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The Public Health Epidemic Not in the News: Sleep

I remember growing up, my farmer grandparents would go to bed before 9 and wake before the sun. They had earned it, working hard all day, but also resting in the afternoon when the Florida heat was too much to tend to the fields and animals. They, like most farmers, had a great understanding of what their bodies needed: rest and sleep to maintain a hard physical lifestyle. Now we stay glued to electronic devices and computers all day, do very little physical work that isn’t outside of a gym, and we don’t slow down for restful afternoon times that reset our clocks. We do mental work all day then do more work when we get home and stay up late for entertainment like television or social media. Burning the midnight oil has become a standard American attitude. But where it’s led is to a public health epidemic of insufficient sleep.

According to the CDC….
Sleep is increasingly recognized as important to public health, with sleep insufficiency linked to motor vehicle crashes, industrial disasters, and medical and other occupational errors. Unintentionally falling asleep, nodding off while driving, and having difficulty performing daily tasks because of sleepiness all may contribute to these hazardous outcomes. Persons experiencing sleep insufficiency are also more likely to suffer from chronic diseases such as hypertension, diabetes, depression, and obesity, as well as from cancer, increased mortality, and reduced quality of life and productivity.

Sleep insufficiency may be caused by broad scale societal factors such as round-the-clock access to technology and work schedules, but sleep disorders such as insomnia or obstructive sleep apnea also play an important role. An estimated 50-70 million US adults have sleep or wakefulness disorder. Notably, snoring is a major indicator of obstructive sleep apnea.


According to data from the National Health Interview Survey, nearly 30% of adults reported an average of less than 6 hours of sleep per day in 2005-2007. In 2009, only 31% of high school students reported getting at least 8 hours of sleep on an average school night.

Circadian rhythms are physical, mental, and behavioral changes that follow a roughly 24-hour cycle, responding primarily to light and darkness in an organism’s environment. They are found in most living things, including animals, plants, and many tiny microbes. This internal clock, which gradually becomes established during the first months of life, controls the daily ups and downs of biological patterns, including body temperature, blood pressure, and the release of hormones. Circadian rhythms are important in determining human sleep patterns and have been linked to sleep disorders like insomnia. They’ve also been associated with obesity, diabetes, depression, bipolar disorder, and seasonal affective disorder.


Light is the main cue influencing circadian rhythms, turning on or turning off genes that control an organism’s internal clocks.

For people suffering from sleep dysfunction lifestyle can be a major contributor. For people with adrenal fatigue, their second wind usually kicks in around 11pm and creates a pattern of insomnia. If you’re waking between 1 and 3 am your liver may be lacking the glycogen reserves needed for conversion by the adrenals to keep the blood glucose levels high enough during the night. Blood sugar is normally low during the early morning hours but, if you are hypoadrenic your blood glucose levels may sometimes fall so low that hypoglycemic (low blood sugar) symptoms wake you during the night. This is often the case if you have panic or anxiety attacks, nightmares, or sleep fitfully between 1 and 4 am. Both too high and too low nighttime cortisol levels can cause sleep disturbances.

Our bodies are designed to handle acute stress. Being chased by a predator for example, we go into sympathetic mode otherwise known as fight or flight. Resources are prioritized and survival takes over which suppresses immune function, digestion, sex hormone production, for instance. To put into modern day terms, imagine when you’ve avoided a car accident. The stress hormones adrenaline, epinephrine, and dopamine take over. Your heart pounds, your hands my sweat, it takes you some time to calm down and recover. Our bodies can handle those types of situations when it’s a rare occasion. It becomes a problem when we live in a chronic sympathetic state like so many Americans do these days. Chronic stress looks like this:


Your circadian rhythms are easily disrupted if cortisol is continuously released due to chronic stress. If cortisol remains high at night, melatonin isn’t released. Even though you may be able to fall asleep despite high cortisol levels your rest may be disrupted causing further stressors that create a vicious cycle.

