How To Make Sleep A Priority
Sleep has been difficult for me most of my life. It is hard for me to fall asleep and harder to stay asleep.
Growing up on a farm, I got up at 5 am to milk the cows. When I went to college, I continued to get up at 5 am. I’d have breakfast then go the library to study or to the studio to paint. I thought sleeping 4 to 6 hours a night was optimal. I had a lot to do, and I preferred to study or paint rather than sleep.
When I was in medical school and residency, there was even more to do. I had overnight call every third night, sometimes every other night. Private practice was a little better, but I still had trouble falling asleep. I’d awaken at 2 am and be wide awake, unable to fall back to sleep. I’d get up and read.
When I had children, there was even more to do. Getting by with only 4 to 6 hours of sleep seemed like a blessing. Little did I understand that sleep deprivation was accelerating the damage to my brain.
Once I was in a wheelchair, I started reading papers about neurodegeneration. That is how I slowly pieced together how important mitochondria are in the development of disability. Part of me is incredibly grateful that I have had trouble sleeping most of my life. However, I now know that sleeping only 4-6 hours each night was a huge strain on my brain.
Sleep is when many important processes that are essential to our health occur. Sleep is when we make hormones and remove toxins from our blood and our brain. Sleep is when we consolidate memories.
Once I understood how vital sleep is to my brain and my health, I prioritized getting more sleep. I started paying attention to what was associated with better sleep and what was associated with poor sleep. I got a sleep tracker to monitor how many hours I was spending in deep sleep and rapid eye movement (REM) sleep, which is when we dream. I tweaked my routines and my sleep improved. I now get 7 to 8 hours of sleep each night.
Sleep disruptions are very common in the setting of multiple sclerosis, Parkinson’s disease, Alzheimer’s, and other neurodegenerative diseases. Sleep disruption is also common in anxiety, depression, and other psychiatric diseases. Often sleep disruption occurs years prior to the neurological and/or psychiatric disorder. Because sleep is so critical to brain health, I am not surprised that poor sleep is also associated with more aggressive disease and shorter time to job loss and disability accumulation.
Sleep is regulated in part by the hormone melatonin, which is secreted by the pineal gland in the brain in response to darkness.1,2 The production of melatonin gradually declines over the age of 40, and is markedly reduced after 60.3 Melatonin has anti-inflammatory, antioxidant, and neuroprotective properties.1,2,4 However, melatonin production is often reduced in neuroinflammatory and neurodegenerative disorders, which means people with multiple sclerosis, Parkinson’s, and Alzheimer’s are more likely to have sleep problems, caused in part by inadequate melatonin in the brain.5
In the setting of multiple sclerosis, adding melatonin improved sleep quality6 and was associated with reduction of inflammatory cytokines TNF alpha and interleukin 1 beta.7,8 Taking 6 mg of melatonin in the evening was associated with improved balance and waking function and reduced fall risk in the setting of multiple sclerosis.9
In a meta-analysis, adding melatonin significantly improved sleep quality in the setting of Parkinson’s,10 dementia, cognitive impairment,11 mental health problems,12 metabolic syndrome,13 respiratory disorders,13and cancer.14
My approach to improving sleep for my patients and myself is the following:
- Get outside in the morning, preferably within 2 hours of sunrise. Even 2 to 5 minutes of looking at the sky will be helpful.
- Have a consistent ritual for winding down 1-2 hours before going to bed.
- Use red or amber lights after the sun sets.
- Use an app to shift the display on your phone and computer to reduce the blue light (which will suppress melatonin production).
- Add a meditation or mindfulness practice at bedtime, which can be as simple as belly breathing and focusing on the words “in” and “out.”
- Shift your workouts earlier in the day.
- And take melatonin 1-2 hours before going to bed. Start with a low dose. Patients under 40 may do well with just 1 mg. Patients over 40 or who have had their diagnosis for several years are more likely to require higher doses.
Sleep is key to our health. And as we age our melatonin levels fall, deteriorating our sleep. Most people over 40 with sleep issues will benefit from adding melatonin to their sleep routine.
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Claustrat B, Leston J. Melatonin: Physiological effects in humans.Neurochirurgie. 2015;61(2-3):77-84.
inich DM, Henning M, Darley C, Fahoum M, Schuler CB, Frame J. Is Melatonin the “Next Vitamin D”?: A Review of Emerging Science, Clinical Uses, Safety, and Dietary Supplements. Nutrients. 2022;14(19).>
Verma AK, Singh S, Rizvi SI. Aging, circadian disruption and neurodegeneration: Interesting interplay.Exp Gerontol. 2022;172:112076.
Mack JM, Schamne MG, Sampaio TB, et al. Melatoninergic System in Parkinson’s Disease: From Neuroprotection to the Management of Motor and Nonmotor Symptoms.Oxid Med Cell Longev. 2016;2016:3472032.>
Hardeland R, Cardinali DP, Brown GM, Pandi-Perumal SR. Melatonin and brain inflammaging. Prog Neurobiol. 2015;127-128:46-63.
Hsu WY, Anderson A, Rowles W, et al. Effects of melatonin on sleep disturbances in multiple sclerosis: A randomized, controlled pilot study.Mult Scler J Exp Transl Clin. 2021;7(4):20552173211048756.
Sanchez-Lopez AL, Ortiz GG, Pacheco-Moises FP, et al. Efficacy of Melatonin on Serum Pro-inflammatory Cytokines and Oxidative Stress Markers in Relapsing Remitting Multiple Sclerosis. >Arch Med Res.2018;49(6):391-398.
Yosefifard M, Vaezi G, Malekirad AA, Faraji F, Hojati V. A Randomized Control Trial Study to Determine the Effect of Melatonin on Serum Levels of IL-1beta and TNF-alpha in Patients with Multiple Sclerosis.Iran J Allergy Asthma Immunol.2019;18(6):649-654.
Jallouli S, Ghroubi S, Dhia IB, et al. Effect of melatonin intake on postural balance, functional mobility and fall risk in persons with multiple sclerosis: a pilot study.Int J Neurosci. 2022:1-11.
Ma H, Yan J, Sun W, Jiang M, Zhang Y. Melatonin Treatment for Sleep Disorders in Parkinson’s Disease: A Meta-Analysis and Systematic Review. Front Aging Neurosci. 2022;14:784314.
Tseng PT, Zeng BY, Chen YW, et al. The Dose and Duration-dependent Association between Melatonin Treatment and Overall Cognition in Alzheimer’s Dementia: A Network Meta- Analysis of Randomized Placebo-Controlled Trials.Curr Neuropharmacol.2022;20(10):1816-1833.
Salanitro M, Wrigley T, Ghabra H, et al. Efficacy on sleep parameters and tolerability of melatonin in individuals with sleep or mental disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev.2022;139:104723.
Fatemeh G, Sajjad M, Niloufar R, Neda S, Leila S, Khadijeh M. Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials.J Neurol.2022;269(1):205-216.
Lim S, Park S, Koyanagi A, et al. Effects of exogenous melatonin supplementation on health outcomes: An umbrella review of meta-analyses based on randomized controlled trials. Pharmacol Res. 2022;176:106052.