Chapter 2: Sleep

Opinion: Medical science is still very primitive despite the media’s glorification of current day accomplishments.

I am putting sleep first because I see it so rarely addressed with any emphasis to patients. I can't emphasize it enough though with all its effects on a person’s health. Sleep is that part of a person’s day where most substances and hormones, necessary for energy production and general function during wake time are formed, recuperated and/or replenished. Specifically I am talking about thyroxin, cortisol, growth hormone and serotonin. There are others, but I think these are the main players related to sleep.
Thyroxin is a hormone very central to the process of energy production in the human body by way of being involved in the transformation of fuels into energy inside body cells. Cortisol and growth hormone are two other substances important for transformation of fuels into energy. Serotonin is important in this regard because of its function as a key neurotransmitter in the brain to orchestrate bodily processes, among other things. More to follow.
These substances, when present in healthy physiological quantities can ensure efficient functioning of cells and hence tissues (and tissue repair) and hence organs and hence the whole body. When sleep is regular then cortisol should be on a low level of output in the initial sleep phases and towards morning it should escalate for the wake up phase of the day. Thyroxin production should be preceded by what is called a TSH surge, which should occur about 2- 4 hours after going to sleep. TSH is responsible for stimulating the thyroid gland to produce thyroxin. Growth hormone is mainly produced during sleep but can be produced when the person is physically active, has a low blood sugar, low blood fatty acids, starving or under stress. Growth hormone is essential for producing energy from body fuels and of course tissue growth. Last, but not least is serotonin. It is a major player in signaling other cells to perform different functions such as memory, pain control, thinking, sweating, production of certain other hormones and many other functions. One of its fates is it is transformed into melatonin, which many believe (me included), is a very important hormone that promotes sleep. During sleep and when
the eyes are closed serotonin consumption goes down. As soon as the eyes are opened serotonin activity increases and therefore its reservoirs will be depleted.
From above I think it is essential to have a regular sleeping pattern in a sufficient amount to allow above substances to form and to allow serotonin to be replenished. It is necessary to realize that the quantities of all of above substances are limited to the various factors of supply and demand.
In deciding how much sleep is sufficient I would prefer to go back to our ancestors and estimate how much they used to sleep and then utilizing that make a decision. Our forefathers of millennia before didn’t have electricity or any other form of controllable or efficient lighting yet, and therefore I would assume that they went to bed soon after sundown and woke around dawn. So I would estimate that in the summer they would have gone to sleep around 10 PM depending on how tired they were. They probably next morning would wake around 6 AM. In the winter those numbers would be closer to 7 PM to 7 AM. Given the fact that we are genetically like them then we should sleep similar to them but keep in mind the current day environmental differences. Since we have an artificial environment of light and temperature then the translation to present day humans I think should be 7- 8 hrs nightly in the summer and 9-10 hrs nightly in the winter. If the environment is under tight control then an average of 8-9 hours sleep per 24 seems appropriate. I may revamp these numbers in the future depending on my knowledge developments.
Regularity is essential to enable the “biological clock” in the brain to orchestrate the production and conservation of aforementioned substances. This is because it takes a while for the “biological clock” to put itself in an efficient rhythm (a groove so to speak), which will be optimal for the orchestration.
For those who have trouble sleeping I advise being in bed every cycle around the same time aiming for above numbers. You won’t fall asleep in the beginning days but eventually you will. Give it at least four weeks and hopefully your sleeping pattern will solidify. Even if the sleeping pattern doesn’t evolve in a clear way, then I still advise sticking to a sufficient regular pattern of being in bed with your eyes closed and lights out. This is because just by going to bed every cycle at the same time, with the lights out and eyes closed then the hormonal rhythms; production and substance replenishment will be able to establish themselves. Albeit not as efficiently as if you were attaining a natural sleep cycle, but still better than giving the brain chaotic signals of irregularity that won’t give the brain a chance to set up more optimal hormone and chemical rhythms.
Attaining a healthy sleeping rhythm becomes much easier when the other pillars of health are adhered to. This will become more apparent in the coming chapters.
Some factoids: in Japan it was seen that males who slept less than 7 hours per night or more than 10 had almost 2 times higher mortality than those who slept in the 7 –8 hour range. Note to physicians - In a recent study in the USA the best survival was found among those who slept 7 hours per night. Participants who reported sleeping 8 hours or more experienced significantly increased mortality hazard, as did those who slept 6 hours or less. No explanation was apparent to the authors either way but still their final conclusion was that short sleep or insomnia wasn’t constituted as a hazard to health. This last is an example of using statistics to explain a medical phenomenon without logic or reason. I would say the reason for the increased mortality in those who sleep more than 8 hours is related to what other illnesses they suffered from. As far as the increased mortality in those who slept less than six hours, it is for sure to be significantly related to insufficient sleep itself, the other illnesses that those people may have, and all the interplay with the hormones mentioned previously.
Another aspect about promoting sleep is I disapprove of using sleeping agents that take the place of the body’s own system for promotion of sleep. I am talking about sleep inducers such as zolpidem, benzodiazepines, antihistamines, alchohol, barbiturates and supplemental melatonin. All of these if taken frequently and long enough will inevitably decondition the body’s own “machinery” for carrying out the process of sleep induction and render the brain less able to induce sleep naturally with normal rhythms and cycles. I do prescribe them very sparingly and only in extreme circumstances.
A safer way to help natural sleep promotion is ensuring the presence of tryptophan in our diets. How that works: Tryptophan is an amino acid present in many animal and plant proteins, and in the body is transformed into 5-HTP and then into serotonin and to a certain degree into melatonin. The last is an important hormone necessary for promoting natural sleep.

In summary, to promote sleep:
• Go to sleep every night (or cycle) at the same time.
• Stay in your bed for 8-9 hours, eyes closed, lights out. If you must, you can listen to music, radio or tapes…etc.
• Ensure a good protein intake.
• Apply the other Pillars of Health such as exercise and avoiding harmful substances.
• Use the natural supplement 5-HTP if necessary. (Doctor’s supervision necessary).
• If above fails then talk over with your doctor the possible use of an agent which can elevate your brain’s level of serotonin (which will transform into melatonin) at least for a temporary period until your own body’s mechanism kicks in.