Sleep

Nearly 1 in 3 Canadians suffer from sleep disorders or do not get enough sleep on a regular basis. Sleep is essential to our physical and mental health, yet many factors in our daily routine have a negative impact on our sleep. Stress, multiple responsibilities and distractions, and certain bad lifestyle habits reduce the quantity and quality of our sleep.

WHAT IS SLEEP?

We spend about a third of our lives sleeping, so it is an understatement to say that it takes a major place in our lives, but why do we need to sleep? Plusieurs processus biologiques importants ont lieu durant notre sommeil. Several important biological processes take place during our sleep.

  • Our brain integrates and assimilates new information. It also gets rid of toxic waste.
  • Our nerve cells communicate and reorganize, supporting healthy nerve function.
  • Our body repairs cells, replenishes energy and secretes proteins and hormones that play essential roles in the proper functioning of the body.

Sleep is divided into different phases, which can be described as the architecture of sleep.

  • REM (rapid eye movement) sleep. Dreams appear mostly during this phase.
  • The non-REM sleep is divided into 4 phases. Phase 4 corresponds to deep sleep.

Throughout the night of sleep, the non-REM and REM phases will follow each other in cycles of about 90 minutes. However, the ratio of non-REM to REM sleep will change during the night, with REM sleep increasing in importance during the second part of the night. All phases are important and play different roles for our body and brain.

 

Sleep is regulated by our circadian rhythm or internal clock which keeps us awake and alert during the day and prepares us for sleep at the end of the day. This internal clock is very stable and works on a 24-hour cycle. Sleep pressure increases with wakefulness and decreases with sleep.

The chronotypes:

Sleep patterns differ from person to person. Some people are early risers while others are night owls. This is what we call chronotypes. There are 5 chronotypes: definitely morning type, morning type, intermediate type, evening type and definitely evening type. 

 

The chronotype is innate and deeply genetically determined. For people who must adhere to a daily routine that is not their own, performance and health can be impacted.

It is not a matter of lack of willpower or laziness but a deeply rooted characteristic that is very difficult to change. In an ideal world every person could adapt their daily routine to their chronotype. Unfortunately this is not always possible and it can have an impact on quality of life and health, so it is important to get as close as possible. In order to determine your chronotype, you can do a simple and scientifically validated test available on the internet: the AutoMEQ.

HOW MUCH SLEEP DO WE NEED?

The amount of sleep varies depending on the individual, but in general, it is recommended:

  • Newborns to 3 months: 14-17 h
  • 4-11 months : 12-15 h
  • 1-2 years : 11-14 h
  • 3-5 years : 10-13 h
  • 6-13 years : 9-11 h
  • 14-10 years : 8-10 h
  • 18-64 years : 7-9 h
  • More then 65 years : 7-8 h

WHAT ARE THE EFFECTS OF SLEEP DEPREVATION?

Insufficient or poor quality sleep has been associated with mood changes, anxiety, depression, poor memory, lack of concentration, poor motor function, fatigue, weakened immune system, weight gain, high blood pressure, insulin resistance, chronic diseases such as cardiovascular disease and diabetes and premature death.

WHAT IS INSOMNIA?

People with insomnia have difficulty falling asleep, staying asleep or waking up too early, all of which have an impact during the day.

CAUSES AND AGGRAVATING FACTORS:

Insomnia can be associated with one-time or chronic stressors, such as bereavement, loss of a job, separation, a stressful job… It can also be related to medical problems such as depression, anxiety and pain. Other factors can explain periods of insomnia such as certain medications, alcohol and caffeine.

  • Medications: There are a wide variety of medications that can have a direct or indirect impact on sleep, talk to your doctor or pharmacist.
  • Alcohol can have mixed effects on sleep. It has sedative effects but is also associated, especially if taken in excess, with poor sleep quality, reducing the REM phase. It is best to minimize its consumption.
  • Caffeine is a natural stimulant found in coffee, tea and cocoa. Its effect varies according to each person, but generally it is preferable to avoid caffeine in the afternoon since it remains in the system for a long time and can affect sleep. Caffeine can make it difficult to fall asleep and can increase nighttime awakenings.
GOOD SLEEPING HABITS TO ADOPT  To improve sleep or treat insomnia, it is important to understand the causes. Good sleep habits are crucial to improving sleep.
  • Consistency is key: get up and go to bed at approximately the same time each day.
  • Allow time to decompress before bedtime. Avoid stimulating activities and looking at a television, computer or telephone screen. The blue light emitted by the screens could have a negative impact on sleep.
  • Sleep in a quiet, dark environment. The bedroom should be well ventilated and tempered. The ideal temperature would be between 16 and 19 degrees Celsius.
  • The bedroom should be reserved for sleeping and sexual activities. Avoid working or watching television in the bedroom.
  • Go to bed when you feel sleepy.
  • Take a hot bath before bed.
  • Avoid forcing sleep: If after 30 minutes, sleep does not come, it is better to leave the room and relax in another darkened room. Do relaxing activities like reading or listening to relaxing music. Avoid looking at a screen.
  • Avoid vigorous physical activity in the evening.
  • Exercise regularly during the day, go outside or into nature, expose yourself to natural light.
  • Relaxation and breath control technique.
  • Naps: this depends on the quality of your sleep. If you have trouble sleeping at night, avoid naps. If you don’t have sleep problems, you can take a short nap. Ideally less than 20 minutes and early in the afternoon. Avoid naps at the end of the day or in the evening because they can cut into your sleep at night.

