Sleep Soundly Every Night, Feel Fantastic Every Day (17 page)

If you have difficulty going to sleep or staying asleep, take the Insomnia Severity Index (ISI) and determine your sleeping pattern and discover whether your sleep issue is mild, moderate, or severe. The ISI (facing page) has seven questions and each one is scored. Then you add the seven scores to get your total score. Compare your score to the guide located below.

This index provides a rating scale from 0 (no problem) to 4 (very severe) for each sleep problem. For every issue, please rate the severity ONLY for the last two weeks and
circle
the number that best describes your answer.

Add the scores for all seven items

Questions 1 + 2 + 3 + 4 + 5 + 6 + 7 = _______ your total score

Total score categories:

0–7 = No clinically significant insomnia

8–14 = Subthreshold insomnia

15–21 = Clinical insomnia (moderate severity)

22–28 = Clinical insomnia (severe)

 

 

I LOVE getting up in the morning! I clap my hands and say, ‘THIS is going to be a great day!'

—DICKY FOX from
JERRY MAGUIRE

Nearly every creature on earth has an internal “clock” that works in tandem with the planet's rotation around the sun. This inner clock regulates how bees gather honey, and it signals birds to migrate. This biological clock, called circadian biology, is governed by the circadian rhythm, the natural oscillations that occur within the 24-hour cycle and regulates eating, sleeping, and much more, as you will see in this chapter. When this rhythm is disrupted, you may have difficulty with delayed sleep, hormone dysregulation, as well as changes in body temperature and moodiness.

Circadian is derived from the Latin
circa
meaning
about
+
dies,
meaning
day.
The primary circadian rhythm within the brain modulates body temperature, muscle tone, heart rate, and hormones' secretions. Yet did you know that the heart and other major organs also have “clocks” which pace
the metabolic functions? No wonder that sleep deprivation and sleep disruptions wreak havoc across the spectrum of one's health.

Through the systematic study of sleep biology and the observation of sleep behaviors, circadian biology and the genes that regulate the biological processes every 24 hours were discovered. The enormous value in this science is that it provides the framework we now use for sleeping: the sleep stages, how the brain and body work in each cycle, what happens when sleep cycles are disrupted, and how the “right” kind of sleep restores health. I have great respect for this entire evolutionary process of our circadian biology, and I will be the first to tell you flatly that most people totally disregard how delicate and sensitive this circadian biology can be. Some of this disregard is a lack of knowledge, and in other cases, the disregard is blatant until a health issue occurs.

The circadian rhythm regulates our cycles of sleeping and waking in alignment with the outside world. Light is the most important stimulus that resets the circadian rhythm. Other stimuli include exercise, noise, meals, and temperature. For example, the presence of bright light signifies that it's time to be awake (and makes falling asleep difficult), whereas darkness encourages sleep and makes it difficult to wake up. A normal circadian rhythm regulates both sleep, as well as body temperatures, based on a 24-hour cycle.

The main control center of circadian biology is the suprachiasmatic nucleus (SCN). The SCN influences sleep directly in the brain through chemical output or indirectly through release of the melatonin hormone via the pineal gland. Two types of genes control the SCN: Period genes and Timeless genes. These genes produce proteins, “Per” and “Tim,” respectively. The function of these proteins is to increase the
activity of neurons in the SCN, which regulate waking and sleeping.

The SCN also controls the activity level of other areas of the brain and regulates the pineal gland. The pineal gland secretes melatonin, a hormone that increases sleepiness. Melatonin secretions begin two to three hours before bedtime, and when taken as a supplement, it can be used as a sleep aid to advance the internal clock. Melatonin affects the receptors in the SCN. When the SCN is damaged, for example, an irregularity in the Per gene can result in body rhythms that are no longer synchronized to light and dark. This, in turn, leads to a circadian rhythm sleep disorder.

Any number of biological and lifestyle factors can disrupt the circadian biology. The two main ones include:

Shift work:
Starting in the 1960s, people began working in shifts. Industry prophets of the time predicted increasingly more shift work as global industrialization was the “future.”

Technology:
The technology revolution changed our waking and sleeping rhythms over the last two decades. Thus, we function within a false sense of time that does not match our genetically coded natural rhythm. Our false sense of time robs us of quality sleep and can shorten our hours in sleep. Blue light pollution is the major cause of this.

The cells in the eye called rods and cones use light to build images. Retinal ganglion cells respond to light and dark. These cells communicate with the neurons at the brain's base that sets your daily circadian cycle. Melanopsin is particularly sensitive to blue light, a band of light in the narrow 400 to 480 nanometer range.

When blue light hits the retina, a signal is sent to the hypothalamus, and melatonin production is turned off and delayed by several hours. This results in an inability to fall asleep and trouble in waking up, as melatonin levels are inappropriately elevated in the morning. This is easily explained by 95% of Americans polled by the National Sleep Foundation who reported using some type of electronics a few nights a week within the hour before bed.

