Sound Sleep, Super Salubrity
The importance of sleep in establishing salubrity (health).
Photo by David Clode on Unsplash
Both Ayurveda and modern preventive medicine hold that there are elements of lifestyle that are essential to preventing unwell-ness and disease. In today’s allopathic model, these are referred to as the “pillars of health.”
Each of these pillars alone, if not completely sturdy, can buckle and lead to health challenges. Our generally agreed-upon pillars of health are wholesome nutrition, appropriate and measured movement/exercise, routine stress management, and quality sleep.
Quality sleep. Quality sleep. What is that, and how many of us actually get it?
While that question is hard to answer universally, generally we can piece together that it involves 7-9 hours of sleep nightly for most adults, with at least one 4-hour-long uninterrupted block of sleep in that 7-9 hour window. It is somewhat easier to quantify what number of folks definitely do not get enough sleep. For the sake of simplicity here, we’ll focus on disrupted sleep in adults, using data from the CDC and sleepfoundation.org.
At least 35-40% of adults in the US don’t get enough sleep based upon sleep volume (“short sleep duration,” defined as less than 7 hours per night) alone.
50-70 million adults in the US have at least one ongoing sleep disorder of some kind.
9-15% of US adults have disrupted enough sleep that it affects daytime activities.
We know that there is a relationship between short sleep duration and a number of lifestyle diseases and markers of well-being. These include (but are not limited to):
Higher BMI (relative to a single individual’s healthy baseline; this is a larger topic to be discussed separately at a later time)
Type 2 diabetes
High blood pressure/hypertension
Heart and brain blood vessel disease (angina, heart attack, stroke)
Reduced/impaired mental health
Reduced lifespan
We know that there is a similar relationship between poor quality of sleep and these markers of well-being. And again, this is not a complete list.
So, whatever quality sleep is, too many of us aren’t getting it. And the numbers that we have likely greatly underestimate how many people have less-than-quality sleep.
The Ayurvedic perspective on sleep is - to put it simply - that sleep is of top importance. It is considered one of the core bodily urges, referred to as vegas, which one should take care not to avoid or disregard. This is because all of the vegas reflect natural movements, functions, and cycles. When, for example, a person ignores the urge to poop on an ongoing basis, this can result in constipation-like tendencies and retention of digestive gasses, which can in turn contribute to hemorrhoid formation due to straining, etc. When instead a person regularly ignores the urge to sleep, they lose connection to their natural day/night (circadian) cycles, which changes body chemistry and can cause a series of other problems.
A lot of stuff can affect sleep negatively. For the sake of argument, though, let’s assume that sleep issues are due to pushing back at the urge to sleep. Here, sleep hygiene can be corrective.
Some ways to improve sleep hygiene are listed below. These generally are true for most people, though there can sometimes be exceptions:
A consistent sleep schedule and developing regular bedtime habits, including on weekends
Optimizing the sleep environment: it is ideally quiet (but pleasant white/pink noise can be used), dark (as in blackout dark), relaxing/free of distractions (especially electronics), and a comfortable temperature (usually 68-72 degrees Fahrenheit)
No food or calorie-containing beverages 2-3 hours before bed (unless certain herbal medicines are being given for specific reasons)
Avoid caffeine (or other stimulants) for at least 12 hours before sleep, because stimulants literally keep the nervous system awake, and caffeine has a long half-life
Avoid alcohol, especially before bed, because alcohol interferes with circadian cycle and reduces REM (deepest stage) sleep
Physical activity during the day, and avoid exercise 3-4 hours before bed, because late exercise raises core body temperature; we want surface temperature to go up and core temperature to go down a bit around bedtime
Intentional relaxation before bed; a warm bath, meditation, yin yoga, etc
Therapies to raise surface temperature w/o raising core temperature (sweat without activity, hot bath or sauna)
When possible, get 20-30 minutes of outdoor morning light (or something similar) shortly after waking
Photo by Isabella Fischer on Unsplash
But what about when disturbances to sleep happen because of some other issue or condition? In cases like these, sleep hygiene by itself can be helpful, though is often not enough.
We know that a number of issues have this effect, including:
Emotional distress of any kind; there seems to be a connection between REM sleep and less brain activity the next day in key brain regions
Depression and/or anxiety (which are a two-way street with disrupted sleep)
Past emotional and physical traumas, especially in cases of PTSD
Obstructive sleep apnea
Central sleep apnea
Sinus problems of all kinds (viral, allergic, structural, etc.)
Vagus nerve dysfunction
Restless leg syndrome (often connected to iron deficiency, though not always)
This is not a complete list, and it is not unusual for multiple of these factors to contribute together to poorer sleep. And this is not a coincidence - although each case of disrupted sleep will stand on its own, almost all cases have some disruption of vata common to them. That is to say, the flow and movement of breath and/or nervous system signaling and/or musculoskeletal function is affected negatively. Those harmful changes in turn can disconnect functions in the body from their usual day/night cycles.
What can we do in these cases? Our approach must always address the underlying causes of the problem. One synonym used in Ayurveda for the word “cause” is hetu. Depending on the hetu profile fitting the situation, different interventions will apply. Some of these might include:
Comprehensive dietary assessment and therapeutic nutrition interventions: for example, calorie density reduction in the evenings, complex carbohydrates in the evening, healthy (non-meat) tryptophan-loading, vitamin B6 and/or B12 and/or magnesium supplementation
Behavioral therapy of various kinds
Trauma-informed therapies and approaches, such as EMDR
Directed visualization, breathwork, and meditation
Yoga posture prescriptions
Mood and sleep cycle support with medicinal herbs, chosen to fit each individual’s case; examples include jatamansi (Nordostachys jatamansii), tagara (Valeriana species), Brahmi (Centella asiatica), tulsi (Ocimum sanctum), shankhapushpi (Convolvulus prostratus), Bacopa monniera, skullcap (Scutellaria lateriflora and other subtypes), chamomile (Matricaria chamomilla), saffron (Crocus sativus)
Nasya therapy: medicated oil taken through the nose, a great way to deliver medicinal support directly to the brain; herbs like Brahmi, shankhapushpi, and skullcap can also be used in this way
Soothing/relaxing therapeutic massage, such as abhyanga (as opposed to deep tissue or another approach with deeper pressure)
Targeted marma (pressure point) treatment
And more!
Do you seek support with your quality of sleep, or a specific sleep condition / issue? Do you know someone who might benefit from our Ayurvedic approach? Book a cost-free, 15min Consultation, and we’ll discuss!
Professional disclaimer: please do not initiate any herbal or other medicinal interventions without the guidance of a knowledgeable provider.
Dr. Matt Van Auken, MD, MPH
Dr. Matt is an Ayurveda-trained, triple board-certified physician.
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