WHAT IS THE PLACE OR DRUGS AND SUPPLEMENTS?

There are many over-the-counter and prescription medications and supplements available for insomnia.

Over-the-counter medications and supplements:

Diphenhydramine (Benadryl, Sleep eez…) and dimenhydrinate (Gravol). These are antihistamines used for their drowsiness effect. They are used to promote sleep and not to maintain sleep.  They have a very short duration of action and their effectiveness decreases with use, often after only a few days of use. They also have several side effects.

Melatonin: It is a natural hormone that is secreted by our body to prepare us for sleep. The natural secretion of melatonin increases at the end of the day and ceases with exposure to light the next morning. Melatonin supplements are available on the shelves, however its use is ambiguous.  It may help slightly in falling asleep but has little or no impact on maintaining sleep. However, it seems to be more effective against jet lag. It is recommended to use the lowest possible doses and to take it 1-3 hours before going to bed.

Other supplements that can be used include magnesium, apigenin (a derivative of chamomile), glycine, ashwaganda and GABA.

Prescription drugs:

Benzodiazepines (Serax, Ativan, Valium, Xanax…). These are anxiolytics, i.e. molecules that reduce anxiety. They are sometimes used to treat insomnia. These molecules can cause physical and psychological dependence and require withdrawal when used long-term. Their effectiveness may decrease over time. They have many side effects and can increase the risk of falls and cognitive loss. They have been shown to have a negative impact on deep sleep.

 

The “Z drugs” (zopiclone, zolpidem…). These are sedatives used for sleep disorders. They especially help to fall asleep and can help to maintain sleep. However, they have several side effects and can cause daytime sleepiness, especially in the morning.

A new class of drugs, orexin antagonists, including lemborexant (Dayvigo), offers an interesting new alternative for treating insomnia.

Other medications can be used to treat sleep disorders, such as antidepressants like trazodone, antihistamines or antipsychotics. It is important to treat the medical cause of the insomnia first if it is present.

Medications and supplements can be used if non-pharmacological methods are not sufficient. Attempts should be made to use them for short periods of time and under medical supervision. Your doctor or pharmacist will be able to guide you according to your profile.

PSYCHOTHERAPY

There are different psychological approaches to the treatment of insomnia. The first recommended treatment is Cognitive Behavioral Therapy for Insomnia (CBT-I). It aims to intervene at the behavioral level, at the cognitive level by helping to control ruminations that interfere with sleep, and by teaching relaxation techniques. This technique has been shown to be effective and to produce lasting effects.

AND WHAT ABOUT FOOD?

In general, a balanced diet consisting mostly of unprocessed foods will have a positive impact on sleep and overall health. Some specific foods seem to have a positive impact on sleep. Walnuts and legumes are believed to be natural sources of melatonin and may increase our natural levels.  Dark green leafy vegetables contain carotenoids that act as blue light filters. Whole grains, bananas, avocados, soybeans, nuts and seeds are rich in magnesium, which may act as a muscle relaxant.

It is best to refrain from eating acidic and spicy foods if you suffer from digestive disorders such as gastroesophageal reflux disease (GERD). GERD can have a negative impact on sleep.

It is also recommended to avoid eating 2-3 hours before going to bed.

WHEN TO CONSULT?

Do not hesitate to consult a health care professional if:

  • You experience episodes of insomnia several times a week
  • Your condition deteriorates and you feel distress
  • You have difficulty carrying out your daily activities
  • You use sleeping pills regularly or for some time and your insomnia is not resolved

ARE THER OTHER TRICKS?

There are other ways to help improve your sleep, such as connected health tools and apps. To find out more, talk to your doctor and quatuor  care team.

*The information contained in this form does not replace the advice of a health professional and is provided for information purposes only.