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Dr.BETHDiDomenico ND
How is your sleep?
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A seemingly simple and question that affects much of one’s health and well- being. In my 28 years of practice, I’ve witnessed insomnia become far more common and multi-factorial than most people realize.
Why sleep matters.
Sleep problems rarely have just one cause, and they often affect nearly every aspect of health.
This can include: immune function, cognitive ability, risk of heart disease, obesity and diabetes, mental health and mood, physical recovery, perceived pain, and reaction time.
The following is not comprehensive, but a list of things patients can do to improve their sleep health.
The foundations of good sleep.
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Most adults need 7-9 hours of sleep for optimum health. Ideally, this is all together and during the same hours nightly, with a good rule being bedtime before midnight for best health results.
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Discontinue caffeinated drinks (and foods like chocolate if you are sensitive) 12 hours before bedtime.
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Keep your phone and computers at least 6 feet from your head and turned on airplane mode at night.
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Avoid computer screens an hour before bed.
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Make your last meal at least 2 hours before bed.
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Create a comfortable, clean, dark bedroom environment. Exercise or movement during the day will help your body relax at night.
Additional factors to consider and discuss with your doctor.
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Magnesium (Mg) is one of the most common nutrient deficiencies in the US. Among other things, it is helpful to relax muscles, support regular blood flow and soften stool. Many people find that Mg before bed supports sleeping.
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If you are snoring, wake up short of breath or anxious, you may not be getting enough oxygen. If you sleep with another, ask them if they hear you stop breathing. Some people benefit from encouraging nasal breathing at night. Please let your doctor know if you’re interested in a sleep study, ruling out allergic triggers, or techniques like mouth taping.
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Insomnia can be a sign of hormonal imbalance- especially at certain times in a woman’s cycle, during menopause and andropause. Hormone testing or balancing may benefit.
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Sleep teas and herbal formulas can be helpful, though for some, tea before bed means waking to urinate. And some herbs can have interactions with medications or can be stimulating for some.
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Melatonin is a popular over-the-counter supplement for sleep support. However, it is a hormone and though it may be helpful short-term, it’s not right for everyone and is most safely used under the guidance of your clinician.
Things I’ve learned over the years.
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Occasionally I suggest patients try sleeping in a different environment such as a cozy hotel with a comfortable bed. This has led to useful discoveries including sensitivities to bedding materials, environmental triggers or simply the need for a better mattress or sleep setting.
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Our systems are not used to being “on” every minute of the day. Our parents and ancestors lived without cell phones, podcasts, social media and other distractions all day long. If you never get a down time during the day, your system may make it happen at night when you’d rather be sleeping. Consider allowing processing or unplugged and unplanned time during your day so that you can sleep at night.
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Light can have a huge impact on sleep and melatonin levels. Keeping lights low 2 hours before bed will signal melatonin production. In the same vein, exposing oneself to bright light for at least 20 minutes in the morning can help with waking and sense of alertness.
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Make sleep a priority. Schedule it in if needed. It’s as important as eating and drinking for health. If you are traveling or need to be up late, plan time to catch up on sleep. Melatonin can also be helpful here for regulating sleep during daytime hours if needed.
If you’re struggling with sleep, you’re not alone—and there are often more options than people realize. I’m always happy to talk through possible causes and create a plan that works for you.
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Modern Lifestyle's Effect on Health
As a naturopathic doctor, I’ve been treating patients for over 25 years. That isn’t very long in the scheme of things, yet in this short time, I’ve observed many relatively new lifestyle factors that are adversely affecting the health of patients. Whether technology-related or cultural and social habits, much has changed in health in the last quarter century. Read on to decide if modern living is adversely affecting your health.
1. Sleeping with electronics.
Insomnia and anxiety have become the most prevalent of symptoms for my patients. Why don’t we sleep anymore? Could it be the streetlight in front of our home that stays on all night? Or perhaps the murder show we watched before bed? Or perhaps the latté we had after lunch. While these can affect a good night’s sleep, there is a new culprit on the list. A new question I ask my patients with insomnia is whether they sleep with their electronics. I didn’t ask this 20 years ago, because then, we’d all have thought it a ridiculous question. But now we may have our laptop, electronic reader, and cell phone all within inches of our heads. Most of us don’t need a phone at night. You grew up without a phone next to you and you made it this far. I suggest you put the phone more than 6 feet from your head and on airplane mode at night, or turn it (and all the other non-alarm clock electronic devices) off.
2. If it doesn’t exist in nature, don’t put it in or on your body.
This seems simple enough, but if you’re using body care products that were not homemade or purchased from a health food store, or eating “food” out of a package with a lengthy paragraph of ingredients, you are feeding your body unnatural substances and expecting it to act naturally.
Nature has been pretty good to us, yet we constantly look for ways to improve upon it. The chemical industry has provided us with a host of artificial ingredient options in the last 15 years, but one thing remains true: few, if any, are better than natural ingredients. For example, sucralose (Splenda®), saccharine (Sweet’N Low®), and aspartame (Equal®) are rampant in our food supply. Research shows a direct correlation between the consumption of these “diet” foods and weight gain. Despite their advertising, these chemicals don’t taste better, satisfy more, or lower obesity or diabetes. Organic cane sugar is fine in moderation for most individuals. Stevia, a naturally derived sweet plant substance is even better.
