Side Note: Importance of Sleep

I will mention again that I am not a physician, but I am a Registered Sleep Technologist and I have been in Sleep Medicine for 13 years.

Sleep is as important as diet and exercise. I’m sure you have heard this before and it doesn’t come as a surprise. But what you might not know is that the QUALITY of sleep is much more important than the quantity.

But let’s talk a brief moment about the quantity of sleep. According to the most recent studies and according to the National Sleep Foundation, here are the sleep duration recommendations based on age:

Newborn (0-3 months): 14-17 hours
Infant (4-11 months): 12-15 hours
Toddler (1-2 years): 11-14 hours
Pre-school (3-5 years): 10-13 hours
School age (6-13 years): 9-11 hours
Teen (14-17 years): 8-10 hours
Adult (18-64 years): 7-9 hours
Older Adult (65+): 7-8 hours

As you can see, the older you get, the less sleep your body needs. But notice how teens need almost the same number of hours as school age and pre-school children? I have two teens and I know that sometimes it is difficult for them to get the appropriate amount of sleep. Between school, sports, extracurricular activities, homework, chores, and down time, there’s barely any time to squeeze in at least 8 hours of sleep. But nonetheless, it is essential to their health and success.

Since our bodies require less sleep as we get older, it is imperative that we ensure that we get good quality of sleep. This begins with the basics. Here are some tips to make sure you are getting the best quality of sleep you can. These tips are good for all ages and all types of sleepers.

Most important – always wake up at the same time every day. If you have a tough time waking up with an alarm clock, there are also daylight alarm devices out there that can lighten your room and stimulate your brain to wake up using light therapy. If you have to get up at 6am for work or for school, then get up at 6am everyday, including weekends, holidays, and vacations. Yes, this means that if you should be getting at least 8 hours of sleep and you have to be up at 6am, this means you need to be getting into bed by 10pm at the latest. Wha- wha- what – you say? Yes, I did. Which brings me to my next tip…
Go to bed when you are tired. As some of you Keto-ers already know, it is important to listen to our bodies. So if your body is telling you that it’s time to go to bed, listen to it. Maybe your body needs to get caught up on some sleep (there is such a thing as sleep debt, but later on that). And maybe it’s just the opposite. Maybe your body isn’t tired yet…
If you haven’t fallen asleep after 20 minutes, then get up. Again, listen to your body. For some, especially women who may have some hormonal changes occurring, the body can’t sleep when you want it to. The important thing to remember here is that that is okay. Insomnia can become an issue if we allow ourselves to start to worry about how many hours of sleep we are getting or not getting. Go to bed when you are tired, and if after 20 minutes you aren’t tired or can’t fall asleep, then get up and do something quietly and relaxing until you feel tired again. But…
Stop using electronics or bright light at least 1 hour before bedtime. If you do get up, don’t go on your computer or phone and start scrolling through your IG or FB accounts (or reading my blog even though it’s just so entertaining). The back light can stimulate your brain waking you up rather than helping you get sleepy. Television can have the same effect. Turning down the brightness of your electronics may help.
Do not consume caffeine for at least 8 hours before your bedtime. Caffeine stays in our bodies for quite some time. Caffeine consumption can start creating a vicious cycle. For instance, you are tired so you need caffeine to get through the day. You can’t get to sleep at a decent hour because your mind is still going (from caffeine consumption). So you are tired the next morning… and so on and so on. Now if you are tired throughout the day and you got good sleep, well this is another topic we are going to talk about further below.
Create a bedtime routine. When you have a bedtime routine, your mind will start recognizing that it’s time for bed when you start your routine. This is recommended to new parents with infants and toddlers, but it is a very good practice for all ages.
Keep the bedroom for sleep and bedroom activities. This also is a good practice for all ages. This means to not have a television or other electronics in your bedroom. Some say that they can’t sleep without the television on. But studies have shown that the decibels in television shows, especially commercials, can actually arouse the brain causing activity instead of rest. For children, try to not have their playroom also be in their bedroom. No office space, no computers, and no lit-up clocks. That’s right, no clocks, especially is you have a habit of looking at a clock in the middle of the night. I use my cell phone’s alarm clock. I make sure the sound is off for all other notifications and I turn on an alarm for my morning wake-up time. It’s also important to put your phone face down so that light doesn’t shine into the room. If needed, use noise cancelling and light blocking curtains for your room. Noise and light can awaken your brain. With this being said, don’t wear earbuds or headphones to bed. If you must have noise, or if there is outside noise you can’t escape from, invest in a noise cancelling machine. They have plenty to choose from at Bed, Bath, and Beyond. There are even apps for relaxing/white noise.

Alright, so you are doing all of these things and following all of these steps and you still have some struggles. I had mentioned sleep debt above. This occurs when your brain and body has not gotten quite enough sleep that it has needed or wanted. Let’s say, for instance, you couldn’t get to bed until 1am (whether it was a long night out on a date, or you had to study for an exam, or you just couldn’t get to sleep), and you still have to be up at 6am because as mentioned above, you still have to get up at the same time every morning. You are tired and and your mind is going to add that sleep time to your sleep debt. It will get caught up and this is where you need to listen to your body. Maybe it’s getting caught up by taking a nap in the afternoon when able. And maybe it’s going to bed a little earlier than usual. Whatever you do, still (say it with me) get up at the same time every morning.

I had mentioned briefly above that hormones can also play a role in the amount of sleep we get or don’t get. Babies through pre-school children need a lot of sleep because they are growing – physically and mentally. School age children and teens also have growth spurts – hormones are released during certain stages of sleep that aids in physical and mental growth. The same thing happens to women during certain hormonal stages of their lives – monthly, during and after pregnancy, menopause, etc. The same for men when there are fluctuations in their hormones. This is why there is a range of sleep duration recommendations. You have to listen to your body and hear what it needs and wants.

