Light and Sleep

Sleep has been consistently demonstrated as a key component of overall health, and poor sleep is associated with various negative physical, cognitive, and mental health outcomes. Optimal sleep requires the sleep–wake circadian rhythm to be synchronized to a 24-hour period. Light is a key determinant in the synchronization of the circadian rhythm to this period. Exposure to bright light in the morning can advance the sleep period, while bright light in the evening can delay the sleep period and lead to negative sleep outcomes. The home environment should make appropriate use of light so as to optimize sleep and eliminate environmental light pollution. Light can also be utilized to treat circadian phase sleep disorders.

Sleep and Health

Sleep is a core component of human physiology, supporting physical, mental, and emotional health. Unfortunately, insufficient sleep and insomnia are increasingly common problems both in the United States and around the world. Poor sleep is strongly associated with diabetes, obesity, and other cardiometabolic diseases. Pro-inflammatory states associated with disrupted sleep schedules and insufficient sleep are hypothesized as risk factors for cancer. Sleep disturbance impairs cognition and memory, increasing the likelihood of accidents and drowsy driving. Poor sleep is a common and exacerbating feature of many mental illnesses and may impair treatment response. Finally, the burden of insufficient sleep is calculated both in financial costs and increased mortality. Given this evidence, clinicians should recognize and treat disturbed sleep to decrease the risk of disease and improve overall quality of life.

Sleep and Cannabis

With the rising interest in cannabis, the concept of medicinal cannabis for sleep has quickly grown. The chemistry of cannabis and its medicinal effects are becoming known. Within sleep science, cannabis research has noted a connection to circadian rhythm and sleep staging. Early research has looked at insomnia, obstructive sleep apnea, restless leg syndrome, rapid eye movement behavior disorder, posttraumatic stress disorder, and chronic pain. At this time, there is encouragement for future research based on available studies. However, rigorous studies are needed before the medicinal use of cannabis for sleep can be supported by medical literature. Nevertheless, cannabis is being self-administered, and patients are looking for education. The healthcare provider has a unique opportunity to partner with patients through education and guidance, making it important for medical experts to learn about cannabis.

Circadian Rhythms and Homeostatic Mechanisms for Sleep Regulation

This chapter examines circadian rhythms and homeostatic mechanisms for sleep regulation. It reviews the current evidence describing the two-process model of sleep regulation and how to assess disruption to either of these sleep drives. This chapter also reviews the role of the photic and non-photic resetting of the circadian rhythm and describes how some aspects of modern society can cause sleep and circadian disruption. Further, this chapter describes how misalignment between the circadian rhythm and sleep homeostasis, such as occurs during jet lag and shift-work, can lead to sleep disruption. The short- and long-term consequences of circadian misalignment are also reviewed.

Sleep Duration, Timing, and Napping as Components of Healthy Sleep

Although optimal sleep is essential for overall health and well-being, questions exist regarding the sufficient duration of sleep, appropriate timing of sleep, and whether or not naps are helpful or harmful. Generally speaking, for optimal sleep health, adults should aim to obtain between 7 and 9 hours of sleep per day. The optimal timing of this daily sleep is during the nocturnal hours. In regards to napping, evidence is mixed regarding whether napping represents a detriment to optimal sleep behavior. For those who engage in napping, characteristics of napping such as the duration, timing, regularity, and environment are important factors to consider.

Manual Medicine and Sleep

Manual medicine and manipulative techniques encompass a wide array of techniques that provide structural, vascular, and energetic manipulation to influence musculoskeletal and general health. Manual medicine requires special focus on the physical exam in order to determine the most efficacious manipulative and physical therapy techniques. Manual medicine has been shown to be of benefit independently and adjunctively in the treatment of a number of musculoskeletal and pain conditions. There is a small but growing body of evidence in support of specific manual medicine techniques to treat insomnia and other aspects of sleep disorders.

The Future of Sleep (and Dream) Medicine

Envisioning the future of sleep medicine begins with an examination of the limitations imposed by our presumptions about sleep itself. Damaged by the overarching sociocultural forces of denaturation, industrialization, and medicalization, the tenets of integrative medicine provide a foundation for imagining a radically transformed sense of sleep and more effective approaches to managing sleep loss. With a greater recognition that we cannot separate what supports healthy sleep and dreams from what supports our general health, the future will emphasize sleep health promotion and prevention. The future of sleep medicine will be integrative in the broadest sense of the term. Beyond the integration of conventional with complementary and alternative medicine, it will likely encourage a richer integration of objectivity and phenomenology, the individual and the natural world, and waking consciousness with sleep and dreams.

Treatment of Pediatric Sleep Disorders

Sleep problems are common in childhood and are associated significant morbidities negatively impacting the patient and family and thus necessitating early intervention and treatment. This chapter is focused on management addressing the etiology and predisposing and precipitating factors of sleep disorders spanning from infancy to childhood and adolescence. Current recommendations for safe infant sleep, promotion of sleep hygiene strategies in childhood, and treatment options of representative pediatric sleep disorders such as sleep-disordered breathing, insomnia, sleep-related movement disorders, circadian rhythm disorders, and hypersomnia are reviewed. Additionally, management of sleep disorders unique to medical disorders such as Prader-Willi syndrome, Down syndrome, and autism also are addressed.

Pharmaceutical Sleep Medications and Medications That Affect Sleep

While sleep medications can improve sleep for those suffering from insomnia, other medications, particularly antidepressants and antipsychotics, can significantly reduce sleep quality. The mechanism by which this occurs is often indirect and variable, and it is not entirely understood. In this chapter, the authors examine how these drugs affect various sleep parameters as evidenced by polysomnography and which phase of the sleep cycle is most impacted as a result of their actions. This chapter also discusses the risks and downsides associated with long-term use of prescription and nonprescription insomnia agents, as well as important age considerations with their use.

Mind–Body Interventions and Sleep: Dealing with Stress and Improving Emotional Wellness

Research has shown that sleep is essential to our physical and mental well-being. In this chapter, the authors discuss the relationships between psychological functioning, stress, and sleep, demonstrating that sleep plays a key role in cognitive and emotional processes and mental health. They also illustrate how various psychological factors contribute to sleep disturbance and explore different relaxation techniques shown to improve sleep quality, including deep breathing, guided imagery, progressive muscle relaxation, and mindfulness meditation. Finally, the authors examine Mindfulness-Based Therapy for Insomnia, a pioneering intervention that integrates cognitive-behavioral therapy (CBT) and mindfulness training.