The Sleep-Wake Cycle

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It's been a few years since we've discussed sleep, and while the tips in our 2018 post are still good to follow, there are even more that we constantly find ourselves repeating to patients. Plus, sleep is so important that it deserves more than one blog post!

Just like with digestion, the goal of any holistic approach to insomnia should be to support the body in its natural processes. Whether you have difficulty falling asleep, interrupted sleep, or restless sleep, reinforcing the body's main circadian rhythm - the 24-hour cycle of sleeping and waking - can help even out imbalances to promote deeper rest.

Our internal clock is largely influenced by two hormones: melatonin and cortisol. When the sun sets, the decreased light signals the pineal gland to start producing melatonin, and production ramps up until it's time for bed. In the morning, sunlight tells the adrenal glands to make cortisol...and then the cycle of melatonin -> cortisol -> melatonin repeats. When it comes to insomnia, most people only consider the "sleep" part, taking mega-doses of melatonin as they get ready for bed. Doing this ignores the body's innate way of doing things, so instead we recommend reinforcing what should be happening naturally.

Our ancestors had the option of going to sleep when darkness settled or staying up by firelight, keeping melatonin levels steady as they increased after sunset. Nowadays, we are surrounded by various types of light, many of which are bright and/or contain blue light. Our brains read these as sunlight, so melatonin doesn't follow its natural progression. Luckily there are ways that you can counteract this disruption:

• Dim your lights at night.
• Use small night lights - we love Himalayan salt lamps! - rather than turning on full sets of lights if you wake up to use the bathroom, get a glass of water, etc.
• Avoid screens before bed, opting to read, meditate, or do another restful activity instead. If you need to use a screen, check to see if it has a mode that decreases blue light or buy blue light glasses to wear while you're using it.
• Develop a bedtime routine to train your mind and body to wind down. This isn't so much about light but rather about conditioning yourself, similar to the famous Pavlov's dog experiment. (He essentially conditioned dogs to salivate any time they heard a bell because they began to associate the sound with upcoming food.) Set and stick to a bedtime schedule, for instance by washing your face, brushing your teeth, writing in your gratitude journal, and reading in that same order each night.
• If you need extra melatonin, try taking a tiny dose at dusk instead of a large amount when you turn in. As stated a few times, the brain produces melatonin in response to the sun going down. At this point, taking 0.25 mg or so of the supplement will give the production a little bump up, so that it can gradually ramp up from there. 

How you wake up also influences your circadian rhythm, so it's worth following nature in the morning as well.

• Expose yourself to sunlight or bright light on waking to let the body know that the new day has started.
• Eat within one hour of waking to regulate cortisol. Cortisol is a stress hormone that often gets a bad rap because it can contribute to conditions like high blood pressure and blood sugar dysregulation if it is elevated for too long (e.g. with chronic stress). However, cortisol in itself is not bad and serves important functions in the body. It naturally increases as we wake...and eating tells it to decrease back to its normal levels. This is especially important for women, but if you practice intermittent fasting per a doctor's orders, reach out for a discussion before changing your eating habits.

When Traditional Chinese Medicine (TCM) was developed thousands of years ago, scholars and practitioners did not know about melatonin and cortisol, viewing nature and the body through their own parameters instead. The sleep-wake cycle is most intimately tied to that of Yin and Yang. Yin belongs to the night, and Yang to the day. In terms of health, Yin is coolness, moisture, and rest, and Yang is heat, energy, and activity. 

For the most part, supporting the transitions between Yin and Yang line up with the tips above, but you may also consider these:

• Avoid exercise right before bed as it heats and energizes the body, promoting Yang and not Yin.
• Pursue restful activities before bed instead of stimulating ones, e.g. try to stop working, cleaning the house, etc. at least an hour or two before you intend to go to sleep. (Again these are Yang, not Yin).
• Do something active in the early hours of waking to increase Yang.