How to improve your sleep

One of the popular beliefs is that you have enough time to sleep when you are dead. I have to admit that until recently I did not pay attention to my sleep. But over the last year I taught a wellness class for my resident physicians and sleep is an essential part of a healthy living. I felt I had to read more about sleep. One book that I really enjoyed was: “Why We Sleep: Unlocking the Power of Sleep and Dreams” by Matthew Walker.

Matthew Walker makes a great case for sleep. Sleep is pretty much the Swiss army knife for health and it is free. Poor sleep has been correlated in studies with all the diseases you can imagine from heart disease, obesity, diabetes, degenerative brain diseases (Alzheimer’s) to cancer. The obesity connection is really interesting. Humans are the only animal who voluntarily deprives itself of sleep. The other animals decrease sleep only when they don’t have enough food. This connection sleep/food is likely preserved in us. When we don’t get enough sleep our brains/bodies are guessing that we are food deprived and we feel like eating a lot of food high in calories (junk food).

Basically the recommendations I found so far are:
- Allocate enough time for sleep - at least 8 hours per night
- Use dim lights in the evening (or red lights if you have them), no screen time, turn your devices to night mode (reddish color of the screen)
- Cold room: 65-68 degrees F (use socks if needed, obviously this temperature is much easier to achieve in the winter)
- Decrease worry/anxiety: best is meditation, another option is to do journaling one hour before bed and end the journaling with a couple of things for which you are grateful that day
- No food/exercise for 2-3 hours before bed
- No alcohol in the afternoon/evening
- Limit/give up coffee (including decaf) or caffeinated beverage (i.e tea, Coke, Pepsi). If you sleep enough you might not need any of these
- Create the connection between bed and sleep, go to bed only when sleepy, don’t do anything else in bed (like reading or watching TV). If you don’t fall asleep get up and do something else
- Avoid sleeping pills, they do not induce normal sleep

And even more recommendations:
- If you snore discuss with your doctor about a sleep study, maybe you have sleep apnea
- If your sleep partner interferes with your sleep, consider sleeping in different beds/rooms

Matthew Walker appeared on a few podcast shows that I follow. You can listen to him on Peter Attia podcast: episode 1, episode 2 and episode 3.

Diet, weight and being in pain

Lifestyle changes is not probably a topic that most doctors discuss with their patients in pain. One of the great physicians of the early 1900s William Osler once said ”The good physician treats the disease; the great physician treats the patient who has the disease.” The best way to treat a disease in my opinion is to treat the whole patient with the biopsychosocial approach : see my previous post on slow medicine vs fast medicine. Most diseases occur because of the interaction between genes, lifestyle and environment.

Diet is an essential part of our lifestyles. Currently, the diet of most people in the US is contributing to many diseases. Below is a graph with the prevalence of diabetes in US:

People can argue which food increased the diabetes prevalence, but I think it is pretty clear that the diet is the cause. Definitely, this increase is not due to purely genetic factors. Our bodies are very efficient in using energy and our food is too high in calories. It is quite remarkable that nowadays we pay more for food with less calories in order to eat healthy. Our ancestors would be incredibly puzzled.

Interestingly enough many patients I see in my pain clinic do not make a connection between their lifestyle and their pain. Many of them blame osteoarthritis (inflammation) in their joints for their pain. Diet has a very important role for inflammation in our bodies and the standard american diet rich in processed food and sugar is one of the worst. Some diets shown to help with inflammation and prevention of disease are DASH and Mediteranean diet. A few institutions recommend antiinflammatory diets: Harvard link, Cleveland clinic link and University of Wisconsin pdf file. Besides inflammation there are studies showing that food rich in excitatory molecules aggravates chronic pain. One example is monosodium glutamate (MSG) with studies showing that MSG is not good for some fibromyalgia patients (an overview here). A review of the inflammation and chronic pain is on the pain science website.

In addition to the diet obesity creates a state of inflammation in the body that seems to induce diabetes, heart disease, cancer (one scientific paper) and probably pain too. This is a decent review of the relationship between obesity and chronic pain: practical pain management link. One indirect link between obesity and pain is diabetes which damages nerves and creates neuropathies. Obesity also creates mechanical stress and increases the risk of damage in the weight bearing joints. Everybody who is overweight/obese can try the following experiment: get a backpack, put 30 pounds of weight in it and walk around….this is how your 30 pound lighter body feels every day.

If you need motivation to change your diet you should watch a few lectures by Robert Lustig: http://www.robertlustig.com/. If you are interested in biochemistry, metabolism and general science Peter Attia might be a place to start: https://peterattiamd.com/. Serious research about lifestyle changes and various diseases was published in prestigious journals over many years by Dean Ornish who promotes healthy diet, stress reduction, social support and moderate exercise. Obviously diet and lifestyle changes cannot fix everything and that is why we have modern medicine to help. But if there is a choice between medications, surgeries and lifestyle changes I am not sure why somebody would choose the first two options.