“Let our day prepare us for sleep so that sleep can prepare us for the next day.”

I honestly do not know who I heard this from, and I may have butchered the original quote a bit, but when it comes to sleep and our lifestyle, nothing says it better.

These days up to 30% of adults in the developed world have some form of insomnia. They have the tools to get to sleep, the time and space but just can’t get the sleep that they need. 10% of people are chronic insomniacs.

Sleep deprivation, though, is a bit different. Sleep deprivation is when we don’t have all the creature comforts, time and space, and everything at our disposal that should get us good sleep. We are deprived of these things and hence deprived of sleep. When we are deprived of a quiet and safe places to sleep, that is sleep deprivation. When we’re deprived of time to rest, that is sleep deprivation. And often enough, you could probably consider the constraints we put on ourselves as a self-determined sleep deprivation.

For those who find themselves working two or three jobs and sacrificing more than their time to sleep, their overall health, hopefully we can focus our efforts at having equity of consideration when contemplating society changes and future needs of those most in need but least adaptable. By doing this, all other populations and society will succeed.

The associations and correlations between sleep and health show us that the same poor lifestyle that leads to poor health also leads to poor sleep. Poor sleep leads to poor lifestyle, and the negative spiral down towards chronic disease and basic ill health both physically and mentally compound to the point at which digging out of the depths becomes harder and harder. Exiting the negative spiral with intentional behavior choices that promote both good health and sleep is what is needed. This is hard for even the most dedicated of us, and so many others have environmental and social aspects to their lives making the need for structured help critical.

Here I hope to write a bit about what I have learned and educated other health professionals on when it comes to how a person’s environment and social determinants can affect sleep in quantity and quality. Non health care professionals should benefit from this information as well. We all need to practice a learned perspective with each other, and healthcare professionals an equitable practice when helping patients optimize health which primary comes from choices made every day within the confines of their lives.

A lot of times trying to find the sweet spot for what works to optimize health can seem like a choose your own adventure. In some ways, it really is. We know the basics, the big pillars of what makes our lifestyle lead us to better health. But in our request to find our right balance and traverse the adventure that is health and longevity for the long run, let us be empowered to find our own way, and less influenced by those who seek to gain our business.

It’s more so that there are many other aspects of lifestyle that influence sleep so that sleep can influence our lifestyle and our health. What we should not do is chronically sacrifice sleep for another lifestyle endeavor is such as diet and exercise, connection or even stress management. Unless more focus on another particular pillar of health will also positively influence our sleep, we should prioritize sleep more.

I’m reminded of a woman that stuck around after one of my cooking classes several months ago. She was having difficulty losing more weight after losing 75 pounds in the last year. This is quite a feat, and she divulge that she did this through mostly diet. However, she was 70+ years old and still had obesity. We discussed optimizing her diet, but then she mentioned how she hardly gets any sleep. By focusing solely on one pillar of health, diet in her case, to the exclusion of others, she may have been causing more stress to negate the positive effects of diet. It might be worth her time to focus more on her sleep quality and quantity.

This is because with lack of sleep our bodies produce hormones that drive up cortisol and cause us to crave foods such as those high and fat and sugar. If our bodies are not getting enough sleep to reenergize, it will be told to seek out foods that can get us the energy we need regardless of what they may do to our glucose levels, cholesterol, or blood pressure.

Every time I think of this innate biological mechanism, I’m reminded of the times during my medical residency driving home in midafternoon after a 36 to 48 hour call, and having absolutely no self-control when it came to driving by Taco Bell and not going through the drive-through for a few Chalupa‘s. My body was convincing my mind that only greasy and salty fast food that could be consumed in a matter of minutes was the only thing that could allow me to survive.

I can relate to the sector of the population that serves the rest of us while we sleep. People working jobs such as being first responders, stocking our grocery shelves, and cleaning our office buildings, may have yet one more reason to see health disparities. In an article titled “Daytime Eating Prevents Internal Circadian Misalignment and Glucose Intolerance in Night work” (SA, 2021) details a small study looking into the circadian misalignment of our peripheral system, not just our central system that usually gets all the circadian credit. Our internal organs respond to messages from a time cues referred to as Zeitgebers. When we do things like stay up too late at night because we have to work when we would otherwise be sleeping, and we eat during these times, this can cause a misalignment of our circadian metabolism and lead to increased average glucose levels through glucose intolerance. Over the long-term, it would be reasonable to conclude that this can lead to health consequences such as increased inflammation within the body as well as diabetes. This is concerning because so many people who may not have the education or other occupational opportunities to work “banker hours“ and serve the public by doing critical jobs at night, and eating at night, are losing out on health afforded the rest of us and are some of the least likely to have a choice as to when they work.

For those who either know me or have looked closely at my bio, before I was in Lifestyle Medicine and Culinary Medicine, I was in Emergency Medicine. While I educated residence and medical students in Emergency Medicine, I always made sure to include what I felt was education needed for the hidden curriculum. This hidden curriculum included sleep management, caffeine dosing, and sleep strategies for shift work. I’m glad to have read recently about this topic on a Canadian blog and podcast, Emergency Medicine cases.com. Episode 207 investigates this matter in depth.

