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From the Townsend Letter
February / March 2019

New Whys and Ways to Sleep Better,
Especially After 40

by Dr. Devaki Lindsey Berkson
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There are two planets. One where you get a great night's sleep and feel phenomenal the next day. And a second where you can't get a good night's sleep, and your tomorrow feels like trudging through molasses.
     
In modern life, it's easier to end up on planet number two. Healthy sleep is under continual attack, and threats against achieving a restorative night's sleep keep mounting.
     
Today's sleep gets mugged in many ways:

  • By chronic daily stressors, like tending aging parents or having kids who announce they want to change their genders, or from single severe traumas – such as tornadoes and wildfires to anything like betrayal, getting fired, or receiving a serious diagnosis.
  • By night-shift work schedules.1
  • By excessive electromagnetic field exposures2 that occur regularly in towns across an America dotted with electrical and Wi-Fi towers.
  • Unhealthy food habits. Magnesium lives inside red blood cells where it nudges healthy enzymes for sleep. Regularly consuming junk food3 creates nutrient deficiencies, especially magnesium deficiencies.4 Late night eating syndrome5 – lying down too much, eating too much, all too soon before bed (unfortunately normal for life in the good ole USA) – dings sleep.
  • Sugary foods – like candies, colas, pastas, and pastries – disrupt the sugar hormone insulin, derailing sleep. And vice versa: chronic insomnia creates chronic blood sugar issues.6
  • Hormonal swings can disrupt both genders.
    o Women wake from hot flashes7 urgently flinging off their sheets, and sleep is disrupted. Today's toxic planet is rife with endocrine-disrupting pollutants. These hormone-altering chemicals are making some younger women develop hot flashes earlier, with sleeping issues earlier, too.
    o As middle-aged males go through "andropause," lower levels of testosterone8 can worsen sleep. Again, our toxic planet and diets are promoting an epidemic of lower testosterone levels in American males,9 which can ruin sleep.
  • Even climate change10 is being linked to worsening sleep through disasters such as hurricanes, floods, wildfires and higher temperature levels.
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What Does Sleep Loss Do to Us?
Insomnia – the inability to achieve restorative sleep – gives you a worse tomorrow. You have a greater likelihood of being exhausted the next day, as well a greater risk of feeling anxious and depressed. By the way, this is also true the other way around11; mood issues can worsen sleep.
     
"Perimenopausal insomnia"12 is one of the most common complaints of midlife women. The perimenopause is when hormone levels yoyo as eggs age and regular ovulation becomes harder to achieve. During this time, women typically require more sleep to feel better the next day. Yet they oftendon't get it. Bone-curdling exhaustion manifests. Life feels harder. Up to forty percent of perimenopausal women complain of serious sleep and fatigue issues. Much more so than same-aged men. Female hormones nosedive much faster in middle-age, compared to male hormones that typically decline more slowly. Though with today's pollution, this appears to be changing.

Of note is that the age of perimenopause13 is lowering. This is due to hormone-altering chemicals in today's dirty world along with today's dirtier diets. Perimenopause historically occurred in a woman's mid-to-late 40s. Now some women are starting their perimenopause in their late twenties and more in their thirties. As menstruation milestones wane, so does sleep.
     
Without adequate sleep, we're not only tired and wired, but we also can't think as clearly, get any job done as well, plus we are more accident-prone. Inadequate sleep promotes errors in judgment, even more neuroticism, and less mindful conscientiousness14 (no matter how much you try to sit and shut off your thoughts).
     
Lack of restorative sleep raises stress hormones15 (epinephrine and cortisol) that shrink the hippocampus (hippocampal atrophy). The hippocampus is the area deep inside your brain where your sense of "self" lives. I call it the seat of your 3 M's (me-ness, memories, and motivation). Lack of sleep causes poor memory retrieval, overwhelm, and self-doubt as hippocampal function16 degrades. Maybe you're seeing a psychotherapist when you need to address your sleep.
     
