Sleep and Mental Health | Deep Sleep, Circadian Rhythms and Neurotransmitters

Foreign. I'd like to welcome everybody to today's presentation on sleep and mental health. I AM your host, Dr. Donnelly Snipes. In this presentation, you're going to learn about the function of sleep, sleep cycles, how much is enough, and believe it or not, most of us don't get enough. And how lack of sleep contributes to feelings of depression and anxiety and irritability. And then we will finish up with some of the dirty dozen. I think techniques for helping people improve their sleep quality through improving sleep hygiene. Sleep is a time when we rest and restore. There was a period back in the 80s, I think that there was this theory going around that you could do some sort of deep meditation for five or 10 minutes and forego the need for sleep. Well, they found that that really isn't the case. A lot of the research has indicated that when we are sleep deprived, we have a lot of physiological responses that are detrimental. Adequate sleep improves memory and learning, increases attention and creativity, and aids in concentration and decision making. Toxins that accumulate in the brain are thought to be cleared out during sleep. And if you go to the sleep foundation, you can read all about adenosine. But basically when we think and throughout the day with all the stuff that our brain does, the byproduct of that is something called adenosine. And as adenosine builds in our brain, it creates what they call sleep pressure, which is know when you're feeling groggy, when you want to go to sleep. As the aden, as the adenosine goes up, sleep pressure or the desire to go to bed also goes up. So it's an interesting little system because when you go to sleep and you get into deep sleep, this doesn't happen when you're in light sleep. When you get down into that deep sleep, your brain is able to clear out the adenosine. It's kind of like a factory. You know, I, I liken our body to a factory a lot. And the janitors come in overnight and they clean out everything and it's all brand spanking new and beautiful and ready for you to be as optimally functional as possible the next day at work. Same thing for your brain. Healing and repair of cells takes place during sleep. Your body isn't functioned on, hopefully digestion. It's not focused on fight or flee. It's not focused on all of those other things that we use energy for during the day so it can divert and direct its energy toward healing and repair. This is also another time where not so much in the brain. We already talked about the Adenosine. But a lot of the activity of clearing out some of those free radicals and free freeing up your body from the pressure from the oxidative stress happens during sleep. Sleep also helps to maintain the balance of hormones in the body. And it's not just argonautal hormones. Gin and leptin regulate our feelings of hunger and fullness. They are also regulated by our circadian rhythms. So if our circadian rhythms are out of whack, then we are probably going to have more difficulty knowing when we're hungry, hungry and when we're satiated. If you have had a schedule for, for a length of time, you know, for a month or more, you've kept on a kind of a similar schedule. You'll probably notice that you get hungry about the same times. And part of that is because by virtue of your circadian rhythms that are set partially when you sleep, your body secretes hunger hormones at the times when you're supposed to eat. So you know that that's an interesting thing. And when we look at infants and, and young children who typically are on a pretty stable schedule, we can see this. You could have set your, your watch by my son when he was little, when he would take his nap, when he would be hungry, when he would get up. He was one of those kids that you could just, you know, his cycles were very functional. We'll say that. I'm avoiding saying the word rigid, but you know, I just said it. He has always been one that has been very structured, even in his just routine functions. Insulin also is regulated in sleep. Insulin is responsible for the regulation of glucose in the blood. People who are diabetic and pre diabetic, which is a significant portion of our population. I think the last time I looked at the data it was like upwards of 20% of people in the United States are either diabetic or pre diabetic. And insulin is in integral into regulating blood sugar and it's integral or, or stabilizing blood sugar and insulin levels are integral to managing diabetes. So sleep can also help with management of insulin related conditions. Sleep deficiency is linked to a higher risk of cardiovascular disease, stroke, diabetes and kidney disease. So let's think about that just kind of really quick. People who don't get a lot of sleep often, not all the time, have underlying anxiety, depression or what they have, you know, sometimes called type A personality. People who typically are more likely to have hypertension also often have sleep problems. People who have difficulty sleeping also often have, not often, but also do have a relationship with sleep apnea and sleep apnea is also correlated to guess what cardiovascular disease. So we can see how sleep and cardiovascular disease kind of go hand in hand. People need that good sleep, and they don't exactly understand all the reasons why, but they do understand that poor sleep is associated with cardiovascular disease. Those type A personalities, people who have high levels of anxiety, people who have high blood pressure, tend to be at greater risk for stroke. We've already talked about how if you are not getting good quality sleep, your body