One time I developed a shoulder injury while lifting weights. During the day, the pain was annoying, but I could ignore it. At night, the pain became major because every time I tried to sleep, I eventually rolled over on that shoulder and woke up. That went on for months, and I became an unwilling insomniac until the shoulder healed. I felt like a walking zombie!
Many of you know exactly how I felt. Everybody wants to sleep well, but many of us can't for reasons that range from troubling life situations to physical problems to poor eating habits. You may even have a serious sleeping disorder. Suffice it to say that if you have difficulty sleeping, you are not alone.
Here are some of the common deterrents to a good night's sleep:
Stress and anxiety. By far the biggest cause of insomnia is stress. People lie awake trying to work out their life's problems, mourning the past and worrying about the future.
Painful physical conditions. Arthritis, chronic back pain, tension headaches, degenerative disk disease, bursitis, tendonitis and virtually any other painful condition can rob an otherwise healthy person of sleep.
Caffeine. Many people doom their sleep by consuming caffeine in coffee, soft drinks, chocolate and over-the-counter headache medicines like Excedrin. Caffeine increases the stress hormones adrenaline and cortisol. Also, caffeine can remain in the body for up to twenty hours. More than 80 percent of all Americans consume caffeine regularly, and the average American drinks about three cups of coffee a day.
For some people, that's a recipe for sleepless nights.
Cigarettes and alcohol. Nicotine and alcohol can interfere with sleep. Some people think alcohol helps you to fall asleep, but in fact alcohol can disrupt the stages of sleep, causing you to sleep lighter and to awaken feeling less refreshed. Nicotine from cigarette smoking is a stimulant that causes adrenaline to be released, which often causes insomnia.
Medications. Decongestants, appetite suppressants, asthma medications (such as theophylline), prednisone, thyroid medications, hormone replacement, some pain relievers, some blood pressure medications and certain antidepressants may all cause insomnia.
Food insomnia. Many people eat too much sugar and highly processed foods before bed, keeping their nightly date with a bowl of ice cream, piece of cake or bag of popcorn. These carbohydrates stimulate excessive insulin release from the pancreas. The result is a "sugar high" of energy. But later, usually in the middle of the night, your blood sugar hits a "low," which triggers the adrenal glands to produce more adrenaline and cortisol. Suddenly you are awake and feel hungry again.
Low-carb diets. These diets can also create a low-blood sugar reaction, causing you to awaken in the middle of the night. Even if you fill up your stomach with healthy foods at bedtime, it may affect the quality of your sleep. When you eat too much protein or eat too late, you generally will need more sleep. This is especially true when you eat too much meat. That's the reason why animals, like lions and tigers, usually require up to twenty hours a day of sleep—their bodies are having to digest and assimilate all the protein in their bellies.
Exercise. People who exercise within three hours of going to sleep raise their levels of stress hormones, which may interfere with sleep.
A bad mattress or pillow. Is there anything more frustrating than a mattress that is too saggy or too hard, or an overstuffed pillow?
A snoring spouse. My neighbor came to me one day and said, "Please give my husband something to stop his snoring! I can't even sleep in the same bed anymore. He snores so loud that our kids in the other bedrooms wake up scared in the middle of the night." Many people feel that desperate. A snoring spouse wrecks many people's sleep. I'll share my remedies for snoring in a later section.
Newborn babies. As welcome as they are, babies can ruin sleep patterns. Breast-feeding mothers know how an active nighttime routine can make their brains and bodies feel like jelly.
Hot flashes or menstrual cramps. Women over 50 often know the aggravation of being kept awake by hot flashes or night sweats. Other women have such severe cramping that they become insomniacs every month when their period arrives.
Enlarged prostate. Some men over 50 find themselves on a there-and-back-again loop to the bathroom when they should be fast asleep.
Environment. Noisy neighbors and their dogs, the room too hot or too cold, bright lights shining through your bedroom window or trucks, planes, trains or motorcycles passing by can all disrupt sleep patterns.
Each of these sleep thieves is responsible for countless hours of lost sleep, lost productivity, lost creativity and lost mental health.
Let's take a closer look at some of these sleep thieves—in particular, those having to do with what we choose to ingest as food or drink. As you will see, our consumption habits can greatly impact the quality of our sleep.
I am not against drinking one or even two cups of organic coffee in the morning because of the numerous health benefits of coffee. However, caffeine increases alertness and stimulates the central nervous system. And, unfortunately, many Americans are drinking coffee or some other caffeinated beverage in the late afternoon or evening, and that is affecting their sleep. It takes about six hours to metabolize half the caffeine in a small cup of coffee.
So if you drink your coffee in the late afternoon or evening, the caffeine will probably stimulate your nervous system and keep you alert during the night, thus prohibiting you from entering the deeper stages of sleep. The more deep sleep you attain the more refreshed you usually awaken. If you are suffering from insomnia, limit your coffee intake to one to two cups a day in 8-ounce cups, not 16-ounce cups, or approximately 150–300 mg of caffeine a day.
