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Research continues to underscore just how important sleep is, and how harmful a lack of sleep can be. Sleep deprivation is known to induce oxidative stress1 and increase anxiety levels.2 Acute sleep deprivation may even contribute to increased levels of DNA damage.1 When patients do not sleep enough, or deeply enough, this dysfunction can affect their blood pressure, heart rate, mental status, hormones, and immune function.3 In addition, adults who are short sleepers (less than seven hours) are more likely to report 10 chronic health conditions, including depression, arthritis, diabetes, and asthma.4
Over one-third of the US population has reported sleeping less than the recommended seven hours a night,5 and with increased anxiety levels reported during 2020,6 sleep loss may currently be experienced by a greater number of people. According to a 2020 poll by the National Sleep Foundation, half of the respondents reported feeling sleepy anywhere from three to seven days a week, with the higher number of sleepy days corresponding with elevated levels of stress.7
Excessive daytime sleepiness is one of the leading reasons that patients present to sleep clinics.8 As a functional medicine clinician, how do you talk to your patients about sleep and give them tools to improve this important lifestyle factor? In the following video, IFM educator Shilpa P. Saxena, MD , offers some tips:
Relaxing Into Sleep: Mind-Body Interventions
In some cases, sleep can seem difficult despite our best efforts. People suffering from lack of sleep are often encouraged to engage in nonpharmacological activities that relax the mind and body—from biofeedback to meditation and yoga. But relaxing isn’t sleeping. Can any of these lifestyle interventions actually help propel an individual into restorative sleep?
Research suggests that mind-body interventions have been shown to improve sleep quality, reduce sleep disturbances, and effectively treat insomnia.
From Tai Chi to Yoga
A 2020 systematic review and meta-analysis evaluated the effects of different mind-body interventions on health outcomes in older adults (37 studies comprising 3,224 participants).9 For analysis, the interventions were sub-grouped into tai chi/qigong and yoga/pilates, and results suggested significant overall effect sizes favoring experimental groups compared to non-exercise control groups in all outcomes, including sleep quality.9 A 2019 systematic review and meta-analysis of 49 studies echoed the effectiveness of mind-body therapies like tai chi, qigong, and yoga in reducing insomnia severity and improving sleep quality for both healthy individuals and patients.10
Sleep disorders are commonly experienced by cancer survivors; in fact, 51-90% of cancer survivors experience some form of sleep disturbance.11 A 2019 nationwide randomized controlled trial (RCT) of a yoga therapy program (two 75-minute sessions for four weeks) in 410 cancer survivors found improvements in overall sleep quality and reductions in daytime dysfunction.11 Yoga therapy participants also demonstrated a statistical trend for greater reductions in sleep medication use compared to controls.11
Women with pre-menstrual syndrome (PMS) are known to experience sleep problems due to the fluctuations in hormone levels. An interesting study in 2018 found that yoga reduced sleep disturbances in patients with PMS, which subsequently improved the efficiency of their sleep.12 According to the study, results were based on the 10-week treatment of three 60-minute yoga sessions practiced per week.12
Mindfulness and Meditation
A 2020 RCT assessed the impact of yogic meditation in sleep quality.13 Participants in the study were healthy pediatric healthcare professionals (n=64), and the experimental group attended two 30-minute yogic meditation classes each week for eight weeks.13 Polysomnography and Pittsburgh Sleep Quality Index scores indicated that compared to the control group, participants in the yogic meditation group fell asleep faster and experienced both fewer disturbances and improved sleep quality.13
A 2015 randomized clinical trial examining the effects of a mindful awareness practice resulted in improvements in sleep quality, which was superior to a sleep hygiene education intervention.14 Mindfulness exercises included mindful sitting meditation, mindful eating, appreciation meditation, friendly or loving-kindness meditation, mindful walking, and mindful movement. Participants engaged in a mean of 10 to 30 minutes of mindful experiential practice in each class in addition to the teacher-delivered didactic material and group discussion. The study, published in JAMA, also showed that the mindful awareness practice yielded significant improvements of insomnia symptoms, depression symptoms, and fatigue severity 14
Sleep is a complex, active process of restoration for the body, and patients experiencing sleep dysfunction can suffer both from physical and psychological disturbances that greatly affect their quality of life. Talking with patients about their sleep hygiene is the first step in beginning to evaluate how, over the course of their lives, sleep has impacted their overall health. Through IFM’s Applying Functional Medicine in Clinical Practice (AFMCP) course, learn more about the connections between sleep and other biological processes in addition to the lifestyle treatments that may help to improve your patients’ sleep quality and overall health.
