DNC News


DNC NEWS: Sleep Debt


Subject: Most people live in a state of chronic low level sleep deprivation which weakens their health.


People need to sleep. When they don't sleep as much as they need, they feel tired. This “iou of tiredness”, when the hours of sleep are less than a person's physiological need, is called sleep debt. When sleep debt becomes chronic, it causes profound changes in endocrine, cardiovascular and immune function, none of which are desirable. Trying to improve the function of these and other physiologic systems without first paying back the debt of missed sleep is difficult.


In 1910 people slept an average of nine hours a night. There is every reason to believe that in preceding years and centuries people slept at least this long. Average sleep duration stayed at about nine hours a night until about 1960. Since then sleeping has become unfashionable; the average night's sleep has fallen to seven hours a night during the workweek and less than eight on weekends. About one-third of the population sleeps six hours or less per night. Another third sleep eight hours a night. People who work shifts often sleep less than five hours a night on workdays. This is a huge change. If sleep were a nutrient, most of us would be suffering from deficiency symptoms.


Not getting enough sleep causes problems. Past research on sleep debt focused on factory workers: sleep loss of only two to three hours will result in poor performance, slowed physical and mental reaction time, increased errors, decreased vigilance, impaired memory and reduced motivation and laxity.


Recent research has focused on more fundamental physiologic changes in the body when sort changed of sleep. Underlying the foggy thinking from missed sleep is a state of profound endocrine dysregulation. [1] Thyroid hormones levels rise . Growth hormone, which normally surges during the first few hours of sleep, is depressed, contributing to obesity, reduced lean muscle mass and insulin resistance. [2] Afternoon and evening cortisol levels rise as sleep debt increases. [3] Elevated evening cortisol increases night time alertness and interferes with sleep. This creates a vicious cycle. Sleep deprivation messes up carbohydrate metabolism. Only allowing people four hours of sleep a night for four nights lowers their glucose clearance rate by 40%. This decrease is comparable to the decrease seen in gestational diabetes. Similar results have been shown with less dramatic sleep debts. Age related insulin resistance may be the simple result of increasing sleep debt. In Type II diabetics, good sleep is correlated with better glycemic control. [4]


Several of the risk factors for heart disease seem related to sleep debt. Besides increasing insulin resistance, sleep debt triggers abdominal obesity, increased blood clotting, increased triglycerides, increased Type II diabetes, and high blood pressure. People who have trouble sleeping have increased the risk for heart trouble later in life. [5] Sleep debt is linked to obesity in both children and adults. [6] In men two or more days a week with less than five hours of sleep causes a 200-300% increase in heart attacks. [7] This increase is five to ten times the risk from having high LDL cholesterol.


Studies have shown sleep deprivation results in impaired immune function, especially of natural killer cells which are essential in defending against viral infection and cancer. [8] Even modest sleep deprivation, such as preventing sleep between 10 pm and 3 AM or between 3 and 7 AM , was enough. [9] Sleep debt is on the list of things which prevent flu shots from taking effect and working.



With sleep debt there doesn't seem to be an easy way to declare bankruptcy. Extended night time rest may be the only way to reverse the physiological changes. You have to pay this one back. It doesn't just take sleep but requires good sound sleep. Chronic light sleep, without a deep sleep phase, causes most of the same changes as sleep deprivation. Sleep quality is disrupted by jet lag, night shift work, chronic stress, caffeine overuse, and patterns of activity and rest that do not match the natural rhythm of light and dark. Not only do you need enough sleep but it's got to be good sleep.


Initial recovery from sleep debt, measured by normalizing endocrine function, typically requires three days of 9.5 hours or more of sleep. In chronic sleep debt it may take a lot more sleep to get over it. In experiments, healthy people, who did not start out ‘tired', spent 8 to 14 hours in bed a night for a month, showed continuous improvement in the same endocrine markers which deteriorate with increasing debt. This suggests that even healthy individuals may carry a substantial sleep debt even in the absence of obvious sleep deprivation.


In the history of naturopathic medicine, bed rest or extended sleep has been a common therapeutic prescription. It is a mainstay of traditional European spa therapy with a two to three week stay in a supportive setting being the routine. The pattern in these spas is usually an early bedtime, extended sleep and an afternoon nap or rest period. Henry Lindlahr an American naturopath who ran a 200 bed in patient facility in Chicago nearly a century ago routinely prescribed complete bed rest on weekends for his out patients who had chronic diseases. Researchers have used extended 14 hour sleep periods to adjust REM sleep patterns and have suggested it as a treatment for rapid cycling bipolar disease. [10]


So what can we do about this?

Sleep more. Get out of the modern mindset that time spent sleeping is time wasted. Go to bed earlier and sleep later. Set aside nights to go to bed earlier and sleep later.


A good way to start is to set aside three days, such as a long weekend, and catch up on sleep. Three days in a row of 9.5 hours of sleep is a good goal for most of us. Though keep in mind this is the average sleep your great grandfather had his entire life.


Self-prescribe bedrest for anything that ails you. Modern habits would have us work through every illness keeping to our normal routine. In reality we should be resting in bed and sleeping extra.


Trouble sleeping is one of the most common complaints we hear in practice although many people don't even see it as a problem; they just don't sleep well or through the night or feel rested in the morning. We need to sleep well to feel healthy. For people who say they can't sleep well I suggest the following routine to try as a starting point in improving sleep patterns. If this isn't enough, well, you have our phone number.


