Festival of Sleep

Hello my Zebras and Spoonies! Thanks for coming and visiting me today, I’m glad that you are here.

Today is actually a holiday. Admittedly, one that most people have never heard of and one that few people celebrate. Today is the Festival of Sleep Day. It is also National Straw Drinking Day, Weigh-In Day, National Chocolate Covered Cherry Day, and Humiliation Day. There are a lot of strange, little know holidays out there that few people know about or celebrate. I’ve decided that I will be highlighting some of the ones that I think are fun or that highlight important issues. If you’d like to know more about these strange little holidays, you can go to Days of the Year or Holiday Insights. Because the strange fact of the matter is that there is a holiday on every day of the year and on most days, there is actually more then one.

The Festival of Sleep is all about celebrating sleep and reminding people of how important sleep is for good health. The research on the importance of sleep is pretty profound, yet most people in America are still not getting the sleep that is needed. And this isn’t a problem limited to us Americans. [4] Despite not really understanding why we need sleep, it is clear that we do really need it. [1] Having adequate, high quality sleep is important for both our biological and psychological wellness. Insomnia is associated with many adverse outcomes, including but not limited to: increased infection rates, [5] increased rates of chronic illnesses such as coronary artery disease or diabetes, increased risk for anxiety, increased risk for accidents and a general increased risk for death. [1, 2, 6, 9, 10] Research reflects that high quality sleep is a protective factor, reducing the risks for negative emotional response when a person is under stress or in pain. [1] Restorative sleep is associated with a reduction in chronic pain. [1] While there are a lot of unanswered question in this research (such as does the medical problem cause the sleep disturbance or vice versa?) it is clear that getting adequate rest is important.

Stress is a significant factor is sleep disturbance. [2] “In fact, stress is considered the primary of persistent psychophysiological (or primary) insomnia.” [1] This means that if a doctor cannot figure out what is causing your sleep disturbance, it is most likely stress. Those who work in a high stress environment were found to have a 30% incidence of insomnia as compared to those in a low stress work environment who only had an incidence of 5%. [2] Having burnout is another major risk factor for insomnia [2] and it is arguable that this is simply another reflection of the impact of stress on our sleep. Lack of social support is another risk factor for insomnia [2] that is suggestive that stress has a major impact on our sleep. If we think about what stress does to our bodies, it makes sense that it would have an impact on our sleep. “In a medical or biological context stress is a physical, mental, or emotional factor that causes bodily or mental tension. Stresses can be external (from the environment, psychological, or social situations) or internal (illness, or from a medical procedure). Stress can initiate the “fight or flight” response, a complex reaction of neurologic and endocrinological systems.” [3] Stress increases the body’s energy state while sleep needs the body’s energy state to be decreased.

The first thing to mention when talking about improving sleep is that everything in our health is connected and about finding balance. Improving the symptoms of our chronic illnesses is likely to lead to improved sleep as the symptoms of our chronic illnesses are likely to be a factor in impaired sleep. Just like improving our sleep is likely to improve the symptoms of our chronic illness. Thus, it is often about first assessing where one is most likely to achieve improvements. It is always important to take a “big picture” look at things before trying to make changes in your care plan. Maybe tackling your insomnia directly isn’t the best approach. Perhaps addressing your uncontrolled pain is the primary concern as it is impacting more then just your sleep. This is just something to keep in mind when you are considering ways to improve your sleep. Tackling the problem indirectly often has more positive results.

“According to the American National Sleep Foundation, non-pharmacological treatment options are the preferred first choice of treatment for sleep problems. Pharmaceutical options should be prescribed after, or in combination with, a more durable non-pharmaceutical treatment. Non-pharmaceutical interventions can include cognitive behavioral therapy, sleep hygiene advice, relaxation exercises and physical activity.” [11]

Research reflects that cognitive behavioral therapy with the use of mindfulness is the gold standard treatment for insomnia. In fact it has been shown to be more effective then using education (sleep hygiene advice) and physical activity (exercise) combined. [13, 14, 15, 16, 17, 18] Additionally, this intervention has been shown to maintain it’s effectiveness for a year after the completion of the intervention. [14] “Insomnia begins with the discomfort of sleep itself, but as it continues, patients fall into a vicious circle with negative thoughts related to sleep. As such, those who experience chronic insomnia fall into a vicious cycle of ‘increasing sleep worsens as the desire and effort to sleep increases’ which in turn leads to a strong desire to get more sleep and avoid daytime fatigue. MBI corrects sequential cognitive and behavioral processes and can be a useful nonpharmaceutical intervention for insomnia. In many studies, MBI for insomnia has been proven with stability and efficacy.” [16] Since there are no know side effects from this treatment, the success rates are higher than any other form of treatment and the benefits are sustainable, this should be the first line of treatment for insomnia.

