Neurotransmitters: Relationship to Sleep Cycle Disturbances
Insomnia is a common condition that significantly affects one’s day-to-day functioning and well-being. More than one third of all Americans suffer from sleep disorders at some point in their lives. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), chronic insomnia is considered to be any type of insomnia that lasts more than six months. Chronic insomnia is associated with an increased risk of depression, anxiety, cognitive dysfunction, daytime fatigue, as well as increased use of health care resources.
The major causes of insomnia are generally divided into three categories. This includes medical conditions, psychological conditions as well as environmental problems. Psychological conditions that can affect sleep cycle regulation including depression and anxiety. Approximately 40% of people that suffer from depression also have insomnia. Depression can contribute to significant alterations in REM (Rapid Eye Movement) sleep. Stress can also shift the levels of our hormones, including the stress hormones cortisol and DHEA. Disruptions in cortisol levels throughout the day and night can significantly impact our sleep/wake cycle.
The sleep/wake cycle is regulated by a complex biological process that works like an internal clock. Within our brain, the hypothalamus, our body’s anatomic time keeper, is central to the release of the chemical melatonin. Melatonin helps to regulate the sleep/wake cycle. Additionally, several neurotransmitter systems play a role as well. This includes the Serotonergic, Dopaminergic, Acteylcholinergic, and Norepinephrenergic neurons.
Some additional examples for causes of insomnia are listed below:
- Medical conditions - Fever, pain, infection, cardiac, neurological, endocrine, pulmonary, gastrointestinal conditions, adrenal dysfunction and thyroid disorders, HPA axis deregulation. Medications including antidepressants and stimulants can also cause insomnia. Rebound insomnia from benzodiazepine and hypnotic agent use can also occur.
- Psychological conditions - Depression, anxiety, panic disorder, thought disorders, stressful or life-threatening events, bereavement.
- Environmental problems - Shift work, jet lag, noise or frequent intrusions.
Proper Sleep Habits
The following includes a list of behavioral techniques that may help patients with sleep cycle disturbances:
- Practice relaxations techniques before bedtime.
- Avoid stimulating activities three hours to bedtime including intense exercise. Exercise during the day helps promote restful sleep at night.
- Avoid naps throughout the day.
- Maintain a regular sleep schedule, set a time to get up in the morning. Early rising and early to bed mimic the body’s natural day/night cycle. A "night owl" schedule disrupts the body’s natural sleep/wake cycle.
- Avoid caffeine and stimulants.
- Avoid consuming large meals at least two hours prior to bedtime.
- Avoid watching the clock while in bed. This creates more anxiety.
- Avoid dehydration as well as over-hydration prior to bedtime (decrease visits to the bathroom throughout the night)
- Assess your sleep environment. Be sure that the bed and pillows are comfortable and that room temperature is ideal.
Up until the 1950's, most people thought that sleep was a time the body lays dormant. However, we now understand the brain is very active while we sleep. In fact, sleep is crucial for the body to function and maintain optimal health.
Sleep plays a large role in the body's ability to cope with stress, or what we call "the stress response." The body has natural systems in place to control both physical stressors (over-training, diseases, toxic exposures, etc.) and emotional stressors (worry, anxiety from work, financial stress, the loss of a loved one, etc.). In both cases, the body responds to stress in the same way- by releasing stress hormones such as cortisol that is designed to protect the body on the short term from the stressful event. However, most Americans have some form of stress on a daily basis. Over time, cortisol elevations cause shifts in other hormones (such as DHEA, Estrogen, Progesterone, and Testosterone) as well as neurotransmitters. This often leads to sleep cycle disturbances, which then causes more stress on the body; and the cycle continues.
There are many ways to naturally restore sleep cycle disturbances. Testing your neurotransmitters and cortisol levels can be helpful to pinpoint what type of support will provide the fastest relief. However, there are more basic techniques that can be implemented for relief such as belly breathing techniques, yoga, prayer & meditation, or other stress management therapies. Hypoglycemia can also be a culprit for sleep cycle problems. It is important to maintain healthy blood sugar levels throughout the day for healthy sleep cycles at night. Try to avoid heavily processed and highly refined foods, especially in the evening.