has difficulty regulating blood sugar. And then kidneys filter out the toxins. So. And kidneys, kidney disease is one of the main complications of diabetes. So we can also see that there are other connections there. Why do you care? Most of us that are in this class are, are behavioral health clinicians. Well, number one, a lot of our clients have underlying or concurrent physiological health issues. And number two, it's helpful in motivating clients to consider improving their sleep if they see all of the reasons that sleep can help them. Not just, you know, it may give you more energy, but look at all the things that you can theoretically help to prevent. You know, this is a risk factor you can take off the table. Sleep deprivation is correlated to difficulty concentrating, irritability and fatigue or loss of energy. A lot of that is due to two factors. One, not clearing out that adenosine, and two, when we are sleep deprived, the body registers that as a stressor. And in order to give us the energy to function that when we are, are sleep deprived, our HPA axis is activated. The HPA axis causes a dump of cortisol and norepinephrine and adrenaline. You know, so it's kind of like our body trying to give us natural caffeine. You know, we don't have natural caffeine, but that's kind of sort of what your body's trying to do. And so that can increase irritability and that can increase difficulty with concentrating. So let's talk about sleep cycles really quick. Stage one, non REM sleep is when you drift in and out of light sleep and can easily be awakened. That's when you're kind of dozing off. A lot of people when they're on airplanes or watching tv, they may drift into this non REM sleep. Stage two, non REM brain waves slow. With intermittent bursts of rapid brain waves, your eyes stop moving, your body temperature drops, and the heart rate begins to slow down. This is one of those things that a lot of people don't really recognize. They think, oh, they want to be all warm and snug as a bug when they go to sleep. In actuality, when we sleep, it's better when for the ambient temperature to be a little bit cooler because we need to cool down in order to go to sleep. And the heart rate slows down when we slow down, which makes sense, you know, you know when you sit still that your heart rate tends to drop a little bit. When you are completely relaxed, your heart rate's going to drop even more. So stage two, non REM sleep, usually lasts for about 20 minutes. Stage three, non REM sleep, also known as deep sleep or delta sleep, is marked by very slow brain waves. There is no voluntary movement, and you're difficult to wake. There have been a few times where I have been awakened during this, you know, deep sleep. And these are the times when you wake up and you. It takes a minute to kind of get your bearings and figure out, okay, what's going on here. This stage usually usually lasts for about 30 minutes. The largest percentage of deep sleep comes in the early part of the total night's sleep pattern. If you have a fitness tracker that tracks your sleep, one of the things that you may notice is that in the beginning of the night, the duration of your deep sleep is longer than towards the end of the night. And you want it to be that way. That's actually good. It shows that there's less for the janitors in your brain to do to get you ready for the next day. So that is, you know, totally awesome. And that's what we really want to look for, REM sleep, which is we talk a lot about REM sleep. And I can't remember if I address it in this presentation or not, but REM sleep is actually altered in many people by taking antidepressants. Antidepressants can actually minimize REM sleep for some people. So that is an important side effect to be aware of. But I digress. REM sleep is characterized by temporary paralysis of the voluntary muscles and fast, irregular breathing, inability to regulate your body temperature faster, brain waves that resemble the activity of a person that is awake. This is really. This is your dreaming period. And not everybody remembers their dreams, but most people, most nights go through multiple REM cycles. Now, these sleep cycles, non REM sleep all the way through, you know, deep sleep, then REM sleep. They estimate that a full sleep cycle, including all of those things, lasts about an hour and a half for most people. And, you know, they may get shorter throughout the night, but you will go through multiple cycles of this, of this sleeping. So thinking about our clients who often Wake up in the middle of the night. Sometimes they, we, sometimes they'll be, be waking up when they're going back into that phase of light sleep. So how much is enough? Well, newborns and children up to three months old need somewhere between 12 and 18 hours of total sleep and two and a half to three and a half hours of deep sleep. Three months to one year old, 14 to 15 hours of sleep. Now when we think about young children, you know, we want to include in that nap time. This doesn't, this isn't just, you know, sleep all night long because we know that definitely newborns don't sleep all night long, but throughout the day they need to amass roughly 15 to 18 hours of sleep, kind of like our cats do. But when children start to get older, their need for sleep does not significantly decline, even though they may be in, in School. So 1 to 3 years old, they're probably still in preschool, daycare, something like that. 12 to 14 hours of sleep. So if they're getting a, let's just say an hour nap during the day, that means they still need 11 to 13 hours of sleep at night. And this can be really challenging for families, especially