In high stakes medicine, such as in the emergency department, not only for physicians, but also nurses and paramedics and really anybody who must have very fast cognitive processing skills with very few errors while attending to patients, sleep needs to play a critical role in advancing this clinical judgment and capacity to make faster decisions. There is no computer aid algorithm or pop-up in the EMR, order set or triage system that can supplant the critical judgment needs of those working in high risk medical and other essential fields. Not to mention the working memory, mental resilience, emotional stability, interpersonal skill regulation, and anxiety deference needed for the everyday sanity stabilization of the healthcare professional. All these essential qualities are gained through high quality and adequate quantity of sleep.

The opposite of having cognition and emotional stability due to lack of sleep is also spelled out in this American Journal of Lifestyle Medicine article, “Effects of Sleep Deprivation on Physical and Mental Health Outcomes: An Umbrella Review.” Shah et al point out that sleep loss has real risks to mental health with evidence to show a “definite increase in anxiety levels, aggression, depression, and lowering of the mood”. Emotional stability, instability and dysregulation, and the increase in anxiety is believed to be attributed to increase amygdala activity. The amygdala focuses on emotional processing and is closely connected to our prefrontal cortex where most of our first order thinking and decisions are made. Impairment in amygdala processing results in poor emotional responses, dysregulation of our emotional control, and anxiety, and a downward spiral when this then impedes sleep more.

Anyone who has experienced this in real life has done so by way of having trouble reading emotional cues, being overly critical of people or ourselves, manifesting incorrect assumptions, renumeration of negative thoughts. This all creates conflict when it comes time for sleep. We become frustrated with our position, impatient with time, and irritable with the concept of good sleep for good health. And the spiral digs downward.

This article also dives into the mini factors that lack of sleep, leads to cardiovascular disease, stroke, and metabolic syndrome. One of these pathways that leads to cardiovascular disease by way of high blood pressure is that in sleep disturbances there is an absence of a normal dip in blood pressure that occurs during regular sleep. There’s an increase in inflammatory markers and reactive, oxygen species and a restriction of nitric oxide, which is an important vasodilator. Higher daytime blood pressures and inflammation can and often do help ignite the fire of chronic disease, keep it smoldering, and lead to poorer sleep by way of physical disturbances that disallow the body to sleep deeply enough or just enough.

One of many papers that spell out the average sleep needs for humans and the association to health is “Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies” by F Cappuccio (EHJ, 2011). The recommendations boil down to 7 to 9 hours of sleep for the average adult to avoid some of the top chronic diseases like cardiovascular disease and diabetes. Average is the key word here as some people are not average and may need more or less depending on other factors of their health and lifestyle. When we are sick or injured, we need more so our bodies can heal us. If we are a professional athlete, we need more to repair the damage done by practicing our physical profession. Rarer is the need for less, although these people do exist, most likely in far fewer numbers than some individually believe.

A book entitled “Hello Sleep” by Dr. Jade Wu, does detail that sleep is a very individual need, and that commonly held beliefs as to what works and doesn’t work for sleep needs can differ between people. So for a few, if they feel overall very rested and productive on a routine six hours of sleep and don’t struggle at night to get more, that’s just them. They can fret over another health behavior if improvement is needed. (She also goes rogue and states that it is perfectly acceptable to read or do another relaxing activity in bed before sleep for a short while if that is what makes you sleepy. Thank God!)

What I like most about this concept is that it finally allows for the triage of behavior change in a more broad context, and puts the patient, or person, more in charge of finding their own improvements. So much time can be wasted in sleep anxiety when the real culprits of ill health and chronic disease are also factors that may positively influence sleep even more.

Flipping this around now to focus on the other 30%+ of us with perceived or real sleep problems. While most reading this can already spout off several “sleep hygiene” practices, how doable are they? How realistic are they for you? For your friend or neighbor or coworker who has ever mentioned that they don’t sleep well? It is largely not even a complaint anymore. Lack of sleep, either in reality or by perception, is a fact of life now. It doesn’t have to be for anyone. For some, however, the “sleep hygiene” practices are as theoretical as SNAP benefits these days, or saving for retirement.

Most humans sleep better in a dark, cool and quiet space. While there’s a lot of emphasis put on the darkness of the space with blackout curtains and eye pillows and such, would we expect people to be able to hang up black out curtains in a space they don’t own? Are eye pillows and sleep masks comfortable? Do they provide a sense of security when living conditions may be insecure? Does everyone have the money to shell out on the maybe possibility that these things will help? Do we expect that the entire house can conform to the sleep needs of one person? Does everyone have a partner who would respect the sleep needs of the other by not having a TV in the bedroom, keeping it dark and quiet, or getting their snoring investigated?

