Unlocking the Secrets to a Restful Night: Your Circadian Rhythm

Karen had many children from adults to young children and her house was always busy. She did not want to miss out on any fun at night, and she had to get kids ready for school in the morning, so she got little sleep. “I have taken to heart the motto, ‘”Early to bed and early to rise,’” she quipped. “I go to bed early in the morning, around 1:00 AM and then wake up early in the morning, around 6:00 AM.”  Later, she had a very hard time with sleep, and always felt tired. A sleep study revealed that her sleep was backwards, and she rarely had more than 20 minutes of deep sleep.

Our daily sleep and wake cycles are essential for the function of the body. During the day we have a “catabolic metabolism” which means we are breaking down our bodies – nothing major, just daily “wear-and-tear.” However, at night we get an “anabolic metabolism” during which we repair all the damage done during the day. If we don’t get adequate sleep, the repair function doesn’t happen, and we age. Repair must be a daily event, or we gradually get more damage. Eventually, there is too much damage to repair. We can get a little better, but once we have floated too far downstream, we will not be able to get back the lost function. This is true of the heart, kidneys, brain, skin, and even muscles. Just like everything else in the world, it is essential to keep the body in good repair daily. Thus, sleep is essential to prevent aging.

There are many ways to disrupt sleep-wake cycles. Anything that prevents us from a good circadian rhythm can also prevent the repair of our bodies. Modern lifestyles are not conducive to good circadian rhythm. We can turn on lights, watch movies, exercise, work, eat, and do everything anytime of day. Before electric lighting and refrigerators, this mostly wasn’t possible.

Graveyard Syndrome

Charlotte was a nurse working nights for the past eleven years. She came in with complaints of pain, fatigue, hot and cold intolerance, insomnia, brain fog, and getting sick all the time. This had come on gradually over the years. As we discussed her sleep problems, it became clear that she did not have a regular sleep schedule. Because she was working nights, and she had a family, she took care of her family during the day, and only got sleep at irregular intervals, such as when the kids were at school. Then she would take a nap before work in the evening. On weekends she tried to sleep at night, but her body was used to being awake. “It’s like having ‘jet lag’ all the time!” she lamented.

Shift work has been shown to cause a great deal of damage to the circadian rhythm, and to the body.[1] The adrenal glands that control the circadian rhythm require regularity. Being inconsistent leads to dysfunction of the glands, which changes the way the whole body functions. This is called “graveyard syndrome” or “shift-work sleep disorder.” This is where the adrenal glands are not functioning properly, and people feel “half-asleep all day, and half-awake all night.” This affects every regulatory system in the body:[2]

• Immune system —
• Nervous System
• Blood pressure
• Heart rate
• Temperature
• Digestive system
• Circulation
• Thyroid function
• Sexual function
• Hormones
• Metabolism
• Insulin sensitivity
• Orexin[3]

The adrenal glands affect every cell in your body, so they naturally control everything about the way they body functions. That’s why Charlotte could have so many different problems due to only one dysfunctional gland. The circadian rhythm is not something to take lightly.

Sleeping pills — Sedatives, hypnotics, tranquilizers[4]

Alcohol has always been the “drug of choice” for sleep problems. However, though people may pass-out, they don’t get restful sleep with it. One 2018 study compared sleep quality among subjects who consumed various amounts of alcohol:[5]

• Less than one drink per day decreased sleep quality by 9.3%.
• One to two drinks per day decreased sleep quality by 24%.
• More than two drinks per day decreased sleep quality by 39.2%.

Interestingly, most of the prescription “sleeping pills” work in the same area of the brain as alcohol, and cause the same problems. Of all the prescription medications for sleep, only the orexin inhibitors improve daytime function, but only increase sleep by zero to fifty minutes.[6]

One problem with sleeping pills is that they may knock people out, but generally don’t give good sleep.  Some of them are dangerous.  One of my patients who lived alone called the police because someone got into his house at night.  He was very meticulous, but began finding tools in the garage moved, food on the kitchen counter, and stuff on the floor.  One day he woke up on the kitchen floor with sandwich fixings all over the counter and realized that he was sleep walking, eating, and who knows what else.  The medication Zolpidem caused this.  Some have even been known to get in their cars and drive while sleeping.[7]

Antidepressants and over-the-counter sleeping pills are all anti-histamines.  They block the wake-up neurotransmitter called “histamine” causing people to feel sleepy. They do not interrupt sleep architecture, but can create other problems, such as dementia if used regularly.[8]

Another issue with sleeping pills is that all of them may cause dependence.  Not that you can’t live without them, but rather when you stop them you have problems sleeping. The rule is: Don’t rely on sleeping pills to sleep. Instead, change your circadian rhythm.

