When we look at improving our health we tend to focus on the obvious things like nutrition and exercise. However, we spend 1/3 of our lives asleep, and most of us pay very little attention to optimizing it. Over millions of years, the process of sleep has been preserved by evolution. Even though when an animal sleeps they are at risk of attack, evolution has kept sleep in most animals. This just shows you how important sleep is to health and wellbeing. In this article, I as a heart doctor in Singapore look at why ensuring you get good sleep is so important and common questions people have regarding sleep and how to improve it.
Some of the problems with poor sleep:
Sleep and the risk of heart disease – Sleep has a big effect on cardiovascular disease. People that are sleep deprived have a greater risk of heart attacks. One example of this is that when the clocks go forward, and we lose an hour of sleep, there is a spike in the heart attack rate on that day. In addition, it has been shown that people who are chronically sleep deprived have a higher rate of coronary artery calcification. One of the reasons for this is that when you sleep poorly you activate your stress hormones and produce more adrenaline and cortisol, both drivers of arterial disease. You are basically activating your fight or flight response if you don’t get enough sleep. In addition, this drives high blood pressure, a risk factor for heart disease. This is one of the reasons why sleep apnea also increases your risk of heart disease.
Poor sleep lowers testosterone – Poor sleep massively impacts sex hormones too with men suffering a drop in testosterone when they have less than 5 hours sleep. Too often men are looking to get testosterone supplementation when correcting sleep deficiency is enough to normalize testosterone levels.
Lack of sleep is associated with weight gain – When you are sleep deprived you activate hunger hormones causing you to eat more. Also when you are sleep deprived you are less likely to exercise so it is a double whammy for weight gain!
Poor sleep causes increase in Alzheimers protein – Just one night of poor sleep increases the amounts of beta-amyloid in the brain. High levels of beta-amyloid are found in patients with cognitive dysfunction and Alzheimers disease.
How do you optimize your sleep?
There are key areas you can focus on to improve your sleep quality.
- Lighting – 60 minutes before bed start dimming all the lights. Make sure the bedroom is completely light free!
- Temperature –In order to initiate sleep, you need to drop your core body temperature. Therefore, the bedroom needs to be cool. Ideal bedroom temperature is 18 – 20 degrees centigrade. Take a hot shower or bath before bed, paradoxically this lowers your body temperature by dilating your peripheral blood vessels allowing you to lose body heat.
- Relaxation – Try to wind down for 1 hour before bed, reading, meditation etc. Avoid all work/email and social media. Another good tip is to write down all the things you are worried about on a piece of paper, this has the effect of getting them out of your mind.
- Exercise – exercising is good for promoting sleep, but the timing is critical! Exercise raises your body temperature and activates your sympathetic nervous system, both of which are detrimental to sleep. So ideally do not exercise within 2 hours before bed. Exercise in the morning if possible, for maximum sleep benefits.
- Consistency – go to bed and wake up at the same time every day. The body loves routine and fall into a pattern quickly. Even if you have a bad night of sleep, still get up at the same time. If you have a “long lie” it alters the regular rhythm, and the body doesn’t like it.
- Caffeine – Caffeine keeps you awake, and it hangs around in the body for a long time. Some people are more sensitive than others. After 12 hours 25% of the caffeine you drink will still be in your body. So ideally don’t drink any caffeine after 10am.
- Alcohol – People often have a “night-cap” to help them get off to sleep. However, despite what people think, alcohol destroys sleep. You may fall asleep easier, but the quality of your sleep is massively impacted. If you drink alcohol before you go to sleep you wake up multiple times during the night (fragmented sleep) , and have deeply unrefreshing sleep. It also decreases the amount of REM sleep (dream sleep) that you have. REM sleep is super important when dealing with emotional issues, ie alleviating stress. In addition, alcohol is a potent diuretic making you go to the bathroom multiple times per night. Stay away from all alcohol after 2pm if you want to preserve your sleep quality!
- Eating –Don’t eat for 3 hours before bed. Eating raises your body temperature, and your body temperature needs to drop to initiate sleep. In addition, eating just before bed increases the risk of indigestion and reflux that can affect your quality of sleep.