In this age of warming winters, hellish summers, and fickle springs and falls, having a cool, cave like, sleeping space is hard to come by even for those with plenty to spend on reliable AC and well insulated homes. The decisions between energy bills and food, regardless of political whims, are now normal. How hot can you take it and still get a good night’s sleep? How cold is too cold to be comfortable and sleep. Was the bedding a luxury purchase worth the sleep it gives? Would this be a purchase you could make again if it was between bedding and feeding your kids? How hot is the bed partner, human or other domesticated animal?

The quiet of the sleeping space can be subjective as a lot of us will admit to having a close relationship with our white noise of choice. We love our white noise, our ocean waves, our fan blast, sometimes more than our bed partner. The constant low tones drowned out tiny sounds that come here and there, a branch crack, a cat meow, benign footsteps, sounds that would otherwise wake us up in total silence as if they were dangerous elements ready to strike us at our most vulnerable. Instead, white noise lets those tiny sounds pass but still allows for the big sounds to come through. Big sounds that could spell life threat, wake up and get out. Neighborhoods with high crime, dense traffic at all hours, and midnight trains have sounds not typically drowned out by white noise? Ear plugs? Have you felt secure and comfortable wearing them on a nightly basis? Family members who can’t keep quiet despite constant lecturing because they are too young to understand speech yet?

These small considerations can actually be quite crucial then it comes to being across or behind the line of sleep or no sleep. Good sleep can be a household project, a determination of priorities, a big adventure into a financial experiment. Just an acknowledgement that sleep can also be a privilege some of us experience and sometimes squander routinely.

Quality and quantity of sleep is also contingent on the activities of the day and what is done before sleep. We should think of what we put our body and minds through during the day as important as what we do in preparation for sleep.

· Diet: Eating when we wake up can wake us up, especially if it consists of plenty of complex carbs. Getting our major protein in during the last meal of the day 3-4 hours prior to sleep helps us prepare for the fast that we will experience during the sleeping time. Eating at night, even when we have to work at night, can cause blood sugars to rise, putting us at risk for chronic diseases including diabetes (SA, 2021).

· Physical Activity: We burn ATP into Adenosine with physical activity. Adenosine builds up to help induce sleepiness. We reconvert the Adenosine into ATP during sleep. Meeting our exercise goals, especially the Physical Activity Guidelines for Americans, we can help our bodies make and secrete hormones and enzymes that lead to more high quality sleep that restores and repairs our muscles, bones, skin, and immune system. Adding more NEAT (Nature and Physical Activity) in any way possible is a tremendous step in the right direction.

· Light exposure: Sunlight is the brightest light we will ever naturally be exposed to. It was once the only light besides fire we every had to deal with, and fire is not that bright compared to the sun. Natural light exposure during the early and mid day tells our mind that it is day and later will be night. Day is for thinking and working. Night is for sleeping. We can retrain our circadian rhythm daily just by spending time outside. Adding physical activity to this time compounds the positive benefits.

· Dosing of nap time and caffeine: short naps of 20 minutes or so for increased alertness without hampering nighttime sleepiness. 90 minutes or so to complete a full sleep cycle when staying up is needed for work or other life needs. Caffeine metabolism is as personal as diet. Average is several hours, and part of adulting may be to learn your own average and prepare yourself for consequences of decreased sleep if you are experimenting and wrong. It might be better to get a 20 minute nap and a sunshine boost mid-day instead of a coffee.

Even if Social Determinants of Health preclude someone from experiencing improved quality and quantity of sleep, these steps above should be at least easier and cheaper and hence more doable than bedding, curtains, new housemates, a new partner, risking the food bill, etc.

Good night.

· Chellappa SL, Qian J, Vujovic N, Morris CJ, Nedeltcheva A, Nguyen H, Rahman N, Heng SW, Kelly L, Kerlin-Monteiro K, Srivastav S, Wang W, Aeschbach D, Czeisler CA, Shea SA, Adler GK, Garaulet M, Scheer FAJL. Daytime eating prevents internal circadian misalignment and glucose intolerance in night work. Sci Adv. 2021 Dec 3;7(49):eabg9910. doi: 10.1126/sciadv.abg9910. Epub 2021 Dec 3. PMID: 34860550; PMCID: PMC8641939.

· Shah AS, Pant MR, Bommasamudram T, Nayak KR, Roberts SSH, Gallagher C, Vaishali K, Edwards BJ, Tod D, Davis F, Pullinger SA. Effects of Sleep Deprivation on Physical and Mental Health Outcomes: An Umbrella Review. Am J Lifestyle Med. 2025 May 27:15598276251346752. doi: 10.1177/15598276251346752. Epub ahead of print. PMID: 40443808; PMCID: PMC12116485.

· Francesco P. Cappuccio, Daniel Cooper, Lanfranco D'Elia, Pasquale Strazzullo, Michelle A. Miller, Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies, European Heart Journal, Volume 32, Issue 12, June 2011, Pages 1484–1492, https://doi.org/10.1093/eurheartj/ehr007

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