Some Recurring Sleep Myths: Television versus Melatonin

When I discuss sleep issues with patients, specifically issues which may result in lest rested sleep, I frequently hear beliefs about sleep that are... well, just not true. I thought I would address a few common ones which frequently come up in conversation and explain them a bit.

1. Television before bed.

When I tell people that they should have a regular pre-sleep ritual before bed that does not include the television, such as reading 1 short story from a book collection/1 magazine article/1 newspaper article, they often tell me that watching TV is their ritual and they have to do it if they want to relax and fall asleep. That is actually just not true, if they are implying that it is the only thing that will or would work for them. It may be the only thing tried so far, or perhaps the easiest regular thing to do before bed, but not the best thing to do before bed. And it is often quite counterproductive.

I realize that studies suggest at least 80% of people (in America) keep a TV in the bedroom and at least 50% of people's dominant pre-bedtime activity is watching television. That makes it common... but common has no relationship to what is actually good for us.

Our brain and body have the great capacity to pick up new habits and rituals and we can easily replace TV with a book if desired. The reality for me as much as anyone else is that it is easier to watch TV passively than to actively read a book's short story, so we might gravitate to the easier-to-accomplish ritual.

But what's so wrong with TV? Well, it's not inherently bad; the timing is just all off. First of all, most TV shows are designed to at least hold your attention in 30 or 60 minute increments, so many people will drift off after they reach at least one "stopping point" which is the end of some segment of watching in one or most of these increments. The commercials are usually louder than the show, so they will continue to interrupt the person's sleep after they drift off, until the timer turns the TV off, the first restroom break, or all night. Ongoing flashing lights from the TV can have the same interrupting quality as well.

But the bold light of the late night TV/ipad/computer/laptop/iphone in your face up close is the frequent culprit. Long before we all lived in houses with artificial suns, we woke and slept to the sunrise and sunset. This was so long a part of our history that we have a special unconscious anatomic pathway for light, separate from the pathway for light that we respond to and this pathway even intact in most blind individuals. This is a whole different pathway for light that enters our pupil and hits our retina at the back of the eye. Instead of heading on to the back of our head (occipital lobe) to be interpreted as images, this pathway heads down on a smaller tract to a part of the brain called the hypothalamus, before communicating back a part of the brain called the pineal gland.

Now this is where it get's interesting:

The pineal gland is where melatonin is released, and melatonin is one important(of many) neurotransmitters that communicates to your brain that it is time to start orchestrating sleep.

Melatonin is chemical night.

It makes sense. You, as a conscious human, cannot consciously demand that your brain start orchestrating dozens of neurotransmitters into place to start negotiating sleep, just as I cannot consciously understand my desktop computer enough to demand the pixels to show me a picture of the melatonin molecule. But I can click on Google to search for it and let my computer work on its automatic, pre-programmed setup to show it to me. In the same way, the sun sets and the brain's automatic plans start, stimulated by melatonin at almost the same time each evening/night, to help you go to sleep.

So, what does this have to do with Television? It's an artificial sun, an... anti-night if you will. It shuts down the production of melatonin because that light pathway I spoke of above is not stimulated by darkness as it should be. Reading under moderate indirect light (like it's predecessor, campfire) does not inhibit melatonin's release.

So again, our sun, and our little mini-electronic suns (like the TV) suppress melatonin and therefore suppress sleep momentum. Nighttime (darkness), lets melatonin rise so the complex mechanisms can start pushing our brains into sleep. 

If you're watching television, you're telling the body the sun's still up, the day's still happening. This distorts our baseline circadian clock that we develop over days and weeks in our background, the clock that helps you wake without your alarm in the morning after awhile (if you're getting enough good sleep).

So, develop a better pre-sleep ritual strategy than TV. Your physiology will thank you for it.

In the most straight-forward way I know, I have summarized the extra pathway for light I mentioned above:

The Retinohypothamic Tract:

Lack-of-sun/Night/Darkness

 to

Pupil

to

Retina

to

Hypothalamus (The suprachiasmatic nucleus to be specific)

to

Down into the Midbrain & Brainstem

to

Pineal Gland

and

Voila!.... Melatonin



Good Sleep Habits & Hygiene 101

Now before we talk about good sleep hygiene, we need to talk about religion. And you don't have to be religious to appreciate the relevancy. Most belief systems do NOT believe that religion IS the faith. Faith is the actual personal connection a believer has with their deity. The religion is the body of rituals that humans do to help guide our faith (not replace it) or to provide a conduit for transendance to take place as a manifestation of our faith. For instance, prayer to Allah, the God of Moses, or Jesus is NOT faith.... but it is a ritual communication that leaves one open to experiencing a deeper connection/faithfulness. Now, I realize that is a big introduction for a blog entry about sleep. But what is true for one aspect of our lives is often true for other aspects of our lives and our health as human beings as well.

What I'm trying to argue is that we are beings of ritual; the importance of this fact, that we often neglect as busy people.