A Routine for Establishing Healthy Sleep and Recovering from Sleep Debt:

This simple routine is a good place to start in reestablishing a healthy 8.5 to 9.5 hour sleep cycle in an individual with chronic sleep debt or who is suffering from the effects of night shift work or jet lag.


  1. Timing: Select a time to go to bed so you can get enough sleep before you need to arise in the morning. A target goal should be 8.5 to 9.5 hours of sleep. Sleep before 11 PM is more beneficial to the cause, while wakefulness after 1 AM is detrimental.
  2. Eat Early : Eat a substantial breakfast with abundant protein and try to consume 80% of your daily protein at breakfast and lunch. Protein raises heat production. Have an early dinner so that your stomach is empty by bedtime. Five to six hours is best but three hours should be the minimum time. Body metabolism increases with digestion and this elevation in activity may hinder sleep. This rule does not apply to everyone; some people wake at night due to hypoglycemia and they may benefit from bedtime snacks.
  3. Be active: Engage in some outdoor activity during the bright daylight hours around noon , even if it's just a 20 minute walk during lunch. Bright natural light suppresses melatonin and helps to establish a normal daily rhythm, with the melatonin increasing again as sleep approaches. Try to keep your vigorous exercise in the daylight before 1 PM. This allows time for the body's metabolism to slow down and cool off before sleep. Exercise after sunset may hinder sleep.
  4. Slow Down before Bed . Don't engage in intense mental activity for at least two hours before bedtime. Light reading is ok. Turn off all bright lights after sunset and very strictly for the last hour before bed. Use gentle lighting, even candle light if possible.
  5. A tepid bath before bed . Tepid means neutral, not hot. The water temperature should be 92 to 97 degrees F. It should feel somewhere between natural temperature and slightly warm. It should not feel hot. Add warm water as needed to keep from feeling cool. This is your chance to burn candles, listen so soothing music and so on.
  6. Herbs: Take a dose of mild sedative herbs 30-60 minutes before bed. Take another dose at the bedtime you've set for yourself.
  7. No lights: Turn off all of the lights, draw curtains if the moon or street lights are bright and don't turn on any lights until morning. Lights prevent the surge of melatonin which signals the body that it is time to sleep. Even small amounts of light are enough to prevent melatonin production so keep your bedroom as dark as possible. Electromagnetic fields (EMF) may also prevent melatonin production so you may want to unplug any electrical devices that are near your bed.
  8. Stay in bed. If you wake before 8.5 hours roll over and go back to sleep. Stay in bed for at least 9.5 hours and take a short nap in the late afternoon.
  9. This works: This routine will usually re-establish the sleep-wake cycle in three days.


Things to take:

There are a number of safe and useful sedative herbs to use before and at bedtime. Our favorites are skullcap ( Scutelaria lateriflora ) Passionflower ( Passiflora incarnata ), Valerian ( Valeriana off .), Oatstraw ( Avenna sativa ) and Hops ( Humulus lupus ). Magnesium supplements may also be useful. [11] If these are not enough, again, you have our phone number. Please don't call after bedtime.


[1] Rev Neurol ( Paris ). 2003 Nov;159(11 Suppl):6S11-20.  [Impact of sleep debt on physiological rhythms]
]Spiegel K, Leproult R, Van Cauter E.

[2] Sleep. 1997 Apr;20(4):267-7.Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4-5 hours per night. Dinges DF, Pack F, Williams K, Gillen KA, Powell JW, Ott GE, Aptowicz C, Pack AI.

[3] Sleep. 1997 Oct;20(10):865-70. Sleep loss results in an elevation of cortisol levels the next evening.
Leproult R, Copinschi G, Buxton O, Van Cauter E.

[4] J Assoc Physicians India . 2003 May;51:479-81. Sleep in Type 2 diabetes.Vigg A, Vigg A, Vigg A.

[5] J Intern Med. 2002 Mar;251(3):207-16.Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population. Mallon L, Broman JE, Hetta J.

[6] Lancet. 1999 Oct 23;354(9188):1435-9. Impact of sleep debt on metabolic and endocrine function.
Spiegel K, Leproult R, Van Cauter E.

[7] Occup Environ Med. 2002 Jul;59(7):447-51.  Overtime work, insufficient sleep, and risk of non-fatal acute myocardial infarction in Japanese men. Liu Y, Tanaka H; Fukuoka Heart Study Group.

[8] Semin Clin Neuropsychiatry. 2001 Oct;6(4):295-307. Neuroimmunologic aspects of sleep and sleep loss.
Rogers NL, Szuba MP, Staab JP, Evans DL, Dinges DF.

[9] Adv Neuroimmunol. 1995;5(2):97-110. Sleep deprivation and human immune function.
Dinges DF, Douglas SD, Hamarman S, Zaugg L, Kapoor S.


[10] Biol Psychiatry. 1998 Jun 1;43(11):822-8.Treatment of rapidly cycling bipolar patient by using extended bed rest and darkness to stabilize the timing and duration of sleep. Wehr TA, Turner EH, Shimada JM, Lowe CH, Barker C, Leibenluft E.

[11] Pharmacopsychiatry. 2002 Jul;35(4):135-43Oral Mg(2+) supplementation reverses age-related neuroendocrine and sleep EEG changes in humans. Held K, Antonijevic IA , Kunzel H, Uhr M, Wetter TC, Golly IC, Steiger A, Murck H.


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