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I wanted to talk about this today because many, many, people tell me about sleep products they’ve bought, but yet they’re still sleeping poorly. When that happens, the product isn’t addressing the cause of the sleep problem. I wonder “What is going on? What is the root cause? What are the other contributing factors? What solutions are in our control?” A key principle of naturopathic medicine is to empower people with the knowledge to care for themselves. ‘Docere,’ the root of the word doctor, means ‘to teach’. Let’s gain knowledge and skills first.

Random Use of Products
I’m not opposed to all sleep related products, far from it. There are some I personally use every day, and recommend. A few favorites are blue blocking glasses, a good programmable thermostat, black-out blinds, high quality melatonin in different doses for different needs. What I am opposed to is skipping over the diagnostic phase, and the skill building which empowers people to care for themselves and their loved ones while avoiding extra costs. Without the know-how of sleep and circadian physiology, along with lifestyle and behavioral practices to improve them, all the products in the world may not to work.

Let’s look at melatonin products as an example. You’ve probably heard people share that they tried melatonin, but it just didn’t work for them. Research shows melatonin does work for various sleep, circadian, and medical conditions (2). But precision is required. Here are some of the considerations that go into using melatonin effectively:

- Does the person have insomnia, or is it a circadian rhythm disorder such as delayed sleep wake phase disorder (DSWP)? Symptoms of DSWP can mimic insomnia symptoms. Or is it another sleep disorder entirely, such as obstructive sleep apnea, for which melatonin is not indicated.
- What dose is proven effective for this condition? A physiologic 0.3mg, a high 3mg dose, or an even greater pharmacologic dose, as used in some medical disorders?
- What time should the melatonin be taken? Right timing could vary between 6 hours in advance to right at bedtime. Or even in the middle of the night.
- Is the brand reputable, and does it contain what it states on the bottle? Studies which have evaluated melatonin supplements in grocery stores found that the amount was different from what the label stated in many brands, and some also contained serotonin (3).
- Is the melatonin packaged in blister packs so it does not lose its’ anti-oxidant potency? Melatonin is a powerful anti-oxidant, but will lose that power when it interacts with air before use.

The risk of skipping to the product buying step first, is wasted money and time on the wrong solution, while effective treatment is delayed.

When you start working with someone to improve your sleep, expect their first step to be a full evaluation and determination of what the core sleep problem is. Of course we can’t always know immediately, in make take an iterative process to figure that out. It’s also highly likely for someone to have several sleep disorders, and several lifestyle factors that disrupt sleep too. If the sleep expert skips over evaluation and goes straight to selling products, that is a red flag. With over 60 sleep disorders (the number depends on which lexicon you use) the necessary first step is to figure out what is causing the problem in the first place.

Precision Use of Products
Once assessment is complete, products themselves will work much better when used in line with sleep and circadian science. One product I love and use regularly are blue-blocking glasses. The color of light from the sun changes as the day progresses. Morning light is rich in blue light. This blue light signals to our body that it is morning, time to start our day and get active. Throughout the day natural light gradually changes, until we get those lovely golden-red hues of sunset. That evening light signals to our body that night is approaching, time to slip into a more restful state and eventually to sleep. Being surrounded by blue light at night prevents that physiologic shift. Blue blocking glasses allow us to be in the built environment using our devices and LED lights, while signaling to our brain that night is approaching. Some considerations to use blue blockers well include:
- What color should the lenses be to truly block blue wavelengths? A deep orange (almost red) lens blocks blue light the most. The glasses should be specifically designed to block blue light.
- How long should they be worn before bed? The formal recommendation is to get only 10 lux of light that’s devoid of blue for the three hours before bed (4).
- Prescription glasses with an embedded blue filter, or wearing blue blockers constantly during the day, can be problematic as we don’t get that strong morning light signal to start our day.

Sleep Knowledge and Skills
Once you’ve got the assessment, the next step is to incorporate behaviors and lifestyle approaches that are known to improve sleep. That’s my focus here: Nature Cure, Circadian Rhythms, and Sleep Health. Some of the essential skills and understanding we will build in the coming months:
Nature Cure: seasonal changes to the hormones of sleep and wake, the impact of environmental factors on sleep, how sleep improves with camping, mental health improves with nature
Circadian Rhythms: your core body temperature: why it matters and what to do about it, teen sleep changes are circadian rhythm changes, shift work sleep health, precision use of melatonin
Sleep Health: use sleep to improve performance, sleep skills for travel, exactly how much sleep you do best with, do you need a sleep study, create an ideal bedroom, what are the 60+ sleep disorders

Although sleep skills alone can improve sleep, products alone won’t. Join in as we build sleep skills here at Be A Skilled Sleeper!

