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Learning About Sleep Disorders

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Sleep disorders are everywhere!

Despite what you’ve heard about Obstructive Sleep Apnea,  many people with sleep apnea are not obese and their necks are not fat! They do not necessarily snore. We now know that it doesn’t really matter why you don’t sleep. If you just wake up a lot and feel tired in the morning you are at increased risk of developing chronic illness at a younger age.

As a Neurologist I did hundreds of sleep studies on young, healthy daily headache sufferers. They were all abnormal, adults as well as children. They didn’t stop breathing but they were missing the deeper phases of sleep. I found out that if I could get their sleep better I could make their headaches better. Then it became obvious that it didn’t matter if it was headache or neuropathy or tremor or falling down. If there was an illness of any kind sleeping better made the repair faster and more effective.

In 2009 we published a paper suggesting that Vitamin D deficiency began to affect our sleep beginning in the 1980’s when sunscreen and air conditioning came into common use because there are vitamin D receptors in the Sleep Switches that run our sleep.

If it’s a deficiency we can fix it!!! You can fix it, for yourself and your family. But you really need to understand sleep in order to succeed.

Why do we Sleep?

We sleep to repair and replenish our supplies. Every night we make chemicals like thyroid hormone, insulin, serotonin, dopamine, interferon. We make enough to last 16 hours then we run out. We don’t grow a third arm during the night but we do actually re-make ourselves to look the same, every night.  That means if we are not able to get into and stay in deep, paralyzed sleep every night our organs begin to fail. We get heart disease or liver disease, or kidney disease, or high blood pressure. Most authors attribute our widespread sleep problems to “not doing it right”.  We “stay up too late”, we’re “too busy”. I disagree, I believe that sleep is completely involuntary, you can’t  “do it wrong”. If you don’t sleep normally there’s something wrong with you! This site exists to explain what happened to you and how to fix it! First, some basics about how doctors talk about sleep:

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 we can still move about and wake easily. Light sleep is recorded on the hypnogram below as a horizontal line. REM sleep is in black, recorded at the top. Light sleep is drawn below REM but above Slow Wave sleep.

There are two phases of  Deep Sleep:

Slow Wave Sleep (depicted below as “Deep Slow Sleep”)

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. Children grow in slow wave sleep and probably, adults repair during slow wave sleep. Memory work is thought to happen in both REM sleep and slow wave sleep.

Repair in Slow Wave Sleep

The reason why it’s called  Slow Wave Sleep (SWS) is because the brain wave pattern is slow, steady and regular. Growth hormone is released only in this phase. Kids only grow in this phase, and in order to grow they have to be paralyzed!

Growth hormone is released in a steady flow during SWS  in kids.

It’s released in pulses during SWS in adults. Clearly we’re not growing as adults, but it’s doing something!

I believe that the same hormone that makes kids grow makes adult repairs, and only in SWS. 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 we had during the day. We can’t fix parts that are still moving! If we move inappropriately during deep sleep the repair crew has to stop and wait, and they don’t get finished. Parts that don’t get paralyzed don’t get repaired and they hurt the next day. And when that happens night after night parts just “wear out”.

Your knees were supposed to last you your whole life!  That also implies that our body can actually re-build those joints. If we can mend a broken bone we can also re-make a joint. We just need enough time, perfectly paralyzed in the healing phases of sleep.

Yes, that does mean that you can have pain because of things your body is doing during the night while you are completely unconscious.

How Do We Get Paralyzed?

There is a switch in the brain that has wires (nerves) that run to every muscle in our body.  We can be running and screaming in our dreams without actually moving.  This paralysis protects us from being found and eaten by the lions while we’re sleeping under a bush, which is good, but there are some problems with being paralyzed. Obviously, if we paralyze the chest and diaphragms we stop breathing and die. Also,  if we don’t swallow our own spit from time to time we drown.  So the paralysis “switch” has to do this just right!

To be able to fine-tune this complicated process the paralysis cells are broken up into three groups; mouth and throat, chest and diaphragm, and “all the rest”. In some phases of sleep we paralyze just the arms and legs, in other phases we paralyze the mouth and throat along with the arms and legs. We get the most paralyzed of all while we’re dreaming in REM sleep.

