A healthy lifestyle includes daily exercise, abstinence from smoking, alcohol and caffeine moderation or avoidance, consistent sleep duration of seven to eight hours per night, as well as healthy eating and snacking behavior. This healthy lifestyle is associated with a 50 to 70 percent reduction in mortality when compared to those who do not ascribe to healthy living. Adhering to a healthy, balanced diet has been shown to improve both sleep duration and overall sleep quality.
Effects on Body Metabolism
Sleep deprivation is associated with obesity, insulin resistance and increased appetite. In fact, studies have demonstrated increased caloric intake of 300 to 500 calories per day, predominately from high-carbohydrate and high-fat foods, in adults having six hours or less of sleep per night. One cohort of college freshman consistently selected sweet and starchy foods on days when sleep was resisted to less than six hours per night, as compared to healthier options when sleep was normalized to more than seven hours per night.
Proteins such as leptin and ghrelin, which balance energy intake with energy expenditure, are also perturbed in sleep-deprived individuals and favor weight gain and inactivity. Individual fat cells or adipocytes are significantly different in people subjected to sleep deprivation. In one group of patients, fat cell composition and insulin sensitivity were compared during sleep restriction of four-and-a-half hours per night for four days followed by a subsequent four-day period of normal sleep of eight to eight-and-a-half hours of sleep per night. Lack of sleep “aged” fat cells approximately 20 years by making them less sensitive to insulin and more prone to fat conservation.
Magnetic resonance imaging (MRI) studies have demonstrated increased activity in the amygdala, a part of the brain that mediates emotional responses and survival instincts, in subjects with insufficient sleep. This may be the basis for the often erratic, risk seeking and eating behaviors that can be more prominent during periods of insufficient sleep.
Complimentary medicine has a poorly defined role in the treatment of insomnia and insufficient sleep. While interventions like tai chi, yoga and acupuncture have demonstrated benefit in small trials, their overall efficacy remains unclear.
Sleep-promoting foods, such as chamomile tea, milk, tart cherries or kiwi, are associated with improved sleep onset and maintenance, but scientific support for these observations is lacking. Composition of meals — for example, high-fat versus high-carbohydrate biased portions — have no consistent effect on sleep parameters or chronic insomnia. Macronutrients, such as tryptophan and melatonin, are sleep-promoting at pharmaceutical doses and may be helpful in some subjects. Of note, tryptophan is a precursor of both melatonin and serotonin, two substances deeply implicated in sleep and circadian rhythm.
Other natural remedies, such as valerian root, kava kava, magnesium and B vitamins, have been touted as natural sleep aids. Valerian root is a perennial herb and tall, flowering grassland plant and is one of the best-studied natural sleep remedies. While studies have mainly supported a role in sleep promotion, valerian root does have some usually mild associated side effects, such as headache, dry mouth, disturbing dreams or daytime drowsiness. Its anxiolytic properties can help with rumination and worry. Valerian root should not be combined with alcohol, used during pregnancy or continued in advance of surgery because it may have unpredictable effects on the central nervous system when combined with anesthesia.
Kava kava is a root found in the South Pacific islands. It is known for its Valium-like calming effect and is used as both a stress reducer and sleep aid. Liver toxicity is a possible side effect, and the FDA requires that kava kava preparations contain warnings. Serious allergic reactions are also possible, and taking this medication should be immediately discontinued at any sign of hives, facial rash or facial and lip swelling.
Melatonin is a naturally occurring protein that is sleep promoting. Taking this medication 30 to 60 minutes before bedtime, at doses of 0.3 to 5 milligrams, can help initiate and maintain sleep. Smaller doses at specifically timed dosing intervals are also highly effective in altering the body’s circadian rhythm. Vivid dreams and hallucinations occasional accompany melatonin use and can be disturbing enough to merit discontinuation of use.
Finally, marijuana has been long regarded as a relaxant and sleep-promoting agent and was used widely for the treatment of insomnia well before efforts to legalize its possession were solidified. Subjectively, marijuana is noted to decrease sleep latency, increase overall sleep time and increase deep, slow-wave sleep. However, the objective benefits of marijuana on sleep are less clear, and studies evaluating the relationship between sleep and marijuana are small and far from definitive. Further investigation is merited.