Sleep well and dream big,
Dr. Catherine Darley

PS. Our upcoming class is this Sunday, May 17 at 4pm EST. Join in by becoming a paid subscriber.

Leverage Light & Darkness to Strengthen Your Circadian Rhythm

Light and darkness exposure is foundational for setting our circadian rhythm. Yet in our modern lifestyle, we’re not getting the right signals. This has a huge impact on our well-being, in ways that are both immediately noticeable, and are more subtle yet compound over years. The good news is that we can design our light environment to create a robust circadian rhythm.

What you’ll leave with:
- A personalized plan to optimize your light and darkness exposure
- Understanding of why a strong circadian rhythm matters for every day, and long-term health
- Tips and tools to make the plan easy and actionable

Leverage Light & Darkness to
Strengthen Your Circadian Rhythm

• May 17, 4-5pm EST

Light and darkness exposure is foundational for setting our circadian rhythm. Yet in our modern lifestyle, we’re not getting the right signals. This has a huge impact on our well-being, in ways that are both immediately noticeable, and are more subtle yet compound over years. The good news is that we can design our light environment to create a robust circadian rhythm.

What you’ll leave with:
- A personalized plan to optimize your light and darkness exposure
- Understanding of why a strong circadian rhythm matters for every day, and long-term health
- Tips and tools to make the plan easy and actionable

“How Much Sleep Do I Need?”
Identify Your Ideal Sleep Total

• June 14, 4-5pm EST

“Is 6 hours of sleep enough?” It’s not enough, not for the vast majority of us. So how do we know exactly how much sleep we actually need? And how much sleep do we need to be at our best? This is a critical first step to making your optimal sleep plan.

Over 1 in 3 of us don’t get the sleep needed during the work week. Insufficient sleep has a global impact on our well-being, from physical and mental health, to performance and emotional intelligence. Insufficient Sleep Syndrome is actually a diagnosable disorder! Come learn how to identify your optimal sleep total, and how to build it into your lifestyle.

What we’ll do together:
- Explore what goes wrong when living with insufficient sleep
- Identify how much sleep you personally do best with
- Create an Optimal Sleep Plan that embeds sufficient sleep into your lifestyle

Your Sleep Sanctuary:
Design a Bedroom That Works

• July 12, 4-5pm EST

Our bedroom has a huge impact on the quality of our sleep, which spills over into the quality of our days. There are so many components to design a bedroom where you can truly rest. In this class we will cover them all, from the most obvious to the subtle. Often people tell me “I never realized X would make such a big difference in my sleep.” Come learn what that X is for you!

What you’ll leave with:
- An understanding of all the bedroom features to optimize for sleep, and what the mechanisms are
- How to do an in-depth bedroom assessment
- Your personal design for a bedroom that works

Now we know better. Having a routine strengthens our circadian rhythm, synchronizes our systems, and improves our sleep. Our behaviors impact the peripheral clocks of our circadian system, while light and dark exposure have the biggest impact on our master clock. Here are the behavioral time points that matter.

Right Time Your Meals
Meal timing is an important cue that signals to our peripheral ‘clocks.’ Every cell in our body has these clock genes, which tell it to do more or less of its’ function at certain times of day. Meals signal to our body that it is day, time to be in active mode. A couple key features of meal timing to consider:
- Start with breakfast, ideally within an hour of waking. Eating breakfast will help your body be on an earlier schedule, and counter-act all those influences that push us not to be sleepy til late (think factors like light in the evening).
- Avoid eating a late dinner, as that will push your body clock later.
- Start each meal within the same 30 minute window every day, seven days a week. For example breakfast starts between 7-7:30am, lunch between noon-12:30pm, dinner between 5:30-6pm. Customize the times, and the number of eating windows, for you.