3. Unless you live on a farm, activities of daily living do not count as an exercise program.
Going shopping and doing the dishes and laundry are all important things to do, but it doesn’t count as credit towards cardiovascular or even functional exercise. Exercise used to be a thing we did during our daily activities of living – things like walking to school or work or the store, or milking the cows and toting the jugs. Exercise was outdoors and required more than a few minutes, some occasional heavy breathing, or technical work using our fine motor skills. This is a big reason why obesity was almost non-existent just decades ago. If your routine never involves fresh air, some unpredictable terrain (ie. stairs or a mountain trail), sweat, effort and hard breathing, or some physical skill that can be developed, then find a way to move your body on a regular basis to push it's limits and build muscle and cardiovascular health.
4. Our convenience has become our pathology.
A woman visiting the U.S. for the first time from Tanzania was recently asked what she thought about her time in Seattle. She said she was amazed at how many things we have and are able to buy. She was initially impressed by how independent we are. But then she noted that we seem very sad and alone as people. When you have access to everything and can get what you want by the click of a keyboard, then you don’t need to participate in society. You don’t need to rely on others or ask a favor or even talk to your neighbor. When she makes a cake in Tanzania, it’s a village event. One neighbor has the chicken eggs, another brings sugar from the city and a third has the oven. Here, instead of the old corner store to catch up with the locals, we now are all busy behind our laptops- even if we're out at the coffee shop. It is a recipe for isolation. Even when humans have all the food and comforts imaginable, they still need human-to-human interaction. I don’t think she meant meeting the pizza delivery person at the door, either. Which leads me to my next modern maladaptation…
5. We need an intimate relationship with our food.
Michael Pollan’s book Cooked: A natural history of Transformation, reminds us of our past nurturing relationship with food. “The rise of fast food and the decline of home cooking also have undermined the institution of the shared meal, by encouraging us to eat different things and to eat them on the run and often alone. Survey researchers tell us we’re spending more time engaged in ‘secondary eating’, as this more or less constant grazing on packaged foods is now called, and less time engaged in ‘primary eating’– a rather depressing term for the once-venerable institution known as the meal.” Research shows that, by simply spending time touching or preparing our food, our sense of satisfaction and ability to digest and absorb go up measurably. How many of you have known a child that has little interest in vegetables until they help in a garden, working the dirt and watching their seeds grow? Children understand the best food is that with which your own hands had the privilege of working.
6. Sitting is the new smoking.
So notes Nilofer Merchant in her TED Talk. We now sit on average 9.3 hours per day (compared to 7.7 hours of sleep) with some significant health consequences. Sitting and inactivity have serious implications regarding back and neck pain, as well as more severe health issues. An estimated 60-80% of our adult working population experiences some level of back and neck pain, at a cost of around $86 billion a year in lost time and medical expenses. This doesn’t include the cost of more significant health complications. Regularly sitting for more than 3 hours watching a screen makes you 64% more likely to die from heart disease. As soon as you sit, the enzymes needed to breakdown fat drop 90%. Each additional hour past 3 hours spent on a screen results in an 11% higher death risk over a 15 year period.
Exercising the prescribed 30 minutes a day is just not enough if you are sitting 8+ hours a day. In no other task do we assume that 30 minutes of practice outweighs 8-9 hours of poor performance. In fact, when compared, people that watched more than 3+ hours of TV are equally obese whether they exercise or not. It is the sitting that is deadly, even more than the lack of exercise. Humans are built to move. Going to the gym is not necessarily the solution. Getting up is. Getting up frequently is even better.
7. Technology is changing our sense of time and joy.
Anxiety is another condition, like insomnia, that my patients report more often now then 20 years ago. Are you able to live joyously in the present moment? Can you take a phone and computer-free vacation, or even a day to remember (or show your children) what it used to be like in the old days?
According to a recent editorial in the Huffington Post, “Over-reliance on technology–constantly checking email and social networks, and being distracted by alerts on our mobile devices–can take us out of both the past and the future, and into a state of heightened “present hedonism” in which we’re constantly focused (in a sometimes compulsive way) on what’s either right in front of us or coming immediately afterwards. We now know that our brain chemistry is changing as a result of technology and social media. My experience as a physician is that patients are feeling more isolated, anxious and uncertain about the future than ever before.
8. Instead of recognizing that our physiology is changing for the worse, we label it the new norm.
If you are the rare individual that has maintained your weight for the last 30 years, you’ve probably noticed that your clothing size keeps going down when you shop. Didn’t you use to be a 10? They really have sizes 0 and 00 now. Clothing sizes have changed to both sell more clothes and meet cultural norms.
The same thing has happened with lab results. Just 18 years ago it was protocol to run an HIV test on any patient with white blood cell counts below a critical level. Now half of my patients have these low level white blood cell counts. Not only are these patients not HIV+, but, according to the lab, they’re cell count is now in the “normal” range. In other words, when, as a society, our lab values change to a new common number, the lab just changes the reference range. So, while it isn’t healthy or optimal to have low white blood cells, we just change what we call “normal.” The same goes for how we view weight: collectively as a society, our weight keeps going up, so the insurance companies simply change the actuary tables to reflect what is common. Lab results that used to be labelled as diabetic and now normal to "pre-diabetic".
What can you do?
Make a conscious choice not to be a lab rat.
It may sound like I am down on technology, but I acknowledge many ways it has vastly improved our lives. Like telehealth medicine. And we have information at our fingertips that allows us to make educated choices. Fifty years ago, when the pesticide DDT was sprayed down the streets filled with children playing to show how safe chemicals were, people had no way of knowing what they were being exposed to. Now we have Wikipedia, the Environmental Working Group (EWG.org), and quality stores like Marlene’s and PCC that do a lot of the research for us. You can choose to know which ingredients change your (or your child’s) hormones, which increase your risk to cancer, and which are not even researched in humans yet.