insights

Read Time 4 Minutes

Research continues to underscore just how important sleep is and how harmful a lack of sleep can be. Sleep deprivation is known to induce oxidative stress¹ and increase anxiety levels.² Acute sleep deprivation may even contribute to increased levels of DNA damage.¹ When patients report sleep disturbances or do not sleep deeply enough, this dysfunction can affect their blood pressure, heart rate, mental and cognitive status, hormones, and immune function.^3-6 In addition, not getting enough sleep has been associated with chronic health conditions such as depression, type 2 diabetes, obesity, and heart disease.⁷

Over one-third of the US population has reported sleeping less than the recommended seven hours a night.⁸ According to a 2020 poll by the National Sleep Foundation, half of the respondents reported feeling sleepy anywhere from three to seven days a week, with the higher number of sleepy days corresponding with elevated levels of stress.⁹ Excessive daytime sleepiness is one of the leading reasons that patients present to sleep clinics.¹⁰ As a functional medicine clinician, how do you talk to your patients about sleep and give them tools to improve this important lifestyle factor? In the following video, IFM educator Shilpa P. Saxena, MD , offers some tips:

Relaxing Into Sleep: Mind-Body Interventions

In some cases, sleep can seem difficult despite our best efforts. People suffering from lack of sleep are often encouraged to engage in nonpharmacological activities that relax the mind and body—from biofeedback to meditation and yoga. But relaxing isn’t sleeping. Can any of these lifestyle interventions actually help propel an individual into restorative sleep?

Research suggests that mind-body interventions have been shown to improve sleep quality, reduce sleep disturbances, and effectively treat insomnia.^11-13

From Tai Chi to Yoga

A 2020 systematic review and meta-analysis evaluated the effects of different mind-body interventions on health outcomes in older adults (37 studies comprising 3,224 participants).¹⁴ For analysis, the interventions were sub-grouped into tai chi/qigong and yoga/Pilates, and results suggested significant overall effect sizes favoring experimental groups compared to non-exercise control groups in all outcomes, including sleep quality.¹⁴ A 2019 systematic review and meta-analysis of 49 studies echoed the effectiveness of mind-body therapies like tai chi, qigong, and yoga in reducing insomnia severity and improving sleep quality for both healthy individuals and patients.¹⁵

Sleep disorders are commonly experienced by cancer survivors; in fact, 51-90% of cancer survivors experience some form of sleep disturbance.¹⁶ A 2019 nationwide randomized controlled trial (RCT) of a yoga therapy program (two 75-minute sessions for four weeks) in 410 cancer survivors found improvements in overall sleep quality and reductions in daytime dysfunction.¹⁶ Yoga therapy participants also demonstrated a statistical trend for greater reductions in sleep medication use compared to controls.¹⁶

Women with pre-menstrual syndrome (PMS) are known to experience sleep problems due to the fluctuations in hormone levels. An interesting study in 2018 found that yoga reduced sleep disturbances in patients with PMS, which subsequently improved the efficiency of their sleep.¹⁷ According to the study, results were based on the 10-week treatment of three 60-minute yoga sessions practiced per week.¹⁷

Mindfulness and Meditation

A 2020 RCT assessed the impact of yogic meditation in sleep quality.¹⁸ Participants in the study were healthy pediatric healthcare professionals (n=64), and the experimental group attended two 30-minute yogic meditation classes each week for eight weeks.¹⁸ Polysomnography and Pittsburgh Sleep Quality Index scores indicated that compared to the control group, participants in the yogic meditation group fell asleep faster and experienced both fewer disturbances and improved sleep quality.¹⁸

A 2023 randomized clinical trial (n=127 adults aged 50 to 80 years with self-reported sleep difficulties) explored the benefits of an in-person mindfulness class (formal mindfulness exercises, self-inquiry discussions, application of mindfulness practices to noted sleep difficulties, at-home guided meditations) compared to an in-person sleep behavior informational course (sleep biology, helpful tips for optimal sleep habits and environments, and included breathing exercises).¹⁹ Both the mindfulness class and informational course were held weekly for a two-hour group session and lasted eight weeks. Results indicated that both groups showed reductions in insomnia severity, with significantly greater improvement seen in the mindfulness-based intervention.¹⁹

Conclusion

Sleep is a complex, active process of restoration for the body, and patients experiencing sleep dysfunction can suffer both from physical and psychological disturbances that greatly affect their quality of life. Talking with patients about their sleep hygiene is the first step in beginning to evaluate how, over the course of their lives, sleep has impacted their overall health. Through IFM’s Lifestyle: The Foundations of Functional Medicine course, learn more about the connections between sleep and other biological processes in addition to the lifestyle treatments that may help to improve your patients’ sleep quality and overall health.

