Longevity Bloomington Newsletter #23 - Sleep
Why it's important, how much you need and how to get more
Research Roundup - Sleep
Difficulty sleeping is a very common problem. It is estimated that 50-70 million Americans suffer from one or more sleep disorders. It is so common that many folks do not seek treatment for their excessive daytime sleepiness as they assume it is normal. Luckily, there are many treatments and/or behavior modifications that can be made to improve your sleep.
Why is sleep important?
When you sleep, many vital bodily functions occur that are important for your health. Historically, most people believed that sleep was a passive activity during which the body and brain were inactive. It is now known that sleep is a period during which the brain is quite busy and engaged in a number of activities that are necessary to life.
Think of your brain as taking on the role of a housekeeper when you sleep. Recent research has shown that sleep removes toxins from your brain via a recently discovered series of channels called the glymphatic system. The glymphatic system is a waste clearance system for your brain. It is responsible for replenishing as well as cleansing the brain as you sleep. Imagine going to bed at night with a pile of dirty dishes and waking up to a clean kitchen! This is essentially what they believe the glymphatic system does for your brain. This system was only discovered in 2012. As such, there is still much to learn about this nocturnal housekeeper and future research will undoubtedly uncover more information.
In addition to the housekeeping function of sleep, you just feel better after a full night’s sleep. You’re typically in a better mood. You have more energy to do the things you enjoy doing. Overall, life is just better after you have slept well.
How much sleep do you need?
Although the amount of sleep each individual needs will vary, most guidelines recommend between 7-9 hours of sleep for adults.
Potential problems associated with inadequate sleep
If you aren’t taking your sleep seriously, you should. Long term sleep deprivation can increase the likelihood of a host of health problems. Most of the research in this area is not of the highest quality due to the fact that sleep is hard to study and most of the adverse effects of poor sleep take a long time to manifest. Also, many of the ill consequences of poor sleep (such as chronic pain) share a bidirectional relationship with sleep. This means that poor sleep can cause you to develop chronic pain but also, being in pain can make it harder to sleep. With this in mind, research has demonstrated that poor sleep can increase the likelihood of:
If you want more information about the relationship between sleep and any condition above, click on the condition and it will take you to a research study with more information. I will avoid going into great detail about any of the above conditions in an attempt to avoid inducing a significant amount of anxiety for those folks that already worry about their sleep. Most people that have trouble sleeping do not need help in finding things to worry about it in regards to their sleep. This increased anxiety results in “losing sleep over losing sleep”. Instead, we will focus most of this article on ways to improve your sleep.
Different types of sleep disorders
Insomnia - the most common sleep disorder. It is the inability to initiate or maintain sleep. It can also manifest as the individual waking up several hours early and being unable to resume sleeping. Most individuals with insomnia exhibit excessive daytime sleepiness that impairs their ability to perform daily activities. We will discuss treatment options in more detail below.
Obstructive sleep apnea - a condition in which your upper airway becomes blocked while you sleep. Risk factors include excess weight, older age, high blood pressure, smoking, diabetes and male gender. You may want to talk to your healthcare provider about sleep apnea if someone tells you that you snore or gasp during sleep. Treatments include continuous positive airway pressure (CPAP), oral appliances, surgery, weight loss, and avoidance of lying on your back while sleeping.
Circadian rhythm sleep disorder - a condition in which your body’s internal clock (circadian rhythm) is out of sync with your environment. This can be temporary in the case of something such as jet lag or longer term in the case of a “night owl” needing to wake up early for school or work. Effective treatment requires a multifaceted approach aimed to re-align circadian rhythms with the desired sleep and wake schedule. Examples of this include adherence to good sleep hygiene (as discussed below), avoidance of bright light in the evening, increasing light exposure in the morning as well as the use of melatonin prior to sleep.
In addition to the above disorders, there are numerous other issues that could affect your sleep. Menopause, pain, medication, frequent urination, anxiety, depression and many other issues can cause a disturbance in your sleep. This is why it is important to visit your health care provider to determine the exact cause of your poor sleep. Knowing the cause will allow you to pick the correct treatment for your particular condition and start getting better sleep at night.
Treatment for insomnia
Insomnia is the most common sleep disorder. It affects nearly 1/3 of all adults in the United States. As such, we are going to spend a little more time discussing treatment options for insomnia.
Sleep Hygiene
Before we discuss more specific treatment options for insomnia, we first need to talk about sleep hygiene. Sleep hygiene refers to both your sleep environment and behavior. Think of sleep hygiene as good sleep habits that should be practiced daily to maximize your chances of a good night's sleep.