Posterior brain stem.

Paralysis is controlled by the Nucleus Reticularis.

What Happens if We Don’t Get Paralyzed Correctly?

Sleep apnea and inappropriate movements in sleep, like kicking or talking happen because the paralysis switch is goofed up,  it’s  “wobbling”.

Too paralyzed, throat collapses = sleep apnea.

Not paralyzed enough = kicking or talking.

Obviously if we get paralyzed every night somebody has to be sure we don’t stop breathing and die. There has to be a ”supervisor” that is watching all the time to be sure we stay alive during this paralysis. When the supervisor sees us struggling because we’re too paralyzed it wakes us up to light sleep. Even though this saved our life, every time we wake to light sleep the repair crew has to stop working. If the normal repair phase is frequently interrupted the repairs don’t get finished and our joints hurt in the morning.

This is a sleep study.

See where line two, ”airflow” goes flat (uh oh!) he stopped breathing!

Line one shows “arousal” the brain just woke him up to breathe.

Why REM-related apnea is important

During REM sleep we are the most paralyzed of all, only the diaphragms are still moving. Getting slightly “too paralyzed” can happen only in REM sleep.  “REM-related apnea” means stopping breathing only in REM. Interrupted REM sleep robs us of the ability to repair our brain. Many people with REM related apnea have trouble with memory and are depressed or anxious. REM related apnea may be a milder, earlier form of the severe “sleep apnea” seen in the person who stops breathing during every stage.

Frequently REM related apnea  is not reported on the sleep study. If you have only a half hour of REM (should have 2 1/2 to 3 hours) and you stop breathing 8 times (every four minutes) your sleep study report says:

8 apnea episodes over 8 hours of sleep:

So the “Apnea Hypopnea Index”(AHI) is ONE!

(AHI = how many times per hour did you stop breathing).

AHI of one is “not significant” and you are told that your sleep study was normal. Actually  it is very, very abnormal. Even the half hour of REM that you do have is interrupted every four minutes so your brain couldn’t get anything done!

This sleep abnormality was very common in my daily headache sufferers. They frequently had very little or no REM sleep and that finding was not mentioned on the report.

Vitamin deficiencies 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! It is a hormone that we make from cholesterol when our skin is exposed to the sun. Food comes from the sun, plants are dependent on the sun. Every animal on our planet is dependent on the sun and so are we!

D3 is not in the food, it’s a chemical we make. D2 is an older hormone made by plants and fungus. Even though the government has put D in the milk you would have to drink 100 cups a day to keep a normal D blood level.

D hormone is made from the sun to link our 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 ( that is the only sun wavelength that makes D on our skin) 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. The obesity does not cause the sleep disorder! The obesity AND the sleep problems both come from vitamin D deficiency! See also  vitamins and sleep.

How much Vitamin D Should I Take?

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 reason for their recommendation. 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 also cause  sleep malfunction. Based on careful observation of over 5000 patients there’s a narrow band between 60–80 ng/ml where the sleep is best.

The FDA has been put in the unenviable position of recommending a dose of a hormone (not a vitamin) to every American. They have purposefully and wisely chosen  to recommend 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. The FDA recommended dose has nothing to do with the vitamin D dose that you should take,! You must find out how much your body needs. And the dose you need will not be the same as your relatives or your neighbors and it may change as you get older.

Other Vitamins for Normal Sleep:

D deficiency is the most common cause of all of the sleep disorders but B12, B5 and iron deficiency also play a role. Most people become B12 deficient because they are D deficient. Low D makes the parietal cells of the stomach produce less intrinsic factor. Intrinsic factor is a special protein that binds to the B 12 in our food to help us absorb it. Low D leads to low intrinsic factor and then to low B 12. People with known B12 deficiency should also have their D checked and replaced. If only the B12 is replaced, the sleep improves temporarily but worsens again. B12 shots are not better than pills.  Daily oral dosing of 1000mcg of B12 per day is better. See the vitamins and sleep section for a more complete description of what you’ll need.

