Media contact: Anna Jones
Clocks have sprung forward, and the countdown to spring has begun. While daylight saving time brings an hour of sunlight from morning to evening, it also brings more yawns as the lost hour of sleep is often felt in the days following.
This National Sleep Month, experts from the University of Alabama at Birmingham Marnix E. Heersink School of Medicine recommend ways to help catch up on some z’s.
Beware of melatonin overdose
When sleep seems to be hard to come by, most people will turn to sleep aids such as melatonin; but S. Justin Thomas, Ph.D., associate professor in the UAB Department of Psychiatry and Behavioral Neurobiology, says to be mindful of the amount taken as it could cause some side effects.
“A melatonin overdose is the presence of side effects resulting from taking too much melatonin,” Thomas said. “Since melatonin impacts multiple aspects of physiology, symptoms of melatonin overdose are varied but can include headache, excessive sedation, hypotension (melatonin lowers blood pressure), gastrointestinal upset and vomiting, among others.”
Thomas says a melatonin overdose can be hard to define since there is not an official standard safe dosage for everyone. This is largely because it is dependent on a variety of factors, including one’s age and rate of metabolism. A dose that might trigger side effects in one person may have little effect on someone else.
Thomas also encourages patients who wish to try melatonin to look for bottles with the United States Pharmacopeia label, as melatonin is an over-the-counter supplement that is not regulated by the Food and Drug Administration.
However, by maintaining good sleep habits, it may decrease the need for melatonin in the long term. Megan Hays, Ph.D., an associate professor and clinical psychologist in the UAB Department of Physical Medicine and Rehabilitation, says there are many steps one can take to develop good sleep habits and prevent chronic sleep deprivation.
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Get the lighting right
“Light plays a key role in how we sleep and is the primary synchronizer in our circadian rhythm, but not all light is the same,” Hays said. “Blue light is better during the day, as it helps promote a restful night’s sleep by cuing the body into wakefulness and energy expenditure during the day.”
Exposure to bright light during the daytime is crucial as it can help calibrate the body’s circadian rhythm, which is the 24-hour internal clock that coordinates many processes in the body, including sleep. Circadian rhythm is controlled by the circadian pacemaker, which is a small part of the brain that is influenced by exposure to light. When the retina receives light, it is carried to the brain, which sends signals to organs and other systems that align with the time of day.
Because the circadian rhythm is influenced by light, it is important to aim for at least 30 minutes of natural light a day. This natural light can come from being in the sunlight or from a SAD, or seasonal affective disorder, lamp. As evening approaches, Hays recommends transitioning to warm light and eventually to darkness to best prepare the body for sleep.
Maintain a regular sleep schedule
A chronotype is the natural inclination of the body to sleep at a certain time. There are three chronotypes: night owl, lark or somewhere in between.
“Your body likes and rewards regularity,” Hays said. “Ideally, you should try to align your behavioral patterns with your sleep chronotype and natural circadian rhythm. If you have a fixed schedule, try to make adjustments to your schedule to accommodate the natural rhythms of your body, such as more cognitively challenging tasks in the morning or vice versa.”
Hays says a consistent sleep-wake cycle is important and recommends people maintain the same wake-up time daily, so the brain will start to get sleepy at the right time every night. It is also important to build sleep pressure throughout the day, which gets stronger the longer one stays awake. Daytime light exposure and exercise can build sleep pressure, which also helps the brain signal when it is time to go to bed each night.
“Although we do recommend maintaining a consistent sleep-wake cycle every day, sometimes this may be difficult on the weekends,” Hays said. “If you decide to sleep in on the weekends, we recommend getting back on track with your normal sleep-wake cycle as soon as you can and trying not to sleep in much past one hour of your usual wake time.”
A night or two of poor sleep can be normal. But if the problem persists, it may be time to seek professional advice. UAB Medicine’s Sleep/Wake Disorders Center provides advanced testing, diagnosis and treatment of sleep disorders in a relaxed, casual setting specially designed for your comfort and well-being. Learn more at uabmedicine.org.
Do not try too hard
“Sleep does not reward effort,” Hays said. “It is an involuntary behavior and cannot be forced.”
Hays recommends keeping the sleep and wake environment separate and teaching the brain to recognize that the bed is only for sleep and sex. On sleepless nights, after tossing and turning for 25 minutes or more, get out of bed and try to distract yourself from thinking about sleep by reading a book or doing another low-key activity. Thomas recommends doing these activities using little to no light as light can suppress melatonin. Try to avoid going back to bed until sleepy.
Quiet the mind
Stress and anxiety interfere with sleep, and watching the clock can only lead to more anxiety.
“Sleep is like landing a plane,” Hays said. “You have to gradually get to a place where you are relaxed enough to fall asleep.”
Practicing relaxation techniques before bed such as breathing exercises, journaling any lingering thoughts on paper, or listening to a podcast may help one become more relaxed before bed. Additionally, Hays recommends trying to postpone worry at night by “downloading” racing thoughts to paper and allowing a 15- to 30-minute worry window the next day well before bedtime. It is also important to avoid catastrophic thinking about sleep and to remember that sleep is a gradual process and cannot be forced.
Improve the sleep environment
Try to make the sleeping environment as dark as possible, and keep the temperature between 60 to 67 degrees Fahrenheit for the most comfortable sleep. While white or pink noise machines may relax some people and help them fall asleep, experts warn that the noise machine should not be too loud as it may disrupt a person’s sleep cycle. Additionally, try to avoid watching TV while in bed, as televisions and electronic devices emit the same blue light as the sun, disrupting natural circadian rhythms and confusing one’s internal clock, according to the National Sleep Foundation.
Insomnia
Insomnia describes difficulties initiating or maintaining sleep, and/or early morning awakenings, causing significant daytime distress and impairment, says Christina Pierpaoli Parker, Ph.D., assistant professor in the Department of Psychiatry and Behavioral Neurobiology. For chronic insomnia, she says, these symptoms must occur at least three nights per week for three months and not be explained by another disorder or insufficient opportunity to sleep to meet diagnostic criteria.
If issues persist and are causing daytime stress and impairment, Parker recommends asking your doctor for a referral to a behavioral sleep medicine provider who can provide cognitive behavioral therapy for insomnia. CBT-I is an evidence-based, brief treatment for chronic insomnia using talk therapy to interrupt unhelpful thoughts, feelings and behaviors that could be perpetuating insomnia.
In clinical trials, CBT-I demonstrates more efficacy and durability than sleep medication alone – meaning it works better and its therapeutic benefits last longer. It also costs less, has fewer side effects and is preferred by most people.
Health risks of chronic sleep deprivation
Chronic sleep deprivation can interfere with the body’s internal systems, including one’s respiratory, cardiovascular, digestive, immune, endocrine and central nervous systems. Additionally, insufficient sleep has been linked to the development and management of chronic diseases and conditions, including Type 2 diabetes, heart disease, obesity and depression. It has been linked to an increased risk of heart attack and stroke and, in some cases, cancer. Additionally, research has linked chronic insufficient sleep of five hours of sleep or less per night to a 15 percent increased mortality risk.
Chronic sleep insufficiency is also linked to cognitive decline. Just one sleepless night can impair performance as much as a blood alcohol concentration of 0.10 percent, beyond the legal limit to drive, according to the Centers for Disease Control and Prevention. It has also been linked to increased risk of Alzheimer’s, anxiety and mood disorders.
“While these statistics may seem scary, please know that these are the results of sleep deprivation over a long period of time,” Hays said. “If you do miss sleep and incur a sleep debt, we just recommend trying to get back into a normal sleeping pattern right away.”