This section is not meant to be a summary of current science. It is a summary of my thoughts about how sleep works based on my patient observation as well as current science. (Please see the lecture section also to go through this information in a more visual way. I find text without pictures a little dry… So you may find the powerpoint lectures easier to follow.)
Why do we sleep?
We sleep in order to perform the daily maintenance that our body needs. The only reason why our bodies last more than a few years is because of this nightly maintenance. If we are not able to get into and stay in deep, paralyzed sleep we are not able to do nightly repair and we age more rapidly than the people around us. Most of the articles about sleep attribute our modern, widespread sleep problems to “not doing it right”; “we stay up too late, we’re too busy”. I believe that sleep is completely involuntary, normal humans can’t “do it wrong” because sleep is not really by choice. Normal healthy humans all fall asleep about the same time, 9-10pm and wake up about 6–7. Sleep has always been involuntary, since the day we were born. No matter what you want to do, you will fall asleep and you will wake up again.
Light Sleep and Deep Sleep
The first stage of sleep is Light Sleep, a “waiting phase” to be sure we “are in a safe place to get paralyzed”. Light sleep is still sleep but the brainwave pattern is irregular, and we are still moving about. After a period of time we flip into the first phase of deep sleep. There are two phases of Deep Sleep; Slow Wave Sleep and Rapid Eye Movement (REM) Sleep. The major difference between light sleep and deep sleep is that in deep sleep we are paralyzed and performing the “work” of sleep.
Repair Hormones in Slow Wave Sleep
Slow Wave Sleep is called that because the brain wave pattern becomes slow, steady and regular. As we enter this phase there begins to be a pulsatile release of Growth Hormone. This is the same hormone we use to grow as children. In kids the growth hormone is a steady flow and they grow, while paralyzed, in deep sleep. In adults this same hormone is released in pulses. I believe that this growth hormone acts as the “boss hormone” calling all the specific repair hormones; bone, muscle, tendon, joint, vein, hormones to come out as a “repair crew” to repair any injury that occurred during the day. If we move inappropriately during deep sleep the repair crew has to stop and wait, and sometimes they don’t get finished.
Why Do We Get Paralyzed?
There is a small switch in the posterior brain stem that “flips” when we enter deep sleep. This switch prevents signals from the brain from passing through the spinal cord to the face, arms and legs, paralyzing us. If you’re sleeping under a tree with your whole tribe and you talk or snore, you and your whole tribe gets found and eaten by the lions. You can also think of this paralysis as: we “turn the machine off so we can repair it”. Obviously, if we were to paralyze the chest and diaphragms we would stop breathing and die, so the switch that prevents our movement is actually designed to separate out the cells that go to the breathing muscles and allow them to keep functioning while we paralyze the rest. Also, the mouth and throat still need to move, because if we don’t swallow our own spit we’ll drown. So the paralysis “switch” in the brainstem has three groups of nerve cells; all get paralyzed, but to slightly different degrees.
What happens when we don’t get paralyzed correctly?
Two common sleep disorders seem to result from a malfunctioning paralysis switch. We can be “too paralyzed”, which results in “sleep apnea”, or “not paralyzed enough” which leads to leg movements called “Periodic Limb Movements of Sleep”. Often both happen in the same person. In order to explain this observation I picture the paralysis switch more like a speedometer needle. When it’s not working right, instead of cruise control, 55 mph, the needle is wobbling back and forth between “a little too paralyzed” and “a little not paralyzed enough”. If the mouth and throat are slightly too paralyzed, as we suck in air our throat collapses, preventing the flow of air. The brain senses that there is no air flowing and it wakes us up to light sleep. As soon as we get to light sleep we are no longer paralyzed, we open the airway again and then fall back into deep sleep. Even though this saved our life, every time we wake to light sleep and move a little, the repair crew stops working. If the normal repair phase is frequently broken up by episodes of waking to light sleep the repair cannot happen normally. Every part of the body that’s still moving or “tensed up” doesn’t get fixed and those parts may hurt when you wake up.
Rapid Eye Movement Sleep
REM sleep is the next phase of deep sleep and we are the most paralyzed in REM sleep, only the diaphragms are still moving. If a person only stops breathing in REM sleep they have “REM related apnea”. Interrupted REM sleep robs the person of the phase of sleep where we make new memories, polish old memories and probably repair the brain just like we do the body. Many people with REM related apnea not only have trouble with memory but they are also depressed or moody. This “REM related apnea” may be a milder, earlier form of the severe “sleep apnea” seen in the person who stops breathing in every stage of sleep. This is the most common pattern of abnormality in my daily headache sufferers.
Sleep Apnea Does not Just Happen to Fat People
Despite what has been written about Obstructive Sleep Apnea, most people who have this disorder are not obese and there is nothing abnormal about the way their neck is formed. They do not necessarily snore and are not always witnessed to stop breathing.
In 2009 a couple of my headache patients with sleep apnea told me that the extra vitamin D that they had started made their sleep, and then their headaches, better. This was after 6 years of wondering “why are 9/10 of the sleep studies, even in my young, healthy headache patients abnormal?” I discovered that all of my patients who had abnormal sleep also had vitamin D deficiency. I looked in the scientific literature to see if anyone had reported that low vitamin D produced sleep disorders. The answer is no, but on looking further, it turns out that there are vitamin D receptors all over the posterior brainstem, right where the “clock” that times our sleep, and the “paralysis switch” are . What if we might be able to give back something that the brain was lacking and make the sleep return to normal?
