Understanding Sleep and How to Improve It

Sleep is critical to good health. According to the National Center of Disease control one out of three people do not get enough sleep, other sources state that this number is much higher. Research is showing that lack of sleep can lead to an increase in weight gain, diabetes, cancer, reduced immune function, hormone imbalance, cognitive decline, depression and reduced memory. American’s used to sleep 8 to 8 ½ hours in 1960 and are now sleeping 6 to 6 ½ hours. However for good health we require 7 to 8 hours of sleep (18) In essence lack of sleep is at epidemic levels and the consequences are significant. Addressing the root cause of insomnia is critical to resolving and or reducing the affects of insomnia. Insomnia is a very complicated and multifaceted condition that is not fully understood. Fortunately there is much research in the area of sleep as well as modalities and life style changes that can reduce insomnia.

The physiology of sleep is dynamic. There should be 4 to 5 sleep cycles during 8 hours of sleep. The duration of each cycle is 90 to 120 minutes. Within each cycle there are four stages of sleep, three are non-rapid eye movement (REM) stages and 1 is a REM stage of sleep. Each of these stages has specific physiological and emotional benefits for the body and mind.

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Stage 1 is the transition stage where the brain waves begin to slow from fast to slower. The muscles begin to relax and that can lead to twitching. The heart rate and breathing slow and breathing becomes deeper. At this point the person can still easily react to environmental noise and is easily woken up. This stage lasts 5 to 15 minutes.

Stage 2 is longer, 45% to 55 % of the total nights sleep for adults. This stage is when the body and mind slows even more and conscious awareness of the external environment is gone. At this stage short image dreams occur. The purpose of this stage is so the brain can save, file and trash information.

Stage 3 is where the very deep sleep occurs. The brain is completely at rest and all eye and muscle activity stops. This is the cellular repair and regeneration stage for the body. The largest amount of skin, deep tissue and over all healing takes place. During this stage there is an increase in white blood cell formation, T4 cells and red blood cell re-oxygenation. It is hard to wake someone in this state of deep sleep.

REM sleep is 20% to 25 % of the total sleep times in adults. During this stage respiration becomes rapid, irregular and shallow. The heart rate and blood pressure increase. There is rapid eye movement and rapid brain wave activity similar to being awake. The purpose of this stage is healing the emotional and psychological health of the body as well as cementing memories. Emotions are processed, stress relieve occurs, detoxification of

our feelings of: fear, anger, happy and sad. Dreams will be episodic and have long stories (13).

What Causes Insomnia?

There are five different types of insomnia (15):

1) Acute insomnia is when someone has a short time where they are having a hard time sleeping. This is usually due to a stressful life event and it is able to resolve without treatment.

2) Chronic insomnia is defined as a person who has trouble falling asleep or staying asleep at least three nights per week for three months or longer. This type of insomnia is on going and needs treatment to sleep.

3) Co-morbid insomnia is when the insomnia occurs with another condition that is psychiatric in nature such as anxiety and depression.

4) Onset insomnia is when falling asleep at the beginning of the night is difficult.

5) Maintenance insomnia is when a person is unable to stay asleep. They wake up and have difficulty falling back to sleep.

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The Pineal gland is a big player in sleep. The pineal endocrine gland is in the brain. It is a small gland shaped like a pinecone. The pineal gland is responsible for converting serotonin to melatonin and releasing it so that the body knows it is time to slow down and sleep. The pineal gland get its info from how much light and the wavelength of the light entering the eye.  The light enters the eye and travels through the optic nerve to the suprachiasmatic nucleus (SCN), which is located in the middle of the brain just behind the eye socket (13) The SCN is considered the master clock for determining the circadian rhythm (18). Every cell in the body has mini clocks that follow the master clocks lead. Melatonin plays many roles  in addition to supporting sleep, it actually genes on and off. Research is now showing that a reduction in melatonin is increasing the risk of cancer to 4 times (18).

Light is critical to the circadian rhythm.  Blue light has short wave lengths that are rapid. It tells the body it is time to wake up and be active. This blue light is what comes from electronics, television and computer screens. Bright natural light tells the brain the same thing that it is time to wake up and produces serotonin. Serotonin is the awake, happy hormone. It plays a huge role in sleep, mental health, cognitive function and learning as well as a growth factor in some cells that are important in healing, especially wound and skin healing. 90% of serotonin is made in the gastrointestinal tract and affects the function of the gastrointestinal tract and 10 % is made in the brain. Serotonin is a major player in the health of the circadian rhythm. By getting enough natural light during the day it actually helps with sleep at night because it regulates and keeps the circadian rhythm in balance. This is why it is so important to get be outside in the natural light. The recommendation is 5 to 15 minutes in the first light of the day and then 30 minutes in the brighter light of the day (13,17,18). This recommendation is a minimum recommendation. Ideally spending more time outside is recommended.

