A Holistic Exploration of Sleep-time Struggle

Article published at: Agora London Mar 15, 2024
A Holistic Exploration of Sleep-time Struggle
All Hormone Health

Did you know that 1 in 5 of the UK's population experience sleep issues? 

The quality of sleep has become an increasingly serious concern in modern times. In this article, I will explore essential physiological aspects of sleep, providing insights from a holistic perspective that includes contributions from medical, psychological, nutritional, and physical training experts. By examining these interconnected elements, we aim to offer comprehensive advice that addresses the multifaceted nature of sleep.

So, what defines a healthy sleep?

Healthy sleep comprises three main components: duration, continuity, and depth. Achieving quality sleep can be influenced by various factors such as late-night screen use, exercising close to bedtime, diagnosable sleep disorders  and, of course, stress.

The presence of darkness aids in the production of the sleep hormone 'melatonin,' inducing sleepiness at bedtime. On the other hand, exposure to natural daylight helps suppress melatonin, making us feel more awake. As we age, changes in hormone levels can lead to sleep disturbances, and vice versa, creating a potentially vicious cycle. Sleeplessness can impact around 10 different hormones, causing changes in appetite, mental well-being, cardiac health, and even fertility.

During peri- and post-menopause, numerous women contend with challenges related to falling asleep or remaining asleep. This may coincide with issues like hot flashes, leading to increased awakenings, restless legs syndrome, nocturia (night-time urination), and sleep-disordered breathing, such as obstructive sleep apnea. An inadequate amount of restorative sleep can exert ramifications across all facets of life, often manifesting as low mood, heightened anxiety, fatigue, and more.

Recent surveys (see list of sources at the end) highlighted some interesting data:

  • 74% of UK adults reported a decline in quality sleep over the past 12 months
  • Young adults aged 35-44 got the least sleep, with almost 50% only getting 5-6 hours per night and only 33% getting the recommended 7-8 hours
  • 1 in 10 people were getting only 2-4 hours of sleep per night.
  • Approximately 1 in 10 adults in Europe have chronic insomnia and the overall prevalence is increasing
  •  1 in 3 adults in the United States reported not getting enough rest or sleep every day.

The typical individual dedicates approximately one-third of their lifespan to sleeping. During this period, our bodies engage in replenishing energy reserves and carrying out necessary repairs. During this time, our minds categorise and store the memories accumulated throughout the day. The required amount of sleep varies based on factors like age, gender, overall health, and other contributing elements. Furthermore, our sleep patterns undergo transformations as we age, influencing the quality of our sleep. Studies have revealed that individuals consistently obtaining less than six hours of sleep per night face a notably heightened risk of stroke and heart disease.

What causes sleep challenges? 

Typically, they stem from a misalignment among circadian rhythm, sleep/wake homeostasis, and environmental factors. The circadian rhythm, a 24-hour cycle governing the body's internal clock, regulates vital functions like the sleep-wake cycle. Disruptions to these rhythms, influenced by environmental cues like light, can lead to sleep issues such as insomnia, impacting both physical and mental health. Additionally, sleep/wake homeostasis signals when rest is needed, accumulating a sleep debt throughout the day. Properly timed naps play a crucial role in recharging energy levels.

Stages of Sleep.

The sleep process involves four distinct stages that individuals cycle through multiple times nightly, comprising two sleep types: REM (rapid eye movement) and Non-REM.

Non-REM sleep induces a reduction in muscle tone, body temperature, heart rate, and blood pressure. Upon initially falling asleep, you enter Non-REM sleep, encompassing three progressively deepening stages crucial for restful and reparative sleep.

In Stage 1, characterised by light sleep, you may easily wake in response to slight sounds or movements, representing a transitional state between wakefulness and sleep. Stage 2 follows, still a light sleep but slightly deeper than previous stage, progressing to Stage 3 if undisturbed.

Stage 3, also known as slow-wave or deep sleep, involves a profound sleep state with decreased responsiveness to external stimuli, potentially causing disorientation upon waking. Final Stage 4, REM (rapid eye movement), signifies a phase where the body relaxes, and the brain intensifies blood flow to process the day's events. REM sleep supports learning consolidation and the development of social and emotional abilities, accompanied by dreaming and deep relaxation.

Each cycle spans approximately 90 minutes, and a typical night's sleep comprises five cycles. Disturbed sleep often involves numerous shortened or incomplete cycles. REM sleep duration increases with each cycle, while Stage 3 sleep decreases.