There are other age-specific sleep variations that occur. Because of the hormones that occur in our teen years, there is a sleep variation called delayed sleep phase. This occurs when the teen starts waking up later in the day and is going to bed later in the night. This begins a cycle that is difficult for them to break due to their hormones. This is very common and is the main reason why there is a large push to have middle school and high schools start after 9 or 10am rather than at 7:30 or 8am. By following the tips above, you can battle this, but know that it is common.

Another age-specific sleep variation is in older adults: advanced sleep phase. They still get 7-8 hours of sleep, but they are going to sleep earlier and waking up extremely early. There are many reasons that could cause this and they are still researching it. Some say it is due to hormones, some say because of light or lack of, and some say it’s due to lack of activity. In any case, just remember that’s it’s okay. Listen to your body and sleep when you need to. Just try to get up at the same time every morning.

Now we are getting to the point of this conversation where you may need a little more than some of these tips we mentioned. Now we are going to start talking about when it’s time to talk to your doctor.

Insomnia: You have done all you can to try to get some sleep and you just can’t. If you get to the point of frustration, it’s time to talk to your doctor. Untreated insomnia can really take its toll on your health and safety.
Snoring: This is the number one cause for disrupted sleep, both for you and your sleeping partner. How many of you have been told you snore or have heard someone snore? Let me tell you right now – SEE A SLEEP SPECIALIST RIGHT NOW AND GET IT CHECKED OUT. Snoring is a sign of obstructed breathing. It’s two pieces of tissue vibrating against each other as air tries to pass through. This type of breathing can cause your oxygen to drop and cause havoc, especially after years of occurrence. Have you ever heard someone get loud with their snoring and then quiet only to snort and get loud again? This is what we call crescendo-decrescendo snoring. That pause you hear in between – they have stopped breathing, an event called apnea.
Obstructive Sleep Apnea: This event occurs when air has ceased for more than 10 seconds due to an obstruction. The oxygen in the blood begins to drop, the heart rate begins to increase due to the lack of oxygen, and then the brain sends signals to the body through adrenaline to start breathing again. In order to send this signal, blood sugar and blood pressure increase – the body starts to breath again (sometimes you’ll hear a breath through snore or gasp). The oxygen level comes back up to normal, and everything begins to stabilize and relax again. And then guess what happens. Yes, the same thing over again. Now when I run a sleep test on someone, if someone does this less than 5 times an hour on average as they are sleeping, we consider that normal (even though it’s a little freaky to think it happens at all, right?). But anything over 5 times an hour needs to be addressed and taken care of. I have seen people stop breathing more than 100 times an hour. Could you imagine? ONE HUNDRED times an hour that person’s oxygen level is dropping, blood sugar and pressure is rising, and then going back and forth like a roller coaster all night long. Is this rest?
Sleepwalking, REM Behavior Disorder, Limb Movements. Sleepwalking is normal in children, but they should grow out of it. It can become an issue if it continues as an adult. It can even become dangerous. I remember in college we had a speaker come and talk to us about her experience. Of course, this was more about overcoming obstacles more than sleep medicine, and at the time I knew nothing about sleep medicine yet. The woman had always been a sleepwalker. The night before her wedding (a highly stressful time), she had been dreaming that she was diving into a swimming pool. In reality she was standing on the edge of her bed and dove off, head first, and broke her neck paralyzing her from the neck down. This is an extreme case, but it sticks out in my mind and reminds me that sleep disorders are nothing to play around with and should get checked out.

There are many other sleep disorders out there: narcolepsy, central sleep apnea, parasomnias, but these are the “first sign” ones. If any of the following symptoms apply to you get checked as soon as you can.

If someone has told you that you snore or stop breathing in your sleep.
Excessive daytime sleepiness – if you begin to doze off while talking to someone, while sitting in a car, while watching television or a movie, or need to take a nap even when you have had enough sleep the night before.
Uncontrollable high blood pressure – sleep apnea has been linked to high blood pressure, especially when you have difficulty controlling it with medication.
Diabetes or pre-diabetes – increased blood sugars has been directly linked to sleep apnea. There have been many studies that have shown that when apnea is treated, blood sugars are easier to control.
GERD, or reflux issues – this not only can cause sleep issues, but it is also a possible sign of sleep apnea.
Heart failure has also been directly linked to sleep apnea.

These issues along with other breathing issues (COPD, asthma, Parkinson’s, MS, ALS, and others) have all been linked to sleep apnea. Treating sleep apnea cannot only reduce the affects of these diseases but in some cases reverse them. You also will have increased energy.

Does this sound familiar? Don’t we say the same thing in the Keto community? Get rid of sugar and carbs and we can reverse some of these diseases and have increased energy. Well, the same thing is to be said about making sure that you are getting good quality of sleep and resolving any sleep disorders.

I would go even as far as to say this: if you are following your Keto Lifestyle and find that you are still tired during the day or still having issues with your blood sugars, check on your sleeping. See a sleep specialist and have a sleep study done. A sleep study can easily tell you if you have sleep apnea or not. If you have sleep apnea, the standard and best treatment available right now is through PAP (Positive Airway Pressure) therapy. Some of you may have heard about CPAP masks and machines. They are nothing to be scared of. If it takes care of the apnea, then you need it. Some of us are scared of the Keto Lifestyle, but we need it. These things go hand in hand. Sleep is just as important as diet and exercise.

If you have any questions, please post your comments or contact me through the contact page.