Relaxation exercises have been shown to be helpful with improving sleep in some limited research. [24, 25, 26] However, there isn’t a good body of research to provide us with direction as to which methods would be the best to use. In general, the research on the use of relaxation methods to improve sleep is lacking. Generally, relaxation exercises are lumped in under sleep hygiene for this reason. However, the principles behind this are fairly sound. As previously discussed, stress has a large impact on sleep. Thus, logic indicates that practices that reduce stress would also promote sleep.

Sleep hygiene includes the environmental and habit changes that promote good sleep. One intervention many providers use is to provide teaching related to sleep hygiene. However, you can easily educate yourself on sleep hygiene. You can even use the Sleep Hygiene Index to assess how well you are doing with your sleep hygiene. This short survey has been shown to be a good measurement of how well you are sleeping since the sleep hygiene indicators are correlated to insomnia. [19, 20, 21, 22, 23] The basics of sleep hygiene include: keep a consistent sleep schedule, create a relaxing routine around going to bed, don’t use electronic devices while trying to sleep, limit caffeine intake, make your sleeping environment comfortable, use your bed for nothing other than sleep or sex, limit napping and manage your stress before going to sleep.

Exercise has been shown to have a positive impact on our sleep. [7, 8, 9, 10, 11] “Although there is significant research surrounding sleep and exercise as they affect one another in multiple, diverse populations, the specific physiological factors by which the two interact are still undefined.” [8] The fact is that we really don’t understand the function of sleep, let alone how other factors such as exercise interact with that function. It is also important to note that there is much variability in the research results regarding the effect exercise has on sleep when that research is looking at the real world rather than in controlled conditions. [10] “How exercise should be administered and when it should be practiced is still under investigation, but there are several findings of significance that support the use of exercise as a means to improve sleep quantity and quality throughout the lifespan.” [8] One clear advantage to trying exercise to promote sleep is that it is associated with decreased use of sleep medication. [11] It’s also important to note that exercise has many other benefits to health. In fact, one study found that having adequate exercise completely negated the risks associated with insomnia. [12]

While science is far from being able to provide all the answers about sleep, it is clear that it is an important factor in our health. Also, keep in mind that you are really the best judge of whether or not you are getting good sleep. Like most things in medicine, improving your sleep is a matter of trial and error. Make some changes and see if they work. If you are struggling for a long time or have severe insomnia, consider seeing a sleep specialist to get treatment.