Intentional Exercise Timing
Exercise is another behavior that sets our body clock. Thankfully, exercise timing doesn’t need to be quite as exact as meals, but is more about periods of the day as in morning, afternoon, or evening.
- Exercise before 4pm will help you stay on an earlier schedule.
- Exercise after 7pm will shift your body clock later.

Social Factors Strengthen Your Circadian Rhythm
Human beings are social creatures (and yes, to varying degrees!). Our social interactions are actually cues that signal to our circadian system. Here we want to have predictable social times. Think not only times when we socialize for fun, but also include whenever we interact with others.
- For many of us, we get a lot of our interaction with co-workers. Whether going to the office, or working from home, create a routine where you interact with your co-workers at a predictable time every day.
- If you have a more flexible schedule, intentionally create a lifestyle where you predictably interact with others. Could be a fun coffee date, or simply doing your errands and appointments in the same time block daily.

Why A Strong Circadian System Matters
When I say “strengthen” your circadian system, I mean to create or maintain a high amplitude circadian rhythm. As children, our circadian rhythm is very robust, very high amplitude. With aging, our circadian system weakens and flattens out. Decreased circadian amplitude is associated with chronic disease and aging. And of course, low circadian rhythm contributes to poor sleep too.

You’re Invited!
This year let’s get together regularly and talk sleep. Once a month we’ll gather via zoom for a deep dive on a specific sleep skill. Tomorrow, February 23rd at 9am PT / noon ET we’ll talk about How to Create a Sleep Healthy Lifestyle. Come learn the eight daily touch-points to strengthen your circadian system and improve your sleep. I hope you’ll join me!

Here’s the zoom link: https://us02web.zoom.us/j/85675454749pwd=blz8Yn412VLbibQBXD86YxX8C07Z2G.1

Sleep well and dream big,
Dr. Catherine Darley

The content of the "Be A Skilled Sleeper" Substack webpage (such as text, videos, audio, images, and other materials created by the Institute of Naturopathic Sleep Medicine) and other materials contained on this webpage (collectively, "Content") is for informational purposes only. The Content is not medical advice and is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately.

We may be so busy during the day that there’s literally no time to think things through as we need to, or night thinking could be a long-term habit, or be from a particularly eventful period in life. Today I’m sharing four steps to calm your mind so you can rest.

First, Define Sleep Time as Only for Rest
A good way to think about sleep time is that it serves an entirely different purpose than wake hours, and is even “time out of time.” In other words, during the day we take care of our roles and responsibilities, but during the night we set them aside in order to rest and restore. We do not take those wake time responsibilities to bed with us. Re-define sleep time as time you are ‘off-duty,’ even from thinking things through. Give yourself permission to take this time for yourself, for recovery. You worked hard enough already. (Of course there are exceptions, like when we must care for children or ill adults during the night).

Second, Put Your Thoughts to Rest
An hour or two before bed, take 10 minutes to write down the thoughts that tend to come up in the night, with the intention of “putting them to bed.” The writing can take any format, from a full sentence narrative or problem-solution chart, to simple thought bubbles or even a drawing. Then have an enjoyable wind-down for the remaining time before bed. It may take a little practice to learn what thoughts need to be discharged with the journaling, and to learn this internal limit setting. Journal every night for a month so you have the chance to figure out what works for you. The goal is to ensure time to process worry during the day, so it’s been taken care of, and does not need to emerge during sleep hours.

Third, Thought Stopping
If thoughts arise in the night, do some gentle thought stopping along the lines of “I already thought about that, and will have time tomorrow, now’s time to rest.” Come up with your personal phrase that really speaks to you. It’s important that this phrase really hits your heart with the power of truth. A rote mantra or platitude that you don’t actually believe won’t work. Another that people have shared is “I worked hard today, and take care of my business. I can pick that up tomorrow morning, after wake time.”