When the sun goes down the light changes to a longer light wave with a slower frequency this is the amber light. If we were living without artificial lights, our body would react with slowing down and preparing for sleep. However, we have lights and electronics and they send a message to continue to stay awake. It is recommended to use light bulbs in the house that can change to an amber color and or wear amber colored glasses to help prepare for sleep mimicking the natural light (17) Also it is very important to reduce the blue light on computers and phones once the sun goes down. This can be done through an app or built in mechanism in the electronic device.

There are many factors that affect sleep and another key one is the hypothalamic, pituitary, adrenal axis (HPA) (5). This triad is the central stress response system. When the HPA axis is elevated then sleep is reduced and if the HPA is lowered, sleep is improved. The HPA system is very intricate and has many steps involved. When the HPA is in balance and working well all is good however when it is out of balance it wreaks havoc on the central nervous system. The more out of balance the HPA axis is the more it becomes out of balance.

The HPA axis affects the production of cortisol, which is another substance that greatly affects sleep (4). With an increase in cortisol there is a reduction in the ability to sleep and the sleep quality is reduced. Cortisol is important and in a healthy system that is in balance, cortisol will be stimulated and released from the adrenal glands in response to a stressful situation. The body reacts with flight or fight. The cortisol released creates a feed back mechanism where once it is released the HPA system registers the cortisol and the HPA system becomes calms down so that it is not stimulating more cortisol to be made. In turn the cortisol production from the adrenals slows down and the body returns to homeostasis.

Unfortunately, many people are in a chronic state of stress. This means the HPA axis is elevated and sounding the alarm that the body is in fight or flight much of the time. This results in the adrenals pumping out cortisol. The cortisol feedback loop no longer becomes effective and the cortisol HPA relationship losses it’s balance point.

The limbic system, in addition to other parts of the brain, affect the HPA axis. The limbic system is the emotional part of the brain as well as affects the flight or fight response and hormone regulation. The olfactory system is interconnected with the limbic system due to the olfactory bulb being located in the limbic system. When an odor molecule is inhaled it enters the nasal passage where receptor cells in the epithelial lining of the mucus membrane are located. This information is then transmitted to the olfactory bulb. For this reason aromatherapy can influence the HPA axis and calm the HPA axis down with the use of essential oils that have the therapeutic action of calming the central nervous system. It has been studied and shown that the use of rose oil and patchouli oil have resulted in calming the sympathetic nervous system (1). Another study (2) showed that Rose (Rosa damascena) has a hypnotic quality on the central nervous system of mice. The oil reduced the activity of the hypothalamus and pituitary gland resulting in a longer sleep time compared with the use of diazepam.  Lavender (lavendula agustafolia) has also been shown to calm the central nervous system. Through inhalation, the lavender acts on the limbic system to calm the central nervous system (3).

75 % of Americans are reported to be deficient in magnesium (16). Although the effect of magnesium on sleep is not fully understood it plays a very important role in sleep. Sufficient magnesium levels actually raise the point at which the adrenals are triggered for the flight or fight response (17). Meaning the adrenals are not stimulated to release cortisol as easily when there is adequate magnesium supplies in the body. In this way a reduction in cortisol production will improve sleep. A study conducted in 2012 showed that with dietary supplementation of 500 mg of magnesium for eight weeks resulted in a statistically significant increase in sleep time (6). Magnesium is considered one of the most important trace minerals in the human diet. Magnesium is responsible for over 300 critical biochemical reactions of the body. As people age there is a decrease in magnesium due to bone loss. Bone mass is the most important source of magnesium for the body.

Clearly magnesium is a big player in sleep. The daily-recommended amount of magnesium, according to Dr. Perlmutter, is 400 mg for men and 300 mg for woman.  The type of magnesium also makes a difference. To improve sleep magnesium L-threonate is said to cross the blood brain barrier and improve sleep (17).  Magnesium rich foods are also important. Foods high in magnesium are dark leaf vegetables, nuts, seeds and legumes.

Float tanks are an added benefit to magnesium intake as well as calming the central nervous system and promoting sleep (7).  Float tanks have a large amount of Epsom salt added. The tank is very calming and soothing. The research has also shown to reduce other issues that have the affect of stimulating the central nervous system such as reducing pain and anxiety. By reducing issues that stimulate the central nervous system, the body has a better chance of sleeping.