If you have any liver impairment caused by medications such as statin drugs or history of a fatty liver, cut that amount of caffeine in half. If you still have problems with insomnia, keep cutting back your caffeine intake until you have either weaned off coffee or you are sleeping well. Beware that over-the-counter medications can be packed with caffeine as well. For example, one Excedrin contains 65 mg of caffeine. Cold medications also commonly contain caffeine. So watch your intake of those products before bedtime.
Chocolate can also keep you up at night due to its caffeine component. Chocolate ice cream, chocolate cake, chocolate candy bars, chocolate milk—all of these contain caffeine and theobromine, which are both stimulants. Chocolate also contains tyramine and phenylethylamine, both of which increase alertness and can contribute to insomnia.
Sugar and Carbs
Caffeine is not the only dietary enemy of sleep. Sugar can be just as bad for your ability to rest. A poor diet of too many simple sugars and processed carbohydrates can also lead to insomnia. We in America eat far too much sugar, and when we eat sugar before going to bed, sleeplessness can be the result.
Americans are now consuming more fat-free foods, which usually means they are over-consuming highly processed carbohydrates and sugars. Foods high in processed carbohydrates and sugars stimulate insulin release from the pancreas. Insulin in turn triggers the body to store more fat. Insulin may also cause low blood sugar. Low blood sugar then triggers the adrenals to produce more adrenaline and cortisol, which may cause you to be awakened in the middle of the night.
Eating sugar and processed carbohydrates before bedtime often leads to low blood sugar in the middle of the night. This can also happen if you go to bed hungry. You can prevent this dip in blood sugar that wakes you out of sleep by eating a light, well-balanced, high-fiber snack at bedtime. Eating a light evening snack that is correctly balanced with proteins, carbohydrates, fiber and fats will stabilize blood sugar levels and improve sleep.
You may use whey protein, rice protein or a vegetarian protein other than soy (such as Life's Basics). These are protein powders that may be mixed with water, coconut milk, skim milk or plain low-fat kefir. Or you may get plain protein powder such as whey, vegetarian (such as Life's Basics) or rice and make a smoothie with frozen fruit and ice mixed with water, coconut milk, skim milk or plain low-fat kefir.
Late-Night Eating and Drinking
When it comes to what keeps you up at night, it's not just what you consume but also when you consume it. Eating a large meal close to bedtime can cause insomnia. Our digestive tract is not designed to digest in a prone or supine (lying) position and works best when we are up and moving around. Our stomach and pancreas are also not designed to be undergoing major digestion of food while we are sleeping. This is another reason we see so much heartburn, indigestion and acid reflux in America, which also contribute to our insomnia. Foods containing both tyrosine and tyramine cause insomnia because they are converted in the body to norepinephrine, which is an excitatory neurotransmitter that stimulates us and may keep us awake. Foods high in tyrosine include milk, cheese, yogurt, cottage cheese, soy, peanuts, bananas, turkey and lima beans. Foods that are high in tyramine include red wine; yogurt; sour cream; aged cheeses; pickled meats; many fish; fermented foods such as soy sauce, sauerkraut and pickles; figs; raisins; dates; fresh baked breads and processed meats such as bologna and salami.
Also, consuming too many fatty foods close to bedtime will delay digestion and can cause insomnia. Fats take much longer to digest compared with carbohydrates or proteins.
Let's not forget one more culprit: alcohol. Many individuals drink one or two glasses of wine at night since it helps them unwind and fall asleep. Yes, as I mentioned previously, alcohol does help you fall asleep; however, you are more likely to awaken later in the night. Alcohol intake reduces the time spent in stages three and four and REM sleep, which are the most restorative stages of sleep.
What's more, alcohol can worsen snoring. So alcohol is actually a double-edged sword when it comes to sleep. Also, a major problem with many of my patients is overconsumption of fluids in the evening. As a result, they are up two to three times a night urinating. After 7:00 p.m. simply cut back on your fluid intake.
Dr. Colbert Approved Bedtime Snacks
- A piece of fruit, like a small apple, grapefruit, 4 ounces of berries or kiwi with a small handful of nuts (walnuts, almonds or pecans)
- One serving of low-fat, whole-grain crackers or one piece of whole-grain bread with about a teaspoon of organic peanut butter or two ounces of turkey
- One-half cup organic skim milk or low-fat cottage cheese or low-fat, no-sugar yogurt (if not sensitive to dairy) with fruit added
- A small bowl of whole-grain cereal (about ½ cup) with organic skim milk
The Case of the Snoring Spouse
Does your partner happily saw logs all night while you watch the ceiling? If your spouse snores, it could be sign of sleep apnea (which we will discuss in a later chapter on sleep disorders). But know that even though all patients with sleep apnea snore, all snorers do not have sleep apnea.
Have your partner undergo a medical evaluation if he or she seems to stop breathing for short periods of time. Snoring that is not related to sleep apnea does not pose any health risks and does not cause daytime drowsiness for