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SLEEP SEMINAR WITH DR. MARCUS ANG


Last Thursday, 2nd August, Aaron Shephard (personal trainer, Bodyform) Annelies Grimshaw and Dannielle Baker- Holmes (clinical nutritionists, Key Nutrition) hosted a sleep seminar with the guest speaker Dr Markus Ang, a leading sleep specialist, at The Three Brothers bar in Ponsonby. It was an all-round fantastic night with enough information to send me home, quite frankly wide awake. Ironically, I sat down with my alcoholic beverage in hand and began to soak in all I could from this seminar while writing notes into my electronic artificial light source and sipping on the stimulant/depressant that would later disrupt my sleep.

This topic is close to my heart as I have always had a busy mind and in the past, having trouble switching my mind off and falling asleep. Through diet and lifestyle changes I have already improved my own sleeping habits but I was eager to learn more. My father also suffers from sleep apnoea so I really wanted to learn all I could to pass on the information to him, and all of you.

It was a privilege to listen to Dr Ang a well-spoken and intellectual man, who I must say lost me at certain parts of the talk. He spoke with authority on the subject and I respected his honesty while answering some of the hard questions that were raised. He made a disclaimer at the start of his talk, which I will reiterate. His talk (and my blog) would focus in a relatable way for the general public who suffer mild forms of sleep disturbances. He said that the complexities of sleep could be spoken about for hours. However, if you, or anyone you know suffers from a more serious form of sleep related issue this blog summary of the evening will not go as in-depth into the causes and effects that you may need to know. If that is the case I would recommend you book an appointment to see your local GP and get referred on to a sleep specialist.

I learnt a great deal and I’m going to try explain concisely my 5-main take always from this seminar. I will summarise the main points at the end as well to just round it all up.

1.Sleep is natural

however because we have advanced so significantly into the intelligent, innovative humans we are, we have over complicated a natural rhythm. Sleep issues can derive from many areas and those must be addressed first, i.e. diet, lifestyle (shift work), genetics and mental health conditions. Sleep is all about confidence, we need to be confident that we CAN fall asleep, we need to relax into our natural rhythm and allow our bodies do what they naturally do.

Our circadian rhythm naturally goes with the flow of light, darkness and seasons. However, because we have created artificial light it can affect and disrupt this flow and this then disrupts our natural hormonal responses. In regards to sleep the three hormones that Dr. Aang spoke on were melatonin, cortisol and serotonin.

Melatonin is secreted when the retina detects the absence of light. Studies have shown that we do not need melatonin to sleep however, we sleep better with more of this hormonal production. If we then stay awake under artificial light until midnight the hormone is inhibited and does not begin its work. Melatonin helps us to enter into a deep restorative sleep where our anabolic (growth) hormones do their best work. For males that is where 70% of your growth or ‘gains’ occur, in your sleep.

Cortisol levels drop during sleep but peak again once the light receptors in our retina sense light. Even if you are still sleeping the hormonal change of states will begin without you even being fully conscious or aware of what is happening inside the body. The human body has plenty of cortisol receptors which means we are very sensitive to its effects. Cortisol is known as the ‘stress hormone’. In this instance, it’s a good stress. It has other functions such as controlling blood sugar levels, regulating metabolism, helping to reduce inflammation, and assisting with memory formulation. However, in the morning It gives you the boost of energy you need to get up and moving. These two hormones work like ying and yang and help your body do what needs to be done at the appropriate times.

The final hormone that was mentioned is serotonin or the ‘feel good’ hormone. Interestingly vitamin D promotes the secretion of serotonin which lowers the risk of depression or anxiety which often leads to insomnia and trouble getting to sleep. A simple 20-minute walk is what’s recommended to get your daily dose to let your skin absorb vitamin D from the sun. Walking under diffused light is best, which filters out the harsh UV rays. Walking underneath green leafy trees on your lunch break at a local park would be an excellent way to do this.

Our body wants to find a rhythm and stick to it, our body is always trying to sync back into nature and respond to the environmental cues however, if you are like me and your work demands you to work at irregular times then we are literally going against nature by waking up so early. I KNEW I HATED MORNINGS FOR A REASON. Thankfully there are things that can be done to mitigate the damage. The best thing would be to have a perfect working schedule, but for now that’s not possible (for me anyway) so in the following points I will pass on the instructions from Dr. Ang to optimise your sleep.

2. Sleep hygiene

This refers to the practical tasks you can do to make sure you can get to sleep without tossing and turning. Not the actual cleanliness of your sleep as the name may suggest, although it is advisable to also have clean sheets…

- At night when the sun goes down be careful not to engage in anything that will keep your cortisol levels high as we spoke about earlier these need to drop to allow you to enter into a deep restorative sleep. Yes, even exercise late at night may be a hindrance.

- Don’t use the hours before bed time to start thinking up big ideas or listening to very mentally engaging and active podcasts. Activities an hour before sleep should be relaxing. You can also try drinking chamomile tea, listening to some calming music, or taking a bath / shower (which has the added benefit of opening your pores and dilating your blood vessels, increasing blood flow while decreasing blood pressure and relaxing your muscles and mind in preparation for sleep).

