All living creatures have times in their cycle when they shut down their metabolic activity for healing and repair to take place. In humans we call this sleep. During the flu epidemic after the First World War, a few sufferers developed neurological damage in which they lost the ability to sleep. All were dead within two weeks – this was the first solid evidence that sleep is an absolute essential for life. Happily the body has a symptom which tells us how much sleep we need. It is called tiredness – ignore this at your peril! During sleep we heal and repair, during our waking hours we cause cell damage. If there is insufficient sleep, then the cell damage exceeds healing and repair and our health gradually ratchets downhill. Lack of sleep is a major risk factor for all degenerative conditions from heart disease to cancer and neurological disorders.
Humans evolved to sleep when it is dark and wake when it is light. Sleep is a form of hibernation when the body shuts down in order to repair damage done through use, to conserve energy and hide from predators. The normal sleep pattern that evolved in hot climates is to sleep, keep warm and conserve energy during the cold nights and then sleep again in the afternoons when it is too hot to work and hide away from the midday sun. As humans migrated away from the Equator, the sleep pattern had to change with the seasons and as the lengths of the days changed.
Get the hours of sleep
People needed more sleep during the winter than in the summer in order to conserve energy and fat resources. Furthermore during the summer humans had to work long hours to store food for the winter and so dropped the afternoon siesta. But the need for a rest (if not a sleep) in the middle of the day is still there. Therefore it is no surprise that young children, elderly and people who become ill often have an extra sleep in the afternoon and for these people that is totally desirable. Others have learned to “power nap”, as it is called, during the day and this allows them to feel more energetic later. If you can do it then this is an excellent habit to get into – it can be learned!
The average daily sleep requirement is nine hours, ideally taken between 9.30pm and 6.30am, i.e. during hours of darkness, but allow for more in the winter and less in the summer. An hour of sleep before midnight is worth two after – this is because human growth hormone is produced during the hours of sleep before midnight.
To show how important the balance of hours of sleep and rest are, divide the day into 12 hours of activity and 12 hours of rest. If you have one extra hour of activity (13 hours), you lose an hour of rest and sleep (11 hours). The difference is two hours!
Our biological clock is set by light. Electricity gets in the way here! Our forbearers went to bed when it was dark, simply because it was cold, boring and probably expensive on energy to do otherwise. Their daily biological clock was reset daily. They slept longer in the winter as they went into a semi-hibernation state in order to conserve energy when food supply was low. Conversely, during the summer they had shorter sleeping hours and longer working hours in order to store up food and resources to allow them to survive the next winter. People living on the Equator, of course, have the same sleep requirement throughout the year, but the further away from the Equator one is, the more obvious is this change from winter to summer. We have lost respect for those annual rhythms – actually we all need more sleep during the winter than in the summer because we go into a state of semi-hibernation and our behaviour should reflect this. Many people get into a habit of sleeping shorter hours in the summer and sustain this same pattern through the winter artificially. As a result, as a nation we are chronically sleep deprived. The average sleep requirement is for nine hours, but the national average is 7 ½ hours. Lack of sleep is a major risk factor for heart disease, cancer and, of course, chronic fatigue syndrome.
We can use light to help re-establish our biological clock. We need bright light during the day. This switches off melatonin production and melatonin is, of course, the sleep hormone. The best light is full spectrum light and we all prefer to sit in sunshine, or next to natural light from windows. Failing that one can use light from a full spectrum light box.
Conversely, at night we should use light, or rather darkness, to allow our own endogenous melatonin
production to happen. The only way to do this is to be disciplined about the time at which one goes to bed, and not allow electricity to get in the way of adequate sleep. I often jokingly threaten my patients with cutting off their power supply to their house every night at 9pm, which would certainly help them to restore a more normal circadian rhythm! It may take some weeks or months for the body to adjust, but this is vital for short and long term health. The bedroom should be dark for melatonin to be produced – light pollution is a major problem and blackout curtains may be necessary.
Disturbed sleep is a common symptom of hypoglycaemia
When blood glucose levels fall for any reason, glycogen stores in the liver many be mobilised to prop them up. Another rapid and very effective way in which the body repletes the low glucose is by conversion of short chain fatty acids to glucose. In a healthy person on a good balanced diet the only time this is of
importance is during the night because of the long break between food intake. Short chain fatty acids are used to prop up circulating glucose and prevent a fall below whatever that person’s usual fasting glucose level is. Short chain fatty acids are made in the gut by bacteria fermenting fibre (and such starch as escapes small intestinal digestion). Production is maximised from about 3 hours after food intake.
That is to say, short chain fatty acids are highly protective against the dips we see in blood sugar.
Therefore, a key symptom of a hypoglycaemic tendency is disturbed sleep. This occurs typically at 2 – 3 am, when blood sugar levels fall and there are insufficient short chain fatty acids to maintain a blood sugar. Low blood sugar is potentially serious to the brain, which can only survive on sugar and, therefore, there is an adrenalin reaction to bring the blood sugar back, but this wakes the sleeper up at the same time. Alcohol – the commonest symptom of alcohol causing hypoglycaemia is sleeplessness.
Initially alcohol helps one to go to sleep, but then it wakes one up in the small hours with rebound
Recognise the sleep wave
Actually sleep does not gradually creep up on us during the evening – it comes in waves. There is a sleep wave about every 90 minutes and you will get to sleep most efficiently if you learn to recognize and ride the sleep wave. Often there is a lesser one earlier in the evening when people drop off to sleep in front of the telly, or they jump and make a cup of tea to wake themselves up because “they are not ready to go to bed” – actually they are! My sleep wave comes at 9.20 and I like to be in bed reading well before this — it is immediately recognisable now I have learnt to expect it!
Other causes of poor sleep
- Get the right hormonal balance.
- High level of DHEA mean low levels of melatonin.
- Hypothyroidism can certainly present with insomnia
- Hypoglycaemia can be a major main cause
- Menopausal Sweating. I am increasingly coming to view that this is a symptom of low blood sugar
- Bio-rhythms or circadian rhythms
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