Fourth, Do a Sleep Promoting Practice
Now that you’ve “kicked your thoughts out of bed,” do a sleep-promoting activity instead. Do this any time you realize that you are awake in bed, either at the beginning of the night, or in the middle. This is also a skill, and different strategies will work better for different people. Choose the one that appeals to you the most and use it regularly for a week. Then, if need be, try another strategy until you have an effective one. As you use that strategy repeatedly, it will become associated with sleep onset, and will work more quickly.
- Tell yourself a gentle story, maybe a favorite book or movie from childhood. Review the same story in your mind night after night as your “bedtime story.” This is my personal favorite. I love to go fruit picking, so made up a story of a family going apple picking. I only ever think of this story either when teaching, or those few nights that I’m awake in the night. After falling asleep to it so many times, the family hardly decides to go apple picking and packs their lunch before I’m asleep. They hardly get out to the car, and never to the orchard.
- Do progressive muscle relaxation starting with the toes and working slowly towards the head. Tense an isolated muscle group for a count of 7, then relax it. Go slowly with the goal of being asleep before getting to your head. This is a great strategy who feel physically restless in addition to the racing thoughts.
- Visualize yourself falling asleep. Bring in as many senses as possible. You may use a time you recall falling asleep, or create a visualization maybe of falling asleep in the sun, or in a hammock, or during a nap.
- Do a gratitude practice or prayer. Focus on the good things in your life, the things that make you happy and content. (Avoid any problem solving or planning). Some people have shared doing this alphabetically, and report always being asleep by G or H.
- If you wake from a dream, purposefully go back into the dream and let it carry you back into sleep.

Practice
Do these four steps consistently every night. Work with them. Experiment. Learn what works best for you. Then you can decide whether this is something you will do every night, or if it’s a tool that you’ll use just when something particularly thought-provoking happens. Doing this process consistently will help you learn to set your thoughts aside so you can sleep.

You’re Invited!
This year let’s get together and talk sleep regularly. Once a month we’ll gather via zoom for a deep dive on a specific sleep skill. On February 23rd at noon ET we’ll talk about How to Create a Sleep Healthy Lifestyle. Come learn the eight daily touch-points to strengthen your circadian system and improve your sleep. Comment below or send a DM if you’d like to join in!

Sleep well and dream big,
Dr. Catherine Darley

The content of the "Be A Skilled Sleeper" Substack webpage (such as text, videos, audio, images, and other materials created by the Institute of Naturopathic Sleep Medicine) and other materials contained on this webpage (collectively, "Content") is for informational purposes only. The Content is not medical advice and is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately.

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There are three general purposes to use melatonin supplements. The most commonly known, is using it as a hypnotic for sleep. The second purpose is as a ‘chronobiotic’ to shift the body clock for circadian rhythm disorders. Think jet lag, shift work, and people who are extreme night-owls or early birds. The third purpose is a broad category which includes all melatonin’s actions at the cellular level. This is a rich area of use, but yet is the least commonly known. Let’s dive into these three purposes, and explore a few of the many reasons

Melatonin as a Hypnotic
Hypnotic substances are ones that help us sleep. This is the purpose that often comes to mind first, yet there’s not a lot of research evidence for use. Taking 1mg to 3mg of melatonin within 30 minutes before bedtime is a well-established effective use for difficulty falling asleep at the beginning of the night. For sleep maintenance insomnia, using a time release formula may help. Here a person falls asleep easily at the beginning of the night, but wakes in the middle of the night. In this case, taking a time-release formula of 1 – 3mg right at bedtime is recommended. It will be active later in the night.

Chronobiotic Effects
The second way to use melatonin (which you probably haven't heard about) is to use it as a chronobiotic. A chronobiotic is a substance that signals to the body what time it is, just like our endogenous melatonin signals that it is night. Melatonin taken as a chronobiotic can actually shift your circadian phase somewhat. That’s the mechanism used for circadian rhythm disorders such as jet lag, shift work, delayed sleep wake phase and others. When using melatonin as a chronobiotic, it is taken away from bedtime, at a precise time to make the desired body clock shift. The right timing and dose is very exact, so it’s best to consult with a sleep specialist if you wish to use melatonin as a chronobiotic. Inexact use can produce the opposite effect, making you sleepy just when you don’t want to be, or causing a ‘paradoxical’ response. It’s likely because of it’s chronobiotic effect that melatonin taken for insomnia doesn’t get people the effect they wish.

Virtually the entire class of Circadian Rhythm Sleep-Wake Phase Disorders can benefit from melatonin supplements. Most of the research uses physiological dose of 0.5mg up to low pharmacologic doses of 3mg or at most 5mg. This would include:
-       Delayed Sleep Wake Phase Disorder
-       Advanced Sleep Wake Phase Disorder
-       Jet Lag Disorder
-       Shift Work Sleep Disorder
-       Non-24-hour Sleep Wake Disorder

Indications for Other Sleep Disorders
There is a rare sleep disorder, REM Behavior Sleep Disorder (RBD), in which the normal REM sleep paralysis is not present. This means people act out their dreams, a danger to themselves and others. Melatonin has been helpful as part of a comprehensive treatment plan. RBD requires treatment by a sleep specialist, as it is a complicated disorder, which is associated with future development of Parkinson’s disease.

