I spent time this month interviewing Ann Marie Tommey regarding sleep. Dr. Tommey is a practicing OBGYN in San Luis Obispo who has been focused on preventative and regenerative medicine for over 12 years. She has seen many sleep issues when treating pregnant women, new parents, and women going through menopause. She generously shared her time and knowledge on sleep with us.
Jill: "Hi Dr. Tommey thank you for talking with us today about sleep. I read an article that cited a university study that showed that students who got poor quality sleep had significantly more health problems than student who reported good quality sleep. How much sleep should we be getting and how can we tell if it's "quality sleep"?"
Dr. Tommey: "I just went to the International Functional Medicine conference recently and it was all about what they call modifiable lifestyle factors and of course one is diest, the second is exercise the third one is rest or sleep and the last one is restoration which is all about your business, you know meditation, yoga, massage. There has been a ton more research done on sleep and what they have found overall is that 7 to 8 hours is enough sleep. Ideally that means uninterrupted sleep and of course if you wake up you can quickly get back to sleep. And people who do not have that typically have statistically significant higher in basically all chronic stress related diseases including diabetes, high blood pressure, heart disease, cancer. There are more heart attacks and strokes at night that any other time of day. There is something really big called "chronobiology"* which is being talked about in the wellness industry right now. That even our genetics has a time piece that each organ has a time clock which interplays with our sleep cycles. And we have blown off sleep in Western Culture and often just power through thinking we will be fine, but it's like not really. Sleep is critical."
*Chronobiology is a field of biology that examines periodic (cyclic) phenomena in living organisms and their adaptation to solar- and lunar-related rhythms. These cycles are known as biological rhythms.
Jill: My husband and I often wake up at 3am either with creative highs or with worry. Is this typical?
Dr. Tommey: "3am to 4am is the classic wake up time and it is hormonally related. There is a cortisol fluctuation about that time frame. Cortisol is a product of the adrenal and the adrenal has 3 modes: stress, fear & survival is one, worry is another or creativity, the good stress. And this often happens as we get older because we are gradually depleting those. But that's a whole other topic we can touch on later."
Jill: What factors do we have control over which causes us to have poor sleep?
Dr. Tommey: "Caffeine and alcohol are two biggies. Many people know about caffeine but less people understand this concept with alcohol. Alcohol will put you to sleep, but it affects your blood sugar. You know how when your blood sugar is really high and then it plummets? Well alcohol is a depressant, so it puts you down but then it will cause this ricochet up at about 3 or 4 o'clock in the morning. So people who say they need their cup of coffee in the morning and their glass of red wine at night often are setting up the recipe for this 3 to 4 am wake up call.
A cultural thing that is also taking place is a lot of blue light. Too many screens. Any artificial light tells the brain that it is time to be up. The worst thing you can do when you wake up in the middle of the night is look at a screen. But we often do it - so when we do we should wear amber colored glasses so that we at least cancel out the blue light.
When we read a book instead of watching TV it takes you out of the dialogue of your mind and we are immersed in somebody else's story. That will often help when you are stuck in your mind with either worry or are doing creative problem solving and will allow your mind to rest.
Jill: Are there specific times of life that our sleep is more affected?
Dr. Tommey: For women, peri-menopause and menopausal women experience sleep issues. And men do too as they age. In general our stress levels raise higher (some of this is good stress which causes motivation) as we age and our adrenal gland has 5 (there are more) but 5 basic hormones that it uses to cope with all kinds of stress. And these 5 building blocks begin to slow down. Two of these are being made in the adrenal gland and the other three of them are made in the reproductive organs: testosterone, progesterone and estrogen and basically less of these hormones is being made as we age so there is less fuel to cope. So we have less ability to cope with stress, then we lose sleep which compounds the issue and it becomes vicious cycle.
Jill: What can we do to improve our sleep?
Dr. Tommey: One thing they suggest is to schedule our sleep and to be consistent, which can be difficult for many, but even the iPhone has an app for that which gives you little reminders. The adrenals create cortisol which varies with stress, and there is a light and dark cycle with cortisol and this cycle is very difficult to change. It takes a very long time. So for those people that chronically wake up at 3 or 4 in the morning every morning, that is challenging to change because the circadian rhythm has actually changed. So it takes real effort to make the change.
The other thing people can do is to make sure they are going to sleep 1 to 2 hours before midnight because we only make melatonin from the time we lay down in a dark room until midnight. Melatonin is another hormone produced by our bodies and is involved in synchronization of the circadian rhythms, so it is responsible for your sleep-wake timing, blood pressure regulation, even seasonal reproductiveness among other things. So if you are always up past midnight you are always going to be low on melatonin. So a supplement of melatonin may help.
But the best way to improve sleep is for you to create a routine that you enjoy. If possible involve all 5 senses. Perhaps you take a warm bath with aromatherapy or do a meditation, put on your pajamas, put on some soft music, maybe you stretch, have a cup of herbal tea so it doesn't wake you up in the middle of the night. Whatever it takes to slow down and ease into it. This is why you don't want to watch anything that is too upsetting or that gets your mind revved up. This is in a perfect world of course.
Maybe each night you create a mini vacation to help you ease into sleep and figure out how you can make the last 40 minutes of your day a special time to rejuvenate yourself. And as you do it this will take your system from sympathetic nervous system (the fight or flight system) to the parasympathetic nervous system (which controls homeostasis and the rest and digest systems). Once you create this routine, your biochemistry gets used to it. You will even get to the point where just starting your routine gets you to a more relaxed state. And if you wake up in the middle of the night you can use the routine to get back to sleep. The goal is to get to a place where you look forward to your sleep routine as time for nurturing yourself each night.
Dr. Tommey's Website
The Sleep Foundation
REM Diagnostics in San Luis Obispo for significant sleep issues