families where both parents work out of the house and the child goes to after school care or is in daycare until like six, you know, parents pick them up, then they go home, they've got to eat, bathe, all that kind of stuff, go to sleep, and then they've got to be up at 5:00 or 5:30 to go to daycare again. So it's important to recognize that unfortunately our cultural lifestyle has created a situation where a lot of children, through no fault of their own, through no fault of their parents, just the way things are right now. But children are not getting enough sleep. Even, you know, if parents are Johnny on the spot and you know, everything goes exactly as planned. So that is something we want to look at in terms of interventions, you know, helping parents identify ways if they're young, children are starting to have some behavioral issues or struggling with learning. It's important to examine the sleep duration and the sleep quality. You know, it's not just enough that Johnny's in his bed for 13 hours. We want to know, you know, how, what, what was the quality of that sleep? You know, if, if the little child is in their bed, but there's all kinds of noise and cacophony going on in the house until midn, the little child's probably not going to sleep as well. Three to five years old, they need 11 to 13 hours of sleep. Now again, they're probably still taking a nap at this stage, but we do want to focus on, you know, okay, without that hour nap, you know, they still need 10 to 12 hours of sleep. Some children may need even a little more, some children may need a little bit less. But the average according to the sleep foundation is, you know, is right around 11 to 13 hours. When they get into elementary school, they're not taking a nap during the day anymore. So the only sleep they're getting is at night. And that sleep needs to be roughly 10 to 11 hours. And that's a lot of sleep. But think about all of the things that that child's body is doing not only during the day but at night. It's growing and the br is still developing and organs are still developing. Bones are still, you know, they're not even fusing at this point. They're still growing, they're, they're learning. They are just like little sponges. So it makes sense with all the energy their body has to expend during the day that they may need more sleep at night. 12 to 18 years old, this goes all the way through high school. We need eight and a half to ten hours of sleep. Now think about the teenagers that, you know, how many of them actually consistently get eight and a half to 10 hours of quality sleep every night or most every night. And you know, if the videos were on right now, I could probably see a lot of you chuckling and going, don't know a single one. My daughter does, you know, she is, she's like me, she's very serious about her sleep. But some of her friends will come home from school and again, our culture has created this situation. They come home from school or the school day is over, since they're still virtual learning in a lot of places. But then they have homework until 9, 10, 11 o' clock at night and then they go to sleep and they've got to be at School at 7:30 the next morning. So it doesn't. The amount of homework they have keeps them from get, getting to sleep and prevents them from accessing, you know, other areas of their life like sports and hobbies and, you know, friends and stuff. But that's a whole different soapbox. I can get on. But over 18 years old, which is most of our clients, seven and a half to nine hours of sleep. Now if you have young children at home, you're probably also laughing that, oh, I can't remember the last time I got five solid hours of sleep, let alone seven and A. And that can significantly contribute to weight gain, to difficulty managing eating habits, because there's a lot more grazing. The hung graylin and leptin are all kind of out of whack. It can contribute to depression, anxiety, systemic inflammation, worsening of autoimmune diseases. So we do want to look at people's sleep. Not only the number of hours that they're in the bed, but the quality of that sleep. If they sleep with somebody who has sleep apnea, they're probably not sleeping through the night very well. If they're clinically depressed, they're probably not sleeping through the night very well. And each time they wake up, that takes a little sliver out of their sleep, even if they're in the bed for, you know, seven and a half hours. So let's talk a little bit about those sleep and hormones again. Estrogen usually improves the quality of sleep, reduces time to fall asleep, and increases the amount of REM sleep. Some people will report when their estrogen levels are high that they're very fatigued. Well, this is part of the reason too little or too much testosterone has also been shown to affect sleep quality. Just like most other things in our body, too little or too much causes problems. There's a nice happy medium that we need. Cortisol is your stress hormone, and it prevents restful sleep. Well, that makes sense. If your body's secreting cortisol, then that's part of your fight orf flight reaction. So your body's saying, hey, getting into deep sleep makes you too vulnerable, so you need to stay more awake. Even if the person feels safe in their physical environment, you know, they're in their bedroom, they're in their home, they've got their dogs around them, whatever. If they have high levels of cortisol because of chronic stress at work, for example, that can prevent them from actually getting down into that deep restorative sleep. Cortisol works against serotonin, and if you remember from other presentations, we need serotonin in