References

  1. Robson, S., & Salcedo, N. (2014). Sleep. In Behavioral Fitness and Resilience: A Review of Relevant Constructs, Measures, and Links to Well-Being (pp. 7–12). RAND Corporation. http://www.jstor.org/stable/10.7249/j.ctt14bs379.9
  2. Âkerstedt, T. (2006). Psychosocial stress and impaired sleep. Scandinavian Journal of Work, Environment & Health, 32(6), 493–501. http://www.jstor.org/stable/40967601
  3. Charles Patrick Davis, MD, PhD (3/29/2021) Medical Definition of Stress. MedicineNet. https://www.medicinenet.com/stress/definition.htm
  4. Williams, S. (2013). COUNTING SLEEP. RSA Journal, 159(5555), 36–39. http://www.jstor.org/stable/26204246
  5. Motivala, S. J., & Irwin, M. R. (2007). Sleep and Immunity: Cytokine Pathways Linking Sleep and Health Outcomes. Current Directions in Psychological Science, 16(1), 21–25. http://www.jstor.org/stable/20183152
  6. Barnes, C. M., & Drake, C. L. (2015). Prioritizing Sleep Health: Public Health Policy Recommendations. Perspectives on Psychological Science, 10(6), 733–737. http://www.jstor.org/stable/44281944
  7. Chang, S.-P., Shih, K.-S., Chi, C.-P., Chang, C.-M., Hwang, K.-L., & Chen, Y.-H. (2016). Association Between Exercise Participation and Quality of Sleep and Life Among University Students in Taiwan. Asia Pacific Journal of Public Health, 28(4), 356–367. https://www.jstor.org/stable/26686265
  8. Dolezal BA, Neufeld EV, Boland DM, Martin JL, Cooper CB. Interrelationship between Sleep and Exercise: A Systematic Review [published correction appears in Adv Prev Med. 2017;2017:5979510]. Adv Prev Med. 2017;2017:1364387. doi:10.1155/2017/1364387
  9. Banno M, Harada Y, Taniguchi M, et al. Exercise can improve sleep quality: a systematic review and meta-analysis. PeerJ. 2018;6:e5172. Published 2018 Jul 11. doi:10.7717/peerj.5172
  10. Murray K, Godbole S, Natarajan L, Full K, Hipp JA, Glanz K, et al. (2017) The relations between sleep, time of physical activity, and time outdoors among adult women. PLoS ONE 12(9): e0182013. https://doi.org/10.1371/journal.pone.0182013
  11. Vanderlinden, J., Boen, F. & van Uffelen, J.G.Z. Effects of physical activity programs on sleep outcomes in older adults: a systematic review. Int J Behav Nutr Phys Act 17, 11 (2020). https://doi.org/10.1186/s12966-020-0913-3
  12. Huang B, Duncan MJ, Cistulli PA, et alSleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality riskBritish Journal of Sports Medicine Published Online First: 29 June 2021. doi: 10.1136/bjsports-2021-104046
  13. Wong, S. Y., Zhang, D., Li, C. C., Yip, B. H., Chan, D. C., Ling, Y., Lo, C. S., Woo, D. M., Sun, Y., Ma, H., Mak, W. W., Gao, T., Lee, T. M., & Wing, Y. (2017). Comparing the Effects of Mindfulness-Based Cognitive Therapy and Sleep Psycho-Education with Exercise on Chronic Insomnia: A Randomised Controlled Trial. Psychotherapy and Psychosomatics, 86(4), 241–253. https://www.jstor.org/stable/48516043
  14. Ong JC, Shapiro SL, Manber R. Mindfulness meditation and cognitive behavioral therapy for insomnia: a naturalistic 12-month follow-up. Explore (NY). 2009;5(1):30-36. doi:10.1016/j.explore.2008.10.004
  15. Ong J, Sholtes D. A mindfulness-based approach to the treatment of insomnia. J Clin Psychol. 2010;66(11):1175-1184. doi:10.1002/jclp.20736
  16. Effects and mechanisms of a mindfulness-based intervention on insomniaJ Yeungnam Med Sci. 2021;38(4):282-288.   Published online January 14, 2021. https://doi.org/10.12701/yujm.2020.00850
  17. Falsafi N. A randomized controlled trial of mindfulness versus yoga: effects on depression and/or anxiety in college students. J Am Psychiatr Nurses Assoc 2016;22:483–97.
  18. Michalak J, Probst T, Heidenreich T, Bissantz N, Schramm E. Mindfulness-based cognitive therapy and a group version of the cognitive behavioral analysis system of psychotherapy for chronic depression: follow-up data of a randomized controlled trial and the moderating role of childhood adversities. Psychother Psychosom 2016;85:378–80.
  19. Seun-Fadipe CT, Aloba OO, Oginni OA, Mosaku KS. Sleep hygiene index: psychometric characteristics and usefulness as a screening tool in a sample of nigerian undergraduate students. J Clin Sleep Med. 2018;14(8):1285–1292.
  20. hehri, Azita & Parsa, Leila & Khazaie, Sepideh & Khazaie, Habibolah & Jalali, Amir. (2021). Validation of the sleep hygiene index for the elderly. Journal of Public Health. 29. 1-7. 10.1007/s10389-019-01180-3.
  21. Jad Costa, Samar Helou, Ghassan Sleilaty, Tarek Costa, Jeanine El Helou, Validity and reliability of an Arabic version of the Sleep Hygiene Index, Sleep Medicine, Volume 80, 2021, Pages 260-264, ISSN 1389-9457, https://doi.org/10.1016/j.sleep.2021.01.040.
  22. Andrea Zagaria, Andrea Ballesio, Alessandro Musetti, Vittorio Lenzo, Maria C. Quattropani, Lidia Borghi, Giorgia Margherita, Emanuela Saita, Gianluca Castelnuovo, Maria Filosa, Laura Palagini, Giuseppe Plazzi, Caterina Lombardo, Christian Franceschini, Psychometric properties of the Sleep Hygiene Index in a large Italian community sample, Sleep Medicine, Volume 84, 2021, Pages 362-367, ISSN 1389-9457, https://doi.org/10.1016/j.sleep.2021.06.021.
  23. David F. Mastin, Jeff Bryson, Robert Corwyn. Assessment of Sleep Hygiene Using the Sleep Hygiene Index. Journal of Behavioral Medicine, Vol. 29, No. 3, June 2006.
  24. Kuula, L., Halonen, R., Kajanto, K. et al. The Effects of Presleep Slow Breathing and Music Listening on Polysomnographic Sleep Measures – a pilot trial. Sci Rep 10, 7427 (2020). https://doi.org/10.1038/s41598-020-64218-7
  25. Loren Toussaint, Quang Anh Nguyen, Claire Roettger, Kiara Dixon, Martin Offenbächer, Niko Kohls, Jameson Hirsch, and Fuschia Sirois. Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. Evidence-Based Complementary and Alternative Medicine. Volume 2021. Article ID 5924040. https://doi.org/10.1155/2021/5924040
  26. Stimulus control combined with relaxation improved sleep in secondary insomniaEvidence-Based Mental Health 2000;3:116.

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