The following are some highlights of what I found interesting from an 8 hour lecture on Sleep.
When it comes to sleep, one size does fit all. A little kitten or a big bear, both need a lot of sleep. We can never pay off our sleep debt. Sleep deprivation is defined as 24 hours without sleep. Getting 4 to 6 hours of sleep during the week cannot be fixed by getting 10 hours on the weekend.
We have some strange ideas about sleep. I’ll sleep when I’m dead. Sleep is for the weak. Money never sleeps. Artificial light has created longer work days and shift work and stimulants to help us stay off sleep.
Sleep is one of the top 5 reasons people seek care at a clinic. Sometimes sleep is second only to a pain complaint. Besides stimulants, mood disorders such as anxiety, infections, and disease can interfere with sleep.
Here are some theories on sleep that have been proven to be correct. 1. We may sleep for energy conservation. 2. Neuro-plasticity, which is necessary for brain development and restoration and memory consolidation. 3. Sleep is necessary for detoxification of waste products that build up in our brain.
A sleep disorder can impact, heart disease, diabetes, mood disorders, autoimmunity, obesity, memory issues, immune dysfunction, micronutrient deficiencies. A sleep disorder can predict disease. Depression and fatigue are included in the list. People with sleep disturbances have a higher rate of addictive disorders, alcohol, marijuana, and illicit drug use. Many people self medicate with alcohol due to the sedative effect. People with sleep depravation experience, lower pain thresholds, which is more pain, learning disorders, seizures, weight gain and an increased incidence of cancer.
When it comes to sleep, too little is not good, and too much is not better. People performed worse for cognitive abilities when sleeping too much. However, extra sleep does seem to improve athletic performance.
We don’t just have an opioid epidemic, we also have a stimulant epidemic. Red Bull, Monster, and Rockstar have sales totalling hundreds of millions of dollars. Anyone seen a Starbucks around? 80% of adults use Caffeine. Caffeine works by inhibiting adenosine binding in the central nervous system. With more Adenosine roaming free, we get more sleep deprivation. Theophylline from tea works similarly. These drugs increase dopamine efficiency in the central nervous system. Dopamine is our happy neurotransmitter and that explains coffee addiction.
We should have 5 phases to our sleep cycle. Stages 1-4 are termed non -REM sleep or NREM 1-4. Stages 3 and 4 can be lumped together. The average cycle from stage 1 to REM is 90-110 minutes and lasts 5-15 minutes per phase. As sleep begins REM phase is relatively short and lengthens the longer the individual is asleep.
Stage 1 is light sleep and is 5-10% of sleep. You can be easily awakened in this stage. Hallucinations or even the sensation of falling may be experienced as the brain transitions from alpha waves to theta waves. Stage II is 45 to 55% of sleep. Eye movement stops and brain waves become slower with only an occasional burst of rapid brain waves. We now lose our environmental awareness and it is harder to be awakened. Muscle activity has nearly disappeared. Stage 3-4. 15 to 25% of sleep. This is deep sleep or sometimes called slow-wave sleep. Brain waves have shifted to Delta; smaller and faster, the waves are interspersed. Night terrors, nocturnal enuresis, sleepwalking, and somniloquy can occur. People roused from this state feel disoriented for a few minutes.
REM sleep. 20-25% (occurs the first time about 60-90 minutes into sleep cycles). Unregulated breathing, body temperature and heart rate. EEG shows similar findings to those who are awake but the patient is very difficult to awaken. Increased levels of oxygen consumption and perfusion of the brain. Beta and gamma brain waves. Muscle neurons are hyperpolarized. Newborns spend about 80% of the time in the state.
Our body’s internal clock is regulated by the Supra Chiasmatic nucleus (SCN) in the hypothalamus. Factors that influence circadian rhythm for brain hormones, stress, light and darkness, and timing of meals and size of the meal. Time cues are important for regulating circadian rhythm with light having the greatest influence. Ideally you should not use an alarm clock and you should never hit the snooze button. Hitting the snooze button can lead to sleep inertia. That is a state of cognitive and physical impairment. This can last for minutes to possibly hours. You might know it as grogginess. Those who are generally sleep deprived will experience the greatest amount of sleep inertia. To combat sleep inertia try waking up to natural sunlight, music. A nap that is shorter than 30 minutes in length.
The main hormones involved in sleep and waking are Orexin, GABA, serotonin/melatonin, nor- epinephrine, and Adenosine. Those deficient in melatonin will see the greatest benefit from supplementation. Melatonin production is affected by light and dark stimulus. It is released by the pineal gland and is seen in higher concentrations during winter months. Melatonin can reduce cancer cell proliferation and block cell invasion/metastasis. In schizophrenic patients with comorbid insomnia, 3 mg a night for 15 days significantly reduced sleep onset latency, improved the quality and depth of nighttime sleep, reduced the number of nighttime awakenings and increased the duration of sleep without producing a morning hangover compared to placebo. It can improve sleep of patients on antidepressants and those that suffer from neurodegenerative disease such as Alzheimer’s and Parkinson’s. Melatonin can reduce neuro- inflammatory conditions. It works better with vitamin B6 and magnesium.
