Tag Archive for: insomnia

Melatonin: Stay the Course

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As we continue to examine the results that appeared to suggest that the chronic use of melatonin in people diagnosed with insomnia could result in an increased risk of a diagnosis of heart failure, heart failure hospitalizations, and death from all causes, let’s put the unreviewed abstract in perspective. One correction from Tuesday. The researchers did not track the subjects for five years; the gathered data from the past five years. That’s an important difference

The simplest way to is to convert the percentage of risk into real percentages. The study reported that the risk of developing heart failure was over 90%. That’s true, but it’s based on the percentage of insomniacs that didn’t use melatonin at 2.7% versus 4.6% in those that did use melatonin. The same logic was used for hospitalizations (19.0% vs. 6.6%), and mortality (7.8% vs. 4.3%). It still seems like a significant risk, but there’s one more number that’s important: the total number of subjects in the study.

Insomnia: The Numbers

In the United States, the average number of adults that are diagnosed with insomnia is 12%. With 268 million adults in the U.S., that means that 32.2 million people have chronic insomnia. The percentage diagnosed is about the same in all high-income countries around the world. The researchers used a database that claims to have 150 million de-identified electronic medical records in its database, so how did the number of subjects get to only 120,000? It should have been at least 15 million.

Yes, the subjects were matched for a variety of criteria including age, gender, medications, and other factors but still, that’s an awful lot of lost subjects. Even without the diagnosis of insomnia, other diagnoses such as depression and other mental health diagnoses result in insomnia. They can also predispose people to heart failure as well. Those subjects would also have been lost.

The most significant information that was not collected was any data on over-the-counter melatonin use. To their credit, they do cite that as an issue, but there are no data as to how much melatonin was actually used by the subjects who took melatonin. There’s no record of melatonin use by people in the non-melatonin group if they didn’t report it as a supplement they use to their physician. There are more questions, but that’s enough to call the results into question.

The Bottom Line

Perhaps after the peer-review process, the data collection will be more clear. But as for right now, the best thing that could be said is that they distributed a great press release that caused a lot of concern. But as for actual research evidence? There’s no reason to modify melatonin use at this point. However, it’s always a good idea for you to report any supplements you’re taking to your healthcare provider.

What are you prepared to do today?

        Dr. Chet

Reference: American Heart Association Scientific Sessions 2025, Abstract MP2306

Melatonin: CVD Risk?

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Medical conferences are always a great source of controversy; studies are presented that haven’t been peer reviewed but have great press releases to advertise them. The American Heart Association met last week, and the Scientific Sessions didn’t disappoint. The abstract that caught my attention was based on an analysis of a large database of subjects from a variety of countries that demonstrated that melatonin used to treat insomnia could lead to an increased risk of cardiovascular disease (CVD) and hospitalization.

Researchers chose subjects who were diagnosed with insomnia and took melatonin for at least a year based on their medical charts. They were matched with control subjects on a variety of characteristics including age, height, weight, and many more variables, who were also diagnosed insomniacs but did not report melatonin use. They were tracked for five years.

The abstract stated that there was a 90% greater risk of CVD diagnosis in the melatonin group. Further, there was a 350% increased risk of being hospitalized in the melatonin group and a 100% increased risk of dying from all causes as well.

Is it time to throw out the melatonin? I’ll give you some perspective on this study on Saturday.

Tomorrow night is the Insider conference call and, wow, there is a lot to talk about! If you become an Insider by 8 p.m. tomorrow night, you can join in on the call. Protein intake. Creatine. Bike paths and medical costs. And even more.

What are you prepared to do today?

        Dr. Chet

A Little More About Sleep

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After last week’s memos on short sleepers, I got a couple of questions about other types of sleep. Let’s take a look.

