A Herbal & Functional Medicine approach to sleep problems
The season’s change is fully upon us now and the last Sunday in October is coming up fast when the ‘clocks go back’ or more precisely… at 2am 30th October, British Summertime ends and we change back to Greenwich mean time. This can bring up sleep problems for many. There may be some comfort in knowing that we actually gain an extra hour in bed but is it all good news? Temporarily we have lighter mornings but research has shown an increase in road traffic accidents and higher rates of strokes and heart attacks after the clock change.
Pondering this as the weekend looms near has got me thinking more about sleep and inspired me to write a little (because this is a HUGE subject.)
Sometimes people come to work with me specifically because they are having trouble sleeping. It’s not always the primary reason for seeking advice, although poor sleep is often a consequence of a health condition a person may be wishing to correct. Herein lies the clue, most of the time chronic or ongoing trouble sleeping is due to other underlying reasons. In this blog I am going to explore some of those potential causes of sleep problems and in part 2 I will write about some of the herbs, essential oils, nutritional supplements and foods I commonly prescribe to assist deep, restorative sleep.
We know it is important to have consistency in the time of going to sleep and waking up and many people really do suffer with adjusting to this enforced change in our circadian rhythm causing temporary or exacerbating ongoing sleep problems.
What is this circadian rhythm and why is it so important for our whole health?
The Circadian rhythm is the 24-hour internal clock in our brain that regulates cycles of alertness and sleepiness by responding to light changes in our environment.
Sleep is a vital activity that every organism needs to function properly. The lack of sleep or poor sleep patterns can have significant impacts on a variety of essential day to day functions. Memory consolidation, body healing, and metabolic regulation occur during the sleep cycle. This sleep-wake cycle can influence eating habits, digestion, body temperature, hormone release, and other bodily functions. Detrimental effects on sleep can negatively affect a person’s ability to properly function and can result in many disorders. (1) including Mental Health, Inflammatory, Neurodegenerative, Cardiovascular, and our response to infections including outcomes in sepsis (2)
Adults need between 7 & 9 hours per night. Between the time of 10pm and 2am the body goes through a process of physical repair and between 2am and 6am there will be psychological repair. If this is interrupted, cortisol ( a stress hormone) will elevate and negatively affect the regenerative process.
If your sleep is not disturbed but you are waking un-refreshed, that is a sign of poor quality sleep and we need to find the reason why.
Questions I always ask during an Initial Consultation
Questions include, how many hours do you sleep? What time do you go to bed, what time do you wake up, do you wake naturally or with an alarm, are you waking refreshed by sleep,do you sleep all night long, if you do wake up, is there a particular time that you do and can you get back off to sleep OK.
If there are no underlying medical reasons for disturbed sleep ( Endocrine – thyroid issues, diabetes) Cardiovascular- hypertension, sleep apnea) and the environment is conducive ( too much late night screen time, traffic noise, street lights, wrong temperature etc) then we dig a little deeper and look at the systems based approach of Functional Medicine to address other reasons for poor or disturbed sleep and sleep problems in general.
I find the Chinese Medicine Organ Clock really useful to keep in mind. Between 1am-3am this is the time of the liver ( think congestion, poor detoxification, unresolved anger, frustration) and between 3am and 5am is the time of the lungs ( congestion, infection, poor oxygenation, unresolved grief) We can then look at supporting these organs with herbs as part of the holistic herbal and nutritional prescription whilst considering the following..
Cortisol
Cortisol is a hormone secreted by the adrenal glands and actually has it’s own circadian rhythm, regulated by the hypothalamus ( the HPA axis).
Cortisol should be low at night which enables us to sleep deeply, often a cause of poor quality sleep is connected with higher cortisol levels. Around 3-4am our cortisol levels will naturally start to rise in order to prepare us for the day ahead, if that ‘Cortisol Bucket’ is already full due to underlying stress, it will overflow and wake us up.
Melatonin
The ‘Vampire Hormone’ Melatonin only come out at night! We make it ourselves in our Pineal gland from serotonin initiated by darkness. The peak production is between 2am and 4am, so now you can understand that Cortisol and Melatonin are in opposition, one helps us sleep, one helps us wake up. When either of these are out of balance, our sleep will be affected.
