Besides Diet and Exercise…Sleep!

This article was originally published as an op-ed in The Jerusalem Post on 23 July 2023:

With all of our emphasis on healthy eating and exercise, it is easy to forget that there are actually 6 pillars of lifestyle medicine. The other four are:

  1. not using substances like tobacco, alcohol and drugs,
  2. managing stress,
  3. good social integration, and
  4. making sure to get a good night’s sleep.

Sleep is a category, where as a society, we are falling very short.  Why aren’t we sleeping enough and what can we do to fix this?

We are coming off a very successful conference for Kosher whole-food, plant-based eating here in Jerusalem.  It was extremely well attended and the presentations by the three physicians were outstanding.  There is no question regarding which lifestyle behavior has the biggest effect on our health. The food we consume is certainly number one.

More than 30 years ago I would have told people that exercise is the most important, then diet, not smoking, and finally, sleep.

Sleep as a priority

Lifestyle is important in its totality. With all of the research that has come out over the past 4 decades, we know that food is king. It might surprise you, but I would say sleep hygiene may now be number 2—maybe even more important than exercise.

Society has changed a great deal over the last 150 years. The invention of the electric light bulb changed everything.  Now using artificial lighting (not from sunlight) is the norm.  It has enabled us to stay up later and wake up earlier.

New technology

Over the past 35 years, with the advent of accessible rapid electronic communication, we can email, message, and voice call anywhere in the world for little or no money.  This has given businesses an opportunity to do worldwide business from one location.  It is now simple and easy to video, email, or call anyone in the world at any time!  Staying up to work or be in touch with relatives and friends has caused sleep deprivation and a malfunctioning circadian rhythm.

Taking devices, such as smart phones and tablets, into the bedroom is now a huge contributor to the problem.  Dr. Sharon Slater is a clinical psychologist who works primarily with teenage females. Dr. Slater recently conveyed to me how sleep deprivation, due to teenagers being up much of the night on their devices, contributes in no small way to countless mental health and cognitive issues.

Not sleeping enough

According to research done at the Mayo clinic, not sleeping enough results in impaired memory, slower reaction times, lack of alertness, and grumpiness.  Tired people are less productive at work, less patient with others, and less interactive in their relationships. The National Highway Traffic Safety Administration in the United States reports more than 100,000 crashes each year due to drivers falling asleep at the wheel.  Needless to say, for those of us who exercise regularly, we all know how unproductive a session can be when we have failed to get a good night’s sleep. More recent research shows how sleep deprivation can contribute to both higher cholesterol, high blood pressure, type 2 diabetes, and overweight/obesity.

How much sleep?

It is imperative for an adult to get 7-9 hours of sleep at night that encompass the three stages of pre-REM sleep and then REM sleep.  We need to go through 4-6 cycles of that each night and REM sleep (that really deep, restorative sleep). Each cycle should take up about 90 minutes.  If that is impossible (for instance you are a night shift worker), at least find time in the daytime to take an hour nap.

Getting practical

What can we do to enhance our sleep hygiene? Dr. Saray Stancic is a board-certified lifestyle medicine doctor. She also reversed all the symptoms of her Multiple Sclerosis. Here are some suggestions from Dr. Stancic’s book What’s Missing from Medicine, on her extensive sleep research.

To fall asleep
  • Your bedroom should be cool, dark, and quiet.
  • Keep the bedroom for its purpose, a place to sleep. Not for reading, working, and being on the computer.
  • Have a good quality mattress; anything beyond 14-15 years is probably not helping you sleep well.
  • Set a bedtime routine. It can be a shower or bath, a few minutes of meditation, deep breathing, or other means of relaxation.
In order to stay asleep
  • Don’t eat or drink two hours before bedtime.
  • Use the bathroom before getting in bed even if you don’t feel an urge to do so.
  • If you drink alcohol, don’t before bed. It decreases the length of REM sleep.
  • Only drink or eat caffeinated drinks and food in the morning hours.
  • Smoking is a stimulant. If you haven’t quit, it’s time!
  • SCHEDULE YOUR SLEEP! Try as best you can to go to sleep and wake up at the same times daily.
  • Smart phones, tablets, and computers are stimulants. Studies show longer screen time equals less sleep.
  • Turn off your alerts and notifications when you get in bed—best to turn the phone off one full hour before bedtime.

Better sleep, better health

My clinical experience has shown me that when it comes to losing weight, my biggest successes are those who get a good night’s sleep. I have also seen people who had trouble lowering their blood sugar, better able to do it once their sleep hygiene improved.

Lack of sleep will also disrupt your metabolism and will cause you to secrete more of the hormone cortisol.  This will increase your appetite and cause you to crave fatty foods.  If you try all of the tips above over a period of time, and you still can’t sleep, seek professional help from a sleep center or a physician that specializes in sleep disorders.  Getting adequate sleep is a key ingredient in order to “add hours to your day, days to your year, and years to your life.” 


One Comment

  1. Samantha Hambling July 24, 2023 at 5:25 pm - Reply

    My daughter had terrible insomnia as part of her medical conditions (EDS & POTS) which certainly didn’t help. She was referred for CBTi and after 6 weeks of group therapy she was sleeping so much better. All of what you suggested above plus a few more ideas, but not thrown at the group all at once as that would seem impossible. It really works!

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