Melatonin Improves Cellular Health
The third way that melatonin supplements are used is for its’ actions at the cellular level. These mechanisms are very important and I anticipate are going to get a lot more attention over the next ten years or so. Exciting! As we discussed in the last newsletter, there is evidence that our melatonin levels are significantly suppressed by all the artificial light at night which we’re exposed to in our built environments. This may be part of the connection between the modern lifestyle and chronic disease.

Some of melatonin’s actions beyond sleep, beyond sleep and beyond circadian rhythms, include:
- It is one of the most powerful antioxidants. And we need antioxidants to help with anti-aging functions.
- It is a very powerful anti-inflammatory.
- It helps with our mitochondria, which is the powerhouse of the cell, creating our energy.
- It helps us keep strong bones. Many of these actions are important for longevity and anti-aging.
- It’s neuroprotective.

The medical research is actively investigating melatonin supplements as a treatment for a wide range of conditions, based on the above actions. Uses span from:
- central nervous system disorders such as migraines, autism and ADHD.
- immune conditions such as autoimmune disorders, and oxidative stress.
- cardiovascular diseases such as hypertension, metabolic syndrome, high cholesterol.
- reproductive disorders such as preeclampsia and PCOS.
- gastrointestinal disease such as ulcers and IBS.
- musculoskeletal disease osteopenia.

As ever, if you are interested in taking melatonin supplements, first consult with your licensed healthcare provider to learn if it’s right for you, and make sure there are no contra-indications for your use. You’ll also want professional advice to get the timing, dose, formula, and source right.

Stay tuned for the next Melatonin series when we’ll talk about all the considerations in choosing a melatonin supplement - dose, timing, formula, source and more.

Sleep well and dream big,
Dr. Catherine

The content of the "Be A Skilled Sleeper" Substack webpage (such as text, videos, audio, images, and other materials created by the Institute of Naturopathic Sleep Medicine) and other materials contained on this webpage (collectively, "Content") is for informational purposes only. The Content is not medical advice and is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately.

Whenever we're talking about melatonin, let’s be clear whether we're talking about endogenous melatonin, which is the melatonin that our bodies produce, or talking about melatonin supplements. Today let's start with the natural melatonin in our bodies, that endogenous, or intrinsic, melatonin.

Our Endogenous Melatonin
Melatonin is called the “hormone of darkness.” It’s a compound that is both water and lipid soluble, so can enter all compartments of the body. Each night, in darkness, the pineal gland deep in the brain releases a pulse of melatonin. That melatonin first spreads through the brain, making us drowsy and lowering our core body temperature. Then it goes into the circulation via the blood and is distributed throughout the body.

Most cell types have melatonin receptors. Melatonin binds to our cells, signaling that it is night, and time to switch into night physiology. Other tissues make melatonin too, but there are some key differences. The extra-pineal melatonin produced elsewhere (such as the gastrointestinal tract) stays local, it doesn’t enter the circulation, so only impacts cells that are nearby. The other key difference is that these cells produce melatonin in response to other stimuli, not the light-dark cycle as the pineal gland does.

Light Suppresses Melatonin
Let’s talk more about how melatonin release is intricately linked with our light-dark environment. You’ve probably heard that blue light suppresses melatonin, here’s how it works: In our eyes there are specialized cells in front of the rods and cones which are used for vision. These intrinsically-sensitive retinal ganglion cells measure the wavelength ie. color of light. Across the day, the wavelengths in sunlight change. Morning has more blue light. As the evening approaches, there’s less blue light, and more in the red spectrum. This is the reason for those beautiful sunsets! These special cells in our eyes send information to the brain about what time of day it is. An area of the brain called the supra-chiasmatic nucleus (SCN) gets this time information. The SCN is the “central pacemaker” which sets our circadian rhythm.