- Cheung V, Yuen VM, Wong GTC, Choi SW. The effect of sleep deprivation and disruption on DNA damage and health of doctors. Anesthesia. 2019;74(4):434-440. doi:10.1111/anae.14533
- Pires GN, Bezerra AG, Tufik S, Andersen ML. Effects of acute sleep deprivation on state anxiety levels: a systematic review and meta-analysis. Sleep Med. 2016;24:109-118. doi:10.1016/j.sleep.2016.07.019
- Rasch B, Born J. About sleep’s role in memory. Physiol Rev. 2013;93(2):681-766. doi:10.1152/physrev.00032.2012
- Centers for Disease Control and Prevention. Sleep and sleep disorders: data & statistics. Reviewed May 2, 2017. Accessed March 24, 2021. https://www.cdc.gov/sleep/data_statistics.html
- Adkins EC, DeYonker O, Duffecy J, Hooker SA, Baron KG. Predictors of intervention interest among individuals with short sleep duration. J Clin Sleep Med. 2019;15(8):1143-1148. doi:10.5664/jcsm.7808
- Czeisler MÉ, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic – United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049-1057. doi:10.15585/mmwr.mm6932a1
- National Sleep Foundation. Sleep in America Poll 2020: Americans feel sleepy 3 days a week, with impacts on activities, mood and acuity. Published 2020. Accessed March 26, 2021. https://www.sleepfoundation.org/wp-content/uploads/2020/03/SIA-2020-Q1-Report.pdf
- Khawaja I, Yingling K, Bukamur H, Abusnina W. Vitamin B12 deficiency: a rare cause of excessive daytime sleepiness. J Clin Sleep Med. 2019;15(9):1365-1367. doi:10.5664/jcsm.7936
- Weber M, Schnorr T, Morat M, Morat T, Donath L. Effects of mind-body interventions involving meditative movements on quality of life, depressive symptoms, fear of falling and sleep quality in older adults: a systematic review with meta-analysis. Int J Environ Res Public Health. 2020;17(18):6556. doi:10.3390/ijerph17186556
- Wang X, Li P, Pan C, Dai L, Wu Y, Deng Y. The effect of mind-body therapies on insomnia: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2019;2019:9359807. doi:10.1155/2019/9359807
- Lin PJ, Kleckner IR, Loh KP, et al. Influence of yoga on cancer-related fatigue and on mediational relationships between changes in sleep and cancer-related fatigue: a nationwide, multicenter randomized controlled trial of yoga in cancer survivors. Integr Cancer Ther. 2019;18:1534735419855134. doi:10.1177/1534735419855134
- Ghaffarilaleh G, Ghaffarilaleh V, Sanamno Z, Kamalifard M, Alibaf L. Effects of yoga on quality of sleep of women with premenstrual syndrome. Altern Ther Health Med. 2019;25(5):40-47.
- Guerra PC, Santaella DF, D’Almeida V, Santos-Silva R, Tufik S, Len CA. Yogic meditation improves objective and subjective sleep quality of healthcare professionals. Complement Ther Clin Pract. 2020;40:101204. doi:10.1016/j.ctcp.2020.101204
- 14. Black DS, O’Reilly GA, Olmstead R, Breen EC, Irwin MR. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial. JAMA Intern Med. 2015;175(4):494-501. doi:10.1001/jamainternmed.2014.8081