order to make melatonin, and we need melatonin to go to sleep. Thyroid hormones, which are too high, can cause insomnia and too low can cause fatigue and lethargy. We also see with people who have hyperthyroid, more anxiety type symptoms and people who have hypothyroid, not enough thyroid. We see a lot of symptoms of depression. Another reason it is so important for people to get a physical and have the blood work done to assess their blood sugar ability, their body's ability to handle blood sugar. So diabetes Pre screening. It's important to have their thyroid hormones screened. It's important to have their gonadal hormones screened. As we get older, just one of the facts of life, as we get older, our gonadal hormone production goes down and that can actually contribute to sleep problems. In terms of nutrition, tryptophan is an amino acid. It's a part of a protein that is in food. You don't really need to seek it out. It's in just about everything, but it's used to make serotonin. Serotonin is used to make melatonin. Melatonin helps you feel sleepy. Caffeine is a stimulant that actually works against these things. It actually will displace that adenosine. And it's a stimulant with roughly a six hour half life for most people, which means it takes about 12 hours to get out of your system. So caffeine that you ingest at noon is still in your body to some extent up until at midnight, potentially. Nicotine and decongestants are also stimulants. They have a two hour half life. Now, if you have a really bad cold, you know, obviously not taking a decongestant before bed is going to have its own problems because you won't be able to sleep. But being aware of the fact that nicotine and decongestants that are taken within four hours of bed will inhibit or will affect sleep until they're out of your body. You know, it's just one of those things to know if people can stop using decongestants or nicotine products or stimulants sufficiently enough before bed, then that can enable their body to be more efficient and effective at helping them drift off to sleep and stay asleep. Antihistamines may make you drowsy, but they contribute to poor quality sleep. And this is one of my frustrations because a lot of the sleep aids on the market are antihistamines. They are either diphenhydramine or, and I can't remember the other one right now, but it used to be the antihistamine that was in the old fashioned Nyquil that just knocked you on your ever loving butt. So when I was younger, we used to say Nyquil was the sniffling, sneezing, coughing, aching, how the heck did I wake up in the middle of the kitchen floor medicine. But anyhow, antihistamines can help you feel drowsy, but they don't help you actually get that good quality deep restorative sleep. Which is why when some people Use antihistamines to help them drift off to sleep. They do sleep more for a more solid period of time. But they may wake up in the morning and still feel groggy and hungover because they weren't getting that deep sleep so that adenosine wasn't cleared out. So they're may have more struggles during the day. Alcohol blocks REM sleep and can cause sleep apnea. Alcohol is a sedative. So when alcohol, when you're ingesting it, when it's in your system, may slow your metabolism, it slows your breathing a little bit. And for people who have sleep apnea, it can contribute to worse worsening of that sleep apnea. But I thought it was interesting that it blocks REM sleep. Ideally, if people are going to drink, they want to make sure that their alcohol blood alcohol level is 0.00 when they actually go to sleep. Eat a high protein dinner to ensure you have enough tryptophan in the body. In addition, make sure you're getting enough selenium, vitamin D, calcium, vitamin A, magnesium and zinc. All of these are used to create serotonin and break down serotonin into melatonin to help you get sleepy. People can download an app like Spark People or something else to monitor their nutritional intake to make sure that they're getting the vitamins and minerals that they need. They can also talk with their doctor about the best type of multivitamin or for them. Some doctors are against multivitamins, some are for them. And there are so many different varieties with so many different, you know, ingredients in them. It really is important to consult with your medical professional, especially if you have concurrent physical conditions or you're on other medications. So let's talk about sleep hygiene. Create a wind down ritual if you have children, or maybe you do it yourself, but I know when my children were younger, I was very rigid. You know, I'm a J, so I tend to be very structured. We would come home from, I would pick them up from school or daycare. We would come home, we would have play time, we would eat dinner, they would take a bath, I would read them a story and tuck them into bed. That was our sleep routine every night for, you know, years. And when we do that, and remember I said earlier that sleep only partially sets our circadian rhythms. Our circadian rhythms are also set by our light levels and our social activity. So what we're doing, our body takes its cues from us. You know, as we are exposed to less blue light, as we are engaging in these behaviors that typically lead up to going to bed. Our body takes its cue for starting to produce melatonin. It's encouraging to a lot of people if they start creating a wind down ritual and keep to it, it takes about a month, but they start seeing that their circadian rhythms are getting more set and it's easier for them to fall asleep about the same time. Reduce or eliminate exposure to blue light one hour or two before bed