Magnesium flakes and Epsom salts are also available to be used in a bath. This is an excellent way to calm the system and prepare for sleep as well.

Sleep Hygiene

Essential oils are becoming more and more recognized for their use in sleep. A study was conducted and found that lavender (Lavandula angustifolia) along with sleep hygiene improved the quality of sleep compared to just sleep hygiene (8). There is much more research being conducted with essential oils and their therapeutic benefits. In general, essential oils that come from the chemical families of Esters, sesquiterpenes, monoterpenols, sesquiterpenols and aldeydes (in small amount) can have sedative effects with some more than others (19).  Some specific oils that are known to be calming are (9,14): Laveneder (Lavedula angustifolia), Clary Sage (Salvia sclerea), vetiver (veteveria zizanoides) and cedarwood (Cedrus atlantica). Oils that are know to be sedative are (9,14); May chang (Litsea cubeba), Lemongrass (cymbopogon flexuosus), Ylang Ylang (Cananga odorata) and Ho Wood (Cinnamomum camphora). Blended in the correct dilution, with the correct balance of oils, and used correctly an essential oil blend can benefit sleep.

As has been mentioned sleep is a complicated issue and more than one modality is often needed. Sleep hygiene is a term used and is defined as

“Habits and practices that are conducive to sleeping well on a regular basis. “Sleep hygiene is the key to sweet dreams’”(10).

Recommendations for sleep hygiene are:

  1. Create a bedtime routine so the brain learns sleep is coming. Suggestions are a bath with Epsom salts, listening to calming music such as binaural beats. Binaural beats have been studied and shown to improve sleep (11). Meditation is another very beneficial form of calming the central nervous system and preparing for sleep. It can be beneficial to apply the essential oil blend after the bath as the skin is warm and it will enhance the absorption of the oils.
  2. Go to bed and wake up at the same time so the circadian rhythm can be restored.
  3. As mentioned above, having light bulbs that can change to an amber light when the sun goes down or wearing amber glasses. Along with changing the setting on electronic devices to reduce the blue stimulating light at night.
  4. Keep your room very dark to sleep. Turn all electronics off.  If you have blue light showing from an electronic device cover it with a red cloth, which will eliminate the electronic light (17).
  5. At least one hour before bed stop viewing all screens to prepare for sleep.
  6. There is scientific evidence that this works: Count backward from 5,4,3,2,1 and then state, “I am going to sleep”. Repeat this as many times as you need to. (12) Mel Robbins, The 5 second Rule to learn about this information. This is fascinating information.
  7. In general lowering the activation of the central nervous system daily to reduce the production of cortisol helps sleep as discussed above. Some recommended tools (17) are:
    1. HeartMath is a feedback mechanism that lets you know when your heart-rate variability (HRV) is elevated or decreased. An elevated HRV means stress levels are down. Or if decreased stress levels are elevated. It is easy to use and there is an app for the phone to use it.
    2. Biofeedback can be beneficial and requires a trained practitioner to implement.
    3. Nature walks as well as  “earthing”. Earthing is walking barefoot on the soil. The benefits are an increase in serotonin which is a natural antidepressant that assists in regulating sleep.
    4. Slow deep breathing can take the central nervous system from sympathetic stress state to a parasympathetic relaxed stated.

There are many other ways in which to calm the central nervous system, and these are just a few.

In conclusion, sleep is multifaceted and can be negatively affected in a number of ways and for many reasons. Much research has been done and continues to be done in the area of sleep as sleeping is critical to good health. It seems clear that managing stress and calming the central nervous system with daily techniques is critical in this high stress culture to support sleep. Maintaining the health of the circadian rhythm is critical to sleep with the balance between serotonin and melatonin. This is primarily addressed through light exposure, making light a huge consideration when addressing sleep issues. Though not discussed in more detail than what supports magnesium intake, diet is also very important, as is exercise and sleep hygiene. Essential oils are also being recognized in the mainstream literature to support and improve sleep. A recent webinar federally funded through Medicare, conducted a study regarding the elderly and sleeping. Essential oils were generally mentioned and recommend (13). Good, consistent sleep is vital and having a diverse choice of modalities to address sleep increases the chances of  improving sleep as each person is unique and requires their own sleep program.