Excessive levels of cortisol are linked to increased belly fat that is not easy to lose.17
     
BioDisruptExcess cortisol can ding sex hormones. Higher levels of cortisol do this by "competitive inhibition." Excessive cortisol swims inside and binds into the estrogen, testosterone, or progesterone receptors and clogs them (competes with the parent hormone). Even if your blood and saliva levels of hormones look normal on testing, these blocked sex steroid receptors can't deliver their signals optimally.18 You feel tired, bloated, fat, and slow. No matter how many green drinks you down. No matter how much your gynecologist or endocrinologist insist that your hormone levels look normal.
     
Excessive cortisol can increase an adrenal and brain hormone called dehydroepiandrosterone, nicknamed DHEA. Excess DHEA can make estrogen or testosterone levels soar.19 Thus, too little sleep causes too much stress hormone, which can lower or amplify sex hormone signals, depending on lots of individual factors that make up individual physiologies, all which ups your risk of various health issues such as hormonally driven cancers.
     
Too high levels of stress hormones for too long depress your immune system. This puts you more at risk of diverse diseases and infections, for example, greater risks of heart disease, type-2 diabetes, and even eye diseases.
     
Did you know that eye doctors are now required to learn about sleep disorders, as sleep is becoming known as a major influencer on eye health?20 Any person with absolutely any kind of eye disease must have their sleep tested and improved to protect their vision.
     
Sleep disturbances are strongly associated with "impaired" release of factors called growth or trophic factors such as brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1).21 Optimal functioning of growth factors protects mood, staves off depression, and maintains neuroplasticity.
     
Sleep is a huge contributor to psychology. Sleep is a portal to help you sort out the things you learned and endured all day long. Studies have linked a nightly battle with insomnia to anxiety, depression, memory loss, dementia, socialization issues and even Alzheimer's and other brain disorders, including Parkinson's.22