For optimal Melatonin production, sleep in a dark room, reduce screen time at night, use relaxation techniques, get out in the daylight, especially the sunshine! ( see part 2 for dietary and herbal support for melatonin)
Serotonin
For a while there was conflicting research, does serotonin help us sleep or does it help us be awake?
In 2019 a study showed that Serotonin is necessary to get enough sleep because it affects homeostatic sleep pressure (3)
When you wake up in the morning after rest you are energetic. As the day goes on, you become tired and sleepy, so there is a building of pressure to sleep. If you don’t sleep that night, your sleep pressure is even higher, and you are even more tired the next day even though it’s light outside, and your circadian clock dictates that you should be awake. And so longer term sleep problems often arise.
“The theory is that, in order to sleep, you need to have high sleep pressure and the circadian clock needs to be aligned with the time of day — night-time for diurnal creatures like us and daytime for nocturnal animals.”
It makes sense to me that we need good levels of Serotonin to get good sleep because we make Melatonin from Serotonin too!
Oestrogen
Oestrogen, serotonin, melatonin and cortisol are all related in terms of their metabolism. Oestrogen works throughout the body, including the brain where it can help to regulate serotonin. Oestrogen helps to keep our body temperature low at night. Fluctuating hormone levels trigger temperature changes causing adrenalin surges in turn affecting cortisol and therefore melatonin.. starting to see a pattern?
Insulin/blood sugar
Research shows showed that people who go to bed earlier and sleep longer have better blood sugar control after eating their first meal the next morning. This means less dips later in the day.
Highs and lows in blood sugar spikes insulin surges which can lead to to insulin resistance and eventually diabetes. (4)
People already suffering with Diabetes can often have sleep problems because of poorly managed blood sugar levels and poorly managed blood sugar levels affect sleep.
The Gut & Microbiome
No blog from me would be complete without some reference to the Gut Microbiome!
It is now well understood that the gut microbiome affects digestive, immune and metabolic functions as well as the regulation of sleep and mental health through the microbiome gut brain axis.
We know emotion and stress affects the composition of the bacteria within the gut microbiome via the vagus nerve and there are some bacteria which produce neurotoxic metabolites which can affect sleep by affecting the vagus nerve function and central nervous system.
The gut microbiome also plays a role in the regulation of the hormones as already discussed especially serotonin and cortisol. In fact,
95% of serotonin is manufactured in our gut…
and only 5% in the brain…
Remember that we make melatonin from serotonin and remember also the relationship between melatonin and cortisol. Also high cortisol inhibits digestion by moving blood away from the gut, in turn affecting the microbiome and the gut barrier.
Studies on mice have shown that interfering with their sleep patterns changes the diversity and structure of their intestinal microbiota ( 4) and further studies have shown that diversity of the gut microbiome promotes healthier sleep (5)
Conditions such as Acid Reflux can really disturb sleep, there are many underlying causes for this condition as I wrote about before, but one condition is directly connected to the microbiome, SIBO- Small Intestine Bacterial Overgrowth. More on that another time..
Sleep to clean your brain
Sleep literally clears the mind. While we sleep the brain actually shrinks.
We have a system known as the Glymphatic System, think lymphatic system of the brain. It’s a waste removal process whereby the brain cells known as Glia cells control the flow of this system by shrinking or swelling.
Studies show that toxic molecules involved in neurodegenerative disorders accumulate in the space between brain cells, this has been demonstrated with a mouse study which showed Beta-amyloid Protein ( a protein associated with Alzheimer’s disease) was cleared faster in the brains of mice who were sleeping.(6)
I hope you have found this interesting, coming soon is part 2 where I will give you some good tips for getting that good sleep!
(1) https://www.ncbi.nlm.nih.gov/books/NBK519507/
(2) https://www.atsjournals.org/doi/10.1513/AnnalsATS.201602-125FR
(3) https://www.sciencedaily.com/releases/2019/06/190624173822.htm
(4) https://link.springer.com/article/10.1007/s00125-021-05608-y
(4) https://pubmed.ncbi.nlm.nih.gov/27912059/
(5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779243/
(6) https://www.nih.gov/news-events/news-releases/brain-may-flush-out-toxins-during-sleep