 

Heidi Lien MPT., CPA.

certified aromatherapist, aromatherapy certification, essential oil class

Heidi recently completed her aromatherapy certification through the Institute of Holistic Phyto-Aromatherapy. She also holds a masters degree in physical therapy. She is a Certified Exercise Expert for Aging Adults and certified as a Fall Proof instructor.  She has been practicing as a physical therapist for 25 years. For the last 14 years she has been working in a skilled nursing facility where she is now Director of Rehabilitation. Heidi was recently invited to join the California Association of Health Care Facilities (CAHF) committee to develop aromatherapy programs that will be implemented in skilled nursing facilities state-wide. She is passionate about holistic health and wellness, and is now pursuing a Health Coach certification to broaden her scope of practice. Her areas of focus are gut health, sleep, pain, cognitive health and aromatherapy. Heidi is launching a product line, BLEND©, as well as her company, Wellvolution.

 

References:

1) Effects of Fragrance Inhalation on Sympathetic Activity in Normal Adults, Shinichiro Haze*, Keiko Sakai and Yoko Gozu Product Development Center, Shiseido Co., Ltd., 2-2-1, Hayabuchi, Tsuzuki-ku, Yokohama 224-8558, Japan Received May 9, 2002 Accepted August 2, 20

2) Potentiation of pentobarbital hypnosis by Rosa damascena in mice. Pubmed. Rakhshandah HI, H. M. (2006, Nov)

3) Biological activites of lavender essential oil, Phytotherapy Research, 2002 Cavanagh, H., and Wilkinson, J.,

4) The Role of Cortisol in Sleep The hypothalamic-pituitary-adrenal (HPA) axis interacts with sleep in multiple ways. This article reviews the effects of the HPA axis on sleep and the converseBy Bradley Bush, ND, and Tori Hudson, ND. Natural Medicine Journal, June 2010. Vol. 2, issue 6

5) The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress; US National Library of Medicine National Institute of Health. Dialogues Clin Neurosci. 2006 Dec; 8(4): 383-395. Sean M. Smith, PhD Sean M. Smith, Clayton Foundation Laboratories for Peptide Biology, The Salk Institute for Biological Studies, La Jolla, Calif, USA ; Wylie W. Vale, PhD*Wylie W. Vale, Clayton Foundation Laboratories for Peptide Biology, The Salk Institute for Biological Studies, La Jolla, Calif, USA.

6) The Effect of Magnesium supplementation on primary insomnia in elderly: A double blind placebo controlled clinical trial. Journal of Research in Medical Sciences. 2012 Dec; 17 (12): 1161-1169.Behnood, Abbasi et al

7) Beneficial effects of treatment with sensory isolation in flotation-tank as a preventive health-care intervention – a randomized controlled pilot trial. US National Library of Medicine National Institute of Health. BMC Compliment Alter. Med. 2014;14:417. Anette Kiegren, Jessica Westman

8) Effect of Inhaled Lavender and Sleep Hygiene on Self-Reported Sleep Issues: A Randomized Controlled Trial. US National Library of Medicine National Institute of Health. J Atern Compliment Med. 2015 Jul;21(7) Lillehei AS1, Halcón LL1, Savik K1, Reis R1.

9)Insomnia facing the challenge naturally: Amomaculture Sleep Edition, September 2017, volume two, issue nine. Anna Doxie, Registered Aromatherapist and organic skin care formulator.

10) Definition of sleep hygiene https://en.oxforddictionaries.com/definition/us/sleep_hygiene

11) Brainwave entrainment for better sleep and post-sleep state of young elite soccer players - a pilot study. Abeln V1, Kleinert J, Strüder HK, Schneider SEur J Sport Sci. 2014;14(5):393-402 doi:10.1080/17461391.2013.819384. Epub 2013 Jul 18. https://www.ncbi.nlm.nih.gov/pubmed/23862643

12) The 5 Second Rule: Mel Robbins, 2017. Mel Robbins.

13) Enhancing the Quality of Sleep; Can it Reduce Antipsychotic Drug Use? Restorative Sleep Vitality Program. Sue Ann Guildermann, RN, BA, MA

14) The Complete guide to Aromatherapy; second edition 2003. Bataglia, Salvatore

15) What are the Different Types of Insomnia? National Sleep Foundation. Sleepfoundation.org.

16) Insomnia? Low Magnesium Could be to Blame. www.drperlmutter.com/insomnia-low-magnesium-levels-to-blame

17) The Thyroid Connection: First addition 2016. Amy Myers, MD

18) Interview on www.amymyersmd.com/2013/06/tmw-episode-10-sleep Dr. Dan Pardini

19) Institute of Holistic Phyto-Aromatherapy, Course binder; 2017. Bruce R Boyton, MD MPH CA