and you can get blue light filters for your mobile devices, for your television, for your computer screens. I encourage you to also consider the bulbs in your house if you have a room where you typically wind down. For me, I wind down in my bedroom. So the lights in my bedroom are actually 2500 kelvin, which is basically yellow. So they have virtually no blue wavelength in them. And you know, they're like 25 watt light bulbs. It's bright enough that I don't get eye fatigue when I'm watching television or doing whatever, but it's not so bright that my brain thinks, oh, it's time to be awake. During the day you want to have the light temperature up over 5,000 kelvin. So it's different, different light temperatures, different colors. If you can't do that, if you don't have a room where you wind down, having a place in your house that you can dim the lights can be helpful. But those daylight bulbs are going to emit, even, even if you dim them down, they're going to be emitting some blue, blue wavelengths. Try to go to bed at roughly the same time every night. Yes, even on the weekends. That doesn't mean that you can't occasionally go out and, you know, party it up until 2 in the morning or whatever. I can't remember the last time I saw midnight, let alone 2am but whatever. Try to go to bed at roughly the same time each night, most nights. That way your, your body does set that system. Eliminate as much light as possible. I encourage people, if they feel safe enough to wear a sleep mask. And this is even if they don't sleep with the light on or a nightlight or the tv. The moon sometimes can be so incredibly bright that it makes it seem like daylight. And the moon has a lot of blue light to it. So sleep masks can be helpful. Eliminate as much noise as possible. If you feel safe. And this is a big issue for people who have trauma histories. They may not feel safe with a sleep mask or earplugs because they feel too vulnerable. And that's, you know, I get it. And if it makes you feel too vulnerable, Then obviously don't do it because that's going to keep you from getting good sleep as well, but eliminate as much noise as possible. Some people use white noise machines and that helps them because it's this stable background sound my daughter has. For whatever reason, her preference is for crickets. She's got the white noise machine, but she's got the cricket sound going. Some people like ocean waves, whatever it is. If you sleep with someone who snores, earplugs can come in handy if you sleep with someone who wears a CPAP machine, unless they've gotten remarkably better. I've had a lot of people, not just clients, you know, family, friends, whatever, complain that CPAP machines are very loud. They're relatively stable most of the time, but they're very loud. So it is important to identify sources of noise that may be keeping you awake and address as many of them as possible. Do not exercise or take a hot bath within two hours of bed. Now, stretching is not what we're talking about. We just don't want to get our core body temperature up right before bed. Keep the room cool. According to sleep experts, 72 is ideal. Now for me. 72. I'm still throwing off the covers and too hot. I prefer more around 62. So it's going to be a personal preference for how cool you want to keep your room. Consider a cooling pillow and mattress topper if you tend to be a hot sleeper. And remember that it's important to pay attention to your bed ergonomics if you are not comfortable sleeping, if you can't relax the muscles in your neck because you've got a bad pillow, or if you can't get comfortable because the mattress is, you know, has butt prints in it, then it may be inhib, inhibiting good sleep. With the advent of so many different memory foam type of toppers, it is more affordable now to address some of these issues. A lot of times people don't have to get a whole new mattress, which can be really expensive, but it is one of those things to consider. Avoid anything that might get you upset, like social media or the news or, you know, doing bills right before you go to bed. Anything that gets you upset triggers your HPA axis, triggers your fight orf flight respons, and can keep you from getting good quality sleep. Reduce or eliminate caffeine at least six, preferably 12 hours before bed. One of the things that I listen for when I talk with people that indicates to me that they may have become tolerant, developed a tolerance to caffeine or they may have some HPA axis dysfunction is when they tell me, oh, I can drink coffee right before bed and it doesn't do anything thing. Or worse yet, I drink coffee and it makes me sleepy. Coffee is a stimulant and if it's not stimulating, then that indicates that there has been some sort of adaptation. Try to drink the majority of your fluids during the day. It is challenging to have to get up in the middle of the night two, three times to go to the bathroom. And so not saying you can't have water beside your bed to sip, but recognizing how long it takes fluid to go through you. Everybody's a little different, you know. But two hours before bed is usually a good cut off. Like for children, having them drink the majority of their fluid before that two hour cutoff can prevent them from having to get up and go potty multiple times during the night. Keep an air purifier in the room if you have allergies. I just for Christmas, I got my husband these new air purifiers for the bedroom that have ion ionization things. They have the UV sterilization as well as ultra HEPA filtration. And it helps him a lot because he's allergic to animals. And we have a lot of animals on the farm and, and in the bed, which takes me