Sleep Stimulant Usage

One of the more common problems I see with sleep is the use of stimulants.  Amphetamines, like those for ADHD destroy parts of the brain and can interfere permanently with sleep.  MSG is notorious for causing sleep problems.  Also, stimulants such as caffeine found in coffee, tea, yerba mate, and so forth interfere with sleep patterns, even if they don’t decrease the time of sleep.[9] Thus, caffeine interrupts sleep, which decreases daytime performance, which makes people feel like they need caffeine to function. It’s a never-ending cycle.

Today, I see many more problems with sleep because of “energy drinks.”  These are very high in stimulants while at the same time adding Taurine, and amino acid to calm the brain so people aren’t shaky and nervous.  The effect of these is to change the brain in the same ways that excessive stress does, bringing out the weakness of the individual, and disrupting sleep patterns. Stimulants during the day interrupt sleep at night, causing people to need stimulation during the day. They remain half-asleep all night, and half-awake during the day.

Sleep and Your Age

The need for sleep does not change throughout life. Older people tend to get less sleep because of problems, such as:

• Sleep apnea
• Restless legs
• Nighttime urination
• Pain
• And so forth.[10]

Don’t let anyone tell you it’s normal to sleep less as you age. Instead, keep a good circadian rhythm, and exercise regularly.

Naps vs Sleep

Many people like to take naps during the day.  There is no problem with this, but remember, the total amount of sleep needed in a day doesn’t change.  So, if you find yourself unable to sleep at night, you might want to cut out the naps during the day. Also, naps do not increase your deep, restorative sleep, or anabolic metabolism. Naps take away from good sleep.

Sleep Apnea and Your Health

Steven is overweight, has diabetes and hypertension.  He comes to the office complaining of being sleepy all the time.  He says he could sleep ten hours and still wake up tired.  The biggest problem is that he’s a long-haul truck driver and has had difficulty staying awake on the road. I asked him how he stays awake and he said, “AMPHETAMINES!”

The fastest growing sleep problem in the world is sleep apnea, which is when a person wakes up frequently at night because of not breathing.  This may happen hundreds of times every night, but the person isn’t aware of any.  Usually, when they are breathing, they snore loudly.  Even though they may sleep long enough, they are always tired because they don’t get enough deep sleep. The problem is that each time they go into deep sleep, the body relaxes completely, and the breathing stops.

There are several treatments which may be useful.  There is a dental appliance that keeps the jaw forward so the airway remains open; this is helpful for some.  Most people with sleep apnea are prescribed a CPAP (continuous positive airway pressure) machine.  This is just a blower that keeps a little air pressure in the nose to keep the airway open.  This works very well, but some cannot tolerate being connected to machinery all night, and don’t sleep well.  There are also physical therapists that specialize in the mouth and tongue who have success in treating sleep apnea as well.  Another option is surgery. There are many different types of surgery for this, but their success rate is around 50%, and there can be significant complications.[11]

By far, the best treatment strategy is to lose weight.  Any of the other treatments work better if the patient loses weight, and most of the time they won’t need the other treatments anymore.  Even those who aren’t obese may benefit from losing weight to reduce or eliminate their sleep apnea.  The problem is that sleep apnea also leads to obesity – it’s a vicious cycle – so this weight loss must be taken very seriously.

Menopause and Good Sleep

I have found many women aged 40 and up have sleep problems because of the loss of hormones.  But, Julia was only 35 when she started having sleep problems.  Now, over 6 years later she was getting worse.  She couldn’t sleep because her mind wouldn’t shut off early in the evening, and when she finally did get to sleep she would wake up burning up, sweating, and kicking off the covers.  She came in to see me because she wanted a sleeping pill, but we found that she had a hormone imbalance.  Given natural progesterone to calm her mind, and natural estrogen to stop the hot flashes, Julia was sleeping like a baby again.

Though we consider menopause as no longer having a menstrual cycle, women begin to decrease in progesterone around age 35. The changes in hormone balance can cause anxiety and affect sleep. This is an especially important time to keep a very good circadian rhythm and maintain good sleep.

Sleep for Restless Legs

Mert was in his early seventies and was having trouble sleeping.  He had tried many sleeping pills, but they didn’t seem to work well.  It took a lot of questioning during several visits for me to find out that he had “Restless Leg Syndrome.”  He couldn’t sleep because he had to move around; he couldn’t keep still.

Restless leg syndrome is when people feel the need to move their legs at night, and just can’t relax them.  It is related to Parkinson’s syndrome, which is a lack of dopamine.  The medical treatment is to give dopamine precursors, but these can cause Parkinson’s disease. Without the ability to relax

On the other hand, there are natural supplements that can be very useful and even diminish the chances of Parkinsonism.  Mert was put on supplements that relieved his RLS and helped him sleep.

