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.

Functional Medicine and Sleep

Functional medicine recognizes that illness does not occur in isolation. Similarly, sleep disorders do not occur in a vacuum because clinical imbalances that lead to illnesses may subsequently affect sleep, and sleep disruption and circadian dysregulation affect chronic disease. As a way of organizing clinical imbalances the Functional Medicine Matrix helps clinicians to examine the body systems, symptoms, and risk factors associated with a specific condition. The matrix provides an outline for the clinician to organize the patient’s clinical imbalances in biological systems, called nodes: these are defense and repair, energy, biotransformation and elimination, transport, communication, structural integrity, and assimilation. The Functional Medicine Matrix assists the clinician in organizing and prioritizing each patient’s health issues, including sleep disorders, as elicited by a thorough personal, family, social, and medical history. The matrix is a tool for organizing what seem to be disparate issues into a complete story to help the clinician gain a comprehensive perspective of the patient and subsequently facilitate discussion of complex health issues, including chronic disease and sleep disorders.

Aromatherapy for Sleep

Aromatherapy is defined as using the essential (volatile) oil extracted from an aromatic plant to improve health and well-being. The naturally occurring chemical constituents in essential oils cross the blood–brain barrier and interact with neurons of the autonomic nervous system. Specific essential oils can be used to treat insomnia via the parasympathetic nervous system by reducing anxiety, improving relaxation, and promoting sleep. They can also be used to treat hypersomnia by increasing alertness through stimulation of the sympathetic nervous system. Essential oils are simple to use and have a low side-effect profile. Essential oils can be blended to create a personliazed aromatic therapy to support relaxation or promote alertness.

Sleep: A Traditional Chinese Medicine Perspective

In this chapter, the use of Traditional Chinese Medicine (TCM) for the treatment of insomnia and other sleep-related conditions is explored. The language of TCM often appears impenetrable to Western researchers, but TCM represents a centuries-old complete, viable, and integrated medical system. The author provides a review of the language of TCM that allows the reader to come to an understanding of the mechanisms for why insomnia occurs, why acupuncture is used in its treatment, and how insomnia is diagnosed in terms of pattern identification using signs and symptoms for differential diagnosis. In addition, sample treatment protocols for both acupuncture and Chinese herbal medicine are presented.

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.