Our Nightly Melatonin Pattern
As the sun sets, and the light dims to less than 10 lux, the SCN allows our pineal gland to start to release melatonin. That melatonin continues to rise until about 4 hours into our sleep period, then will start to decline. Interestingly, when we first wake up, our melatonin is still somewhat elevated. But we open our eyes, open the shades, maybe even go outside, and that burst of light quickly suppresses any melatonin that’s still present. Endogenous melatonin levels from the pineal gland are fairly low, about 70pg at most in adults. (For that reason, we consider melatonin supplements of </= 1mg to be ‘physiologic’ doses, while above that are considered ‘pharmacologic’ doses. More on supplements next time, just mentioning it now to give some perspective on dosing vs. physiology).

Melatonin Levels Change Across the Lifespan
Melatonin levels change across the lifespan. Young children have the highest release of melatonin. Starting at puberty, melatonin levels decrease significantly by about 40%. Levels continue to decline in mid-life, so by the time a person is in their fifties they have quite low levels of melatonin.

The Built vs. Natural Environment
It’s important to note that since the wide-spread adoption of the electric light, we have significantly altered the light-dark cues we are getting. This changes our endogenous melatonin pattern significantly. In the built environment melatonin release starts later, and often ends later. This pushes us to be more night-owls. Children are much more sensitive to the negative effects of artificial light at night as their melatonin is suppressed by lower light levels. This is attributed to the fact that their system has not yet aged. (See my previous post about Blue Blocking Glasses for a solution).

Some studies have shown that in a naturalistic light environment compared to the built-in light environment, people in that natural environment end up having melatonin increased for a couple of hours more in the winter nights versus when they're in their homes with electric light.

Notes on Melatonin Testing
An easy way to test melatonin is through saliva. The standard procedure is to collect saliva specimens for six hours before bed. The challenge though is that the person must be in dim light, less than 5 or 10 lux. For most people this is a challenge, and doesn’t reflect their typical lifestyle. Often test kit instructions don’t mention the required light conditions. For these reasons, I question the value of testing your melatonin, unless directed by your clinician to evaluate for a specific pathology.  

Sleep Skills
There are reasons – sleep, circadian health, cellular health – that we want to have the normal levels of melatonin that people have in the natural light environment. Here’s a few tips:

• Get at least 20 minutes of outside light within the first two hours of your day (Yes, this works even in a cloudy June-uary, as it is here in the Pacific NW!)

• Three hours before bed, dim the lights in your home, or wear blue blocking glasses if you need to use electronic screens or use LED bulbs.

• Make your bedroom dark for sleep, with a bedside lamp handy if you need to get up.

Next newsletter we’ll talk about melatonin supplements, and when they might be used effectively.

Sleep well and Dream big,
Dr. Catherine Darley

The content of the "Be A Skilled Sleeper" Substack webpage (such as text, videos, audio, images, and other materials created by the Institute of Naturopathic Sleep Medicine) and other materials contained on this webpage (collectively, "Content") is for informational purposes only. The Content is not medical advice and is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately.

Personally, I love to nap. Particularly when I’m going through a busy time, a useful strategy is to take a nap about eight hours into my day. The sleep perks up my energy and focus for the rest of the day. Plus, it seems like a treat to take a break. There’s the brief cat nap approach, where you simply sleep where you are. The other approach is a full-on sleep session- changing into sleepwear, closing the shades, and napping in the bed. That’s my fave. When teaching, some of the most common questions are about naps. Should we take naps or avoid them? What’s the right time of day to nap? How long should a nap be?

Should we take naps or avoid them?
The research on naps is mixed, with pros and cons. Naps have been shown to improve cognitive performance for about two hours, particularly when taken by 1pm. A 20-90 minute nap for athletes will improve physical performance, perception, and psychological state. On the other hand, a large study found greater mortality in those who napped while having >6 hours of sleep nightly. It’s thought that the need for extra sleep can indicate chronic disease.

What’s the right time of day to nap?
The circadian rhythm of our core body temperature influences how sleepy we are. As core body temperature drops we become sleepy, and when it rises we wake up. At it’s peak, typically about 3 hours before our natural bedtime, we are most alert. The lowest core temperature is about 3 hours before we naturally wake.

There’s a dip in core body temperature about 1-2pm in the afternoon. This is why we often have a dip in our energy and alertness. This temperature dip makes early afternoon the time we most easily nap. Or, if we’re chronically sleep deprived, it’s the riskiest time for falling asleep unintentionally.