Adequate and quality sleep is vital for overall health. Insufficient sleep not only impairs functioning but can also contribute to long-term health issues. Sleep plays a crucial role in regulating mood, enhancing memory, and maintaining overall health, weight, and energy levels.

We posed several questions about sleep deprivation to our experts. Here are their responses.

1) What are the primary health risks associated with chronic sleep deprivation?

Dr Anita:

If we consistently sleep badly the health risks are significant. Lack of sleep impairs the disease-fighting ability of our infection fighting white blood cells, lymphocytes, also known as T-cells and the production of inflammatory cells called cytokines which can in turn lead to inflammation in the body and accelerated cellular ageing.

Other primary health risks:

Cognitive impairment 

Poor sleep can lead to memory loss, poor concentration and impaired cognitive function. Risk of neurodegenerative diseases and cognitive decline in the long term.

Mental health

Increased risk of anxiety, low mood and depression.

Hormone Imbalance 

Imbalance in our stress and sex hormones, including cortisol, growth hormone, fertility, and libido.

Heart Disease 

Increased risk of hypertension, heart attacks and strokes

Frequent infections

Suppressed immune function can make individuals more susceptible to infections and illnesses and impaired wound healing.

2)  Please elaborate on the potential impact of sleep deprivation on skin health and any specific dermatological concerns or issues that may arise as a result.

Dr Anita:

Circadian rhythms refer to the 24 hour oscillations in behaviour and physiology that we see in every cell of our body, including our skin. Circadian rhythm optimises cellular functions and helps our skin to adapt to the environmental challenges it is exposed to on a daily basis. Night-time is the ‘rest and repair’ time for every single cell in our bodies, including our skin. We know that at night the skin behaves very differently. We see some interesting changes. The PH of our skin raises, the epidermal barriers weaken, blood flow increases, sebum production reduces and keratinocyte proliferation increases. The skin is in recovery and rebuilding mode at night and more at risk of moisture loss at night. Our skincare strategy needs to support these cyclical changes.

3) How can inadequate sleep impact a person's physical health, and are there specific conditions exacerbated by sleep deprivation?

Dr Doyinsola Kuku :

When it comes to how sleep deprivation impacts health, it's essential to understand a few key points. Insufficient sleep can disrupt the balance of hormones in your body, particularly cortisol, often referred to as the stress hormone. Elevated cortisol levels can hinder insulin function, trigger inflammation, and elevate blood pressure, all of which can escalate the risk of heart issues. Prolonged lack of sleep can also lead to chronic inflammation, which is linked to a condition called atherosclerosis, where plaque accumulates in arteries, narrowing them. Inflammation plays a significant role in the formation of arterial plaque, heightening the risk of heart problems. Additionally, insufficient sleep can disturb the balance between the sympathetic and parasympathetic branches of the nervous system, resulting in increased heart rate, elevated blood pressure, and reduced heart rate variability, all of which can adversely affect the heart. Sleep deprivation can also impact the lining of blood vessels, reducing their ability to dilate and increasing resistance to blood flow, further elevating the risk of heart issues. Lastly, inadequate sleep can disrupt how the body manages sugar and insulin, raising the likelihood of developing type 2 diabetes, a significant risk factor for heart problems due to accelerated plaque buildup in arteries and increased susceptibility to heart-related events.

4) Are there any medical interventions or treatments you recommend to improve sleep quality and address mental health concerns related to sleep deprivation?

Dr Doyinsola Kuku:

Addressing sleep deprivation and its impact on mental health involves practical steps individuals can take to enhance sleep quality and overall well-being. Establishing consistent sleep schedules, incorporating relaxing bedtime routines, and creating optimal sleep environments are key behavioural changes that signal to the body it's time to wind down. Avoiding stimulating activities before bed, limiting daytime naps, and maintaining a comfortable sleep environment are crucial for restorative sleep. When behavioural changes alone are insufficient, consulting with a healthcare provider about sleep medications is advised, although caution should be exercised due to potential side effects and dependency risks. Additionally, for those experiencing breathing issues during sleep, interventions such as positional therapy or the use of continuous positive airway pressure (CPAP) machines may be beneficial, following consultation with a healthcare provider. Prioritising sleep hygiene by minimising caffeine and alcohol intake, keeping the bedroom conducive to sleep, and incorporating regular exercise into daily routines further supports optimal sleep and mental well-being. By implementing these strategies and seeking professional guidance when needed, individuals can proactively improve sleep quality, boost mental health, and foster overall well-being.