One person asked if sleeping over 10 or 12 hours per night is problematic. The answer is that it could indicate a problem if done on a consistent basis. Sleep apnea can contribute to more time in bed because the person isn’t able to sustain rhythmic breathing; conditions that result are hypertension and other forms of heart disease. People with metabolic disorders who don’t produce enough energy can also spend more time attempting to sleep. Overall, that much sleep is less than desirable unless there’s a reason, such as a loss of sleep occasionally due to stress or travel.

The second was something called bi-phasic sleep patterns. This is legit; it’s a carryover from before the industrial revolution when lighting became more prevalent. Back in the time before regular lighting, people would go to sleep at sundown, sleep for several hours, get up in the middle of the night and do chores, check on animals, etc., then return to bed until sun-up. With the way the world is regulated these days, that doesn’t happen very much unless individuals are free to set their own schedules. Is that healthy and acceptable? I found nothing to suggest otherwise if it’s a natural pattern. If you find yourself temporarily caught in that pattern, such as with a newborn, don’t worry about it; this, too, shall pass, so adapt as well as you can for now. Avoid doing things that will make you more wakeful, such as watching something exciting on a bright screen or drinking coffee, so you can get back to sleep more smoothly.

I hope that clarifies sleep a little more for you. It seems like the correct duration is what fits you the best. If you have the mental and physical energy to do all you need to do, it’s probably fine.

We’re taking next Tuesday off, so I’ll be back in a week.

What are you prepared to do today?

        Dr. Chet

Sleep: Your Body Decides

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Before we get back to sleep (today’s topic), a reminder: don’t forget to sign up for the Kids’ Top Health Issues webinar tomorrow afternoon! And if tomorrow isn’t convenient, the replay will be available after the webinar ends. You can watch it as many times as you want to take more notes or absorb more info.

Now, about sleep—the question remains: how do you know how much sleep your body needs? After all, we’ve all been told that we need at least eight hours per night. Or do we?

My mother-in-law Ruth had a particular aide in the nursing home who just loved her, and the feeling was mutual. Molly said she never got more than four hours of sleep per night; due to the nature of her job, she could come in at 4 a.m. and be on her way home by noon to spend time with her young children. In fact, her dad was the same way—never more than four hours, and they had all the juice they needed to do all they wanted to do.

That’s why I used to give the answer I gave as indicated in the last Memo: “Don’t worry about it, because that’s apparently all your body needs.” But was there any science to support that? Turns out, there was.

The Science of Sleep

Thanks to an excellent article in Knowable magazine, I had a direction to look for the science behind sleep. (If you have the time, read the article in the reference below.) Two researchers in San Francisco have been researching sleep for about 15 years. The initial part of the research was to find people with different sleep patterns. They found a group that were early risers, but the group that caught their attention was the one they termed “short sleepers”; their research focused on that group for the most part.

The research didn’t stop there. Researching that term yields over 380 papers in PubMed alone. I reviewed the first 50 abstracts. To be blunt, there is a lack of clarity in the research; the primary reason seems to be because there’s no clear definition of what a short sleeper actually is. It can be someone who doesn’t get more than seven hours of sleep. They also mix in people with diagnosed insomnia and sleep apnea and associated conditions such as obesity, heart disease, diabetes, and Alzheimer’s disease.

What is clear is that when researching families with at least two generations of short sleepers, defined as four to six hours per night, there are at least seven gene mutations involved. Further, this group of short sleepers doesn’t seem to be at risk for any debilitating condition and spend the extra time doing more work or tasks.

The Bottom Line

Should you be concerned about how much sleep you get? Yes, if it interferes with your life and you walk around fatigued all the time. The occasional loss of sleep is expected, but habitual loss is the problem. The actual number of hours of sleep you need is the amount that allows you to recover, renew, and get on with the next day. Forget about how much sleep you’re supposed to get.

One of the researchers was quoted stating it this way: “Saying everyone should get eight hours of sleep every night is like saying everyone should be 5 feet 10 inches tall.” Can’t say it any better than that.