Related Articles

Good Sleep Hygiene May Protect Against Infectious Diseases

Sleep Deprivation: A Deeper Dive Into Clinical Screenings, Mitochondrial Impact, and Therapeutic Interventions

Nocturia: More Than Just a Nuisance

Sleep-Immune Crosstalk: Exploring Links Between Sleep Quality, Quantity, & Immune Health

References

1. Cheung V, Yuen VM, Wong GTC, Choi SW. The effect of sleep deprivation and disruption on DNA damage and health of doctors. Anesthesia. 2019;74(4):434-440. doi:1111/anae.14533
2. Bean CAL, Ciesla JA. Naturalistic partial sleep deprivation leads to greater next-day anxiety: the moderating role of baseline anxiety and depression. Behav Ther. 2021;52(4):861-873. doi:1016/j.beth.2020.10.008
3. Li C, Shang S. Relationship between sleep and hypertension: findings from the NHANES (2007-2014). Int J Environ Res Public Health. 2021;18(15):7867. doi:3390/ijerph18157867
4. Chunnan L, Shaomei S, Wannian L. The association between sleep and depressive symptoms in US adults: data from the NHANES (2007-2014). Epidemiol Psychiatr Sci. 2022;31:e63. doi:1017/S2045796022000452
5. Besedovsky L, Lange T, Haack M. The sleep-immune crosstalk in health and disease. Physiol Rev. 2019;99(3):1325-1380. doi:1152/physrev.00010.2018
6. Owusu JT, Rabinowitz JA, Tzuang M, et al. Associations between objectively measured sleep and cognition: main effects and interactions with race in adults aged ≥50 years. J Gerontol A Biol Sci Med Sci. 2023;78(3):454-462. doi:1093/gerona/glac180
7. National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. Sleep and sleep disorders. Centers for Disease Control and Prevention. Reviewed September 7, 2022. Accessed August 10, 2023. https://www.cdc.gov/sleep/index.html
8. National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. Sleep and sleep disorders: adults. Centers for Disease Control and Prevention. Reviewed November 2, 2022. Accessed August 10, 2023. https://www.cdc.gov/sleep/data-and-statistics/adults.html
9. National Sleep Foundation. Sleep in America Poll 2020: Americans feel sleepy 3 days a week, with impacts on activities, mood and acuity. National Sleep Foundation. Published 2020. Accessed August 10, 2023. https://www.thensf.org/wp-content/uploads/2020/03/SIA-2020-Report.pdf
10.  Khawaja I, Yingling K, Bukamur H, Abusnina W. Vitamin B12 deficiency: a rare cause of excessive  daytime sleepiness. J Clin Sleep Med. 2019;15(9):1365-1367. doi:5664/jcsm.7936
11.  Rusch HL, Rosario M, Levison LM, et al. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Ann N Y Acad Sci. 2019;1445(1):5-16. doi:1111/nyas.13996
12.  Han J, Cheng HL, Bi LN, Molasiotis A. Mind-body therapies for sleep disturbance among patients with cancer: a systematic review and meta-analysis. Complement Ther Med. 2023;75:102954. doi:1016/j.ctim.2023.102954
13.  Yang M, Yang J, Gong M, Luo R, Lin Q, Wang B. Effects of tai chi on sleep quality as well as depression and anxiety in insomnia patients: a meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2023;20(4):3074. doi:3390/ijerph20043074
14.  Weber M, Schnorr T, Morat M, Morat T, Donath L. Effects of mind-body interventions involving meditative movements on quality of life, depressive symptoms, fear of falling and sleep quality in older adults: a systematic review with meta-analysis. Int J Environ Res Public Health. 2020;17(18):6556. doi:3390/ijerph17186556
15.  Wang X, Li P, Pan C, Dai L, Wu Y, Deng Y. The effect of mind-body therapies on insomnia: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2019;2019:9359807. doi:1155/2019/9359807
16.  Lin PJ, Kleckner IR, Loh KP, et al. Influence of yoga on cancer-related fatigue and on mediational relationships between changes in sleep and cancer-related fatigue: a nationwide, multicenter randomized controlled trial of yoga in cancer survivors. Integr Cancer Ther. 2019;18:1534735419855134. doi:1177/1534735419855134
17.  Ghaffarilaleh G, Ghaffarilaleh V, Sanamno Z, Kamalifard M, Alibaf L. Effects of yoga on quality of sleep of women with premenstrual syndrome. Altern Ther Health Med. 2019;25(5):40-47.
18.  Guerra PC, Santaella DF, D’Almeida V, Santos-Silva R, Tufik S, Len CA. Yogic meditation improves objective and subjective sleep quality of healthcare professionals. Complement Ther Clin Pract. 2020;40:101204. doi:1016/j.ctcp.2020.101204
19.  Perini F, Wong KF, Lin J, et al. Mindfulness-based therapy for insomnia for older adults with sleep difficulties: a randomized clinical trial. Psychol Med. 2023;53(3):1038-1048. doi:1017/S0033291721002476