to the next thing. Keep animals off the bed. I don't do this one, I'll tell you. You know, I pick and choose the ones that I'm willing to do, but I am not willing to keep the animals off the bed. Number one, when animals are on the, on the bed, they have dander that can aggravate allergies for some people. Number two, when animals are on the bed, they can wake you up through their movements. We have a puppy right now. Well, she's not a puppy anymore, but, but when she sleeps, she inevitably dreams. And when she dreams, she runs and she runs hard. She will shake the entire bed. She is twitching and running and carrying on so much and doing her little puppy bark. So when she sleeps on the bed, she does tend to wake me up. Animals, we also have another dog that if you're making, if you're snoring the wrong way or if he gets cold, he'll come up and press up against you. And I swear he must be, you know, 105 degrees. I think they typically run about that temperature anyway. They, they run hotter than humans. And he is a little one dog, 85 pound space heater. So that can be challenging. And then also I feel guilty, disturbing them when they're on the bed. So I end up, you know, with having this much of the bed to myself and the rest of the king size bed belongs to the dog. So it's difficult to actually be comfortable and in a proper ergonomic position. So those are all the reasons that you should do what I say, not as I do and keep animals off the bed, especially when you're sleeping. And I do keep them off the bed when I'm sleeping for that reason, but they're on the bed the rest of the, the rest of the day getting dander on it. And Ann, you're right, the same can be said about co sleeping with toddlers. My daughter, and my guess is you've had a similar experience. My daughter, when she would go to sleep, she would be sleeping right between us, you know, with her head on the pillow and sometime in the middle of the night she would turn 90 degrees and usually she'd have her have her head on her father and she'd be kicking me in the back and I'm just like, really? But yes, they can also be snuggle bugs and be very hot. But you know, it's worth it. Keep a red light on and a notepad by your bed to write down anything that pops into your head at night. Red lights, Think about the movie theaters and the exit signs. The red lights don't disturb your night vision as much as the bright blue lights. So if you have a red light, flashlight by your bed, a notepad, you can write things down so you don't have to remember to remember them. You know, if you wake up in the middle of the night and you're like, oh, I've got to remember to get trash bags tomorrow. Well, even though you put that out of your, try to put that out of your mind, you're still going to keep yourself a little bit more charged up or, or awake. Trying to remember, to remember that you need trash bags in the morning. So just write it down. Make your bedroom a place of relaxation and sleep. Ideally it's not the place to do homework, not the place to do bills, not the place to have intense discussions with your spouse or anybody for that matter. Try to make it your sanctuary as much as possible. Weighted blankets have been helpful for a lot of people to help them get to sleep easier. Interestingly, weighted blankets, they've actually done studies and foundations that weighted blankets and weighted vests, the pressure increases our levels of serotonin and oxytocin, our bonding hormone, which is one of the reasons it helps people to relax and feel a little bit calmer. The same thing is true with the thunder vests that they market for dogs. Something about that, that pressure stimulates our proprioceptive sensors and it does cause an increase in serotonin and oxytocin. So I thought those. That was kind of cool. I love my weighted blanket, so I will be the first to say whether it is, you know, for real or not. I really do love, love the weighted blanket and I feel like it helps me sleep more restfully, unless it's making me too hot and then it's a whole other issue. Keep daytime naps to under 45 minutes. Why is this? Because we don't want to get into that deep sleep during the day. When we do, then that starts to throw our circadian rhythms into a tizzy. We can get, you know, that, remember the non rem sleep, those first phases are that really light sleep. So ideally keep them to under 20 minutes. So you stay in that really light, dozing sleep. But up to 45 minutes, the experts say, isn't overly detrimental. Interestingly, there is also research out there that says daytime naps, like lunchtime naps, under 45 minutes, but over 20 minutes help increase levels of norepinephrine in the brain. And norepinephrine is one of our main neurochemicals that help with attention and focus. Norepinephrine dysfunction has been found to be implicated in the development of adhd. So that's kind of one of those interesting things that's both for and against naps. I have difficulty. I've tried to take daytime naps and keep them under 45 minutes and I feel so groggy afterwards. I don't feel like it works for me. But I know a lot of people who swear by them. My husband swears by them. He. If he takes a 20, 30 minute nap in the middle of the day, he is recharged and rejuvenated and ready to go. And it's one of those things that people need to explore for themselves. Consider diffusing essential oils. You can get these nice little diffusers that just, just plug right into the wall. Lavender, chamomile, pachuli and catnip are all associated with improved sleep. They're all associated with sedation and helping people be more relaxed, increasing levels of serotonin and gaba. Now, catnip, you may