You Are How You Sleep: The Cost of Sleep Deprivation
What you and your clients are missing due to lack of sleep every night.
Spending a third of our lives horizontal, hallucinating and paralyzed may sound like something from a scary sci-fi movie—but, in reality, these are good things. It’s all about sleep, and getting enough of it is essential.
Indeed, experts and re┬¡search tell us that the quantity and quality of last night’s sleep help determine who we are today. Sleep influences our demeanor, our choices and how others perceive us. It shapes our waking hours, leaving us alert, calm, focused and joyful or tired, grumpy, distracted and unhappy.
That makes sleep a crucial concern for our harried clientele and for ourselves, as busy fitness professionals. We all try to sneak by without enough sleep, and we all pay the price for sleep deprivation. Read on for the latest research on sleep, plus tips on helping your clients to get the sleep they need.
The Science of Not Sleeping Well
Research on the influence of sleep finds trouble in all sorts of places when people don’t get enough of it.
Observers in one study said that sleep-deprived participants looked less healthy and more tired (Axelsson et al. 2010). In another study, people said they felt less likely to socialize with those who were sleep-deprived, since they looked less attractive (Sundelin et al. 2017).
Studies find a tight causal relationship between sleep and emotional brain function. Just one night of sleep deprivation affects emotional working memory (Tempesta et al. 2014). Losing sleep also sacrifices creativity, brain cleaning and memory storage. Sleep abnormalities accompany most mood and anxiety disorders (Goldstein & Walker 2014). Studies have even found that sleep correlates with factors such as financial success, injury risk and sports performance (Walker 2018).
Over time, sleep debt is compounded. The American Sleep Apnea Association links sleep deprivation to moodiness and to losses in cognitive functions such as memory and concentration (ASAA 2017). Lack of sleep can contribute to hyperactivity in children (ASAA 2017) and to a host of ills, including obesity, heart disease, hypertension and diabetes. An article in The New Yorker reported broad impacts on the economy and public health: “In the workplace, sleep deprivation results in injuries and decreased productivity, which is thought to cost the U.S. 18 billion dollars each year. As many as 1.2 million car crashes—20% of the annual total—can be attributed to tired drivers, so it could be said that lack of sleep causes thousands of deaths and injuries every year” (Groopman 2017).
Shirking on sleep is like skipping part of a workout for an entire week—you can’t get that time back. Which muscles would you ignore if you could train only 85% of them regularly? All muscles matter. The same idea applies to sleep.
See also: Less Sleep = More Health Problems
WHY OUR BODY CLOCKS ARE SO IMPORTANT
Circadian rhythms reflect how organisms respond to changes in their environment throughout the day (NIGMS 2017). For humans, the waking hours expose us to light that triggers a trillion clocks in every organ and tissue, according to Nobel Prize-winning research gathered over the past 30 years (Jacobson 2017; Dean 2015).
“Few seem to realize that our very survival depends on living in sync with this internal timing system,” wrote nutrition expert Pamela M. Peeke, MD, MPH, FACP, in Fitness Journal (2018). “Getting out of sync with our biological clocks and rhythms risks a rise in obesity, diabetes, heart disease and cancer.”
Here’s a familiar scenario underscoring the role of the body’s internal clocks: Staying up too late makes it tough to get out of bed in the morning. That increases the appeal of sleeping in, which may be more trouble than it’s worth because the body must adjust to the shift. Sleeping late one day has a cascading effect—when the body’s clocks get off schedule, everything is disrupted.
Thus, sleep mechanisms function optimally on a steady schedule. If you stay awake too late and lose sleep for even one night, your body copes by secreting hormones such as cortisol and adrenaline. Adenosine, a sleep pressure neuromodulator, is not completely cleared, leaving you feeling sleepy and more likely to supplement with caffeine and/or sugar, which can inhibit sleep further and create a vicious cycle.
When suppressed for a night, melatonin—the sleep-signaling hormone—gets off schedule, making it tough to go to bed earlier when wanted. If your alarm clock startles you out of your morning dreams, a domino effect happens that can stress the heart (Walker 2018).
Waking up at the same time every day, naturally with plenty of energy to engage fully with life, is a goal worth striving for. Many people don’t know what they’re missing while riding a sleep-and-wakefulness rollercoaster week after week.
SLEEPING IN STAGES
Research is uncovering the mystery of what happens during the four stages of sleep (Finkel 2018). One thing is clear: We need all of them, every night—just as we need fruits and vegetables, or cardio and resistance training. We can get by without sleep occasionally, but losing sleep chronically has consequences.
