neurons) communicate with each other. In fact, your brain and body stay remarkably active while you sleep. Recent findings suggest that sleep plays a housekeeping role that removes toxins in your brain that build up while you are awake.” (National Institute of Neurological Disorders and Stroke, 2019) In the book Sleep Disorders, it states “ sleeping reinforces learning and memory, while at the same time helping us to forget or to clear stores of unneeded memories. During the course of the day we are inundated with experiences, some of which should be remembered while others need not be. Perhaps sleep aids in rearranging all of the experiences and thoughts from the day so that those that are important are stored and those that are not are discarded.” (Judd, 2010) Some researchers believe this is why we dream that our brain is doing housekeeping.
Structures in the brain that play an active role in sleep are the hypothalamus, suprachiasmatic nucleus, brain stem, thalamus, cerebral cortex, pineal gland and amygdala.
“The hypothalamus, a peanut-sized structure deep inside the brain, contains groups of nerve cells that act as control centers affecting sleep and arousal. Within the hypothalamus is the suprachiasmatic nucleus (SCN) - clusters of thousands of cells that receive information about light exposure directly from the eyes and control behavioral rhythm...The brain stem, at the base of the brain, communicates with the hypothalamus to control the transitions between wake and sleep. (The brain stem includes structures called the pon, medulla and midbrain.) Sleep-promoting cells within the hypothalamus and the brain stem produce a brain chemical called GABA, which acts to reduce the activity of arousal centers in the hypothalamus and the brain stem. The brain stem (especially the pons and medulla) also plays a special role in REM sleep; it sends signals to relax muscles essential for body posture and limb movements, so that we don’t act out our dreams...The thalamus acts as relay for information from the senses to the cerebral cortex. During most stages of sleep, the thalamus becomes quiet, letting you tune out the external world. But during REM sleep, the thalamus is active, sending the cortex images, sounds, and other sensations that fill our dreams. The pineal gland, located within the brain’s two hemispheres, receives signals from the SCN and increases production of the hormone melatonin, which helps put you to sleep once the lights go down...The amygdala, an almond-shaped structure involved in processing emotions, becomes increasingly active during REM sleep...The basal forebrain, near the front and bottom of the brain, also promotes sleep and wakefulness, while part of the midbrain acts as an arousal system. Release of adenosine (a chemical by-product of cellular energy consumption) from cells in the basal forebrain and probably other regions supports your sleep drive. Caffeine counteracts sleepiness by blocking the actions of adenosine” (National Institute of Neurological Disorders and Stroke, 2019)
Neurotransmitters, Amino Acids, Hormones and Chemical Reactions
GABA-(gamma aminobutyric acid) A chemical made in our brain, an amino acid that facilitates communication among brain cells. It reduces the activity of neurons in the brain which aids in muscle relaxation and sedation. Widely used in the brain during NREMS to damp down neural activity and reduce arousal. Many people that suffer from anxiety, insomnia and other brain disorders do not produce enough GABA. GABA plays a strong role in inhibiting over-activity of nerve cells in the brain. Proper levels of GABA are needed to normalize the nervous system, reduce anxiety, fear, hyperactivity and stress related sleep disorders.
Norepinephrine as called, noadrenaline or noradrenalin functions in the brain and the body as a hormone and neurotransmitter. It acts to increase the force of skeletal muscle contractions along with the rate and force of contractions of the heart. It is vital to the fight or flight responses. It mainly functions as a neurotransmitter with some functions as a hormone.
Melatonin-facilitates sleep. It is released about 14 hours after awakening, which is normally 2 hours before sleep onset, by the pineal gland , it reached its peak near the middle of the sleep period, returning to its low waking levels by the end of sleep. Light striking the eyes inhibits its release. If there is an advance or delay in the schedule of light and dark, it will take several days before the release of melatonin follows. It has been shown to cause sleepiness, speed sleep onset, and facilitate sleep maintenance.
Orexin (hypocretin) initially recognized as a regulator of feeding behaviors, mainly regarded as a key modulator of sleep/wake cycle. Orexin keeps some parts of the brain active while we are awake and is produced in the hypothalamus. It is important to maintain long, consolidated awake periods and is especially involved in regulating REMS.
Acetylcholine-is a key neurotransmitter for the arousal of waking as well REMs. It functions in the central nervous system and the peripheral nervous system where it serves as a transmitter substance.
Histamine- the posterior hypothalamus uses this to activate the cerebral cortex. Plays a role in waking.
Adrenaline is a hormone that prepares the body for fight or flight. It increases heart rate, increases blood pressure, expands air passages of lungs, enlarges pupils and redistrubutes blood to muscles.
Cortisol and its controlling hormones promote wakefulness. They make sleep less efficient, reduce both REMS and NREMS and shorten sleep time. Cortisol release primarily follows a circadian rhythm with the highest levels right before or after typical time of awakening and long periods of low levels during waking and into early sleep.
Adenosine- a by-product of the use of certain energy releasing molecules. It is packaged by some neurons and used as a neurotransmitter. The levels in the brain progressively diminish with sleep. Adenosine may very well be the cumulative meter of the brain activity during waking that influences when and how much sleep is needed.
Serotonin is a neurotransmitter and is the precursor to melatonin. It helps with sleep onset by dampening the brain’s response to sensory inputs. It plays a role in appetite, emotions, motor cognitive and autonomic functions.
