Welcome to the first issue of Vibrant Health, a regular e-newsletter covering health topics as diverse as you! We’ll start off exploring something that we all do, just not as regularly or peacefully as some of us would like: sleep! Know someone who’d like to sign up? Send them to www.collinsdc.com/list/?p=subscribe. Enjoy!
- A. Chandler Collins, D.C.
Aid for the Sleepless
So why can’t you sleep? The numbers of people affected by sleeplessness are legion and the causes are numerous. Aside from the obvious causes of sleeplessness — a noisy environment, being sick, stuffed up, or otherwise uncomfortable enough to cause you to have trouble relaxing — there seems to be a large number of people out there who have trouble sleeping that can’t really nail down what’s causing it.
I’ll offer a common scenario for why many people seem to have trouble sleeping. It’s not the only explanation by any means, but we see it walk in the office frequently enough that it warrants special attention.
Part of the problem is what we seem to accept as “normal”. I can’t tell you how many times I hear people say something to the effect of, “Oh yes, I sleep fine. I get up two or three times a night, but it’s no big deal.” Folks, getting up two or three times a night is not normal. It may be common, but it is definitely not normal.
Part of our task here, then, is to understand what a true, normal sleep pattern really looks like, both from a practical and a physiological standpoint. Once we have that firmly established, figuring out where one individual is straying from this path is a much easier task.
For normal sleep, the most obvious thing to point out is that we should sleep through the night without interruptions. Many people assume that they wake up a couple of times a night because they have to go to the bathroom, and not the more likely explanation, which is that after they have awoken they notice an urge to empty their bladder. In other words, their usual pattern of waking up several times a night provides their body the opportunity to urinate. If they were sleeping more soundly the need to visit the bathroom would be less pressing.
Getting to sleep should also be relatively effortless. Overly long rituals of relaxation, or worse, self-medication with prescription, over-the-counter, or over-the-bar depressants should not be necessary. If you regularly climb into bed, shut your eyes, and then toss and turn for an hour or more before finally falling asleep, something is not right. You should then be able to stay asleep for six hours or more. Anything less is probably inadequate.
So what makes us sleep? There are lots of ideas and plenty of research in the area. Probably one of the most well-known theories, and one that seems to hold true clinically, is that a hormone in your brain called serotonin is largely responsible for sleep. As long as the brain pathways for this hormone are working properly, sleep ensues. A question the sleepless might ask, then, is what would interfere with the ability of the brain to produce or utilize this hormone?
Let’s go back to the obvious. We all intuitively know that we can’t sleep when we’re “stressed”. Why would that be? Sure, your brain may be busy processing all the thoughts and feelings surrounding the object of your worries, but there still has to be some mechanism by which your body temporarily suspends the sleep-inducing serotonin system in your brain so that you can go on sleeplessly figuring out how to solve your problems.
That’s where another hormone called cortisol comes in. Cortisol is known as the “stress hormone”. It is released throughout our bodies when we are under any type of stress, be it psychological, chemical, or structural. It is also one of our primary blood sugar hormones. This means that any time we don’t have enough blood sugar to fuel our activities, cortisol is utilized to raise our blood sugar levels so that we can handle whatever tasks our bodies are presented with.
Cortisol levels are highest right after we wake up — that is, right after we’ve finished (hopefully) 6-8 hours of sleep, during which time we typically wouldn’t eat or drink. Cortisol is secreted to keep feeding your brain and other vital organs with the blood sugar, or glucose, they need to survive. Normally, cortisol levels are highest right after you wake up, and then begin to lower right after you eat breakfast and give your body its first jolt of glucose.
What does this have to do with sleep? Well, we know that serotonin is associated with sleep. We also know that we can’t sleep when we’re stressed. It just so happens that serotonin levels happen to be inversely related to higher levels of stress and thus, higher levels of cortisol. This means that anything that might raise your cortisol levels will correspondingly lower your serotonin levels, interfering with your ability to sleep.
Interestingly, part of cortisol’s normal, 24-hour cycle involves a spike in its levels around 3 in the morning, give or take an hour. This is a very common time for people with sleep trouble to awaken. It seems that if you have something that abnormally elevates cortisol during the day, that extra spike that comes along mid-evening can lower your serotonin to the point that you wake up at night.
Those with high daytime levels of cortisol are easy to spot. Remember, cortisol is a blood sugar hormone. Part of the problem, however, seems to be that the energy we derive from blood-sugar produced by cortisol tends to be edgy and anxious. The high cortisol producers of the world then typically crave sugar or alcohol late in the evening. The alcohol and sugar give a quick jolt of glucose to rapidly drop cortisol levels. This then helps to remove the edginess and allows serotonin to rise and sleep to ensue.
Lack of sleep is frequently not the only symptom. Low levels of serotonin affect us in a number of ways. Perhaps the most well known consequence of inadequate amounts of serotonin is depression. Serotonin is the hormone that popular anti-depressants like Prozac and Zoloft work on. Their job is to artificially elevate serotonin so that your mood is not adversely affected. Your gastrointestinal tract function is also almost entirely dependent on serotonin for healthy, regular function. Sleeplessness and a sluggish gut thus frequently go hand in hand.
All of a sudden we have a plan of attack for figuring out how to sleep better. If we can narrow down the main things that tend to raise our cortisol levels, we can reduce the total amount of stress our bodies are under, raise our serotonin levels, and put us back on the road to a good night’s sleep.
Luckily the culprits are relatively clear. Essentially, anything that increases our levels of stress, in any form, will also raise cortisol levels. Our task is to find and treat the actual culprit of depressed serotonin levels so that getting to sleep by artificial means is unnecessary.
Next time, we’ll talk about the myriad ways our serotonin levels get disturbed and, more importantly, what we can do about it!