- Just be sure to allow time for let your core body temperature to drop before sleep. While you are asleep your core body temperature should be dropping 1 – 2 degrees. Sleep in a room that is optimally set at 18 – 19 degrees. This is because the cooling down of your environment signals to your body it is night and therefore it is time to sleep. We shouldn’t wear bulky or restrictive clothes to bed. Wear little around our core and if necessary socks / gloves for our peripheries (feet and hands) and extra blankets If you feel cold.

-Your last meal of the day will hugely effect how you sleep so be sure to have a well-balanced meal of protein, healthy fat and complex carbohydrates. This will ensure your blood sugar levels remain even and you don’t get spikes of insulin from a surge of simple carbohydrates or sugar which can disrupt your sleep. (More on this at a later point)

- Electronics should be switched to a night time filter and lights dimmed to allow the hormone melatonin to be secreted. There are many apps you can use to do this. Essentially, the most important aspect is to block blue light from hitting the receptors in your eye. The apps do this by putting a red filter over the electronic device but alternatively you can buy blue light blocking sunglasses which has the same effect.

- Dr. Ang advised to find a habitual wake time, meaning if possible wake up at the same time every morning. This will enable your body to adjust its circadian rhythm. Our body has an internal clock that we need to respect. This also takes time for your body to sync to and constant irregular start times make it impossible for your body to find its rhythm. (with the exception of the weekends where you can let yourself sleep in.) This explains why even on holiday it takes a few weeks for your body to adjust to sleeping in and why early risers often wake early even when allowed to sleep in.

- If you are an early riser, in the morning, try to minimise your exposure to artificial blue light until 30 mins before you need to be optimally functional. Wake up under dim red light have a shower, get dressed. Then put on lights, drink coffee, drive to work and begin your working day. This will prolong the rise of cortisol and give your body a few more minutes in a restful state before stimulants and stressors give you the boost of energy you need.

- Another activity that was recommended, which I have done for over a year and HAS helped me significantly, is called a brain dump. Write two lists. On one write down all the things you need to do for the next day so you can organise your thoughts and go to bed without that dreaded feeling like you will forget something. On the other list write down any unresolved emotions that sprung up during the day and a potential reason why it struck a nerve. You don’t want to go to bed with that feeling, thought or issue so you simply right it down and choose to deal with it later. Dr. Ang explained the next step was to “throw it away” as if to reinforce the brain dump is done, it’s out of your control and its sleep time now. Myself, I keep those notes on my computer and just close it down when I’ve done all I could for that day.

– as a segue here on the days where I am proud of my productivity I sleep much better. I think subconsciously I am at peace knowing I am proud of my efforts and know I couldn’t have done more if I tried. Being self-employed it’s important I set a cut off time to stop working. In the past I have worked for too many hours and would neglect my sleep. Neglecting sleep is very counterproductive. If I have a bad night’s sleep it will make me a terrible worker and drain my energy for my workouts and instructing clients. I’d rather lose a few hours work time than ruin a whole day.

Another point Dr Ang made was to be strict with bed time habits and keep the bed for two activities, 1 sleep and 2 … well I guess you can figure that one out. We have a cognitive behavioural association mechanism meaning if we can associate our bedroom with relaxing activities, that constant ingrained pattern and connection to a positive physical environment will help us fall asleep more readily and without anxiety.

TIP: I have recently bought a set of electronic candles from Kmart for $3.00 that emit a reasonable amount of light and have a range of colours. I turn this to a red light in the morning and night.

3. Sleeping pills are not the best solution for a disruptive sleep.

I get it, I myself have asked my doctor, “Please, I just need something to knock me out!” Thankfully my doctor had enough sense to say “no”. The two most commonly prescribed sleeping pills are zopiclone and benzodiazapines. It has been proven that zopiclone’s effectiveness is 50% placebo, which reinforces the power of sleep confidence. When that statement really sinks in it means that even the best medicine to get a good night sleep could be just as good as being prescribed a sugar pill with the confidence from your doctor telling you it will give you a good night sleep. Benzodiazapines are literally low dose tranquilizers which don’t allow you to enter into the stage 3 (non-REM) sleep where you have the most growth and repair occur. You may be knocked out and have had a full 8 hours sleep, but the quality will be poor and your body won’t enter into a true state of restoration. Which is why this method should not be considered a true long-term solution. Other popular alternative substances such as alcohol and cannabis were also not recommended as good ways to get a deep sleep for similar and fairly self-explanatory reasons.

4. So, you are sleep deprived and despite your best efforts have had a bad week of sleep, what can you do?

Dr Ang recommended not to sleep all day but to get back into your daily habitual routine as best you can. Power napping has shown its merits in research however no more than 20 minute intervals are necessary and not after 3.00pm, this is so that you don’t enter into a deep sleep and get crudely woken from it. This would leave you feeling groggier than you already did and can make falling into a deep sleep later that night more difficult. The weekend is a good time to allow yourself to catch up on sleep, simply don’t set the alarm and let your body naturally determine how much sleep it needs.