How long should a nap be?
Over the 90-110 minute sleep cycle, we go from light sleep to deep sleep, and back to light. Deep sleep, otherwise called slow wave or Stage 3 sleep, is when our brainwaves are very high amplitude and slow. This is quite different from our waking brainwaves. Therefore, waking from deep sleep will often have us feeling groggy, and take about 20 minutes to become fully alert and functional.

Therefore, a cat nap of less than 30 minutes is easiest to wake from, as it will have us waking from a lighter stage of sleep. Alternatively, take a nap that is a full sleep cycle, so we’re again waking from a light stage of sleep. This can be particularly helpful when for whatever reason you’re not getting sufficient sleep at night, and need to make up that sleep time.

A couple examples come to mind. One is for people who do early morning shift work. One patient was working a very early shift, from 6am to 2:30pm, which required waking by 5am. Going home to nap from 3pm to 4:30pm allowed her to have an active social life in the evening, with a later bedtime of 10-10:30pm. Combining her nocturnal sleep and nap she was well-rested and had all the benefits of sufficient sleep. For teens (the most sleep deprived age group), napping regularly can also increase their sleep total closer to the recommended amount. In our neighborhood, swim team and band meet before school, starting at 5:45 or 6:00am, making it impossible for teens to get enough night-time sleep. Having a nap regularly after school can increase alertness, performance and mood in the afternoon.

When napping is a problem.
Working in a sleep clinic, it’s common for people to come in because they’ve been falling asleep unintentionally at stop signs. This is a sign of such profound sleepiness that it’s unavoidable. If you are falling asleep unintentionally during the day, take immediate action to get help. Stop driving, and otherwise operating heaving equipment or doing activities where injury is possible.  Set up an appointment at your local sleep center.  

Napping later in the evening, particularly for a longer time, can discharge your sleep drive, and make it difficult to sleep later at night. It’s generally recommended to prioritize consolidated nocturnal sleep, and limit naps if they are causing nighttime difficulties.

Bringing it all together.
Napping can be a useful strategy, particularly when you are chronically sleep deprived, or your daytime experience is impaired by sleepiness. I hope these sleep skills help you, everyone needs a good night’s rest.

Sleep well and dream big,
Dr. Catherine Darley

References:

1.       Dutheil F, Danini B, Bagheri R, et al. Effects of a Short Daytime Nap on the Cognitive Performance: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021;18(19):10212. Published 2021 Sep 28.

2.       Lastella M, Halson SL, Vitale JA, Memon AR, Vincent GE. To Nap or Not to Nap? A Systematic Review Evaluating Napping Behavior in Athletes and the Impact on Various Measures of Athletic Performance. Nat Sci Sleep. 2021;13:841-862. Published 2021 Jun 24.

3.       Wang C, Bangdiwala SI, Rangarajan S, et al. Association of estimated sleep duration and naps with mortality and cardiovascular events: a study of 116 632 people from 21 countries. Eur Heart J. 2019;40(20):1620-1629.

The content of the "Be A Skilled Sleeper" Substack webpage (such as text, videos, audio, images, and other materials created by the Institute of Naturopathic Sleep Medicine) and other materials contained on this webpage (collectively, "Content") is for informational purposes only. The Content is not medical advice and is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately.

In past newsletters we talked about women’s sleep, and we talked separately about aging. Let’s bring those topics together now in how to support women’s sleep health through menopause.

Women’s Sleep Complaints Increase with Age
You’ve likely heard women in the office, at home or out and about complaining of hot flashes, and may have even observed them suddenly flush and break into a sweat. These are due to a rapid vasodilation, bringing blood to the skin and causing the symptoms. When hot flashes occur at night it’s very uncomfortable, and some women report sweating through sleepwear and sheets, having to change in the night even. What’s interesting is that waking up usually happens moments before the night sweat occurs. So it’s not the hot flash waking a woman, but she awakes, then has the hot flash. When women are sleeping better, they often report being less bothered by the hot flashes.

The prevalence of sleep disorders increases from the perimenopause to postmenopausal years.