So where is this blue light? First, all of your communication devices (cell phones, computers of all types, televisions) emit blue light. Then include the new government mandated compact fluorescent lighting (CFL) and light-emitting diode (LED) bulbs, which give out much more blue light than the old incandescent light bulbs. Is it any wonder that we are seeing an epidemic of sleep deprivation?

As a result, we see the impact of lack of sleep everywhere, in the form of stress, cognitive dysfunction, chronic diseases, mood disorders, and obesity. In fact, in a recent study, hamsters exposed to blue light at night developed cellular changes in an area of the brain called the hippocampus. This part of the brain is very much involved in memory and emotional processing.

So, short of going back to pre-industrial conditions, what can we do to decrease our exposure to blue light and get our circadian sleep–wake cycle back to normal? My suggestions include:

1.
 
Turning off communication devices two hours before bedtime.

2.
 
Using red nightlights in our bedrooms for illumination. Of all light wavelengths, red light has the least effect on melatonin production.

3.
 
Wearing blue blocker sunglasses at night. These are very effective in screening out blue light. I have instituted this strategy successfully with many of my patients.
Blue blocker sunglasses block blue light, which is the most potent wavelength of light in inhibiting melatonin production. Blue light keeps you awake. This product is excellent for shift workers trying to avoid sunlight on the way home. It also works for people with delayed sleep-phase syndrome in achieving the equivalent of darkness at night. Finally, for those who cannot fall asleep because of late-night use of computers, televisions, and all electronic gadgets you love, blue blocker sunglasses allow you to enjoy the devices without causing a harmful circadian shift.

4.
 
Finally, a software app called f.lux that alters the color of your computer display according to the time of day can be found here:
justgetflux.com

We are being bombarded with blue light. More than 200 million computers are purchased worldwide per year. We need to be aware of blue light pollution and take measures to prevent overexposure at the wrong time of day to prevent disruption of our circadian rhythm and improve our health.

There are six circadian rhythm disorders. If left untreated, the disorders cause a host of physical and psychological problems and disrupt our personal and professional lives. Jet lag and shift work disorders are caused by external factors that result in being out of sync with the normal dark–light cycle. They are also the most common of the circadian disorders.

Most of us are familiar with the term
jet lag
; perhaps we've even experienced it while on a vacation or business trip to another time zone. Jet lag is a temporary condition, lasting
a few days to a few weeks, usually one day per time zone until our bodies adjust to the new time zone. If the time difference is only an hour or two, there is not much chance of jet lag. A change of three hours or more, however, is often enough to throw us out of sync with the light–dark cycle and cause a disruption of our circadian rhythm. For people who travel for a living, such as pilots, this disorder can negatively impact health, mood, and quality of life.

Jet lag symptoms vary depending on the individual, how many time zones they've crossed, and even the direction in which they've traveled. Studies show that east-to-west travel, where you gain hours, is easier to recover from than west-to-east travel. Most people with jet lag experience a disruption of their sleep—they either have trouble falling asleep if they have travelled east; or they wake too early if they've travelled west. They might also have trouble staying asleep. Other symptoms include trouble concentrating, headaches and irritability, and even problems with digestion and elimination.

For short trips, doctors recommend that the person adhere to their normal or “home” sleep schedule as much as possible. For longer trips, the treatment centers around getting the person acclimated to the new dark–light cycle as quickly as possible, and could include light therapy and melatonin. There is also evidence to suggest that timing meals and exercise can help recalibrate the system.

1.
 
Disturbed sleep—such as insomnia, early waking, or excessive sleepiness

2.
 
Daytime fatigue

3.
 
Difficulty concentrating or functioning at your usual level

4.
 
Dehydration

5.
 
Stomach problems, constipation or diarrhea

6.
 
A general feeling of not being well

7.
 
Muscle soreness

8.
 
Menstrual symptoms in women

Jerry works for a financial company. Each month, Jerry flies to England for five to seven days. Every other month, he makes an additional trip to France. Even though he's made these trips for almost a year, he still has not adjusted to what he calls his “screwed-up sleep.” Jet lag is due to the body clock not adjusting, and sleep difficulties are one of the main symptoms. Dehydration is also a main symptom.

First of all, Jerry can't fall asleep because while it may be 10:00 p.m. in France, it is only 1:00 p.m. in California. He is up half of the night. Then when he has to get up for meetings, he has indigestion. He delivers his presentations in a half-groggy state, even yawning about halfway through his talks. When Jerry returns to the United States and tries to get back into the swing of things in California, the readjustment is stressful, as he cannot concentrate well at the morning business meetings. His manager finds him to be tired and slower in initiating the next month's projects.

How long does it take to recover from jet lag? The average is one day for each time zone. So if he has crossed five to seven time zones, Jerry's body clock will not adjust during a seven-day trip.