If you sleep well you most likely take it for granted, while many people out there would do anything to fall asleep in a short matter of time and stay asleep until morning. A restful night in the sack will do wonders for your health and mental and physical performance. Sleep and health are directly related to one another - the better your sleep, the more healthy you will be, and the more healthy you are the better you will sleep. Are you really sleeping as well as you should be? Look at the recent death of pop star Michael Jackson. He took Propofol to knock him out every night. And I say "knock him out" because he surely was not getting restful sleep taking that drug. And when that wasn't available he took up to 10 Xanax pills a day. (Some reports claim as high as 40!) Xanax works by increasing GABA in the body - the most powerful inhibitory (calming) neurotransmitter in the human body. Actually, most all sleeping pills such as Ambien, Lunesta, and the many others work via GABA. Taking one of these pills to help you sleep is obviously not addressing the problem. Wake up and read on...

Many individuals do not get enough quality sleep. I say quality, because quantity is not always a good predictor to justify if you are getting the benefit of sleep. Some people sleep six hours a night and feel great while others may feel the need to sleep ten hours only to wake up tired. What is normal? Basically it comes down to this: You should fall asleep in a relative short period of time (such as less than 15 minutes). You should not wake up, even to go to the bathroom. It doesn't matter how much water you had to drink. (I hear this one all the time: "I drink a lot before I go to bed so I have to get up and pee at 3am every night." Very rarely are these related.) You should not be tossing and turning thru the night. You should wake up rested and feeling good, (that also means pain free). Now - here's the disclaimer on what is normal to wake up to: Barking dogs, the pet(s) on your bed, your significant other snoring (not normal for them though), or possibly crushing you in a small bed, that street light shining in your eye, your neighbor shooting off fireworks at 2am, your kids waking you up, hurricanes and other forces of nature, and any act of war....well, you get the point.

The quality of sleep has a lot to do with the adrenal glands. For my regular readers out there, you know how important the adrenal glands are and why they are the overworked and underpaid hormonal glands. I've talked extensively about the major stress hormone secreted by the adrenal gland, cortisol, in other articles. (You can search adrenal glands in the upper right corner of each web page.) Cortisol is normally high in the morning (6-8am) and then slowly lowers itself throughout the day until it is at its lowest around midnight, ensuring a restful sleep. Fluctuations in this cycle can wreak havoc on sleep cycles, particularly if cortisol levels are high in the late evening. Individuals under high stress and athletes training too hard have a tendency to output high cortisol levels throughout the entire day. Even going long periods throughout the day without eating will increase cortisol levels. Many times these individuals feel as though they do not "need" more sleep because they have so much energy. They may feel hyped-up and always on the go. Often we call this "tired and wired" as they need coffee to get them going in the morning and then they are more productive in the evening (night owls). Many people resort to alcohol to calm them down at night. (You can say it winds you down if that makes you sleep better; yes the pun is intended.)

Some individuals, often from prolonged unresolved stress, have low cortisol levels throughout the entire day. They go to bed exhausted and wake up still tired. Exercise usually gives them a jump-start to get them through the day, as does coffee or maybe some pharmaceutical drug. This is also an adrenal gland dysfunction problem.

Then, there are the individuals whose cortisol levels are out of rhythm with their internal body clock. This is very common, especially in overtrained athletes, heavy stress, long hour jobs, or people eating poorly throughout the day (going more than 5-6 hours without eating or too many refined foods). Their cortisol levels may be fine all day long until the night, when it spikes instead of drops. This could result in just laying there in bed counting sheep while others may fall right asleep yet they wake up in the middle of the night, say around 2-3am. They might lie there for 10 minutes or 2 hours, until they are finally able to fall back asleep. Something is tripping the sleep-wake cycle that needs to be corrected. The most common reason for this is due to a spike in cortisol, (think of it almost like adrenalin, but not as powerful), due to a drop in blood sugar. Your body increases cortisol levels when your blood sugar drops too low so it can pull glucose (sugar) from glycogen (stored sugar) from your liver. That surge in cortisol will wake you up. And you may wake up hungry, or not.

I find it hysterical that there is a diagnosis out there called Night Eating Syndrome. There is actually a study going on at Duke right now to learn more about this. What a waste of time; what a waste of money. Guess what - if you're eating at night it's because either you're not eating enough during the day, or you're not eating enough of the right foods during the day to take care of your nutritional needs. So at night you're trying to play catch-up because you depleted yourself all day long. And you'll pay for it during sleep too. Instead of being anabolic (rebuilding tissue and healing organs), you'll be catabolic (breaking down sugars and muscle to give you energy). Next thing you know you're up buying a ShamWow at 4am. (I heard they're actually pretty good though.)

Another common sleep problem many people experience is waking up in the middle of the night to urinate. Normal? Very rarely. I always use that as a sign to tell me that something is just not as quite right as it should be with the patient. Something is up, (other than yourself at 3am), and again, it is most often due to some physical, chemical/nutritional, or emotional stress stirring up your adrenal glands. Vitamin B1, (thiamine), is the most common nutritional deficiency that can cause this. But this article isn't necessarily telling you to take it.

