Good quality sleep is vital to our general wellbeing, particularly our immunity and mental health, so it’s more important than ever that we sleep well! If you’re finding yourself going to bed later and later, waking up several times in the night, waking up with anxiety, or feeling groggy upon waking.
“For the body, first—sleep, and enough of it, is the prime necessity.” Edward Everett Hale
COVID-19 has brought the world into uncharted waters. Amongst all of the forced change caused by this pandemic, the foundations of our nutrition and lifestyle have been tested and routine has slipped for many of us. As we adjust to the emerging reality of future ‘waves’ and lockdowns for the foreseeable future, it is imperative that we take a moment to check in with ourselves about how we’re doing with maintaining our health foundations, starting with our sleep routine!
A recent survey carried out by King’s College London found that a significant proportion of the UK public has experienced changes to their sleep patterns since lockdown:
- 50% reported their sleep was more disturbed than normal.
- Those who find coronavirus stressful are more likely to report disturbed sleep.
- 2 in 5 say they’ve slept fewer hours a night on average compared with before the lockdown.
- 3 in 10 say they have slept longer but feel less rested than they normally would.[i]
It is alarming that an already long standing health issue - sleep deprivation – might be getting worse! For instance, a 2018 survey found that only 6% of adults in the UK manage to achieve the recommended 8 hours sleep a night![ii] Strikingly, those with less than 7 hours sleep per night are up to 3x more likely to develop the common cold than those with 8 or more hours sleep.[iii] Poor sleep quality can lead to a wide variety of health issues, ranging from anxiety, depression, poor cognition, fatigue, and low immunity, to an increased risk of stroke and coronary artery disease.[iv] Read on to learn more about how you can support your sleep quality and re-establish this vital foundation of optimal health.
WHY IS OUR SLEEP QUALITY GETTING WORSE
From our clinical experience to date, there seem to be several main drivers of the deterioration in sleep quality this year. Amongst the most significant are:
- Disrupted light exposure – our internal clock, or ‘circadian rhythm’, is entrained by our daily exposure to light and dark. We are meant to be exposed to abundant blue-light rich daylight during the daytime, followed by exposure to the red hues of the setting sun and dim light in the evening. This diurnal rhythm of light and dark helps to ensure that cortisol peaks in the morning to promote wakefulness and dips in the evening to help us wind down, alongside a nocturnal rise in melatonin to further prime us for deep sleep. As many of us have transitioned to working from home and seemingly non-stop Zoom or Teams meetings, the majority of us have experienced low levels of daylight exposure alongside very high levels of blue light exposure, not to mention those individuals working in a hospital setting for whom this abnormal light exposure is the norm! This amount of ‘light pollution’ facilitates higher levels of cortisol throughout the day, coupled with lower nocturnal levels of melatonin, which collectively makes us feel stimulated well into the night and drives lighter sleep.
- More stressed and anxious – a high sympathetic nervous system response is another undoubtable driver of poor sleep quality at the moment. This can lead to many of us having our mind racing at bedtime and feeling too anxious to sleep, tossing and turning in sleep, waking up at night with anxiety, and/or not being able to fall back asleep easily. Many of us are tempted to check our mobile phone when we wake up in the middle of the night, but that blue light exposure only disrupts melatonin and stimulates our mind further, making it even harder to fall asleep! Furthermore, after a night of poor sleep, we tend to crave caffeine and sugar during the daytime, which can then negatively affect our sleep quality further, driving a vicious cycle! Notably, those with insomnia usually experience a higher number of stressful life events, in contrast to those without insomnia.[v]
- Increased alcohol intake - a survey conducted by Alcohol Change UK has reported that 1 in 5 have been drinking more frequently since lockdown.[vi] Alcohol increases wakefulness during the night when consumed in high amounts.[vii]
- More sedentary – many of us have become more sedentary as a result of working from home. Bearing in mind that increased daily physical activity has been positively associated with sleep quality,[viii] this has likely had a role to play as well for general worsening in sleep quality this year. Physical activity tires our body which can be a helpful cue for rest in the evening. For many of us, physical activity also means getting outside and into nature, whereby the increased daylight exposure supports nocturnal melatonin levels, which can further support sleep quality.
TOP TIPS FOR BETTER SLEEP
- Increase awareness of sleep quality by tracking your sleep (e.g. Sleep Cycle, Fitbit, Oura ring). This can be especially useful for highlighting the nutrition and lifestyle variables which both help and hinder sleep quality to help you implement meaningful, personalised changes.