Examples of good sleep hygiene:
Wake up at the same time everyday
Keep naps short and limited to the early afternoon
Dim your lights when winding down - bright lights can hinder the production of melatonin
Avoid using electronics such as your cell phone or tablet 30-60 minutes prior to bedtime
Get plenty of sunshine exposure throughout the day
Be physically active
Avoid drinking alcohol later in the evening
Avoid consuming caffeine twelve hours prior to bedtime
Make sure the temperature of the room is comfortable
Block out light with heavy curtains
Here are a few videos with additional information on improving your sleep habits:
Sleep Pressure
Another way to help improve your sleep is by building up “sleep pressure” or “sleep drive” throughout your day. Sleep pressure refers to a homeostatic system in your brain which makes you feel sleepy. It is believed to be related to the creation of a chemical in your brain called adenosine. Adenosine is a byproduct of cellular metabolism, so the brain releases adenosine as energy is used. As you engage in more physical and mental activity during the day, more adenosine is created, and you become more tired. When you sleep, adenosine is cleared from your brain, making you feel alert after a good night’s sleep.
You have probably experienced high amounts of sleep pressure firsthand. Think back to a time when you were traveling to a location that required you to walk all over the city or a day you spent swimming in the ocean all day. You probably slept amazing that night! Similarly, working outside in the garden or yard all day on a project probably resulted in a great night’s sleep!
If you find yourself not being tired at night, review your day. If you have spent most of your day indoors sitting and being sedentary, you have probably not built up much sleep pressure. This lack of sleep pressure may make it difficult to sleep and stay asleep.
So how can you build up sleep pressure throughout your day so that you are more tired at night? Physical and mental activity! You need to incorporate a little more effort into your day. Get outside. Be active! Also, cognitively demanding activities increase sleep pressure as well. Things such as problem solving, socializing and sightseeing will also help to make you feel more tired at night. Here are just a few examples:
Walk more
Get outside and do some yard work
Exercise!!
Have lunch with a group of friends
Play chess or work on a crossword puzzle/sudoku
Learn a new language
Play a musical instrument
As you go throughout your day, think of ways to build up your sleep pressure. Find activities you enjoy. Luckily, nearly all of the activities that increase your sleep pressure will also have a positive effect on your overall health. Increasing your sleep pressure may result in improved sleep at night and better quality of life throughout the day.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
If you have attempted to improve your sleep hygiene and build up sleep pressure throughout the day and you are still having trouble sleeping, cognitive behavioral therapy for insomnia (CBT-I) may be a good option. From the sleepfoundation.org website: “CBT-I focuses on exploring the connection between the way we think, the things we do, and how we sleep. During treatment, a trained CBT-I provider helps to identify thoughts, feelings, and behaviors that are contributing to the symptoms of insomnia.
Thoughts and feelings about sleep are examined and tested to see if they’re accurate, while behaviors are examined to determine if they promote sleep. A provider will then clarify or reframe misconceptions and challenges in a way that is more conducive to restful sleep.”
Here is a video from the sleep foundation with more information about CBT-I:
CBT-I is listed as the first line of treatment in the clinical practice guidelines for primary care physicians for the nonpharmacologic treatment of insomnia. A 2012 systematic review found it to be effective in helping folks with insomnia sleep. From the conclusion: “CBT-I is effective for treating insomnia when compared with medications, and its effects may be more durable than medications. Primary care providers should consider CBT-I as a first-line treatment option for insomnia.”
If you are in the Bloomington, Indiana area and are interested in CBT-I, you are in luck! Bloomington is lucky to have a board certified behavioral sleep medicine provider. Spencer Dawson is a licensed clinical psychologist and assistant clinical professor at Indiana University. I contacted him via email and he provided me with information on how to go about obtaining CBT-I services in Bloomington. You can do so in two ways:
There is an insomnia specialty clinic within the CBT training center at IU. This clinic provides clinical training at IU for doctoral students. These sessions can be done in-person or via telehealth. There are a limited number of new patient slots and the first available appointment is likely around mid-January. The upside of working with a doctoral student is that the costs are low, with a sliding scale that can drop to as little as $1/session with an expectation of 4-8 sessions for most people. You can find more information here: https://psych.indiana.edu/clinics/cbt-clinic/index.html or call 812-855-2313.
Spencer also provides CBT-I services directly through the Sleep Health Center via telehealth. The practice is based in Louisville but does provide telehealth to Indiana. Per Spencer, a full course of treatment isn’t that much more expensive than an in-lab sleep study. In addition to Spencer, there are several other sleep psychologists at the Sleep Health Center. To schedule an appointment with Spencer, you can go here: https://scdawson.com/patients. To learn more about the Sleep Health Center, you can go here: https://www.sleephealthlou.com/
If you are not in the Bloomington area or would like to look elsewhere for CBT-I services, you can search for a provider who is a member of the Society of Behavioral Sleep Medicine here: https://www.behavioralsleep.org/index.php/united-states-sbsm-members or use the Penn International CBT-I Provider Directory here: https://cbti.directory/.
