It is widely known that good sleep is absolutely vital to our general wellbeing and mental health. So, why is it so important? Sleep replenishes our energy stores, regenerates tissues, strengthens connections between brain cells, and removes waste produced in the body.
However, sleep deprivation is becoming a modern epidemic; a 2018 survey highlighted that only 6% of adults in the UK manage to achieve the recommended 8 hours sleep a night.[i] Not being able to fall asleep, waking up throughout the night, or not feeling refreshed on waking can lead to several problems that we sometimes don't associate with sleep at all. It can leave us anxious, less resilient to stress, and prone to depression. It can severely affect our performance, energy, memory, and can increase the risk of heart failure, stroke, and coronary artery disease.[ii]
WHAT AFFECTS OUR SLEEP?
There are two main stages of sleep, each is linked to specific brain waves and neuronal activity. A ‘sleep cycle’ refers to the transition through these two stages: non-rapid-eye-movement (NREM) and rapid-eye-movement (REM) sleep. A full cycle takes around 90 minutes, and it happens several times during the night, with increasingly longer, deeper REM periods occurring toward morning.[iii]
Human beings have an internal clock that lasts about 25 hours and resets itself daily when it is exposed to light; this is known as our circadian rhythm.[iv] A healthy sleep-wake cycle will have a significant effect on daytime energy, blood sugar management, thyroid and adrenal function. It is regulated by a number of factors including hormone fluctuation. Cortisol, the stress hormone,is normally highest at the beginning of the day to promote wakefulness and prime the mind and body for activity, and then lowest at the end of the day to help us wind down in readiness for sleep.
We also respond to dim light in the evening, it triggers the conversion of serotonin to melatonin, the hormone that initiates drowsiness and deep sleep. Melatonin also acts as a powerful antioxidant and anti-inflammatory agent[v] and has been shown to support blood pressure and cholesterol levels.[vi] Low levels of melatonin are associated with depression[vii] and cardiovascular disease.[viii] This sleep-wake cycle is all too easily disrupted by a number of factors; insufficient daylight exposure, especially in the morning, shift work, regular travel across different time zones, and blue (day) light in the evening through the use of screen technology, such as TV and mobile phones.[ix]
Another key driver behind sleep disorders can often be stress, and therefore reducing stress levels can be another good way to improve sleep. When the stress response is out of balance hormones, such as cortisol, can be dysregulated and circadian rhythm can be lost. This is notable in people with insomnia, who usually experience higher numbers of stressful life events, compared to those without insomnia.[x]
Sleep issues could also stem from an imbalance in gut bacteria which play a huge role in regulating our nervous system and are partially responsible for the regulation of our mood, stress response, and sleep.[xi],[xii] This is because gut bacteria produce different neurotransmitters, including melatonin and the main calming neurotransmitter - GABA. Low levels of GABA have been associated not only with insomnia, but also anxiety and depression.[xiii]
Genes can also play a role, in particular the CLOCK(Circadian Locomotor Output Cycles Kaput) gene, which regulates our circadian rhythm, can potentially determine whether we are ‘owls’ or ‘larks’. Genetic variations in the CLOCK gene have been associated with insomnia,[xiv] difficulty losing weight,[xv] and major depressive episodes in patients with bipolar disorder.[xvi]
TOP TIPS FOR GREAT SLEEP
Although there may be many contributing factors to poor sleep, there are also lots of actions that can be taken to ensure the best sleep possible.
Dietary and Nutrient Recommendations
Magnesium has been used for centuries, mainly for its muscle relaxant and calming properties. Rich food sources include: dark green leafy vegetables, quinoa, and almonds. Magnesium taurate is a good option as taurine activates GABA promoting relaxation.[xvii]
High dose vitamin B12 (as methylcobalamin) can improve sleep, daytime wakefulness, and mood upon waking, perhaps due to its influence on melatonin.[xviii],[xix]
The amino acid tryptophan is used to make serotonin and then melatonin. Rich food sources include oats, bananas, turkey, oily fish, and eggs. These can be used in tray bakes, casseroles, and stews to make easy and delicious meals. Melatonin itself is found in certain fruits and vegetables, mainly tart Montmorency cherries, which are typically consumed as cherry juice concentrate.[xx] Smoothies are an easy way of getting the nutrients you need for healthy sleep. A combination of banana, tart cherry juice concentrate, almonds, oats, and cashew nut milk can be a lovely way of switching to a healthier bedtime nightcap.
Lemon balm is a lemon-scented herb whichcan increase GABA levels,[xxi] and in particular Cyracos® lemon balm extract can promote a reduction of anxiety by 18%, stress associated symptoms by 15% and insomnia by 42%, within 2 weeks.[xxii]
L-Theanine is an amino acid found in green and black tea, which can increase the production of alpha waves (associated with relaxation)[xxiii] and reduce cortisol levels.[xxiv] It increases serotonin[xxv] and is particularly effective for improving sleep in ADHD.[xxvi]
Cannabidiol (CBD)is one of many cannabinoid compounds found in the cannabis plant, and has been shown to decrease anxiety and improve sleep within the first month of use.[xxvii]
Taking well-researchedprobiotics may be another way to help you manage stress, therefore promoting healthy sleep. Probioticssuch as certain strains of Lactobacilli and Bifidobacteria, including Lactobacillus rhamnosus, can produce GABA[xxviii] and also influence serotonin.[xxix] When choosing, it is important to choose one containing a combination of the above strains at a good dose (at least 10 billion per capsule).