The stages of sleep are unique and valuable. During the first half of the sleep night, there is more nREM (non-rapid-eye-movement) slow-wave sleep (stages 3 and 4), called deep sleep. During the second half of the sleep night, there is more REM (rapid-eye-movement) dreaming and lighter sleep. Sleep researcher Matthew Walker, PhD, says nREM is involved with memory storage, while REM is the dreaming sleep known for hallucinations and paralysis (Walker 2018).
A late bedtime and early alarm often minimize REM sleep, which has been linked to emotional health, problem-solving and creativity. If people were more aware of this, would they sacrifice these gems for an extra 30 minutes of social media surfing?
One study proposed that REM after SWS (slow-wave sleep) may be responsible for associating new information with pre-existing memory networks in the brain (Batterink, Westerberg & Paller 2017). It seems the first half of the night is geared toward storing memories and the second half helps us integrate past, present and a potentially imagined future. It’s a time for the brain to communicate with itself effectively. Allowing the brain this opportunity seems essential for optimal cognitive function.
“Sleep is like the laundry,” says Ariana Huffington, author of The Sleep Revolution (Harmony 2016). “You’re not going to take out the laundry 10 minutes early to save time. You have to complete all the cycles in the washing machine. Our sleep cycles have to be completed too; otherwise we wake up and we feel like wet and dirty laundry.”
ADOLESCENT SLEEP HEALTH
About 6 out of 10 kids in grades 6–12 do not get enough sleep, according to the Centers for Disease Control and Prevention (CDC 2018). Researchers have demonstrated that just 16–23 minutes more sleep can have a beneficial effect on youth (Li et al. 2013). Schools are delaying start times, and coaches are paying more attention to rest, recovery and sleep thanks to the plentiful research emerging in this area.
Myra Hartzheim, a certified Gentle Sleep Coach specializing in pediatric sleep, advises parents to pay attention to the quality of their child’s night and day sleep and the behavior of the child. “If sleep is interrupted in any capacity with night wakings or early rising, there is a likelihood that the child is not getting the sleep he or she needs,” says Hartzheim. “The child should be able to be calm and focused and cooperate with requirements of school or home if there are no other underlying factors that prevent the child from doing so, including sleep.”
Perhaps kids can be the motivation for parents to sleep better. Hartzheim says, “I believe establishing healthy sleep habits early on in life will help children have healthier habits overall as adults. They will be more in tune with their bodies by knowing what calm feels like and how to get to that state by down-regulating. That is the foundation of sleep.”
Why do we postpone sleep? Does going to sleep feel like losing control, somewhat similar to death? Or is it simply a motivation issue? Many people know the benefits of sleep but fail to prioritize it. A 2018 study by the National Sleep Foundation polled a sample of 1,010 adults and found that 65% think that sleep contributes to next-day effectiveness. Yet only 10% prioritize sleep over fitness/nutrition, work, hobbies and social life (NSF 2018).
The report found that most Americans don’t take into account how much sleep they’ll need when planning for the next day. Perhaps the issue is as simple as needing, and planning for, an earlier bedtime.
It’s tempting to squeeze more activities into the day or get more downtime by sacrificing sleep—especially if we lack energy or feel stressed and overstimulated most of the day. But quantity of time awake does not replace quality. Ideally, downtime should occur during the day instead of taking the place of sleep.
Getting Enough Sleep
A lot of people oscillate between not enough and too much sleep. The NSF and Sleep Health Foundation both recommend 7–9 hours of sleep for adults (aged 18–64), 7–8 hours for older adults (65+), 8–10 hours for teenagers (14–17) and 9–11 hours for children (6–13) (SHF 2015).
Many people are aware of the numbers, yet more than one-third of American adults don’t get enough sleep on a regular basis (CDC 2016). Perhaps we have the wrong goal in mind.
Following the recommended guidelines for sleep is like counting calories. It’s a good starting point, but ranges can mislead because specific sleep needs vary from person to person. Moreover, getting the bare minimum is not the primary goal, although it’s often the main focus for people. Sleeping too much can also be an issue. Researchers in South Korea found that adults aged 40–69 who slept ÔëÑ10 hours a night were more likely to develop metabolic syndrome (Kim et al. 2018). And in adults aged 45–83, Bellavia et al. (2014) found that sleeping more than 8 hours a night increased mortality risk—but only in those with low physical activity levels. Sleep disorders may cause some people to sleep longer to overcome the disruption.
Getting people to sleep better aligns well with the mission of fitness professionals. We know how to plan, motivate and educate. And sleep research covers our core areas of focus: weight loss, performance, injury prevention and behavior change.