Problems from chronic stress causing sleep issues:
Adrenal Fatigue
Digestive, not eating in a parasympathetic mode causes digestion dysfunction
Insulin resistance/weight management
Mood disorders

Maintain a regular bed and wake time schedule including weekends.
It’s important to keep a regular bedtime and wake-time, even on the weekends when there is the temptation to sleep-in. A second wind hits at about 11pm which is why it is important to be in bed and on your way to sleep by 10:30 to prevent your adrenal glands from kicking into overdrive. Even if your night has been restless or sleep fitfull, sleeping between 7-9am can be restorative

Establish a regular, relaxing bedtime routine such as soaking in a hot bath or hot tub and then reading a book or listening to soothing music.
Avoid arousing activities before bedtime like working, paying bills, engaging in competitive games or family problem-solving. Some studies suggest that soaking in hot water before retiring to bed can ease the transition into deeper sleep, but it should be done early enough that you are no longer sweating or over-heated. If you are unable to avoid tension and stress, it may be helpful to learn relaxation therapy from a trained professional. Finally, avoid exposure to bright before bedtime because it signals the neurons that help control the sleep-wake cycle that it is time to awaken, not to sleep.

Create a sleep-conducive environment that is dark, quiet, comfortable and cool.
Design your sleep environment to establish the conditions you need for sleep – cool, quiet, dark, comfortable and free of interruptions. Also make your bedroom reflective of the value you place on sleep. Check your room for noise or other distractions, including a bed partner’s sleep disruptions such as snoring, light, and a dry or hot environment. Consider using blackout curtains, eye shades, ear plugs, “white noise,” humidifiers, fans and other devices.

Use your bedroom only for sleep and sex.
It is best to take work materials, computers and televisions out of the sleeping environment. Use your bed only for sleep and sex to strengthen the association between bed and sleep. If you associate a particular activity or item with anxiety about sleeping, omit it from your bedtime routine. For example, if looking at a bedroom clock makes you anxious about how much time you have before you must get up, move the clock out of sight. Do not engage in activities that cause you anxiety and prevent you from sleeping.

Finish eating at least 2-3 hours before your regular bedtime.
Eating or drinking too much may make you less comfortable when settling down for bed. It is best to avoid a heavy meal too close to bedtime. Also, spicy foods may cause heartburn, which leads to difficulty falling asleep and discomfort during the night. Try to restrict fluids close to bedtime to prevent nighttime awakenings to go to the bathroom, though some people find milk or herbal, non-caffeinated teas to be soothing and a helpful part of a bedtime routine.

Exercise regularly.
Vigorous exercise is best, but even light exercise is better than no activity. Exercise at any time of day, but not at the expense of your sleep. If your nighttime cortisol levels are too low, you may sleep better when you exercise in the evening, before going to bed because exercise tends to raise cortisol levels. If your nighttime cortisol levels are too high, try doing relaxation or meditation exercises before going to bed

Avoid caffeine (e.g. coffee, tea, soft drinks, chocolate) close to bedtime. It can keep you awake.
Caffeine is a stimulant, which means it can produce an alerting effect. Caffeine products, such as coffee, tea, colas and chocolate, remain in the body on average from 3 to 5 hours, but they can affect some people up to 12 hours later. Even if you do not think caffeine affects you, it may be disrupting and changing the quality of your sleep. Avoiding caffeine within 6-8 hours of going to bed can help improve sleep quality.

Turn off electronics

Most people are photosensitive and watching TV or looking at computers, phones, tablets, etc keeps their melatonin from rising and inducing sleep. Try cutting off visual stimuli at least an hour before bedtime. Use Amber tinted glasses to cut down on blue light that affects cortisol levels.

One thought on “The Public Health Epidemic Not in the News: Sleep”

  1. I never knew about the low blood sugar waking you up. That could be why I wake up a lot in the night (or it could be that darn cat that thinks 3am is a good time to meow at me).

    I’ll have to see what else I can do to prevent waking up. I have noticed that less alcohol helps me sleep more soundly.

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