We seek ritual and our comforted by it. It is ingrained in us to seek it out in our daily routines, the way we approach our faith, and what we try to do with our loved ones as a mean to express our affection, even though it doesn't replace that affection.

So there are habits which can help sleep but really, most of the these habits should also be a constellation of habits at night before bed to create a sleep ritual... which is not a replacement of sleep, but acts as a conduit psychologically to prepare us for a better night's sleep.And study after study support the truth that the pre-bedtime ritual, if done... "religiously," WORKS WELL.

Keep a diary of your ritual and sleep schedule. See if you don't notice a difference after one month.

1. Regular nighttime pre-bedtime ritual to promote good sleep:
--Take the television out of you bedroom. Do not watch television, use your ipad or computer 45 minutes before bedtime. Block other sources of excessive light as well.
--Turn the lights low (but not so low that you strain your eyes), and have a comfortable chair available in another room to sit in. Read a bit of the following before bed: 1 short story from a book of short stories, or 1 magazine article, or 1 newspaper article... but do not read a fantastic novel in your bed.
--Have your sheets washed in a fragrant detergent, such as one that smells like lavender that will help you associate that smell with bedtime each night.
--Turn your clock around when you get into bed so you don't let your eyes linger on the time as a source of frustration if you are taking a few minutes loner to fall asleep
--When you first start laying there to fall asleep, practice deep, slow breathing for about 3 to 4 minutes.
--Finally, only get into bed when you are sleepy. If you are not sleepy, then get back out of bed and do something (non-stimulating) until you are tired again.

2. Keep a regular sleep and wake schedule each night, including weekends when possible.

3. Exercise 30 minutes 3 times a week at least. It reduces stress which inhibits the ability to fall asleep. It improves circulation and oxygenation to the brain to help promote sleep. Now, some say you should avoid it 2 hours before bed because it can be stimulating. While this is true for most people, I cannot argue that this is universally true and for some people it tires them out in a way that helps them fall asleep actually, so this is something you'll have to find out for yourself. BUT I do believe you should be exercising (at least taking some walking laps around your block for 30 minutes each day to every other day) to find out.

4. Do not take naps during the day. Taking a nap during the day and then difficulty sleeping at night, is analogous to having a snack before dinner and then wondering why you're appetite is ruined. If you DO take a nap in the afternoon. It should be a "power nap" only, no more than 30 minutes.

5. Use your bed only for sleep and intimacy with your partner. If you associate your bed with your "home office" or "craft table," then you will be less likely to associate it subconsciously with sleep.

6. Clean your room. A bedroom that is clean reduces the feeling of things being "out of order," reducing a subconscious stress.

7. Do not drink alcohol as a sleep aid. When alcohol wears off, it actually causes rebound stimulation, waking you up at 2 to 4 am usually and making it difficult to fall back to sleep at that time.

8. Don't drink caffeine (tea/colas/coffee/even "decaf" coffee) after 2pm. Some people are extra sensitive to caffeine and it's effects can last 8 hours or more in those people.

9. Turn down your thermostat and shave off a layer of sheet. Those who sleep in a room that is hotter-than-normal slept LESS well than those who slept in a slightly cooler room. A temperature of 70 to 71 degrees is better than 75 to 76 degrees as a sleep-promoting temperature.

10. Be sure to look up the side effects of each one of your medications to make sure you're taking the medications at the right time of day. For instance, HCTZ, a common antihypertensive medication should always be taken in the morning because it can cause a person to urinate frequently during the night. Some antidepressants such as Effexor have mild stimulating effects and should be taken in the morning as well. If you are not sure after looking them up, write them down and quickly ask your doctor.

11. Keep track of later water intake. Even if your bladder can hold the extra water, sometimes a full bladder will subconsciously make your sleep more fitful in the early morning hours before you finally awaken for the day.

12. An hour before bed, write down your "To Do List" on a sheet of paper, so you don't have to worry about forgetting something important. Once you make the list, you can realize that there's nothing that can be done about the list that night, and that the list will be there for you in the morning... after your good night's rest.

13. Avoid spicy or heavy food before bed. They can increase symptoms of reflux more than others. And avoid excessively sugary food as well. It can cause abrupt changes in blood sugar that stimulate the mind. Some foods as a light snack may help promote sleep, such as foods higher in tryptophan:

Baked potatoes with their skin, Bananas, Beans, Cheddar, Cottage Cheese , Eggs, Fish, Gruyere (a type of Swiss cheese), Hazelnuts, Heated milk, Hummus, Lentils, Kelp, Meat (including red meats), Peanuts, Rice, Roasted Pumpkin Seeds, Sesame Seeds, Shellfish, Soy Milk, Soybean Nuts, Sunflower Seeds, Tofu, Tuna, Turkey,Yogurt

Now, that being said, a high-calorie snack habit will eventually be bad for your sleep if it causes you to gain weight and worsen apnea over time.