- Weight loss. Sleep may not directly help somebody lose weight, but lack of sleep affects food choices. “On a simplistic level, your appetite changes,” says Charles Samuels, medical director of the Centre for Sleep and Human Performance in Calgary, Alberta, in a report available on Health.com. Lack of sleep alters levels of ghrelin, leptin and endocannabinoids, three appetite hormones (Fields 2016; Hanlon 2016). “We have very substantial research that shows if you shorten or disturb sleep, you increase your appetite for high-calorie-dense foods,” Samuels says (Fields 2016). Moreover, research suggests that sleep restriction can hinder weight management, a risk more people need to know about (St-Onge 2017).
- Performance enhancement and injury prevention. Studies on basketball players have shown that getting enough sleep correlates with improved performance and fewer injuries (Walker 2018). In fact, research has shown that just one night of partial acute sleep loss can lead to elevated levels of cortisol, which can affect the resiliency of the stress response (Leproult et al. 1997).
- Behavior change. In his book Self-Reg: How to Help Your Child (and YOU) Break The Stress Cycle and Successfully Engage With Life (Penguin 2016), Stuart Shanker points out that it’s tough to resist temptation when stress load is high. He shares stories about clients who made smoother health-related decisions after reducing stress. We all know it’s hard to sleep when stressed, so paying attention to this relationship is essential.
Meditation, mindfulness practices and even naps are emerging in our culture as ways to counteract the effects of our productivity-driven, overstimulated society. Working downtime and rest into the day is part of the sleep solution (Edlund 2010). We’ve got to stop pushing our way through the day, expecting to crash at night and wake rejuvenated in the morning.
Thankfully, stress reduction is an ongoing conversation in the fitness industry and an outcome of regular exercise. We need rest, sleep and recovery to complement exercise effectively.
Fitness Industry Sleep Training
Health coaches and personal trainers are in an ideal position to influence sleep habits—especially since sleep needs are individual-specific, just like nutrition and exercise. There are many ways to get the sleep conversation going in the gym. Here are a few ideas:
INTEGRATING FITNESS AND SLEEP
- Include questions about sleep on intake forms.
- Investigate sleep habits during initial interviews.
- Ask about sleep before personal training sessions.
- Share sleep tips in group fitness classes.
- Take polls on sleep with a show of hands in group fitness classes.
- Administer tests like the Epworth Sleepiness Scale (ESS).
- Guide people to complete a sleep journal (download a free journal at BeverlyHosford.com/sleep).
- Educate people and hold them accountable.
QUESTIONS TO ASK CLIENTS
- How many hours did you sleep last night?
- What time did you get into bed and turn out the lights last night?
- What time did you wake up today?
- Did you wake up at all last night? For how long?
- How rested do you feel on a scale of 1–10?
- What is your stress level on a scale of 1–10?
RESPONDING TO SLEEP DISORDERS
As you investigate clients’ well-being, you may hear about sleep disorders such as snoring, restless legs syndrome, sleepwalking or insomnia. These are reasons to refer to a physician or sleep doctor. Over 100 diagnosable sleep disorders require medical attention.
Sleep doctors need our help. Jerome A. Barrett, former executive director of the American Academy of Sleep Medicine, has highlighted the lack of board-certified sleep medicine physicians and gaps in accredited sleep centers across the country. He recommends that sleep scientists and doctors seek assistance: “Increase the number of those who are qualified to practice sleep medicine by reaching across disciplines to offer an added qualification for other health care providers” (Barrett 2017). Thus, the sleep industry needs the fitness industry.
Addressing the Need for Sleep
Some gyms and corporations are taking the lead. An article on IHRSA.org mentions three companies that are working to get “the lifestyle conversation going immediately”: Avenu Fitness & Lifestyle Studio in Houston; Healthtrax, an 18-facility chain in Newington, Connecticut; and PRO Sports Club in Bellevue, Washington (Hoffman 2017).
In 2017, David Lloyd Clubs offered Napercise, a “40 Winks Workout” targeting tired parents. Nap pods and massage chairs have been appearing at companies like Nike, Google, Zappos and Uber and on some university campuses. At $13,000, a sleep pod is clearly valuable to the bottom line of these companies. Naps aren’t a replacement for nighttime sleep, but when kept short, they do improve concentration, focus, mood and job performance.
Thousands of sleep apps have arrived on the market in recent years. Alas, very few meet criteria for functionality, quality and content for sleep management (Choi et al. 2018). Sleep apps can be problematic because evening screen time can inhibit sleep for 60–90 minutes. It’s better to set the smart device to sound an alarm an hour or two before bedtime and then switch the device off in exchange for a relaxing screen-free period.
Doctors are prescribing an evolving array of home sleep tests that measure brain wave activity, leg movements and breathing to diagnose and treat conditions such as sleep apnea, restless legs syndrome and insomnia. Bear in mind that sleep labs still have the best technology. Sleep studies, often covered by insurance, have people sleep overnight while attached to devices that monitor sleep physiology.
