This podcast episode is based on Journey to Recovery: A Comprehensive Guide to Recovery from Mental Health and Addiction Issues by Dr. Dawn-Elise Snipes Read it for free on Amazon Kindle Unlimited.
Journey to Recovery Series
Adjunct Interventions: Sleep
Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs
Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery
CEUs are available for this presentation at https://allceus.com/member/cart/index/product/id/924/c/
Objectives
~ Learn about sleep
~ The function of sleep
~ Sleep cycles
~ How much is enough
~ How lack of sleep contributes to feelings of depression, anxiety and irritability
~ Understand the connection between sleep and circadian rhythms
~ Learn techniques for sleep hygiene
Why I Care/How It Impacts Recovery
~ People whose circadian rhythms are off
~ Have a difficult time getting restful sleep
~ Usually have higher cortisol levels
~ Often report being tired at all the wrong times
~ Have difficulty concentrating
~ Confuse sleep and hunger cues
What is the Function of Sleep
~ Sleep is time to rest and restore
~ Adequate sleep improves memory and learning, increases attention and creativity, and aids in concentration and decision making.
~ Toxins that accumulate in the brain are thought to be cleared out during sleep
~ Healing and repair of cells takes place during sleep
~ Sleep helps to maintain the balance of hormones in the body:
~ Ghrelin and leptin, which regulate feelings of hunger and fullness
~ Insulin, which is responsible for the regulation of glucose in the blood
Functions cont…
~ Sleep deficiency is also linked to a higher risk of
~ Cardiovascular disease
~ Stroke
~ Diabetes
~ Kidney disease
~ Sleep deprivation is correlated to
~ Difficulty concentrating
~ Irritability
~ Fatigue/Loss of energy
Understanding Sleep Cycles
~ Stage 1 NREM sleep is when you drift in and out of light sleep and can easily be awakened.
~ Stage 2 NREM brainwaves slow with intermittent bursts of rapid brain waves, the eyes stop moving, the body temperature drops and the heart rate begins to slow down.
~ This stage usually lasts for approximately 20 minutes
~ Stage 3 NREM sleep, also known as deep sleep or delta sleep, is marked by very slow delta brainwaves. There is no voluntary movement. You are very difficult to wake.
~ This stage usually lasts for approximately 30 minutes
~ The largest percentage of Deep Sleep comes in the early part of the total night's sleep pattern
Understanding Sleep Cycles
~ REM Sleep (Rapid Eye Movement) is characterized by temporary paralysis of the voluntary muscles and fast, irregular breathing, inability to regulate body temperature, faster brain waves resembling the activity of a person that is awake.
~ Most dreams occur during REM sleep
How Much is Enough?
Sleep and Hormones
~ Estrogen usually improves the quality of sleep, reduces time to fall asleep, and increases the amount of REM sleep
~ Too little or too much testosterone may affect overall sleep quality
~ Cortisol is your stress hormone and prevents restful sleep
~ Thyroid hormones which are too high can cause insomnia and too low can cause fatigue and lethargy
Nutrition and Sleep
~ Tryptophan is used to make serotonin
~ Serotonin is used to make melatonin
~ Melatonin functions to help you feel sleepy
~ Caffeine is a stimulant with a 6-hour half life
~ Nicotine is a stimulant with a 2-hour half life
~ Decongestants are stimulants with a 2 hour half life
~ Antihistamines make you drowsy but contribute to poor quality sleep
~ Alcohol blocks REM sleep and can cause sleep apnea
Nutrition cont…
~ Eat a high protein dinner to ensure you have enough tryptophan in the body
~ Make sure you are getting enough
~ Selenium
~ Vitamin D
~ Calcium
~ Vitamin A
~ Magnesium
~ Zinc
Function of Sleep
~ Allows the brain to focus on rebuilding and repairing
~ Animals deprived entirely of sleep lose all immune function and die in just a matter of weeks.
~ Prisoners deprived of sleep entirely often develop psychotic symptoms
~ New parents deprived of sleep have difficulty with memory and concentration
~ Muscle growth, tissue repair, protein synthesis, and growth hormone release occur mostly, or in some cases only, during sleep.
~ Other rejuvenating aspects of sleep are specific to the brain and cognitive function.
~ While we are awake, neurons in the brain produce adenosine.
~ The build-up of adenosine in the brain may lead to our perception of being tired.
Circadian Rhythms
~ Internal Body Clock
~ patterns of brain wave activity, hormone production, cell regeneration, and other biological activities linked to this 24-hour cycle.
~ normal circadian clock is set by the light-dark cycle over 24 hours.
~ Circadian rhythms allow organisms to anticipate and prepare for precise and regular environmental changes. They thus enable organisms to best capitalize on environmental resources (e.g. light and food)
Circadian Rhythms
~ Circadian rhythm disorders can be caused by many factors, including:
~ Shift work
~ Pregnancy
~ Time zone changes
~ Medications
~ Changes in routine such as staying up late or sleeping in
~ Medical problems including Alzheimer's or Parkinson disease
~ Mental health problems
Impact of too much/too little sleep
~ Explore the effects of:
~ Insufficient sleep
~ Energy Allocation
~ Disrupts normal hormonal rhythms
~ Excessive sleep
~ Disrupts normal hormonal rhythms
~ Can make you sleepier due to lack of movement and light.