- Electronics – Avoid using phones and computers for 1 hour before bed. The blue light potentially decreases your melatonin secretion, but more importantly they “activate” your brain and don’t allow it to slow down in preparation for sleep. These devices are designed to make you pick them up and use them, thus delaying when you should be going to bed. Ever woken up in the middle of the night to check social media or an email?! They also develop anticipatory anxiety, where your brain is anxious about what it will see on email in the morning, so it affects your sleep quality. Keep your iphone/ipad out of your bedroom
- Work out what type of sleeper you are – night owl or morning bird. You will likely always be this chronotype, it is very difficult to change. Just make sure that whatever type you are, that you are getting your full 8 hours.
Related article: 8 Completely Natural Ways to Improve Your Heart Health
How much sleep do you need?
Everyone needs 7-9 hours sleep a night. If you are not getting that then you are not getting enough sleep. There are some very rare people who only need 5 hours sleep, but they have a short sleep gene that means that us enough for them to feel refreshed. Most of us don’t have that gene!Ie it is less than 1 in 10000 people.
If I cannot sleep one night what should I do?
If you can’t sleep you should get out of bed and go into another room and read until you are tired. If you lie awake in bed, the brain starts to associate the bed with being awake. For a similar reason you should not watch TV in bed. The bed should be associated with sleeping only (and the other thing!)
Should you take a nap?
Napping does have some benefits, particularly on memory and learning, and if it doesn’t affect your sleep at night, then go ahead! But if you are a poor night-time sleeper then naps are best avoided. When you are awake, a chemical called adenosine builds up in your brain. The more adenosine you have the sleepier you feel. When you nap you remove some of that adenosine which can impact your ability to sleep that evening.
What is the ideal length of a nap?
15-20 minutes is enough to make you less sleepy. However, if you go for 45 minutes you will wake up in the middle of a deep sleep cycle and potentially feel a lot worse than you did before the nap! If you go for 90 minutes that’s enough for a full cycle including deep and REM sleep. So either 20minutes or 90 minutes but not in between.
Should you use sleeping pills?
This will scare you. Sleeping pills are associated with an increased risk of death and cancer! Zopiclone and zolpidem don’t create sleep, they create unconsciousness. Sleeping pills can be used for the short term, but often when you stop them, it makes it more difficult to sleep, so if you can, avoid them.
Do you have sleep apnea?
Obstructive sleep apnea(OSA) is very common in Singapore. Most people with OSA are undiagnosed and it is estimated that 30% of the population in Singapore has it. OSA basically means you stop breathing multiple times per night, and during these episodes your oxygen levels drop and you regain consciousness although you don’t realise it. Sleep structure is destroyed and you feel deeply unrefreshed in the morning. It can be diagnosed quite simply with a home sleep study. Certain things increase your risk of it – snoring, obesity, high blood pressure, being a man. Having OSA increases your risk of death, heart attack, high blood pressure and many other illnesses. If in doubt ask your cardiologist.
Consider sleeping in separate beds
If your partner is a noisy snorer or their movement keeps waking you, then maybe you should consider sleeping in separate beds! This is called a sleep divorce and it does improve sleep quality for some couples. Paradoxically it may also improve your relationship because if you are well rested you will be far happier and less likely to argue!
Should you use melatonin?
This can be useful to help sleep intermittently, but the doses in commonly available supplements are too high. You only need to take 0.5mg, and some of the supplements are 10mg! If you take too high a dose then potentially you could shut off your bodies production of melatonin.
What can I do if I am a chronic insomniac?
If you are a chronically poor sleeper and really need help, then try to find a practitioner that can help you with cognitive behavioural therapy for insomnia. This is a very effective therapy to help with chronic insomnia.
As you can see sleep is critical to almost all body processes. If you try to optimize your sleep you will not only feel good, but also live a longer and healthier life!
Related article: 6 Ways to Lower Your Cholesterol Naturally
Dr Michael MacDonald is a heart doctor and cardiologist working in Singapore.