A 2016 systematic review also found that self-directed CBT-I programs were effective in improving sleep in adults with insomnia. If you would like to try CBT-I on your own, there are several free or low-cost options to try. The Conquering Insomnia CBT-I is a $50 program that consists of 5 sessions over 5 weeks and can be done from home. There is also a free app called Insomnia Coach that is based on CBT-I and provides a guided, weekly training plan to help you track and improve your sleep. Sleepio is another option that can be used from your phone. If you prefer a book, Quiet Your Mind and Get to Sleep has been highly recommended and is based in CBT-I. As you can see, there are no shortage of resources available if you are interested in CBT-I.
If you are having trouble sleeping, visit your health care provider to determine the cause of your sleep issues. There are hundreds of potential causes of poor sleep. Once you know the cause and you have the correct diagnosis, you can begin seeking treatment to improve your sleep and as a result, improve your life.
Without challenge, there is no change
Progressively increasing the difficulty of a task is required to improve any fitness measure. This is true if you are 15 or 115 years old.
If you want to improve your strength, endurance, balance or anything else, the way to do so is to progressively make it harder over time. It is the only way it works.
If you continue to use the same weight, jog at the same speed, perform the same amount of reps, improvement will not occur.
This principle is referred to as progressive overload and it is a cornerstone of exercise physiology. In order to progress, you must expose your muscles/heart/bones/brain to a stimulus of which it is not already adapted. You must give it a reason to get stronger!
Here are just a few ways to increase the challenge of your workout:
⏺Increased weight (add 5 pounds to your squat)
⏺Increased exercise frequency (go to the gym one more day/week)
⏺Increased reps with the same weight
⏺Increased range of motion (squat deeper)
⏺Less rest time between sets
⏺Increased speed (walk/jog faster)
⏺Same weight with improved technique
If you implement this gradually, it is very safe to do. In fact, progressively loading your muscles and bones will drastically reduce your risk of injury.
Next time you are exercising, work a little harder than last session and you will start seeing progress in no time.
Member Spotlight - Charlene Allen
This month’s member spotlight is on Charlene Allen. Although Charlene has not been a member very long, she has made a huge impact on the class already. She is always supportive of the other members and lightening the mood with her jokes! She has been a great supporter of our program since she started.
How long have you been a member of Longevity? I joined in 2023 upon the recommendation of a very trustworthy friend, and she was exactly right!
What is your favorite exercise at Longevity? Least favorite? No favorite or least favorite exercises; I am just happy to do them and feel very smug when they are finally over because I actually did them!
Where are you from originally? Where did you go to school? Born and raised on a grain and livestock farm in Northeast Indiana (Steuben County) and graduated from Indiana University.
What brought you to Bloomington? Came to Bloomington for college, graduated, and never left!
Tell us about your family. Any information about spouse, kids, grandkids that you would like to share! We have two sons, two lovely daughters-in-law, and four grandchildren here in town that I am certain hung the moon - all four of them!
What did you do for work? I taught elementary school for two years, then after our sons were born, I opened The Eye Center ophthalmology practice with Dr. Grossman in 1980 and worked with him for thirty-seven years - very rewarding work restoring and/or maintaining vision.
If you had to eat one meal every day for the rest of your life, what would it be? I grew up eating home-grown potatoes twice a day, and they are still my very favorite food - mashed, baked, fried, or soup!
What is your favorite hobby? Favorite hobbies are traveling, reading, and shopping.
What’s something about you (a fun fact) that not many people know? I marched with one of those old banged up heavy brass sousaphones in our high school marching band! No one else could/would, so I accepted the challenge.
What do you like to do when you’re not working out at Longevity? I volunteer three mornings a week at IU Health Hospice in administration and down at the Hospice House at the medical park on Tapp Road.
What’s the next place on your travel bucket list? Next trip is back to New England and the Adirondacks for our 55th wedding anniversary in 2024.
Favorite place you have ever been? Two three-week trips to Hawaii were thrilling, loved our Alaska two-week cruise-tour with Holland America, and just returned from a two-week "Circle the Canadian Rockies" on the Rocky Mountaineer train.
CommunityVotes Bloomington Winner
We are blown away with all of the support from everyone! Longevity Bloomington/Ben Weller won the CommunityVotes competition for best fitness center and personal trainer in Bloomington! Thanks again to all of you that voted for us. We truly appreciate it!
200 Class Club
Please welcome the founding member of the “200 class club”……Judy Childers! Judy has been incredibly consistent since day one, attending 200 classes and we have only had 217 in our existence! She shows up every day ready to work and offers plenty of encouragement to the other members. Thanks for all of your support over the last 2+ years Judy!
New Longevity Members
Welcome to Longevity Bloomington! It has been great having you all in class.
Well Attended
We would like to recognize the Longevity Bloomington members that made it to all or most of the classes since our most recent newsletter! Well done!
Longevity Bloomington Exercise Research Lab
Have you ever wondered where we come up with all of the exercises for the Longevity Bloomington functional fitness class? In the lab! Our youngest Longevity Bloomington member rigorously tests each exercise before we introduce it in class!