How Sleep Problems Show up as Neurological Disease:

Each one of us was born with  specific genetic weaknesses. Every night, if we sleep normally, our body finds a way to minimize or “shore up” these genetic weaknesses so we wake up doing fine.  Neurological disorders such as headache, tremor, vertigo, epilepsy, tics,  are genetic disorders.The gene mutation that causes the problem has been there since the day you were born, but it shows up now because your sleep just started to go bad. Fix your sleep and your headaches will go away.

Many neurological disorders have been reported to be related to vitamin D deficiency: Parkinson’s disease, dementia, psychosis, depression, epilepsy, autism, ADD, gait disorders, vertigo. I believe they are related to 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.  “Normal” teenagers who “can’t” fall asleep until 1:00 am have vitamin D deficiency. Before puberty the most common problem is an inability to get out of bed in the morning. After puberty most teens can’t fall asleep or stay asleep and they’re tired all the time, or need more sleep than other people just to operate normally.

Sleep and Psychosis:

We all know that you can make someone “crazy” by sleep depriving them. We’ve seen it on TV, they catch the spy and sleep deprive him to make him talk . Soon he can’t tell what’s real and what’s not.

People who try to sleep but can’t sometimes have the same thing, it just takes longer to show up.   They can get depressed or go “crazy” because their sleep is so abnormal.

The sleep switches are designed so that we can never, ever be awake and asleep at the same time. What would it be like to dream while we’re awake? Distracting at the very least, frightening at worst. Dreaming while we’re awake, produces what we call “crazy”; hearing or seeing things that aren’t really there.

Sometimes it’s called “bipolar” or “depression”. Whatever the name, that person never gets to the phase of sleep where the happy chemicals are made.  “Psychosis” or seeing or hearing things that aren’t really there, has also been linked to both B12 and D deficiency. Post partum depression may be linked to the D deficiency that happens during pregnancy. Mom has to give her D to the baby and is not out in the sun or taking enough D to keep her sleep normal. Each pregnancy she gets more and more D deficient.

Other B Vitamins and Sleep

B 12 is not the only B vitamin that affects sleep. Pantothenic Acid (B5) is absolutely necessary for normal sleep. And just like with vitamin D there’s a narrow band of dosing that works for each person. Overdosing with B5 can cause agitation and insomnia, so it’s important to understand how to use the B vitamins correctly.

It’s a little known fact that 7/8 of the B vitamins are made by our intestinal bacteria. This means that we have always carried around B vitamin generator bacteria in our bodies. Because our normal  intestinal bacteria need our vitamin D, passed down to them in the bile, when our D goes low the normal bacteria die off and are replaced by the “bad bacteria”. We need those B generator guys back again!  They were always the natural supply and they play a huge role in our health, and our sleep. Correcting the intestinal bacteria is part of what you will accomplish with the RightSleep® regimen.

I realize that it’s pretty hard to know the state of your poop bacteria but, if you have irritable bowel symptoms, chronic body pain, burning in the hands and feet, balance difficulties, foot swelling, or bad sleep, it is likely that your poop bacteria are not normal.  I do not think that the antibiotics are to blame for this. Antibiotics were in common use for thirty years before the the term ”irritable bowel syndrome” came into common use. I think  D deficiency, not antibiotics, is to blame.

What do the Healthy Bacteria need in Order to Grow Back?

We are told that the treatment for the “wrong” intestinal bacteria is probiotics or  fecal transplants. (Poop from one person given as an enema to another person to implant the “right” bacteria). But neither of these work for very long. I think  the problem is not the supply of the bacteria it is the intestinal environment. We have to supply the happy, helpful bacteria what they need to thrive and they’ll replace the bad guys.  My experience has been that the “happy, helpful” bacteria need the proper amount of vitamin D (enough so we aren’t sucking up every bit of it for our own use, or a D3 25OH blood level of greater than 40 ng/ml ) plus larger doses of B vitamins for 3 months. See also the FAQ section and sleep and vitamins section.

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