Dr Anita: 

  • Blue light suppresses production of our sleep hormone melatonin, which is made in the pineal gland in our brain and also in our gut. No blue light exposure after 7pm. That includes TVs and phones
  • Eating late at night can impact sleep in several ways. Consuming a large meal close to bedtime can lead to indigestion and discomfort, making it difficult to fall asleep. Eating late at night can disrupt the body's natural circadian rhythm, as the digestive system becomes active when it should be winding down for the night. This can interfere with the body's ability to enter the restful stages of sleep.
  • Magnesium before bed - I totally rate this as a night-time supplement. Magnesium helps by regulating the neurotransmitters and ultimately calming your nervous system in readiness for sleep. It also works alongside melatonin, a hormone your body produces naturally, to control your body clock and sleep-wake cycles.

Dr Tesh:

The best intervention is developing good habits around sleep , such as a pre-bed routine. This routine could involve things like journaling, stretching, winding down with a book or audiobook, and a little herbal tea. A doctor might help by looking for an underlying cause for the poor sleep. For example, chronic poor sleep or waking through the night could be due to menopause, anxiety, depression, stress. They would then try treating the root-cause problem , for example, using HRT for menopause; counselling and/ or medication for mental health problems.

5)  In your experience, what role does sleep play in overall mental health, and how does addressing sleep-related issues contribute to mental well-being?

Dr Doyinsola Kuku

Ensuring adequate sleep is vital for both mental health and overall well-being. Quality sleep supports effective emotional regulation, aiding in the management of stress, anxiety, and mood fluctuations. Additionally, it plays a crucial role in cognitive function, enhancing memory consolidation, problem-solving abilities, and decision-making skills. Furthermore, restorative sleep promotes mood stability, reducing the risk of mood disorders such as depression and bipolar disorder. Lastly, sufficient sleep supports stress management by bolstering the body's capacity to cope with stressors, thereby lowering the likelihood of developing anxiety disorders and experiencing panic attacks. Prioritising good sleep habits and addressing any sleep-related concerns are essential steps towards enhancing mental health and overall quality of life.

Dr Tesh :

Tackling chronic sleep problems can have a profoundly positive impact on someone’s quality of life. You can regain your zest for life, and you’re also helping improve your overall longevity. So it’s definitely a mountain worth climbing! Sleep problems are some of the most common issues I see in clinic, and every person requires a tailored approach. If something doesn’t help your sleep, it is worth trying different things until something clicks.

Psychotherapist Lorraine Collins added:

During sleep, our brain rests, recovers, and reorganises. Sleep offers a chance for a mini-detox of the mind, providing a crucial opportunity for overall mental rejuvenation. Sleep deprivation can significantly impact our well-being, affecting the way we perceive ourselves and approach daily tasks. Simple activities may seem overwhelming as our ability to think clearly diminishes. When deprived of sleep, irritability, heightened sensitivity, and understandable emotional reactions may emerge, resulting in an 'emotional hangover' that affects our interactions with loved ones. Sleep deprivation also impairs cognitive function, memory, decision-making, and coordination. Moreover, prolonged sleep deprivation can lead to more severe health issues, including obesity, diabetes, cardiovascular disease, and a shortened life expectancy. It also has significant impacts  on mental health, contributing to conditions like depression and anxiety.

6) Can you recommend therapeutic techniques or strategies for managing the psychological impact of sleep deprivation and promoting better sleep hygiene?

Psychotherapist Lorraine Collins:

I encourage my clients to prioritise rest, considering it non-negotiable. Rest provides us the opportunity to power down and fosters the practice of good sleep hygiene. Ideally, your phone should be out of sight in the bedroom. However, if you’re really struggling, consider switching your phone to the dark mode setting. This reduces the blue light, which inhibits the production of melatonin, the hormone responsible for regulating sleep. There are helpful resources out there now in the form of sleep apps and podcasts.  I particularly like The Music and Meditation podcast with Nao  https://www.bbc.co.uk/programmes/ There’s also (Sleep Well) by Michael Mosley  https://www.bbc.co.uk/programmes/  and Calm App https://www.calm.com/  has good  night time content/stories to help you drift off to sleep. Another strategy when the mind is racing is to perform a 'brain dump.' Write down everything that might be swirling around in your mind and get it down on paper. This has the same therapeutic effect as flow writing, where you let the stream of consciousness flow from your mind (it doesn’t have to make sense, so don’t overthink it).