• Wake Disorders increases from 5.4% to 14.2%

• Sleepiness increases from 29.5% to 34.2%

• Insomnia increases from 37.6% to 48.3%

• Restless Legs Syndrome increases to 53.1%

• Sleep Apnea increases from 25.7% to 32.5%

There are also circadian changes associated with aging that can influence how a woman sleeps. Older women who sleep poorly have less nocturnal melatonin secretion than younger women, and than older women who sleep well. Core body temperature rhythm is also muted in older women who don’t sleep well compared to those who do.

Sleep Skills for Women Throughout Life
The good news is that there are strategies women can use to improve sleep in the second half of life that have been demonstrated to work. Among those is to directly manage menopausal symptoms, whether it be through herbs and nutrients, exercise recommendations, or other strategies.

I’m pleased to share that I’m speaking on an expert panel at the upcoming Pro-Age Woman Summit, May 2-4. We focus on the best ways to alleviate hot flashes and night sweats and get back to sleeping peacefully. It is free to join in, and I hope you do. The rest of the summit includes a wide range of experts sharing information for women to continue to live life to the fullest.

Join in: https://theproagewomansummit.com/cada

Sleep well and dream big,
Dr. Catherine Darley

Select References:
1.      Salari, N. et al. Sleep & breathing = Schlaf & Atmung. 2023:1–15
2.      Olbrich D, Dittmar M. Chronobiol Int. 2011;28(8):681-689
3.      Bianci M. J Clin Sleep Med. 2016 Jul 15;12(7):1003-9

The content of the "Be A Skilled Sleeper" Substack webpage (such as text, videos, audio, images, and other materials created by the Institute of Naturopathic Sleep Medicine) and other materials contained on this webpage (collectively, "Content") is for informational purposes only. The Content is not medical advice and is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately.

About the Skilled Sleeper Course

Discover the secret to restorative nights and energetic days with our transformative course at SkilledSleeper. No longer will the dread of restless nights loom over your evenings. Our proven strategies, tailored to align with your natural sleep-wake cycle, ensure that a restful sleep is not just a dream, but a nightly reality. Uncover the techniques that will not only rejuvenate your body but also rekindle your zest for life. With a good night's sleep, you'll not only meet your daily commitments with vigor but revel in life's little extras that make every day meaningful. Our course is not just about mastering sleep; it's about reclaiming your days, elevating your performance at work and at home, and nurturing your emotional well-being. With SkilledSleeper, you're not just improving your sleep, you're investing in a happier, more fulfilling life.

Welcome

This course is relevant for every person who sleeps, and needs good sleep to fuel a good life. Please watch the videos and do the worksheets associated with each. This will progressively build your skills as you become a Skilled Sleeper!

Logistics

Each module includes several short instructional videos of approximately 10 minutes each. After most video lessons you’ll be guided to use one of the tools, which include a variety of quizzes and self-assessments, checklists and worksheets, and infographics providing more details. Take the time to thoughtfully complete the worksheets before moving on to the next video. The lessons build on each other, so you’ll get the most value by completing them in sequence. Every 48 hours you’ll have access to the next unit. 

Once you’ve completed the course, you can ask a remaining question through the google form, and it will be answered via a personalized video for you. For additional sleep information:

• Get our weekly Substack newsletter Be A Skilled Sleeper

• View videos on a wide variety of sleep topics at youtube.com/@skilledsleeper

• Follow on Instagram @skilledsleeper for daily tips

To participate in the whole course, you must be a paid subscriber.

Modules

Resources

Explore our range of resources to enhance your learning experience.

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Dive deeper into sleep skills with our in-depth resources:

• YouTube

• Substack

You’re already familiar with some of the ways poor sleep impacts your days. We think of the impacts in 5 domains:

- Cognitive performance
- Physical performance
- Physical health
- Mental health
- Emotional intelligence

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The way we spend our days shapes how we sleep at night. From the time you wake up there are lifestyle practices you can put in place to support healthy sleep. We’ll go through this step-by-step, and you’ll have the chance to create a Sleep Healthy Lifestyle plan. Understanding the basics about circadian physiology will help you stay motivated as you tak…

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Sleep disorders are undiagnosed in the majority of people who are experiencing them. People think they are simply not sleeping well, when they actually have a diagnosable sleep disorder that needs treatment. Is this you?

In module 3 you will learn about the six main categories of sleep disorders, and the health risks you’re exposed to if those sleep diso…

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