Sleep-related technology is finding its way into home lighting and temperature controls as science discovers more negative impacts of artificial lighting and heating on the body’s internal clocks. The new tools help people acknowledge that the day has come to an end and it’s time to sleep.
Lightbulbs and lighting systems have been built to complement the body’s natural rhythms, though they may not produce results accomplished in controlled studies (McKeough 2018).
Light also affects temperature, so paying attention to both is important (University of Haifa 2017); specifically, exposure to blue light from screens can interfere with the body’s nighttime cooling mechanism, which supports sleep. Gel and water pads on the market account for differing temperature needs of bed partners. Moona is a “smart” pillow that cools the body down and learns the user’s sleep rhythms, adjusting to support the various stages of sleep.
Though these devices show promise, getting outside every day and synchronizing with your environment is still a primary goal when striving for high-quality night sleep.
Building Good Sleep Habits
The consensus of sleep experts and research studies suggests that optimal outcomes depend on these essential sleep habits:
- Use a consistent sleep schedule to set the body’s internal clock. Avoid sleeping in and changing bedtime nightly.
- Establish a soothing pre┬¡sleep routine with reduced stimulation.
- Create a sleep-friendly bedroom environment. Make it dark, cool, quiet, comfortable and gadget-free.
- Dim all house lights before bedtime.
- When truly tired, go to sleep—don’t override sleep cues.
- Expose yourself to natural morning and/or daytime light. Get outside for at least 30 minutes daily.
- Avoid caffeine after 10 a.m.
- Eliminate alcohol, nicotine and other chemicals/herbs before bedtime.
- Avoid medications in the evening (unless required by a prescription).
- Nap early (before 5 p.m.) and for under 30 minutes.
- Eat dinner early. Keep food and beverages light.
- Don’t watch the clock or lie in bed awake. Do something relaxing and screen/light-free.
- Follow through—make sleep a priority and part of your routine.
Insomnia can result from obsessing over lack of sleep. Implement sleep changes gradually, emphasizing the goal of committing to a regular bedtime and a regular rising time. Without this commitment, efforts to achieve the needed 7–9 hours nightly can be frustrating.
See also: Tips for a Better Night’s Sleep
FOOD, BEVERAGES AND SUPPLEMENTS FOR SLEEP
Foods thought to help with sleep include turkey, fish, oatmeal, eggs, kiwi, cherry juice and walnuts. Nutrients in these foods do have connections to sleep mechanisms such as muscle relaxation and melatonin release. Keep in mind, however, that there’s no specific research supporting recommendations for these or other foods. Note that candy, cookies and chips are not on any list of sleep-friendly food.
Research on caffeine and alcohol, meanwhile, is clear: Both interfere with sleep. Caffeine stays in your system for up to 12 hours, potentially delaying sleep, and alcohol affects the quality of sleep. Cutting out these two beloved substances can drastically improve sleep and may eliminate the need for them altogether once you experience the alert, calm existence that can result from better sleep.
Supplements such as ginkgo biloba, glycine, valerian root, magnesium, chamomile and lavender are common sleep aids. While they may help you relax, they won’t necessarily overcome erratic sleep habits—and, if consumed as tea, the herbs may send you to the bathroom at night.
Melatonin is a popular sleep supplement. In natural form, it is the hormone that is secreted at dusk each day to signal your body about nighttime. With a regular routine you shouldn’t need to consume it, although it can be beneficial for circadian rhythm disorders and time zone travel; it may also benefit the elderly.
In a recent study of melatonin supplements, content was found to range from -83% to +478% of the labeled content (Erland & Saxena 2017). In addition, serotonin (5-hydroxytryptamine), which is used for neurological disorders, was identified in eight of the 31 supplements at levels of 1–75 micrograms. As with all supplements and drugs, use caution and do your research.
A 2017 meta-analysis by Sateia et al. on individual drugs commonly used to treat insomnia came up with a rating of “weak” for all 14 drugs. Sleep medicine may help you to fall asleep, but it doesn’t fill the need for sleep quantity and quality.
Realizing the Power of Sleep
The more we learn about sleep, the clearer it becomes that it’s the third pillar of health—along with diet and exercise. As the author and researcher Matthew Walker notes, the other two pillars crumble without sleep.
Unfortunately, many of us have lost the feeling of being fully awake and alive. We need to be awake in a way that supports sleep, and we need to sleep well enough to maximize our time awake. Sleep and wakefulness are yin and yang, night and day. They operate best when balanced for the individual.
Integrating sleep within the fitness industry can help people reach all of their health-related goals. We just have to wake up to the possibilities.
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