If you have RLS, try these before bed at night:

• Magnesium 400 mg
• Tryptophan 500 mg
• Tyrosine 500 mg
• Taurine 500 mg
• Velvet bean extract
• Nicotine patches or gum

Cramps and Sleep

Another, similar problem that prevents sleep is night cramps.  Since cramps are related to electrolytes, they are most often treated with mineral supplements, which seem to work for some.  It is common to have electrolyte imbalances due to drinking too much water. Water depletes sodium and potassium, as well as other minerals. I have found that it is best to drink a cup of water only when thirsty. This allows your kidneys to regulate the minerals more easily.

Another issue with cramps is energy. When there is less energy, the muscles don’t relax easily. It requires energy to relax muscles.  The muscles make more mitochondria, and thus more energy, during exercise.

One patient, however, didn’t respond to any of the treatments.  She had suffered with night cramps for many years, trying everything she could think of. I even gave her IV vitamins and minerals in case she wasn’t absorbing them – but that still didn’t work.  One day, her neighbor recommended that she put a couple of bars of soap under the sheets of her bed about at the level of her legs.  She did, and it worked!  She has slept well ever since.  When the effect wears off she just changes the soap, and it continues to work.

• Use coral calcium 1000 mg per day.
• Try magnesium 500 mg before bed.
• Exercise during the day.
• Try the “soap trick.”

Sleep for Anxiety

A common reason for difficulty sleeping is anxiety.  The adrenal glands make adrenaline when we are stressed which causes heart palpitations, shortness of breath, and sleeplessness.  The stress hormones actually change the chemistry of the brain, preventing long and deep sleep.  Ironically, a lack of sleep increases stress hormones, creating a cycle of stress. The best way to treat this is to decrease stress.

• Write in a diary or journal
• Don’t watch television (especially the “news”)
• Use Ashwagandha, Ginseng, Eleuthero, Licorice root, or other “adaptagens”
• Take Melatonin 1-6 mg in the evening
• Try a hot bath, or hot tub with Epsom salts and lavender oil
• Use 5-HTP 100 mg twice per day
• Magnesium 400 mg at night helps relax muscles 

How to Get A Good Night’s Sleep

To maintain a good sleep cycle it is important to start with a good circadian rhythm. Everyone needs to maintain a strict schedule of sleep and wake. As Benjamin Franklin said, “Early to bed, and early to rise, makes a man healthy, wealthy, and wise.” Also, many people don’t know that it’s important to have an empty stomach when going to sleep. This prevents acid reflux, heartburn, and allows Human Growth Hormone (HGH) to repair the body. The following schedule is optimal and applies to everyone:[12]

• Exercise every day
• Lights out at 9 PM
• Go to sleep by 10 PM
• Wake up between 6 AM and 7 AM every morning
• Eat breakfast by 8 AM
• No food after 6 PM

It is best to find the cause of the sleep problem before initiating treatment. Sleep problems are complex, and you may need to try several things before finally beginning sleeping well.  If you have tried the suggestions above without benefit, consider talking to a doctor about a “sleep study,” where you are monitored all night to determine where the sleep problem is.  I rarely order these, but in selected cases they have been useful.  The new wrist or ring sleep monitors are also very helpful. They can tell you where the problems are and help you regulate your sleep. With the right treatment, almost everyone can get a good night’s sleep. Sleep is not something that you can dispense with and stay healthy. Take care of your adrenal glands, because they regulate everything in your body. You will be able to handle more stress with ease, and will repair every night so you never get “old.”

 

 

 

 

Sources:

[1] https://www.sleepadvisor.org/how-shift-work-affects-circadian-rhythm/
[2] https://www.ncbi.nlm.nih.gov/books/NBK537260/
[3] https://en.wikipedia.org/wiki/Orexin
[4] https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/sleeping-pills/art-20043959
[5] https://pubmed.ncbi.nlm.nih.gov/29549064/
[6] https://www.sleepfoundation.org/sleep-aids/orexins
[7] https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-boxed-warning-risk-serious-injuries-caused-sleepwalking-certain-prescription-insomnia
[8] https://www.health.harvard.edu/mind-and-mood/two-types-of-drugs-you-may-want-to-avoid-for-the-sake-of-your-brain
[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292246/
[10] https://www.sleepfoundation.org/aging-and-sleep
[11] https://www.healthline.com/health/surgery-for-sleep-apnea
[12] https://www.goodreads.com/book/show/37534452-the-circadian-code