be going really? But in. Interestingly, for cats, catnip is a stimulant. But for about 60% of them, the other 30 just don't care. Go figure with cats. But for humans, catnip is actually a actually a sedative properties and increases GABA levels. So that's another one of those interesting things to consider. I grow catnip in my garden because it keeps away a lot of pests. And bunny rabbits don't like it. So it keeps them out of my garden. And fresh catnip is potent itself. Catnip essential oil can be a little bit pricey. So, you know, if you have cats and you want to try it, growing catnip is super easy. Just actually it can be too easy because it readily spreads itself itself seeds. So you may want to keep it in a pot, but that one is super easy to grow. Lavender foreign. I've killed every lavender plant that I've ever had, so I can't recommend that for trying to grow it yourself. But it does smell amazing in a pot for however long it lasts. And chamomile is another one of those that you can grow, but I find it's hard to keep going inside. And you can get chamomile tea. You can order the bulk chamomile tea, chamomile flowers that have been dried to use for chamomile tea. But you can also use them in sachets or, you know, boil cam chamomile tea so you can smell it. There are a lot of different ways that you can use these aromas without necessarily having to use essential oils. And selecting the right pillow is really important. Making sure that you've got one that works for your spine and your sleeping position. And I am really particular about my pillows. So this is one of those things that I emphasize. Even if you can't change your mattress, most people can, you know, figure out a way to make sure they've got a good pillow and one that is not, you know, 50 dust mites. I read a story one time, and I can't remember where it was. So this is not one of those, you know, things that I can send you to the citation, but I'm sure you can look it up Online that after three to five years, 50 of the weight of a pillow is actually from dust mites. I was like, ew, that's. That's kind of gross. So sleep is really important for mental health. When people aren't getting enough sleep, then their gonadal hormones may be out of whack. Their gonadal hormones being out of whack will contribute to poor sleep. When they're not getting enough sleep, quality sleep, it also disrupts their circadian rhythms and can disrupt the balance of other neurochemicals like serotonin, dopamine and norepinephrine. Because sleep deprivation is registered as a stressor by the body, which will trigger the HPA axis to be more active. Which is why a lot of times when people are sleep deprived, they tend to be a little bit more irritable. Insufficient sleep quality contributes to fatigue, difficulty concentrating, reduced reaction time and apathy during deep sleep is when the researchers think the brain rests and rebalances over time. Sleep deprivation can cause changes in neurotransmitter levels and even immune system functioning. When we are sleep deprived, when our HPA axis is activated, our immune system is suppressed. So it is important to recognize as well that to stay healthy, people need sleep. But also if they've got autoimmune issues, sleep deprivation or poor quality sleep is probably going to exacerbate those issues because it directly impacts the immune system. Most people could benefit from auditing their sleep quality, reducing light, reducing noises, reducing bathroom trips, reducing wake ups because of allergies or being too hot. If you are working with female clients who are having difficulty with hot flashes, that is definitely an issue that can contribute to increased anxiety, irritability, etc during the day. Not only is their estrogen level dropping, which is inhibiting the sleep, because remember, estrogen improves sleep quality. So as estrogen levels drop, you know, sleep quality gets a little bit worse. But if they're also having hot flashes and they're waking up constantly, or seemingly constantly throughout the night because they can't regulate their temperature, that can in very short order start contributing to a lot of mood as well as physiological issues. So it is important to not minimize that and ask about it and encourage them to talk with their doctor about what they can do. Not everybody is down with hormone therapy and, and I get that, but there are also a lot of other herbs supplements, things that they can do to help them regulate their temperature when they're sleeping so they can get a better night's sleep. The worse their sleep is, the more disrupted their sleep is. The worst their symptoms of menopause as well as behavioral, behavioral and mental health issues are probably going to be the same thing is true when we really didn't talk about it in this presentation. But for men as especially as they get older and they start having issues with their prostate that makes them wake up in the middle of the night to go to the bathroom, there are over the counter supplements that they can talk with their doctor about taking that are, you know, vitamins and Stuff that can help, that help a lot of men with that issue. But also remembering that lower levels of testosterone can similarly impact sleep, sleep, sleep quality. So it's, you know, a matter of making sure that people as we age continue to get not only the amount of sleep we need without having to wake up because of hot flashes or having to go to the bathroom, but also make sure that it's quality sleep. It is a misbelief that as people get older they don't need as much sleep. What generally happens is because of hormone changes and other things, people who are