Adenosine slowly builds up throughout the wakeful state until this inhibitory hormone reaches concentrations that makes subjects sleepy. Valerian is an adenosine receptor agonist.
GABA is the main inhibitory neurotransmitter in the central nervous system. It has nootropic effects. Nootropics are drugs, supplements, and other substances that may improve cognitive function, particularly executive functions, memory, creativity, or motivation, in healthy individuals. GABA may antagonize noradrenaline in the CNS and the periphery leading to: greater fluid flow and metabolic clearance of the brain, and reduction of hypertension. It is effective at treating addictive disorders such as alcoholism, reduction of anxiety and depression. Those suffering from epilepsy have reduced GABAergic neurons and decreases in CNS GABA concentrations. Supplemental GABA does not penetrate the blood brain barrier at appreciable levels. Phenibut is a GABA mimetic and binds to the GABA receptors. Taurine acts as a GABA agonist, it has an anti-anxiety affect.
Greater than 80% of neurons are excitatory and 70 to 90% of synapses release glutamate. One reason why we should not put MSG on our food. Vitamin B6 known as pyridoxal five phosphate (P5P) is essential for over 140 enzymatic reactions. It is a necessary cofactor in the folate cycle. B6 is the rate limiting cofactor in neurotransmitter synthesis: dopamine, serotonin, GABA, noradrenaline, and melatonin. Minor deficiencies preferentially down regulate serotonin and GABA. One reason why simple vitamin supplementation packs such a powerful punch with regard to improved overall health.
A natural monoamine oxidase inhibitor is passionflower. It has an overall calming effect and anti-anxiety property. It stimulates GABA production. It may be useful for muscle spasms and pain. 5 HTP and passionflower helps serotonin production.
Sleep deprivation can decrease thyroid stimulating hormone up to 30%. A decrease in sleep coincides with an increase in appetite. Sleep deprivation affects sex hormone production. Women higher in progesterone and men lower in testosterone were more vulnerable to the effects of sleep restriction on emotion processing tests. I’m not going to make a joke here, but we’ve probably all have experienced someone else’s experience of this.
Infections may play a role in sleep pattern alterations because it can exhaust energy stores. Infectious load leads to inflammation thus the release of cytokines. Cytokines can trigger the release of corticotropin releasing hormone (CRH) from the hypothalamus which triggers adrenocorticotropic hormone (ACTH) to be released from the anterior pituitary resulting in glucocorticoid release from the adrenal glands. An elevated CRH has been implicated in sleep disturbances with influences norepinephrine. Norepinephrine can cause an increase in CRH creating a vicious cycle. Lipopolysaccharides (LPS), also known as lipoglycans and endotoxins, are large molecules consisting of a lipid and a polysaccharide. They can trigger glucocorticoid release and can affect us mostly at night. Or a GABA agonist can down regulate CRH thus improving sleep.
Pregnenolone is the master at the top of the hormone precursor chain. It can be hydroxylated to yield progesterone, cortisol, DHEA. Serum levels of 30 healthy students were measured for progesterone and cortisol. Before having to take exams serum levels of cortisol were significantly higher and progesterone significantly lower. This means that under stress our master hormone pregnenolone is being stolen for other purposes. Adrenal fatigue is not just the exhaustion of the gland but rather a miscommunication in the signaling cascade that leads to alterations in DHEA, cortisol, etc. We see this dysfunction of the hypothalamus pituitary adrenal axis (HPA) more now than ever. Major depressive disorder and PTSD are related to this cycle. Examples of it increased HPA axis activity are, Cushing’s syndrome, chronic stress, melancholic depression, anorexia nervosa, OCD, panic disorder, excessive exercise, alcoholism, diabetes type II, obesity, and hypothyroidism. Decreased HPA axis activities are, adrenal insufficiency, seasonal depression, chronic fatigue syndrome, fibromyalgia, pre-muscle tension syndrome, nicotine withdrawal, postpartum depression, hypothyroidism, rheumatoid arthritis, asthma, and eczema. All this means that HPA axis hyperactivity can have a negative impact on sleep. Phosphatidylserine is known to blunt the rise in cortisol and ACTH following strenuous training and significantly reduce both ACTH and cortisol levels after exposure to physical stress. It’s also been shown to improve mood.
N-acetyl cysteine (NAC) decreases glutamate hyperactivity at the synaptic level. Decreasing glutamate can improve GABA activity. Decreasing glutamate activity will support a healthy HPA axis.
Stay tuned for Part 2