Aldosterone, another adrenal hormone, is responsible for mineral balance in the body (sodium-potassium). It is higher at night, opposite that of cortisol. High aldosterone means that sodium is retained, which also means that fluid is retained. This means that you sleep better since the dreaded walk to the bathroom isn't needed. A low aldosterone at night means you are going to have to get up and go, literally. But at first you have to lie there and wish it to go away; that is some unwritten law that I can't explain to you.

Another reason for frequent nighttime urination is from lactic acid, usually from a hard (anaerobic) workout, irritating the wall of the bladder. This irritation will cause you to wake up and urinate, but often results in low urine volume. That is when you think to yourself, "I got up for this?"...only to return with a similar outcome a couple hours later. For you men out there it is important to note that frequent urination and especially that of low volume can be due to a prostate problem. That is not something you want to ignore. You can read more about this in my prostate article here.

Snoring - definitely not normal - and if you're to the point of sleep apnea and a CPAP machine, well, you've got some work to do. Snoring can result from many problems - hormonal issues (as mentioned above), inflammation (plenty about that on this site), irritation to the digestive tract (from a food sensitivity, medication, or gut fungus/yeast) - to name a few. I tend to look at snoring as a sign that something is not right and needs to be corrected. When someone's health improves, so does the snoring.

Another common sleep problem that people have is waking up at the exact same time every night. They will say, "I wake up at 2:55am every night", or "I can't get to sleep before 1am". When specific times are involved this has to do with the acupuncture meridian system and its relationship to certain organs at those times. 11pm to 1am is the time when the gallbladder is at its highest energy. So if a person has a problem with their gallbladder, (too many bad fats, smoking, caffeine, etc...), then they often can't get to sleep between those times, or if they are asleep before 11pm then they may wake up during that 2-hour cycle. Between 1am and 3am is liver. This is the most common time a person wakes up and is due to many reasons. As noted above, when cortisol levels elevate to pull sugar from the liver, this will wake the person up, as it taxes the liver as well. Also the liver has to deal with detoxification of hormones, such as cortisol and estrogen, leading to more work for the organ at that time. Medications will result in a similar problem, maybe even the same medication you're taking to get you to sleep! 3am to 5am is lung - so think breathing difficulty, and sometimes sinus problems (allergies) can show up here too. And 5-7am is large intestine. Though many people wake up during this time I've often heard someone say, "I can't sleep past 5am no matter what", or "It's like I'm just wide awake at 6am even though I don't need to get up until 7". Their large intestine (colon) is irritated - most likely from a food sensitivity/allergy or some dysbiosis (bad but bacteria), or gut fungus/yeast.

So what can you do about all this? Well, like all things I talk about, sleep problems can be resolved with proper treatment, lifestyle, diet, and exercise modifications. Hormones such as cortisol and estrogen can be measured though inexpensive yet highly accurate saliva tests. Here is a short case history as a common example.

Ryan was a 25-year-old runner who came to my office for knee pain on the inside of his right knee. During the history, he told me that he frequently wakes up four to five nights a week and stays awake for about an hour before he can fall back to sleep. He also gets dizzy when he stands up. (Both dizziness upon standing and knee problems are also common adrenal gland related problems.) His adrenal glands were treated through various therapies and his diet was adjusted accordingly. He was training too anaerobic, and often worked out late in the evening when most anaerobic workouts should not be done, which was raising his cortisol level too high for him to stay asleep. He began training aerobically and earlier in the day. He returned the following week noting that the dizziness was gone and he was sleeping through the night, all but one night that week. His knee was significantly better, and took just two more weeks to return to full function.

Lack of quality sleep really takes its toll on a person over time. Here I briefly described a few very common and very treatable reasons for not getting a good night's rest. There are many other sleep issues that can be discussed - from the use of melatonin and pineal gland function to brain waves, as those done during sleep studies, (which I often find to be unnecessary unless other issues discussed here have been investigated fully, or to get a person on a machine for an apnea crisis). But one last important note on sleep - your environment. Make sure it is dark. The pineal gland which secretes melatonin so you can sleep is turned off by light sources. So the darker the room the better. Many also recommend removing major electronic sources from your room - particularly the TV. (I have a small battery clock by my bed - that's it.) Many people have resolved their sleep problems by removing their TV or their giant LED clock on their nightstand. And your mattress: I've never seen a particular mattress work better than another. As long as you are comfortable then it should be fine. The only mattresses you should stay away from are the ones that contain magnets - either in the mattress or under. These are major endocrine system disruptors and although many say they sleep great on them it's because they're suppressing their entire hormonal system and sedating them heavily. That's not a good thing. And before I forget or someone asks me about RLS (Restless Leg Syndrome), I'll write about that soon too. I equate RLS to "Growing Pains" in children. These are words (which many call a diagnosis) that describe a problem that nobody really understands, but they feel better when they label it and can make a drug for it. They're actually mineral problems, sometimes toxicity issues, but that's all I'll say for now since I'm out of witty humor and this article is pretty long as it is.

Dr. Gangemi