older just don't tend to get that quality sleep. They tend to wake up and they're like, well, I'm awake, do stop caffeine. Six, preferably, preferably 12 hours before bed. People who drink caffeine and it doesn't seem to have an effect on them, just like taking any other stimulant, your body is going to develop a tolerance to it, which can be problematic. It also can indicate when you consume a stimulant or when something upsets you and you just don't have the energy to care. That can indicate dysfunction in your HPA axis, which is your stress response system. So it is interesting to examine, you know, how much people have been drinking caffeine, that is, and the effect that it has on their body and also other things that are going on. Because I mean, think about the cycle that happens. We get stressed, we don't get enough sleep, we compensate for that by drinking caffeine, then we have too much caffeine in our body, so we didn't don't get good sleep even after the stressors passed, you know, and it can be this vicious cycle. So encouraging people to be more aware of their stimulant use. Other things have caffeine besides just coffee. Chocolate has its own stimulants in it. It's got caffeine as well as some other stimulants that also may work to keep people awake. Nicotine and decongestants. Pre workout supplements often have some sort of stimulant in them. So if you're clients are working out in the evening and they're taking pre workout supplements, encourage them to educate themselves about what is in those pre workout supplements and whether it may be contributing to sleep problems. If people are only willing to change one thing this month, encourage them to think about addressing their sleep. Now like I said, I do not adhere to every single one of those sleep hygiene guidelines. I'm stubborn. I'm going to let the animals in the bed. But the more that you can adhere to, the better quality of sleep that you can get. The more alert, the more able to concentrate, the more energetic you are going to be throughout the day, the stronger your immune system is going to be and the more you take off, you know, sleep is that risk factor for a lot of other physiological issues. So you're just taking those off the table. Sleep is really a great intervention to help not only with health, but mental health. And it's something that families can do. It's a healthy behavior that families can focus on together. So everybody is going to sleep at a certain time and working on that as a family health goal. Are there any questions about sleep? Do you have any other great tips for helping people get to sleep that I did not mention? I know there are lots of different things that, that people can do. Creating that wind down routine can be really helpful. And Marie, it appears that you beat me up today. It was. I don't think I got up until about 3:20, but I go to bed really early so that's just, you know, kind of part of farm life. But peppermint tea, that's interesting. I wouldn't have thought about about that as being relaxing, but apparently it is. So that is another one of those things. I don't like chamomile tea, but I can see myself liking peppermint tea. Sleep meditations, excellent suggestion. I did not mention that at all. Progressive muscular relaxation, guided imagery, sleep meditations can all be super helpful because when people are engaging in those activities, they are focusing their mind on something besides the stressors of the day. So that is an excellent suggestion and thank you for pointing that out. I need to add that to the presentation. If, if you wake up with muscle aches, leg cramps, keeping relief cream on a nightstand so you don't have to get out of bed to apply it. That is another excellent suggestion for things like, you know, over the counter sleep aids and supplements that might help people get to sleep. I do encourage them to talk with their doctor. A lot of doctors are recommending melatonin, but it is important to recognize that melatonin can interact with a lot of medications and some people are less tolerant to it than others. And a sleep study or sleep specialist can also be helpful if you're having difficulty sleeping and can't quite figure out why or can't quite get enough good solid sleep. Another tip that I did read is while I love my fitness Tracker, they're not 100% accurate for tracking your sleep. So of if you find that looking at your fitness tracker and your sleep report every day causes you more stress, then don't do it. Because, you know, you can get all charged up about, you know, oh, I didn't get enough deep sleep last night. I got to do better tonight, which just. That's pressure, and pressure is the antithesis of relaxation. So what is Cortisol Manager? Is that an app or. Okay, so a supplement. There are a lot of supplements out there that can help people get to sleep. So definitely consult nutritionists or dietitians or physicians about what their suggestions are based on your particular issues, your particular makeup. As I said earlier, for a lot of us that are getting older, one of the issues may be alterations in our gonadal hormone levels. And so different supplements may be recommended to address those issues as opposed to, you know, something that's just straight up sedating. But. Alrighty, everybody. Thank you. Oh, yes, and you're right, Renee. Lack of sleep and lack of quality sleep does cause a lot of problems with memory consolidation and learning. Same thing is true when people drink at the same time that drink alcohol at the same time that they're studying. But we're talking about sleep today, so, yeah, sleep does. Or sleep deprivation does impair memory consolidation.