Jennifer Caryn Brand Nutrition

Jennifer Brand, MPH, MS, CNS Clinical Nutritionist

Sleep (Problems Sleeping and Insomnia)

If you have problems sleeping you are not alone. It is estimated that 50-70 million Americans have chronic sleeping problems. Getting enough sleep is crucial to good health, and unfortunately there is a wide range of medical barriers to it. Nutrition can influence sleep disturbances, and there are diet, food and nutrient strategies that can be used to help.

Lack of sleep is associated with weight gain. It can lead to poor food choices that affect weight gain, and it adversely affects hormones related to hunger (ghrelin) and fullness (leptin). Studies have shown that those that sleep less have lower levels of leptin and higher levels of ghrelin, so if you are lacking sleep, you may be hungrier, and therefore eat more. When we are sleep deprived we also tend to crave calorie dense foods that are higher in carbohydrates, and this can contribute to weight gain.

Studies have also shown that men who sleep 5-6 hours or less are twice as likely to develop diabetes, and both short and long duration sleep times (durations longer than 8 hours) are associated with type 2 diabetes and impaired glucose tolerance in men and women. So this means that optimizing sleep quality and quantity can have positive benefits for optimizing blood sugar control.

Often issues with sleep are a symptom of another medical problem, and by addressing that underlying problem, we can improve sleep.

There are a variety of reasons for insomnia, and we can look to identify why someone might have insomnia in the first place. We start with things we eat or take that can keep us awake, like alcohol, nicotine, caffeine, cocaine, decongestants like Sudafed, diet pills, Ritalin or other stimulants, herbs like ginkgo biloba, guarana, Siberian ginseng, ephedra, ma huang, bitter orange, and kola nut, and medications including beta blockers, albuterol, Wellburtin, SSRIs (antidepressants), prednisone and other steroids. We want to avoid the things we can that may be contributing to sleeping problems like drinking alcohol and caffeine, smoking and use of elicit drugs. If you are on prescription medications that you feel are causing problems for you talk to your doctor before changing any prescribed medicine regimen.

Next we can look at all sorts of conditions can interfere with sleep. Take anxiety for example. Diet, sleep and anxiety affect each other. Anxiety makes getting restful sleep challenging and difficulty sleeping can cause anxiety. Reducing levels of anxiety is important, and meditation, yoga, and breathing exercises are examples of interventions my clients find helpful in reducing their anxiety levels.

Depression is linked to poor sleep. Insomnia can cause depression, and remember that antidepressants (like Prozac or Wellbutrin) can adversely affect sleep.

Pain from any number of conditions can lead to poor sleep. Arthritis, headaches, reflux, and fibromyalgia, anything that causes pain can make it hard to fall asleep, and hard to stay asleep. Pain gets worse with lack of sleep. Addressing the underlying cause of pain can help improve sleep quality.

GERD, or gastroesophageal reflux, is a common problem, and reflux symptoms reduce quantity and quality of sleep. One of the first things we look at is how close to bedtime are you eating? Eating too much and eating too close to bedtime can cause GI symptoms like GERD. Ideally, you should wait 4 hours between eating and going to bed. There is a wide range of other reasons for GERD, so this is also something we explore when reflux is present, and GERD has many other problems associated with it aside from sleeping disturbances, and there are nutritional interventions to address it.

Insomnia is considered a symptom of menopause. There are nutritional interventions that can help. Many are herbals. Keep in mind with herbal medicine that many pharmaceutical drugs are created based on the action of herbal medicines. Because of this, herbals can cause side effects and drug interactions just like pharmaceutical drugs can. The message here is don’t self medicate with herbals (for insomnia or any other reason). Talk to a professional to see what’s right for you.

Another fairly common issue associated with problems sleeping is obstructive sleep apnea.  This is disordered breathing during sleep. People that have sleep apnea have a greater risk for high blood pressure, heart attack, irregular heartbeat, diabetes, stroke, asthma, some cancers, cognitive and behavioral disorders in children and adults, and car accidents. Common symptoms include snoring or gasping during sleep, and feeling fatigued during the day. Many people that suffer from sleep apnea live in larger bodies, so nutrition plays a big role here. Appropriately nourishing your body to reach a healthy weight is a primary intervention for sleep apnea, and often helps resolve the issue.  There are numerous other reasons that someone may be experiencing sleep disordered breathing, and The Breathe Institute in Los Angeles, CA specializes in addressing all causes of sleep disordered breathing using a multidisciplinary approach. And yes, I do collaborate with them.

The last cause of insomnia I’ll mention is called desynchronosis because there are too many to talk about here. This is a disrupted circadian rhythm. It’s common in jet lag, and it shift workers, so those who work at night. It’s when your body’s internal clock is out of balance. Our circadian rhythms tend to change based on our stage in life too. Teenagers generally like to stay up late and wake up late, and as we get older we tend to go to bed earlier and wake up earlier. Often those with this condition have abnormal hormone levels, in particular cortisol and melatonin.

Cortisol is your stress hormone and it should be higher in the morning and lower at night. Stress is an unavoidable factor in our lives, and more stress leads to higher levels of cortisol (until you end up in adrenal fatigue, but that’s another story for another day). There are many other causes of high cortisol levels, and cortisol stimulates insulin release, and over time, this can lead to diabetes, and weight gain, especially around your middle. So managing cortisol levels by working on reducing stress is important for sleep and for overall health.

Melatonin, is also important to help promote sleep. Low levels of melatonin lead to problems sleeping. Melatonin production increases when it's dark and decreases when it's light. This is a reason why blue light/screen time before bed disrupts sleep! 

To learn more about your unique circadian rhythm and sleep cycles, fill out this questionnaire (it's free and provides helpful information): http://www.cet-surveys.com/index.php?sid=61524. It estimates the time of your melatonin onset, and what your natural bedtime should be! Going to bed before this time could be a recipe for a poor night's sleep.

I think you get a sense of the variety of factors that play roles in sleep problems. This is by no means an exhaustive list. From a nutritional standpoint, diet is first of course. We look for dietary triggers for the problem. We can look for underlying conditions that are preventing adequate sleep, like sleep apnea, and reflux. We also can look to food as medicine to address any nutrient deficiencies that may be contributing to the issue. For example, food is a source of neurotransmitter precursors, where your neurotransmitter balance regulates your sleep, and mood in general. Deficiency of certain vitamins and minerals can also disrupt sleep, so we can address these deficiencies by choosing foods containing the nutrients and supplement where necessary.

As you can see, sleep disorders cause a lot more than just feeling tired during the day. If you have problems sleeping, it is worthwhile to check out why. Contact me and we can explore diet, food, nutrients and lifestyle interventions to help bring you relief, and a good night’s sleep.