Why You Can't Sleep

  • Too much caffeine. Excess caffeine consumption has now been shown to suppress the production of melatonin in pinealocytes (cells in the pineal gland) through competitive inhibition of adenosine A2 receptors by caffeine.
    o Higher cumulative lifetime coffee consumption has been shown to reduce the size (volume) of the pineal gland! This gland makes the sleep hormone melatonin. The size of the pineal gland is referred to as the VPP (volume of pineal "parenchyma" – term for pinealocyte cells). When you regularly drink "excessive" amounts of coffee, the volume of the pineal gland shrinks. Too many cups of Joe over too many years makes your pineal gland shrink!
    o A squattier pineal gland releases less melatonin. Less sleep hormone means impaired quality of sleep, especially in later life from the long-term effects of a "life well-caffeinated."23 Of course, what constitutes too much caffeine and a smaller pineal gland probably depends on genetics and SNPs. It's all individual. There are significant health benefits from coffee, so it's a "Goldilocks" kind of thing, drinking the just right amount for your physiology.
    o Less melatonin also means more risk of cancer, as melatonin is a major anti-cancer fighting hormone.
    o How much coffee is okay? Moderation is the key. One to several cups of coffee, rather than numerous shots of espresso all day long, seems to be the healthiest for most of us.
  • Too much alcohol. With advertisements on TV making alcohol look as safe as water and trendy and cool as heck, too many are drinking too much. Especially young adults. This is linked with harming sleep.24
    o Each of us metabolizes alcohol differently due to various liver capabilities, body size, organ size, and genetics. Some folks can drink more and still get their Z's, but some women will have insomnia from just one nightly glass of wine.
    o Alcohol blocks REM sleep, the most restorative type of sleep, so you wake up feeling groggy. Alcohol also reduces anti-diuretic hormone (ADH) so you may have to get up to urinate during the night, which also is sleep disruptive.
    o Women literally have smaller livers than men, so women are more vulnerable to these potential adverse effects of alcohol than males. Gender unfairness but "is-ness!"
    o Studies yoyo on how much alcohol is healthy or harmful, but most female bodies cannot handle alcohol on a daily basis, and often, those several glasses of wine at night are the enemy of your sleep.
  • Too little exercise. Exercise improves your sleep; there is no doubt about it.25
    Adding just 15 to twenty minutes a day of getting your circulation going, allows your body to wind down more successfully during night time hours.
  • Not being outside. Even just 20 minutes a day in nature enhances well-being and sleep.26 Even just looking out the window at nature, or at pictures of nature, help promote wellbeing and sleep.27
  • Hormone yoyo-ing. In both women and men, hormones out of balance cause sleep out of balance. From hot flashes and night sweats caused by peri- and post-menopause in ladies, to too little T (testosterone) in ratio to too much E (estrogen) in gents (especially chubby dudes), all dent sleep.
  • Growth hormone insufficiency. Human growth hormone is released in the first deep-sleep episode of the night. When adequate levels are released, this phase of sleep is associated with "deep" body/mind rejuvenation. Thus, growth hormone is essential for restorative sleep and vice versa; healthy sleep promotes healthier blood levels of your growth hormone (so does digesting healthy protein and exercising). When you sleep less well and exercise too little, you produce less growth hormone. A growth-hormone-deficient body becomes less efficient at falling and staying asleep. Growth hormone naturally lowers as we age, unless we eat and digest optimally, and continue to regularly work out.
    o By the way, the 24-hr urine hormone test (by Meridian Laboratories) easily measures growth hormone (GH) levels along with other hormones and their metabolites. This is my favorite GH test.
    o The insulin-like growth factor-1 (IGF-1) test is an indirect measure of your average blood levels of growth hormone. Low blood levels of IGF-1, less than 160, are typical in severe fatigue states and elevated levels can also occur from poor sleep, worsening cancer risk or progression.
    o A Belgium double-blind, placebo-controlled study found that women who took 300 mg of oral progesterone before bed, got to sleep faster, slept better, had higher levels of growth hormone and even more stable blood levels of thyroid hormone.28 Did you know that progesterone helps thyroid hormone enter the thyroid receptor to deliver its signal?
  • Unresolved emotions. Emotions of sadness, fear, regret, perfectionism, and even guilt29 disrupt sleep. Unfinished emotional business promotes unfinished sleep. And vice versa.
    o Chronic insomnia makes you feel more insecure and anxious and these feelings then sabotage sleep. Emotions can get more chaotic in mid-life as circumstances become more demanding. Your parents get older and need help, your kids get into shockingly more trouble, close friends or family start to get ill, and you can't believe that your own work life, relationship life, money life, etc., aren't yet stable. Who knew that growing up doesn't automatically make life or sleep, easier?
  • Non-dippers. Healthy blood pressure is supposed to gently lower during the night (compared to pressures during the day) by approximately 10–20%. "Non-dippers" are people whose blood pressure doesn't lower adequately during sleep. This damages restorative sleep. Make sure to turn the TV off, get the phone off the table, those ear-buds out of your ears, and have your doc check your blood pressures, sometimes with a 24-hr pressure monitor.
  • Nocturnal hypertension.
    I had one patient that kept waking at 2:30 AM with rapid heartbeats. Once awake he couldn't easily fall back asleep. In contrast, during the day his blood pressure was perfect. Heart physicals by several heart docs found nothing wrong. After three years, and after several cardiac work-ups found nothing abnormal, he continued to feel worse and worse from disturbed sleep. Finally, a functional cardiologist, I referred him to, ran a 24-hr. blood pressure test. This demonstrated that at 2:30 AM, when he'd consistently woken up with arrhythmias, his blood pressure soared to 190 over 120, even though multiple day-time pressures were continually normal and perfect. When this patient got a small dose of an anti-hypertension drug before bed; sleep immediately normalized. He slept like a baby.
    It's critical to mention, that "nocturnal hypertension" was not the "root cause" but rather a sign of a deeper issue that had to be found and addressed. It turned out that one of his heart chambers was hardened, and also one valve had a leak, none of which was found by the many other heart docs he had seen. It was early enough to use sophisticated nutrition intervention, to ward off fatal congestive heart failure. But the point is that his insomnia and arrhythmias had been flashing red lights for deeper heart issues that were not easily identified by multiple of well-respected specialists!

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