Now, let's hear the perspectives of our nutritionist and trainer regarding sleeping issues.

Trainer Rachel Louise:

1) How does lack of sleep impact physical performance and recovery, and what role does it play in achieving fitness goals?

A lack of sleep can significantly impact both performance and recovery, influencing training outcomes, particularly if you are actively working to change your body composition. If you're exerting effort in the gym without seeing the desired results, I recommend examining your sleep patterns before adding more training sessions to your week. Insufficient sleep quality can also lead to cognitive dysfunction, hindering recovery from daily stress and causing increased inflammation. 

2) Are there specific exercise routines or practices that can positively influence sleep quality and contribute to mental well-being? 

While there isn't concrete evidence on the most effective approach, if you find it challenging to fall asleep, it's not recommended to postpone your workout until the end of the day. Late-day exercise can overstimulate, making it harder to sleep, especially if you have an early morning. Engaging in calming activities like meditation, journaling, or yin yoga can naturally prepare your body for a restful night's sleep.

3) Can you recommend exercises or activities that are particularly beneficial for individuals dealing with both sleep-related challenges and mental health concerns? 

Exercise supports mental well-being, but it's not a substitute for therapy. If you're facing mental health challenges, it's crucial to seek professional advice. Activities like walking, meditation, or gentle yoga can alleviate stress and promote a positive chemical balance in the brain. Regular movement is beneficial for our mindset, so prioritising it consistently is key for our overall health.

Nutritionist Stephanie Smith

1) From a nutritional standpoint, how does sleep deprivation affect dietary choices and overall nutritional well-being?

The significance of sleep extends to the intricate web of hormones that regulate hunger and cravings. Sleep deprivation disrupts the delicate balance of these hormones, such as ghrelin and leptin, leading to an increased appetite and cravings for high-calorie, often unhealthy foods. Elevated ghrelin levels stimulate hunger, while reduced leptin levels, which typically signal satiety, result in an inability to feel full. Prioritising sufficient and restful sleep becomes crucial in maintaining a balanced hormonal environment, promoting better appetite control, and supporting overall well-being.

2) Are there specific dietary recommendations to support better sleep quality and mitigate the impact of sleep deprivation on mental health?

  • Eat at least two hours before bedtime to allow for proper digestion and prevent going to bed hungry, which can lead to night wakings. Consider a small, sleep-promoting snack like warm milk or a light protein/carbohydrate option if hungry.
  • Ensure sufficient magnesium intake through whole grains, leafy greens, nuts, seeds, and more. A magnesium supplement or a relaxing magnesium salt bath before bed can aid sleep, relieve muscle tension, and provide stress relief.
  • Tryptophan, an amino acid, plays a role in creating serotonin and melatonin, promoting sleep and managing mood. While evidence on tryptophan-containing foods is limited, supplements may enhance sleep quality. Tart cherry juice, containing melatonin, could also contribute to a good night's sleep.
  • Limit caffeine intake before 2 pm and opt for herbal tea (like chamomile or passionflower) or alternative lattes in the evening. 
  • Avoid sugar before bed to maintain stable blood sugar levels during the night.

  • 3.
    How can certain nutrients or dietary patterns contribute to or alleviate symptoms associated with sleep-related mental health issues?


    My advice is to focus on obtaining adequate nutrients rather than adhering strictly to a particular diet. Prioritise a well-rounded, balanced diet that includes sufficient vitamins, minerals, fibre, protein, healthy fats, and complex carbs. Consider drawing inspiration from the Mediterranean diet, which emphasises wholefoods, plant-based options, whole grains, extra virgin olive oil, nuts, seeds, legumes, and favours fresh fish and seafood over meat. This diet has been linked to mental health benefits and provides all the nutritional elements to enhance both the quality and quantity of sleep.

    In conclusion, addressing sleeping issues requires a comprehensive approach encompassing medical, psychological, nutritional, and training considerations. Seeking professional advice for underlying medical conditions, incorporating psychological strategies to manage stress and anxiety, maintaining a balanced diet rich in sleep-supportive nutrients, and adopting appropriate training practices are all essential components. By acknowledging the interconnected nature of these factors, individuals can empower themselves to improve their sleep quality and overall well-being. A holistic approach ensures a more sustainable and effective path towards a restful night's sleep and enhanced overall health.






    Sleep On It podcast series