Serotonin Connection
~ Serotonin and sleep
~ L-Tryptophan is used to make serotonin
~ Serotonin is used to make melatonin
~ When serotonin and/or melatonin levels rise, other hormones like norepinephrine go down
~ Depression & Anxiety
~ Too much or too little serotonin impacts mood
~ Symptoms of depression and sleep deprivation are very similar: Altered feeding and sleeping habits, fatigue, difficulty concentrating
Sleep Hurdles
~ Drugs
~ Stimulants (caffeine, pseudoephedrine, diet pills, preworkout supplements, nicotine, ADHD medications)
~ Sedatives (Anti-anxiety medications, barbiturates)
~ Diphenhydramine (Benadryl ®)
~ Pain medications (Opiates)
~ Alcohol
Sleep Hurdles
~ Physical Conditions
~ Pain
~ Pregnancy / PMS / Postpartum
~ Temperature regulation
~ Changes in estrogen levels impact serotonin levels
~ General discomfort
~ Apnea
~ Allergies
~ Sinus congestion
~ Coughing
~ Restless leg syndrome
~ Head Injury especially to the front part of the brain
Sleep Hurdles cont…
~ Hormones
~ Stress hormones (Cortisol, Thyroxine)
~ High levels of cortisol can create agitation, insomnia and sugar cravings.
~ Low levels can be associated with inability to handle stress, extreme fatigue, low libido and mood instability.
~ Estrogen
~ Increases norepinephrine and serotonin
~ Decreases dopamine
~ Testosterone
~ Progesterone: balance estrogen, promote sleep and has a natural calming effect. Abnormal levels of progesterone cause insomnia and contribute to irritability.
Sleep Hurdles cont…
~ Light levels
~ As light increases, so do our motivating chemicals (norepinephrine)
~ As light decreases the body secretes serotonin that is converted to melatonin
~ Physical cues
~ Alarm clock
~ Eating meals
~ Coming home from work
~ Certain routines
Sleep Hurdles cont…
~ Lack of Exercise
~ Exercise helps reduce cortisol levels
~ Increases serotonin levels
~ Can help in reducing aches and pains which keep people awake
~ “Stress”
~ Racing thoughts
~ Ruminations
~ High levels of “fight or flight” (excitatory) hormones
Sleep Hygiene
~ Create a wind-down ritual
~ Reduce or eliminate exposure to blue-light 1 hour before bed (TV, Computer, Phone, some light bulbs)
~ Go to bed at roughly the same time every night
~ Eliminate as much light as possible (Sleep mask)
~ Eliminate as much noise as possible (Ear plugs)
~ Do not exercise or take a hot bath within 2 hours of bed.
~ Keep the room cool (72 is ideal)
~ Consider a cooling pillow and mattress topper
~ Avoid anything that might get you upset (Social media)
Sleep Hygiene
~ Reduce or eliminate caffeine at least 6 (preferably 12) hours before bed
~ Drink the majority of fluids during the day
~ Keep an air purifier in the room if you have allergies
~ Keep animals off the bed
~ Make the bedroom a place of relaxation and sleep
~ Keep a red-light and a notepad by your bed to write down anything that pops into your head
~ Weighted blankets help some people get to sleep easier
Sleep Hygiene
~ Keep daytime naps to under 45 minutes
~ Consider diffusing essential oils
~ Lavender
~ Chamomile
~ Patchouli
~ Catnip (Yep…cat nip…just don’t let the cats in the bedroom)
~ Select the right pillow
Summary
~ Insufficient quality sleep contributes to
~ Fatigue
~ Difficulty concentrating
~ Reduced reaction time
~ Apathy
~ During deep sleep is when researchers think the brain rests and rebalances.
~ Over time sleep deprivation can cause changes in
~ Neurotransmitter levels
~ Immune functioning
Summary cont…
~ Most people could benefit from auditing their sleep quality
~ Reduce light
~ Reduce noises
~ Reduce bathroom trips
~ Reduce wake-ups because of allergies or being too hot
~ Stop caffeine 6 (preferably 12) hours before bed
~ If you are only willing to change one thing this month to start being happier, more energetic and clearer headed, sleep might be a great place to start.
Additional Resources
~ http://www.news-medical.net/health/Function-of-Sleep.aspx
~ http://staging.aesnet.org/files/dmfile/Saper1.pdf
~ http://www.sleepdex.org/stages.htm
~ http://psychcentral.com/lib/stages-of-sleep/
~ https://sleepfoundation.org/how-sleep-works/what-happens-when-you-sleep
~ http://www.ncbi.nlm.nih.gov/books/NBK10996/
~ https://www.drmarinajohnson.com/articles/chronic-insomnia-and-hormones/
~ The Relationship Between Testosterone and Sleep Disorders https://www.ncbi.nlm.nih.gov/pubmed/24435056
~ https://www.bcm.edu/news/sleep-disorders/experts-warn-against-antihistmaines-sleep-aid
~ https://sleepfoundation.org/sleep-topics/how-alcohol-affects-sleep
~ http://www.webmd.com/sleep-disorders/news/20130118/alcohol-sleep#1
~ The Effect of Melatonin, Magnesium and Zinc on Insomnia https://www.ncbi.nlm.nih.gov/pubmed/21226679