This blog post was written by Katie Keating, RN, MS, patient advocate and reviewed by the Bronchiectasis and NTM Initiative Content Review and Evaluation Committee.

Sleep impacts every part of our lives and our health. It is essential for immune health and overall psychological and physical health. Sleep is a time for our bodies to rest and repair on a cellular level, for the brain to detoxify, and it helps regulate our hormones and neurotransmitters. Sleep is our greatest recovery tool.

We cannot achieve optimal health if we aren’t sleeping well. When we’re sleep-deprived it is hard to think straight, stay in a good mood, or have a positive outlook on life. On the other hand, a good night’s sleep empowers the body to recover and allows one to wake up somewhat refreshed and ready to take on the challenges of the day.

Insufficient sleep and poor-quality sleep can be due to diverse factors including medications, food sensitivities, chronic medical issues, possible neurodegenerative issues, angst, or depression. Vitamin deficiencies can impact the production of neurotransmitters and sleep patterns.

Many have experienced sleep issues throughout the pandemic due to social isolation and financial concerns- these are issues which many patients with chronic disorders deal with on an ongoing basis.

Between 10% and 30% of adults struggle with chronic insomnia. The numbers are even higher for seniors — 30% to 48% suffer from insomnia. Women have a lifetime risk of insomnia that is as much as 40% higher than that of men.¹

In the beginning of my NTM journey, sleep was never an issue. I was so exhausted from infections stealing my nutrients and my body fighting the inflammation that I slept like a baby at night. Over time, and not in an acute infectious state, sleep became an issue.

How We Sleep

Sleep progresses through a series of four stages in which different brain patterns are displayed: three non-rapid eye movement (NREM) stages and one rapid eye movement (REM) stage.

Stage 1, “drowsiness,“ is the transition period between wakefulness and sleep. It’s easy to wake a person during this period. Stage 1 is essentially the “dozing off” stage.

In stage 2, “light sleep,” the brain begins to produce bursts of rapid, rhythmic brain wave activity known as sleep spindle. Body temperature decreases, heart rate slows, muscles relax, and breathing slows. People spend approximately 50% of their total sleep in this stage.

Stage 3 sleep is also known as “deep sleep”. It is harder to wake someone up if they are in this phase. Muscle tone, pulse, blood pressure, and breathing rate decrease as the body relaxes even further. This stage is critical to restorative sleep, allowing for bodily repair, recovery, and growth. It may also bolster the immune system and other key bodily processes. We spend the most time in deep sleep during the first half of the night. From deep sleep, we go back to stage 2 sleep before entering REM sleep, stage 4.

Stage 4 is the REM stage. In this stage the brain becomes more active and vivid dreams occur. Dreaming may help you process emotions, retain memories, and relieve stress. Your body becomes relaxed and immobilized during the REM stage. Once REM sleep is over, the body usually returns to stage 2 sleep. Sleep cycles through these stages approximately four or five times throughout the night.

During REM sleep, brain activity picks up, nearing levels seen when awake. At the same time, the body experiences atonia, which is a temporary paralysis of the muscles, with two exceptions: the eyes and the muscles that control breathing. Even though the eyes are closed, they can be seen moving quickly, which is how this stage gets its name. Stage 4 is believed to be essential to cognitive functions like memory, learning, and creativity.

Under normal circumstances, you don’t enter a REM sleep stage until you’ve been asleep for about 90 minutes. As the night goes on, REM stages get longer, especially in the second half of the night. While the first REM stage may last only a few minutes, later stages can last for around an hour. In total, REM stages make up around 25% of sleep in adults.²

How to Get a Good Night’s Sleep

Trying to fall asleep can be a nightmare for some people. Below are ways to achieve a better night’s sleep, as recommended by Dr. Mark Hyman of Cleveland Clinic's Center for Functional Medicine:³

• Get on a regular schedule. Going to sleep and waking at the same time each day creates a rhythm for your body. Your bedroom should be a quiet, peaceful haven.
• Get natural sunlight. Aim for at least 20 minutes of sunshine every day, preferably in the morning. Sunlight triggers your brain to release chemicals that regulate sleep cycles.
• Avoid computers, smart phones, tablets, and television one or two hours before bed. You might also try low blue light exposure for about three hours before bed. Low blue spectrum light helps your brain reset for sleep and increases melatonin. Electromagnetic frequencies can impair sleep.
• Clear your mind. Everyone knows how something resonating on your mind can hinder sleep. Turning your mind off can become a challenge. Keep a journal or notebook by your bed and write down your to-do list or ruminations before you go to sleep so you can close your eyes and make it less likely for your mind to spin.
• Perform light stretching or yoga before bed. This relaxes your mind and body. Research shows daily yoga can improve sleep significantly.
• Use relaxation practices. Guided imagery, meditation, or deep breathing calm your mind and help you drift into sleep.

Below are a few of my favorite simple sleep tips:

• Exercise when up to it, a gentle walk with music and headsets or with a friend.
• Sleep on good quality, cool cotton bedding. Keep your bedroom cool. A cooler sleep environment is one of the most controllable and important factors for getting deep, restful sleep.
• Speak to someone about your day, your concerns for at least ten minutes per day- in person, via phone, via zoom. Releasing your feelings out is good for your immune system.
• Hydrate earlier in the day, keep eye on caffeine, go easy on the alcohol. If you have a glass of vino, enjoy it at an early dinner time, not later in the day.
• Watch foods that may trigger reflux.
• Use Epsom salts in your bath at night.
• Try a sleep app to help you to fall asleep: Insomnia Coach App, Shut I, Calm Sleep, Sleep Sounds, UltraCom CD plus others.⁴

Sleep is a valuable gift and we must continuously work on getting the best sleep we can. We will not heal without sleep nor will our immune systems be functioning up to par. Improving the quality of your sleep will help you to feel your best. Make it a goal to wake up more recharged, level up your ability to function, and to live your best life. Continue to work on finding ways to getting truly restorative sleep. Do not give up. If you sleep better, you will feel better!

References:

1. https://www.sleepfoundation.org/how-sleep-works/sleep-facts-statistics
2. https://www.sleepfoundation.org/how-sleep-works/stages-of-sleep
3. https://drhyman.com/blog/2016/04/13/8-simple-hacks-for-a-better-nights-sleep/
4. Five of the best sleep apps for iPhone and android phones: https://heavy.com/tech/2015/07/top-5-best-free-sleep-relax-meditation-apps-for-iphone-android/

Other References:

https://www.neurologyadvisor.com/topics/sleep-disorders/new-position-statement-on-the-importance-of-sleep-to-health-and-well-being/
https://www.everydayhealth.com/sleep/how-what-you-eat-affects-how-you-sleep/
https://www.webmd.com/sleep-disorders/ss/slideshow-avoid-before-bed
https://www.webmd.com/sleep-disorders/ss/slideshow-how-to-get-back-to-sleep
https://www.ncbi.nlm.nih.gov/books/NBK526132/
https://www.verywellhealth.com/thmb/ZXALi8R12qExkhBrINDU3eQOAZk=/1500x1000/filters:no_upscale():max_bytes(150000):strip_icc()/the-four-stages-of-sleep-2795920_FINAL-5c05c2fc46e0fb00018dac3d.png