What is sleep hygiene? “Sleep hygiene is defined as a set of behavioral and environmental recommendations intended to promote healthy sleep, and was originally developed for use in the treatment of mild to moderate insomnia.” (Irish,2015) The term sleep hygiene in the years since it was first defined has grown in popularity. The studies and articles tend to agree on a majority of practices for sleep hygiene. Create a room for sleep. Avoid bright lights, no television, computer or work items in the room. Do not read in bed, the bed should be used for sleeping and sex only. Establishing that the bed is for relaxation and not wakefulness, will aid in falling asleep quickly. Keep the room at a comfortable cool temperature. Consider blackout curtains to make the room as dark as possible along with a fan for white noise, if you live in an area that has city noise. Establish a relaxing bedtime routine, warm bath, reading, meditation or quiet time. Maintaining a regular bedtime and wake up time, every day of the week, weekends and on vacations. When setting that bedtime and wake time make sure that you are able to get a minimum of seven total hours of sleep.
It would also be helpful to follow the guidance of the organ clock to ensure you are asleep during the 11pm - 1am.Turn off all electronic devices a minimum of thirty minutes before bed. Once you get in bed, do not lay there awake. (The guidelines vary on this a little, some say do not lay there for more than five to ten minutes, other articles say twenty minutes.) Get out of bed, sit in a chair in the dark until you feel sleepy, then return to bed. Do not turn on the television, computer or look at your cell phone. The light from these items will make it more difficult to fall asleep. If you are a clock watcher hide the clock, turn it face down.
Avoid caffeine and nicotine late in the day. “Caffeine is a stimulant that can keep you awake. So avoid caffeine (found in coffee, tea, chocolate, cola and some pain relievers) for four to six hours before bedtime. Similarly, smokers should refrain from using tobacco products too close to bedtime….Although alcohol may bring on sleep, after a few hours it acts as a stimulant, increasing the number of awakenings and generally decreasing the quality of sleep later in the night...avoid drinking within three hours of bedtime” (Epstein, 2007).
Sleep deprivation can cause many health issues; in Understanding Sleep and Dreaming by William H. Moorcroft, Moorcroft explains that sleep deprivation can affect a person’s subjective, behavioral, mental process, and biological health.
“Subjective: lethargy, less ability to experience pleasure, sense of partial loss of
control, disorientation, irritability and negative moods, even paranoia in some
Behaviors: less spontaneous, over responsiveness, decrease in vigilance, decreased sense of humor, less desire to socialize, microsleeps, less able to deal effectively with unfamiliar situations, decreased psychomotor performance, clumsiness
Mental Processes: difficulty concentrating, perceptual distortions & hallucinations, greater indecisiveness, slowing of mental processes such as reaction time, decrease in short-term memory, decline in logical reasoning ability for complex problems, decrease in creativity and mental flexibility, decrease in integrative ability, lapse of consciousness
Biological: heart palpitations, fall in body temperature, droopy eyelids, itchy eyes, tremor, weight gain” (Moorcroft, 2003).
Sleep deprivation is a chronic problem in the United States. Many studies make it clear that sleep deprivation is dangerous. Test in hand eye coordination and driving simulators indicate the response time is the same or worse than intoxication. Sleep deprivation makes the effect of alcohol intensified. Only sleep can reverse the effects of lost sleep. Caffeine, stimulation and or exercise can aid in feeling more awake but not reverse the loss. To reverse the loss of sleep you do not need an hour for an hour of the time lost. Recovery is relatively quick, typically taking one to three nights.
Magnesium is essential to many body functions. It is a catalyst in utilizing carbohydrates, fats, protein, calcium, phosphorus and potassium. A vital mineral that helps to produce energy inside cells. It words hand in hand with calcium. Calcium helps muscles contract while magnesium helps muscles relax. Magnesium helps relieve muscle cramping, spasms, relieve colic and spastic bowel conditions, along with preventing heart attacks. Deficiency can be appear as hypersensitivity to noise, calcium deposits, nervous twitching and spastic muscles. Magnesium and potassium are the first minerals to be lost in an over-acid condition of the body. Magnesium complex is a great supplement for most people. Recommended doses are 1-2 capsules one to three times daily.
GABA Plus is an amino acid that acts as a calming neurotransmitter in the brain. It inhibits over-activity of nerve cells. Many individuals with anxiety, insomnia, epilepsy and other brain disorders do not manufacture sufficient levels of GABA. GABA plays a critical part in normalizing the nervous system. GABA is a non-addictive supplement. Caffeine inhibits GABA, taking GABA will counteract the effects of caffeine. This formula also has passion flowers in it. If a person suffers from mental chatter and spinning thoughts that keep you awake this is a great formula. Recommended dosage is one capsule prior to bedtime to promote sleep. If you wake during the night and are unable to fall back to sleep due to excessive thoughts, take a second capsule.
We are bombarded by commercial ads claiming they have a product to cure our sleep issues. Whether it is a new mattress, white noise machine, pillow, sheets, weighted blankets, curtains, prescription, vitamin or supplement, it is essential research. No one product is going to cure any sleep issue. In order to cure any sleep issue it will take discipline and a willingness to make changes in diet, exercise, thought patterns and behaviors. A good first step in developing a habit of good sleep hygiene. That includes making your bedroom a place for sleep and sex only. There should not be a television, computer or any work-related items in your bedroom. Room darkening curtains, it is important to have no artificial lighting in the bedroom. The bedroom should be a relaxing oasis. Unplugging from all electronics, no screen time a minimum of an hour before bedtime. Turn off the wifi to your home. Do not read on your bed, talk on your phone or watch television. The body needs to be programmed that when you turn out the lights and lay your head on the pillow it is time to sleep. Do not lay in bed for more than five to ten minutes trying to fall asleep. Get up, sit in a dark, quiet room and pray, take relaxing cleansing deep breathes. When you feel sleepy, get back into bed and try to fall asleep again. If you find that you wake up at the same time night after night, look at the organ clock and assess what organ system may need support. Find a supplement that can aid that system and seek advice from a naturopathic doctor. Be willing to make the necessary changes in order to get quality sleep. Quality sleep is imperative to a healthy, happy, better you.