The unfortunate news for shift workers is that there is strong evidence to support how detrimental it is to your health. The constant chopping and changing is extremely hard on your internal clock. If you are for example a nurse, or flight attendant be aware of this stress on your body and try to always prioritise your sleep and nutrition. Schedule your activity around those other factors.

5.Good nutrition will dramatically affect your sleep.

Eating a wholefoods based, well balanced, minimally processed diet will hugely enhance your general health and wellbeing so of course this will flow onto having a healthy restorative sleep. I will go over the main points you need to remember especially in relation to your endocrinology (hormones).

Macronutrients

Healthy fats – Ghrelin, leptin

Complex carbohydrates – Insulin

High quality proteins - Anabolic hormones for growth and repair. (Proteins create the amino acids which are building blocks of our DNA.)

Ghrelin is the hormone that signals to our brain we are satiated (full) we need high quality fats to help us feel full and reduce cravings for high calorific dense foods. Fat will not make you fat, eaten in its correct quantity (which may be more than you think). Fat is absolutely necessary for your body to carry out certain functions, your brain uses fat, it insulates your organs, and does a host of other jobs.

Leptin is the hormone that tells our brain we have enough stored fat on our body and we are not going to starve. Leptin is a hormone that is produced by the fat cells in our body. It is a more long-term hormone that works like temperature regulation. The problem some overweight people may encounter is that much like insulin our body can become resistant to the hormones effect. This is why despite someone with 40% body fat, (obesity) and more than enough fat storage to use, once they have become resistant to leptin their brain doesn’t receive this information and the added fat / inflammation makes the overweight person more lethargic and immobile. This is why for an overweight sufferer of sleep apnoea per se, simply eating less will not help keep the weight off long term. Leptin resistance is hard to undo, not impossible but many factors and dietary changes need to be accounted for to stop the hormonal imbalance working against your efforts.

Insulin is the hormone secreted in the presence of glucose in the blood stream. Carbohydrates are a source our body can break down into glucose to use as energy. If we don’t use the energy we consumed that day it will store through a complex chain of processes as fat on the body. This is why carbohydrates are not essential to your diet, but shouldn’t be removed altogether without guidance or a specific reason as we still need energy to function. It also helps preserve muscle loss if you are on a calorie restricted diet. If we have too much exposure to simple carbohydrates i.e. cake, white refined bread and lollies the hormone insulin is over produced and it builds up to high levels. The body develops a resistance to the constant presence of insulin which eventually results in diabetes, where the body is unable to regulate the glucose level in the blood stream. Exposure to excessive blood glucose for a long duration of time due to diabetes leads to innumerable problems outside the scope of this blog. Usually, this type of diabetes is reversible through dietary changes, but the damage from exposure to excess blood glucose is irreversible. Before your sleep if you have had a simple carbohydrate, it will spike your insulin and this may give you a restless sleep with waking at random times during the night.

Anabolic hormones such as testosterone, progesterone and oestrogen help build muscle and repair cells. Our body has to do this daily to continue living. It is absolutely necessary for your health to eat enough protein. Protein can only be stored in our bodies in the form of muscle. If you don’t eat enough protein and your body is in protein deficit, your own hard-earned muscle will be catobolised to carry out the processes it needs to perform. Protein will not just aesthetically make you look healthier by building muscle (if you are performing resistance based exercises) but it also will increase your basal metabolic rate, helps restore and recover from any sickness.

Micronutrients

give us as much access to all the essential vitamins and minerals our bodies need to function optimally. You can find micronutrients in a variety of fruit and vegetables rich in colour and texture. There are some vitmamins and minerals that you may need to supplement medicinely but if you have a varied diet with plenty of fruit and vegetables you will mostly be getting all the essential vitmans and minerals you need.

At the end of the seminar we were given these sweet little ‘sleep goodie bags’ including an eye mask, earplugs, herbal tea and a moisturiser. So to pass on the favour I will leave you with a few practical tasks you can do today to improve your sleep. This blog is to inform you how you can make actionable changes, which I encourage you to take… RIGHT NOW.

  • Keep your bedroom a calm and relaxing environment.

  • Practice your brain dump technique and leave big ideas and discussions out of the bedroom.

  • Download necessary aps to filter out light on your devices.

  • Go for a quick walk during your lunch break, endeavour to eat a little healthier every day.

  • Avoid stimulants / stressors a few hours before bed time.

  • Set your alarm for the same time Monday – Friday and try get to sleep 6 – 8 hours before that wake time.

  • Work with purpose and productivity every day.

I hope you have learnt something from this blog, I have done my best to relay what I learnt. I thoroughly enjoyed the seminar and spending time writing this blog however I am a personal trainer not a trained doctor so as I mentioned at the start of this blog if you do have more questions or concerns please book in with your GP to be referred to a sleep specialist or follow these links to read more from Dr Marcus Ang or the team at Key Nutrition

https://www.silverdalemedical.co.nz/doctor/dr-marcus-ang/

http://www.keynutrition.co.nz

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©2020 by Catherine Coker Fitness.