What are you prepared to do today?

        Dr. Chet

Reference: Marla Broadfoot. 2024. The Ones Who Need Little Sleep.  www.knowablemagazine.org

Do You Worry About Sleep?

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We’ve all been there—an occasional night when you just can’t get to sleep. Judging from the questions I get, a whole lot of you are worried about getting enough sleep. I’m not talking about chronic sleep issues, which may require working with physicians and sleep specialists (as Paula has done). I’m talking about people who can’t seem to get more than four or six hours of sleep per night.

My first question is always, “How do you feel? How’s your energy level? Are you tired all the time, or can you do all you need to do every day?” The answer to that question is critical. If the answer is something along the lines of “I feel fine—I just can’t sleep any longer than that.” My typical response is “Don’t worry about it, because that’s apparently all your body needs.”

The problem is that I didn’t have a good explanation beyond that. Turns out it may all be genetically determined, and I’ll explain that on Saturday.

Coming Up

Tomorrow night is the Insider Conference Call. For those of you not familiar with Insider membership, the monthly calls are designed to answer health, nutrition, and product questions; I also dig into the health headlines to give detailed answers based on the research behind those headlines. You can join the call if you become an Insider by 8 p.m. ET tomorrow.

Also, the Kids’ Top Health Issues webinar is Sunday afternoon. I’m going to cover the relationship between gut health and constipation, ADHD, and autism. If you have kids or grandkids or work with kids, you don’t want to miss it; if that time doesn’t work for you, you can watch the replay at your convenience.

What are you prepared to do today?

        Dr. Chet

How Exercise Improves Sleep

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To become the best version of yourself, it takes more than just eating better and moving more. One factor that gets overlooked is sleep.

Sleep patterns change over a lifetime; in addition, isolation during the COVID pandemic can also impact sleep patterns. Moderate to strenuous exercise has long been known to have a positive impact on sleep, but what about people who can’t exercise at a high level? Using a technology called actigraphy, researchers in Hong Kong attempted to find out whether mild exercise can help people with insomnia.

Actigraphy is a noninvasive technique that measures physical activity levels of a subject by means of a wristwatch-like motion-sensing device that can be worn for prolonged periods of time. Researchers recruited 320 participants with a mean age of 67 with most subjects being female. There were 110 in the control group, 105 subjects in the conventional exercise group, and 105 subjects in the tai chi group. Subjects in both exercise groups exercised for one hour, three days per week. The conventional exercise was a combination of brisk walking and weight training for 12 weeks, while the tai chi group attended a 12-week Yang-style, 24-form tai chi training program.

When compared to controls, both the exercise and tai chi groups showed improved sleep efficiency, reductions of wake time after falling asleep, and reduced number of awakenings. The actigraphy and sleep diary reports were consistent; there were no differences between exercise groups in benefits.

There’s good reason to believe that if mild to moderate exercise works for people with insomnia, it will work for anyone who wants more and better sleep. Seems like a good deal to me: invest three hours a week to help your entire body and get better sleep as a plus.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. 2021;4(2):e2037199.

Sleep More and Quit Eating Sooner

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Sleep more, eat the same, and lose weight. Seriously? That’s what researchers are going to try to find out. At this point, there’s little question that for most people, lack of sleep messes with the circadian rhythms and negatively impacts glucose metabolism.

But a different research team is looking at another element: how long you eat every day can impact your ability to lose weight. Researchers have done a pilot study looking at eating intervals: the time you eat your first meal until you stop eating for the day. For people devoted to their evening snacks, it can be 16 to 18 hours per day.

In the pilot study, subjects restricted their eating to a period of 10 to 12 hours per day. Over 16 weeks, subjects lost an average of seven pounds. One more thing: they didn’t have to restrict their eating. They ate what they wanted, just in a shorter time interval every day.