- Increase daily intake of supportive nutrients and botanicals:
- Magnesium has been used for centuries for its calming properties. Magnesium taurate is a good option as both magnesium and taurine enhance the calming action of the neurotransmitter, gamma aminobutyric acid (GABA).[ix]
- Vitamin B12 can potentially improve sleep, daytime wakefulness, and mood upon waking, by supporting melatonin synthesis.[x],[xi]
- Tryptophan is used to make serotonin, which is then converted to melatonin.
- Lemon balm can increase GABA levels.[xii] Cyracos® lemon balm extract, in particular, has been shown to reduce anxiety by 18%, stress-associated symptoms by 15%, and insomnia by 42% within 2 weeks.[xiii]
- L-Theanine can increase the production of alpha waves (associated with relaxation),[xiv] reduce cortisol,[xv] and increase serotonin.[xvi]
- Taking probiotics may be another way to help you manage stress, therefore promoting healthy sleep. Certain strains of Lactobacilli and Bifidobacteria, including Lactobacillus rhamnosus, can produce GABA[xviii] and also influence serotonin.[xix]
- Create a sleep routine with a regular sleeping pattern (e.g. 10pm-7am each night).
- Journal before bed to clear and calm your mind.
- Make your bedroom your sleep sanctuary - if your desk is in there, try to move it to another room if you can. If working from home is going to be your reality for the months to come, it is imperative to keep ‘work’ and ‘home life’ separate.
- Increase your daylight exposure e.g. light box for waking (such as Lumie), walk or run before work or on your lunch-break, evening walk to watch the sunset.
- Reduce your evening exposure to blue light. Avoid technology at least 1 hour before bed and engage in a non-tech, calming mindful activity instead e.g. board-game, aromatherapy bath.
- Sleep in a dark, quiet room – e.g. blackout blind, ear-plugs, eye-mask.
- Increase daily movement outside to daylight exposure as well as physical activity, such as an early morning walk in the park.
- Adjust the timing and frequency of your eating to ensure balanced blood glucose levels. Aim for 2 or 3 well-balanced main meals rich in good quality fats, protein, and plant fibre, minimise snacking, and make sure to consume all food within a maximum 12 hour eating window (e.g. 7am-7pm).
- Minimise daily intake of caffeine, alcohol, and sugar, all of which can disrupt sleep quality. Opt for healthy alternatives, such as herbal tea, a glass of chilled kombucha, and naturally sweetened snacks respectively instead.
- Find a relaxation technique which you love and would enjoy practising on a daily basis, such as yoga, meditation, gardening, singing, reading fiction, jogging, or having a bath. Apps such as Calm and Headspace provide guided meditations and can help with a restful sleep.
If you would like more personalised support, please seek the advice of a registered Nutritional Therapist or contact our Clinical Nutrition team on 0121 433 8702 or via email firstname.lastname@example.org.
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[i] King’s College London. https://www.kcl.ac.uk/news/how-the-uk-is-sleeping-under-lockdown. June 2020
[ii] UK 2018 Sleep Survey and Statistics. Nanu Sleep. 2018. Accessed on 28/05/2020 [https://www.chemist-4-u.com/sleep-study/#div10].
[iii] Cohen S et al. Sleep habits and susceptibility to the common cold. Arch Intern Med. 2009; 169 (1): 62-7.
[iv] Mehra R. Sleep Apnea and the heart. Cleve Clin J Med. 2019; 86(9) Suppl 1: 10-18.
[v] Hall M et al. Symptoms of Stress and Depression as correlated of Sleep in Primary Insomnia. Psychosom Med. 2000; 61(2): 227-30.
[vi] Alcohol Change UK. https://alcoholchange.org.uk/blog/2020/covid19-drinking-during-lockdown-headline-findings#:~:text=Around%20one%20in%20five%20drinkers,drinking%20more%20frequently%20under%20lockdown. April 2020
[vii] Britton et al. The association between alcohol consumption and sleep disorders among older people in the general population. Scientific Reports. 2020; 10: 5275.
[viii] Banno et al. Exercise can improve sleep quality: a systematic review and meta-analysis. Peer J. 2018; 6: e5172.
[ix] Jia F et al. Taurine is a potent activator of extrasynaptic GABA (A) receptors in the thalamus. J Neurosci. 2008; 28(1): 106-15.
[x] 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.
[xi] Mayer G et al. Effects of vitamin B12 on performance and circadian rhythm in normal subjects. Neuropsychopharmacology. 1996; 15 (5): 456-64.
[xii] 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.
[xiii] 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.
[xiv] 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.
[xv] 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.
[xvi] 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.
[xviii] Barrett E et al. γ-Aminobutyric acid production by culturable bacteria from the human intestine. J Appl Microbiol. 2012; 113 (2): 411-417.
[xix] Foster JA and Neufeld KM. Gut-brain Axis: how the microbiome influences anxiety and depression. Trends Neurosci. 2013; 36(5): 305-12