Alongside a good diet, lifestyle changes are key in promoting good sleep. The list may seem quite overwhelming at first but try implementing one or two suggestions a week - turning them into great long-lasting habits.
Stick to a routine with a regular sleeping pattern (e.g. 10pm-7am each night).
Limit evening exposure to blue light/electronics and keep the bedroom as dark as possible, using black out blinds.
Try a light box for waking (e.g. Lumie).
Incorporate daily movement during the day and not too close to bedtime. For example, an early morning walk incorporates early daylight exposure and movement.
Adjusting the timing/frequency of eating can help to reduce blood sugar peaks and dips (e.g. time-restricted feeding or ‘intermittent fasting’). Even just eating 2 or 3 balanced main meals rather than grazing can help glucose regulation.
Avoid stimulants such as tea, coffee and sugar in the afternoon and evening.
Stress management – through yoga, mindfulness and/or meditation. You can simply sit and follow your breath or engage in a simple activity such as gardening or doing a puzzle. Apps such as Calm and Headspace provide guided meditations and can help with a restful sleep.
Tracking your sleep has never been easier, there are a number of smartphone apps (e.g. Sleep Cycle), smart watches (e.g. Fitbit), rings (e.g. Oura) which can monitor heart rate, movement, and sleep stages. This can allow you to monitor progress while you are implementing some of the tips we have shared above. If you want to read about sleep, have a look at Matthew Walker’s ‘Why we sleep’ and Shawn Stevenson’s ‘Sleep smarter’.
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[ii] Mehra R. Sleep Apnea and the heart. Cleve Clin J Med. 2019; 86(9) Suppl 1: 10-18.
[iii] Peever J and Fuller PM. The Biology of REM Sleep. Curr Biol. 2017; 27(22): R1237-R1248.
[iv] Duffy JF and Czeisler CA. Effect of Light on Human Circadian Physiology. Sleep Med Clin. 2009; 4(2); 165-177.
[v] Tan DX et al. One molecule, many derivatives: a never-ending interaction of melatonin with reactive oxygen and nitrogen species? J. Pineal Res. 2007; 42 (1): 28–42.
[vi] Sewerynek E. Melatonin and the cardiovascular system. Neuro Endocrinology Letters. 2002; 23 Suppl 1:79-83.
[vii] Brown RP et al. Depressed mood and reality disturbance correlate with decreased nocturnal melatonin in depressed patients. Acta Psychiatr Scand. 1987; 76: 272–275.
[viii] Vyas MV et al. Shift work and vascular events: systematic review and meta-analysis. BMJ 2012; 345:e4800.
[ix] Reiter RJ. Pineal melatonin: cell biology of its synthesis and of its physiological interactions. Endocr. Rev 1991; 12 (2): 151–80.
[x] Hall M et al. Symptoms of Stress and Depression as correlated of Sleep in Primary Insomnia. Psychosom Med. 2000; 61(2): 227-30.
[xi] Alcock J et al. Is eating behavior manipulated by the gastrointestinal microbiota? Evolutionary pressures and potential mechanisms. Bioessays. 2014; 36 (10): 940-9.
[xii] Bravo JA et al. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. PNAS. 2011; 108 (38): 16050-16055.
[xiii] Cullinan WE et al. Functional role of local GABAergic influences on the HPA axis. Brain Struct Funct. 2008; 213: 63-72.
[xiv] Serretti A et al.Genetic dissection of psychopathological symptoms: insomnia in mood disorders and CLOCK gene polymorphism. American Journal of Medical Genetics Part B. 2003; 121B (1): 35–8.
[xv] Garaulet M et al. CLOCK gene is implicated in weight reduction in obese patients participating in a dietary programme based on the Mediterranean diet. International Journal of Obesity. 2010; 34 (3): 516–23.
[xvii] Jia F et al. Taurine is a potent activator of extrasynaptic GABA (A) receptors in the thalamus. J Neurosci. 2008; 28(1): 106-15.
[xviii] Takahashi K et al. Double-blind test on the efficacy of methylcobalamin on sleep-wake rhythm disorders. Psychiatry Clin Neurosci. 1999; 53 (2): 211-13.
[xix] Mayer G et al. Effects of vitamin B12 on performance and circadian rhythm in normal subjects. Neuropsychopharmacology. 1996; 15 (5): 456-64.
[xx] Howatson G et al. Effect of Tart Cherry Juice (Prunus Cerasus) on Melatonin levels and enhanced sleep quality. Eur J Nutr. 2012; 51(8): 909-16.
[xxi] Awad R et al. Bioassay-guided fractionation of lemon balm (Melissa officinalis L) using anin vitromeasure of GABA transaminase activity. Phytotherapy Research 2009; 23(8): 1075–8.
[xxii] Cases J et al. Pilot trial of Melissa officials L leaf in the treatment of volunteers suffering from mild to moderate anxiety disorders and sleep disturbances. Med j Nutrition Metab 2011; 4(3):211-218.
[xxiii] Ito K et al. Effects of L theanine on the release of alpha brain waves in human volunteers. Nippon Nogeikagaku Kaishi 1998; 72:153-157.
[xxiv] White DJ et al. Anti-stress, behavioural and magnetoencephalography effects of an L-theanine-based nutrient drink: a randomised, double-blind, placebo-controlled, crossover trial. Nutrients. 2016; 8 (1): E53.
[xxv] Lardner AL. Neurobiological effects of the Green tea constituent Theanine and Its Potential role in the treatment of psychiatric and neurodegenerative disorders. Nutr Neurosci. 2014; 17(4): 145-55.
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