This was a pilot study using an app that the researchers developed; they’re recruiting 10,000 subjects to see if the idea will work on a greater scale while collecting additional data. Such as what? Well, maybe you actually eat fewer calories when you eat in smaller time frame even if you eat the same foods. By the way, if you want to be a subject, check out www.mycircadianclock.org to see if you qualify.

Back to the sleep portion. The part that interests me the most is the messed up carbohydrate metabolism by eating when your clock says it’s time to sleep. Getting more sleep is not easy these days, but it just might be worth it.

We’ve all heard people say they cannot lose weight no matter what they do. Well, maybe getting a little more sleep and eating over fewer hours may help. Of course, if you’re a diabetic or hypoglycemic, talk with your doctor. But here’s something simple and cheap you could do: sleep more and eat the same over fewer hours. Will you lose weight? We don’t know, but it’s worth a try.

What are you prepared to do today?

Dr. Chet

 

Reference: doi:10.1001/jama.2017.0653

 

Can You Lose Weight by Sleeping More?

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That doesn’t seem to make any sense; you’re not going to be as active because you’re sleeping, so how can that help you lose weight? Well, if you’re sleeping you’re not eating, but there must be more to it than that. Let’s go back to the SCN, the pacemaker of rhythms.

Researchers have found that cortisol and melatonin aren’t the only hormones and organs tied to the light-dark cycles. Hundreds if not thousands of genes also respond to light-dark cycles. Glucose metabolism, the processing of sugars, is tied to these cycles; we seem to process sugars better during the light hours than at night. For some reason, eating carbohydrates in the dark hours results in slow processing of carbohydrates. Typically carbohydrate metabolism is a fairly high-energy process using 15 to 20% of the calories in digestion and absorption, but eating in the evening seems to decrease metabolism enough that it could theoretically result in gaining 12.5 pounds in a year.

Theory and life are two different things. Research on rodents shows that if researchers flip their cycle by feeding them in opposition to their rhythms—they’re day-sleepers, so they’re the opposite of us—they gain more weight when fed the same diet than mice fed during their normal cycle.

What about humans? Is there a solution? Skinny rats are fine, but what’s in it for us? We’ll wrap this up on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: doi:10.1001/jama.2017.0653

 

Could Your Rhythms Be Keeping You Fat?

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You eat well and you exercise, but you still can’t lose any weight. What if the answer was in the natural rhythms of your body? I’m not talking about dance moves; I’m talking about circadian rhythms, the natural 24-hour cycles based on day and night. Since we can pretty much control the amount of light indoors 24-hours per day, our natural rhythms can be in disarray.

I’ve talked about the pacemaker of the heart several times over the years. It turns out that there’s an area in the brain called the superchiasmatic nucleus (SCN) that acts as the central pacemaker for circadian rhythms. It’s found in the hypothalamus and for a small group of cells, it seems to do a lot.

In the mornings in response to daylight, the SCN sends signals to raise body temperature and produce hormones such as cortisol. Time to get up! The SCN also responds to light by delaying the release of other hormones such as melatonin that help us sleep. When it gets dark the eyes signal the SCN that it’s night. Melatonin levels rise in the evening and stay elevated throughout the night, promoting sleep.

What does this have to do with being fat and not being able to lose weight? Now that we know how this pacemaker works, it turns out it could be an important factor. I’ll cover recent research the rest of the week.

What are you prepared to do today?

Dr. Chet

 

Reference: www.sleepfoundation.org.

 

Protein Intake and Sleep Quality

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Today we’re going to look at two studies from Purdue University, Paula’s alma mater, on the role of protein intake and sleep during a weight loss program (1). In the first, 14 subjects were given a diet with an increasing percentage of protein intake. After two weeks on their normal diet, subjects were put on a diet that reduced calories by 750; every four weeks, the protein content was increased, beginning with 10%, then 20%, and finally to 30% protein. Their sleep was assessed using the Pittsburg Sleep Quality test before and then after four weeks on each . . .

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