Vitamin deficiencies may cause Sleep Disorders
Vitamin D deficiency is probably the most common hormone deficiency in today’s modern world. Vitamin D used to be thought of as the calcium and bone vitamin, it is not a vitamin. Vitamin means, “my body can’t make this chemical so I need it from my environment”. It is a hormone that we make from cholesterol on our skin from the sun. D is not in the food, it’s a chemical we make. If you wanted to get enough from the milk supplementation you would have to drink 1,000 cups a day. D hormone is made from the sun to link the body’s metabolism to the length of the day. In the summer, more sun exposure and high D hormone signals the body to make more muscle, make stronger bones, and make the stomach work faster. High D signals the body to use all the food we eat to produce energy and build our body instead of storing it. We sleep less but more efficiently, so we’re up harvesting our crops or gathering food. In the winter the UVB light goes away and our D level goes lower. Low D signals the body to sleep longer, gain weight and hibernate. Hormone D is used by every organ in our body to do its job correctly. People who are D deficient are essentially in permanent winter; they get depressed, feel less active, sleep longer but don’t feel rested, they get sick more often and stay sick longer. They all sleep “wrong”. Many people are both obese and have a sleep disorder because of vitamin D deficiency.
How much vitamin D should I take to sleep well and feel better?
Over the last 30 years, as we’ve been advised to stay out of the sun, most Americans have become D hormone deficient. The FDA recommendation of 800 IU per day is way too low, but there’s a good reason for that. Having a vitamin D level that is too high is just as dangerous as one that is too low. D levels above 80 ng/ml bring back the malfunction of the sleep center and therefore all the symptoms the patient had with bad sleep and a low D, come back at with bad sleep and a high D. There’s a rather narrow band between 60–80 ng/ml where the sleep is perfect.
The FDA has been put in the unenviable position of being asked to recommend a dose of a hormone (not a vitamin) to every American. They have purposefully and wisely chosen not to try to recommend anything more than a tiny dose. This is a hormone that fluctuates in normal humans, month to month and year to year based on where you live, how much sun exposure you have and the color of your skin (which determines how fast we make D). There is no way to recommend a single, correct dose for every person. Therefore the FDA recommended dose really has nothing to do with the vitamin D dose that you should take based on your D hormone level. And the dose you need will not be the same as your relatives or your neighbors and it may change during your life depending on all of the above variables.
Go to www.vitamindcouncil.org for questions about vitamin D dosing and the thousands of responsibilities of D hormone in our bodies. (Also see the vitamin D section of this site.) The only thing that is not there is the link to sleep. D has certain cofactors that help it do its work so always take a multivitamin as well.
D deficiency is the most common sleep disruptor but B12 and iron deficiency also play a role. Most people become B12 deficient because they are D deficient. Low D makes lower stomach acid, a weak esophageal sphincter and acid reflux. Not enough stomach acid makes it hard to break the vitamin B12 off the meat. (B12 is the only B that is predominantly in meat, and iron becomes deficient for the same reason.) People with known B12 deficiency should have their D checked and replaced. If only the B12 is replaced usually the sleep does not improve. B12 shots are not better, take a pill of 1000mcg per day. (See vitamin D handout for why.)
Other neurological disorders linked to poor sleep
Each one of us has a genetic deck we’re dealt the day we are born. Each night we “shore up” each of these genetic weaknesses. I’ve learned over time that the patients with daily headaches have bad sleep, if you fix the sleep the headaches go away. Many other neurological disorders such as tremor, vertigo, epilepsy, burning in the feet, (every genetic disorder where a nerve cell is “switching on inappropriately” instead of quietly doing its job) can also be affected by bad sleep. That means a genetic disorder that’s been in your genes since the day you were born can present now and not in the first year of life because your sleep is disordered. That means it might also go away or get better when your sleep gets better. Many of those neurological disorders have been reported to be related to vitamin D deficiency: Parkinson’s disease, dementia, psychosis, depression, epilepsy, autism, ADD, gait disorders, neuropathy. The explanation for this probably resides in D’s connection to sleep.
Could my kids have sleep problems too?
Sleep disorders are not isolated to adults. Kids can be tired, listless or restless because they don’t sleep well. It is not normal for a child to have a hard time falling asleep and most of the literature telling us that “normal” teenagers “can’t” fall asleep until 1:00 am have been studying D deficient teens without realizing it. Most of our kids are D deficient (see the vitamin D section for more about this) and go to www.vitamindcouncil.org to read about children’s asthma, allergy ADD and autism, all linked to vitamin D deficiency.
Sleep and Psychosis:
We all know that you can make someone “crazy” by sleep depriving them, we’ve seen it used as a form of torture on TV. People who try to sleep but can’t, can also have severe sleep deprivation. One of the things that most of us have never really thought about is how we manage to dream only while we’re sleeping. What would it be like to dream while we’re awake? Distracting at the very least, very frightening at worst. That “switch” in the brain that makes sure that dreaming only occurs during sleep is designed to be absolutely sure that we are never, ever awake and asleep at the same time. There’s a reason why we don’t want to be dreaming while we’re awake, it would produce what we call “crazy”; hearing or seeing things that aren’t really there. That means that some people who “go crazy” might have gotten there because of a sleep disorder. “Psychosis” has also been linked to both B12 and D deficiency. Post partum depression may be linked to D deficiency produced by pregnancy and worsened by accompanying B12 deficiency. If these disorders are something we could prevent by replacing a hormone deficiency I belieive this should be one of medicine’s major commitments. SGominak 1/2011