When you are a child or a youngster sleeping habits are rarely a problem. But as people age, they tend to have problems falling asleep and sleeping through the night. Older people may also have certain hormone deficiencies, which can contribute to a change in sleeping habits.
Some basics regarding sleeping habits
There are a couple of facts that everybody should know about sleep, so you work with nature, not against it.
- The way our bodies are hardwired, we need 7 to 8 hours of sleep and we need to fall asleep between 10PM and 11PM.
- The reason for the relative rigid sleeping schedule time wise is the diurnal hormone rhythm. This is also known as the circadian clock that is dictated by the light of the sun (24 hour cycle). Light going into our eyes in the morning inactivates melatonin. But in the evening the pineal gland releases melatonin after sunset. This is what keeps the internal clock on time. We all know how we derail when we fly east or west. There are differences. I find that I am more affected when I fly west than east. The readjustment for me often takes one or two weeks for a 9-hour time zone difference.
- Melatonin is gradually produced less as we age. The highest melatonin production occurs around 10 years of age. From then on melatonin production declines. This likely is the reason why older people more often have insomnia problems.
- There is interplay between melatonin and cortisol. These two hormones complement each other. When you sleep melatonin governs and resets the hormones to be ready in the morning. This involves an early testosterone peak for the male and cortisol, which has to be ready the moment you wake up. It is cortisol coming from the adrenal glands that rules during the day and is giving us energy. Thyroid hormones also give you energy during the day. As I will explain below, human growth hormone is an energy-giving hormone as well that also clears your mind.
- What is not as much known is that human growth hormone (GH) provides energy for us. Growth hormone is released as a spurt between midnight and 3 AM, when you’re deep asleep. The purpose of that is to get you ready with regard to energy for the next day. If you drink alcohol after 5PM the afternoon before, you will miss most of that GH spurt during the night and have a hangover (lack of energy the following day). At the 23 rd Annual World Congress on Anti-Aging Medicine on Dec. 13, 2015 in Las Vegas the endocrinologist, Dr. Thierry Hertoghe from Belgium gave a talk about GH and said that even one drink during the evening before you go to sleep will cancel 75% of the GH spurt causing a lack of energy the following day. When you have alcoholic drinks evening after evening as many people do, you interfere with your deepest sleep, creating a fitful sleep and you can develop GH deficiency, which can be measured with blood and urine tests. GH deficiency leads to premature signs of aging, such as wrinkles, musculoskeletal problems, muscle weakness and dementia. Many people in their 80’s look “old”. In fact they may be growth hormone deficient and could be treated with human GH, if GH deficiency were confirmed by tests. Part of the aged appearance is reversible in cases of growth hormone deficiency by treating with daily GH injections.
- As we age, we produce less melatonin and less growth hormone. All of these hormone levels can be determined. If they are low, they should be replaced with small amounts of whatever hormone is missing.
- There are other hormones that are important for energy: cortisol from the adrenal glands, thyroid hormones and DHEA from the adrenal glands. When people get older there is a problem with melatonin production and an evening dose of melatonin supplement of 3mg is advisable. People beyond the age of menopause (females) and andropause (males) need bioidentical sex hormone replacement. Once they have sufficient hormone levels, they will also have more energy. It is advisable to get all of these hormones tested using a saliva hormone test. Growth hormone is a bit more difficult to assess, but IGF-1 levels give a first indication what your growth hormone levels are doing. The newest test is a 24-hour urine collection or an overnight urine sample looking for growth hormone metabolites. If levels are found to be low, daily replacement of growth hormone using a pen similar to insulin injections in diabetics can be given, using pure human growth hormone. You would need to seek the advice of a knowledgeable naturopath.
What does insomnia do to you?
From a psychological point of view performance is slower, there is a slower reaction time and there is a risk of developing anxiety or depression. The immune system gets weakened, high blood pressure can develop and there is a risk of developing heart disease, diabetes and cancer. It is common to gain weight becoming overweight or obese. Even your telomeres, the caps of chromosomes in every cell get shortened from too much stress and too little sleep. Shortened telomeres mean a shortened life span.
How to improve sleeping habits
Set your alarm clock for 8 hours later when you go to sleep. Make sure your bedroom is dark, but wake up to the alarm clock after 7 to 8 hours of sleep. Don’t sleep longer than 8 hours per night. Your internal diurnal hormone rhythm will thank you for regulating your sleep/wake rhythm by giving you the energy you want. I enjoy mine.
Sleeping habits include problems falling asleep or sleeping through
Falling asleep: As we mostly have a lack of melatonin, the first step is to take 3mg to 5mg of melatonin at bedtime. But it should be taken during the window of opportunity fitting into the diurnal hormone rhythm as mentioned above: between 10PM and 11PM. It takes 20 to 30 minutes for melatonin to take effect. If you do not fall asleep within that time frame, you are likely thinking too much. If that were the case, I would recommend taking 1 or 2 capsules of valerian (500 mg strength) from the health food store. This combined with melatonin should help in more than 80%-90% of insomnia cases.
Not sleeping through: Some of you, particularly if you are elderly, may wake up at 3 or 4 AM and have a hard time falling asleep again. At that time it would be safe to take another 3mg of melatonin and if this does not work within 20 minutes add another 500mg valerian capsule.
If you continue to have insomnia problems, see your physician. You may need sleep studies done or you may have problems with your thyroid gland (hypo- or hyperthyroidism), which needs to be checked. Other medical problems including depression have to be checked out as well. Melatonin and valerian are safe. Other sleeping pills have multiple side effects including memory problems.
Part of good sleeping habits is to provide a quiet, comfortable bedroom
The following points are good checklist for a comfortable sleep environment (Ref.1).
- Ensure your bedroom is dark, soundproof, and comfortable with the room temperature being not too warm, and you develop a “sleep hygiene”. This means you get to sleep around the same time each night, have some down time 1 hour or so before going to bed and get up after your average time of sleep (for most people between 7 to 9 hours). Do not sleep in, but use an alarm clock to help you get into your sleep routine.
- Avoid caffeine drinks, alcohol, nicotine and recreational drugs. If you must smoke, don’t smoke later than 7PM.
- Get into a regular exercise program, either at home or at a gym.
- Avoid a heavy meal late at night. A light snack including some warm milk would be OK.
- Do not use your bedroom as an office, reading place or media center. This would condition you to be awake. Reserve your bedroom use only for intimacy and sleeping.
- If you wake up at night and you are wide awake, leave the bedroom and sit in the living room doing something until you feel tired and then return to bed.
- A self-hypnosis recording is a useful adjunct to a sleep routine. Listen to it when you go to bed to give you something to focus on (low volume) and you will find it easier to stop thinking.
We need to be aware how important a proper hormone balance is when it comes to a healthy sleep pattern. Thyroid hormones and sex hormones are easy to measure. Bioidentical hormone replacement is needed, if one of the hormones is low. GH needs to be checked by an IGF-1 level and/or metabolites of GH in a 24-hour urine sample as explained above. Melatonin deficiency in older age is replaced the way I summarized above. With these measures sleeping habits improve, and you will get your 7 to 8 hours of restoring sleep. Forget the notion of the past that older people would not need as much sleep. Especially for an aging individual it is important to have a good night’s sleep in order to feel well and energized every day.
Ref.1: Jean Gray, editor: “Therapeutic choices”, 5th edition, Chapter 8 by Jonathan A.E. Fleming, MB, FRCPC: Insomnia, © 2008, Canadian Pharmacists Association.