Lifestyle Medicine Strategies to enhance sleep

Sleep is critical for achieving optimal health, safety, and productivity in life’s pursuits (SMD 2018). It plays a critical role in metabolism, immune function, muscle growth, energy, mood, learning and memory (SMD 2018, Dattilo et al. 2011, Jacobson et al. 2008).

Did you know?

• 4 in 10 Australians frequently suffer from inadequate sleep (SHF 2017).
• In 2016-17, sleep deprivation was linked to 3,017 Australian deaths - 394 deaths from falling asleep while driving or from industrial accidents and 2,623 deaths from heart disease or diabetes (SHF 2017).
• A number of notable accidents and disasters have occurred due to sleep deprivation (SMD 2018).
• Medical errors and traffic accidents are also significant contributors (Landrigan et al. 2004, SMD 2018).
• Being awake for 16 hours or more causes changes in brain activity (Harrison & Horne 2000, William & Fever 2000).
• Sleep deprivation costs Australians $66.3 billion annually (SHF 2017).

The facts

• Almost 20 years ago, sleep research pioneer, William Dement MD said, “You’re not healthy, unless your sleep is healthy” (Dement 2000).
• Wakefulness and sleep occur from the actions of two opposing internal forces (SHF 2017, SMD 2018).
• The body has a biological clock (circadian rhythm) that controls the daily oscillation of different bodily functions, including body temperature and neurohormone secretion (Gillette & Tischkau 1999).
• White (visible) light is made up of all the colours of the rainbow. Of these colours, blue light has more thermal energy and will affect your ability to get the recommended 7-9 hours of sleep per night, while red light has the least power to shift circadian rhythm and suppress melatonin (NSF 2015, PC 2018, Nagare et al. 2018).

What can we do about it?

Here are some strategies to help you get your best night’s sleep:

• Light. Make sure you are exposed to 10,000 lux for 30 minutes every day (Stothard et al. 2017) – that’s full daylight (not direct sun). The best time to do this is early in the morning, between 6.00 and 8.30am, when the circadian rhythm is the most responsive. In winter, exposing eyes to natural light, even on a cloudy day, will produce a favourable response.
• Devices. Turn off all screens, including TV, radio, music devices and mobiles, to help your mind and body switch off well before bedtime. This allows melatonin and cortisol levels to normalize (IOM 2011).
• Caffeine and Alcohol. These affect adenosine, a neurotransmitter which decreases neural activity and facilitates sleep (IOM 2011, Topiwala et al. 2017, GBS 2018, SMD 2018, WCRF 2018).
• Schedule. A regular sleep schedule keeps the circadian sleep/wake cycle synchronized, resulting in fewer reports of insomnia and depression (SMD 2018).
• Gut microbiome. Microbiota activates the vagus nerve, affecting the circadian clock, which in turn regulates the microbiota. (Benedict et al. 2016, Mu et al. 2016).
• Exercise. This enables falling asleep faster with more time in deep sleep and less night time awake (Fairbrother et al. 2014, Young 2007, SMD 2018).
• Inner Chatter. Worrying about a problem or a long to-do list can be a recipe for insomnia (Singer 2017).
• Relaxing rituals. Follow relaxing and enjoyable daily rituals before bedtime to help you fall asleep and sleep well.
• Sleep environment. Blocking out light (Gooley et al. 2011), quietness (Basner et al. 2011), comfort (Jacobson et al. 2008) and ambient temperature are key (Dal Bene 1999, Gradisar et al. 2006).