Sleep and Circadian Rhythms

Dr Lorenzo Cohen and Alison Jefferies in their book ‘Anti-Cancer Living’ list ‘Rest and Recovery’ as one of the six basics to try and get right. Some of us living with cancer can sometimes forget this and spend more energy on other interventions and forget this crucial area of our life.

At a recent Yes to Life Wigwam Support Group meeting this topic was looked at, alongside sleep and circadian rhythms. Members shared their thoughts, support, experiences, challenges and tips. In this blog I will share an initial introduction then some of the thoughts from Wigwam members at the end of this blog. It is by no means a comprehensive look but might spark some interest for folks to explore this area more.

Getting in the rhythm

Circadian rhythms are present in most if not all animals, plants, and even some species of fungi, and have evolved to help adapt their behaviors to the 24-hr change in the external environment due to the Earth’s rotation. It was only recently that the Nobel Prize was award to scientists who started to understand how ‘clock genes’ work.

Michael Rosbash in the Nobel Lecture (Dec 2017) (i) writes of our biological clocks that: “Clocks function to allow organisms to anticipate daily changes in their environment. When something happens every day at the same time, organisms “learn” that the event will occur. This anticipation, preparing for what is going to happen, is a superior strategy to merely reacting to that change. Animals use their clocks to maximize or minimize their encounters with what I like to call the big 3: finding food, finding mates, and avoiding predators”.

So clocks serve our internal processes by providing order. ‘Jet lag’ or shift work are good examples of when there is a challenge between our external environment and our internal biological clock. However it can also happen when our lifestyle is misaligned to our inner clock.

It turns out that a large proportion of our genes are regulated by the biological clock and our circadian rhythm effectively adapting our physiology to the different phases of the day. We now understand much more how our biological clock helps to regulate sleep, meal times, hormone releases, blood pressure, and even body temperature. See image below taken from the press release about the Nobel Prize (ii).

Ayurveda medicine has been aware of rhythms for forever….well it’s been around 5,000 plus years. Dinacharya is a Sanskrit word made up of ‘dina,’ meaning day, and ‘acharya,’ meaning activity. Dinacharya is a daily routine that is about connecting us to our internal body clocks. Key is getting up at the right time each morning so that our bodies get that flood of ‘get up and go hormones’ to take us through the day at our most vital and best. It is the cortisol that is released between 5 and 7am in the morning that is critical; if we don’t get up with that ‘rush’ then we are trying to get up as that hormone drops off.

What is also fascinating is that “when” we eat is turning out to be just as important as “what” we eat. Our body has times of day when it is best to digest to get the most in terms of nutrition from the food. There is, of course, much more to all this but some of the suggestions are that we should aim to wake in the morning and be out of bed between 6am – 7am. Kick start our digestion with a warm drink, first thing. To optimise digestion aim to eat breakfast 7am – 8am, lunch – 12 – 1:30pm and dinner 5:30 – 7pm. Aim to get to sleep between 10-10:30.

One blog I read that was looking at fatigue commented: “…until your body is following that natural circadian rhythm that was built into its design, you’ll never get your fatigue under control. That’s because the very presence of any level of dysregulation will always indicate some sort of problem with your adrenals. The good news, however, is that you can utilize your new understanding of the proper cortisol circadian rhythm as a tool to monitor your progress during your recovery efforts”(iii).

Indeed the importance of sleep can’t be underestimated. Many studies attest to this. In 2000 a study in Clinical Cancer Research compared metastatic colorectal cancer patients and showed those with disturbed and abnormal sleep patterns were five times more likely to die within two years of their diagnosis compared to those with normal rhythms. A scary piece of research to read that only underlines the importance of getting sleep right.

A huge challenge

However as the group shared, getting good rest can be hugely challenging especially when undergoing treatments and the high levels of stress that can accompany a diagnosis. Amazingly 4 out 5 people in the general population say they wake exhausted at least once a week and worldwide 20% of the population report some kind of sleep problem.

In the US folks are sleeping an hour less than 70 years ago. There are no doubt similar figures for the UK. Many of us are just not getting enough sleep or a decent quality of sleep. The ‘Anti-Cancer Living’ book gives lots of background info to all this and how habits have changed. They also note is still a very individual thing with varying needs even amongst similar aged people.

Shared suggestions

The Yes to Life Wigwam Support group members came up with the following – in no particular order – of things which have been useful to them. None of this is medical advice and people should discuss this issue with their medical team.

• Melatonin information on Cancer Active site: https://www.canceractive.com/article/good-quality-sleep-helps-women-beat-cancer-and-helps-tamoxifen Here is a link to contradictions of Melatonin with note re discussing with your doctor: https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/melatonin-side-effects/faq-20057874
• Bamboo pyjamas were mentioned as a great aid for night sweats
• Anna’s Wild Cream by naturopath Barbara O’Neil was suggested to be helpful for night sweats
• A supplement called Soya Isoflavones (from Lambert) can also help reduce night sweats
• The Theta Protocol (visualisation technique by Dianna Stoibal). Theta Healing basics intro video:https://youtu.be/x6WExH_Tzec
• Journal the repetitive thoughts which prevent sleep. This releases each one enabling relaxation.
• Gratitude prayers and meditation
• THC Cannabis; not legal in UK for sleep
• Avoid blue light several hours before bedtime and use blue light glasses if possible. A red bulb is believed to be helpful
• Get a proper alarm clock, and keep your bedroom a phone free zone.
• Reduce psychological stress; probably the key cause of sleep problems.
• Avoid sleeping pills if you can; ‘pill sleep’ does not feel restorative and no drug on the market increases the deepest stages of sleep.
• Tai Chi or Yoga
• Cognitive Behaviour programmes; some look at sleep.
• Alcohol consumption can become a stimulant when metabolised.

• You have peaks and troughs in your sleep all night but the deepest part is the first part of the night. This is the most important part for your brain and for your body to rest and recover so if you are going to get interrupted it’s better in the early hours of the morning than the first part of the night.
• Lux from light makes you sleep better so when you’ve had a lot of natural light in your eyes during the day you are more likely to get a better night sleep. Reflected light is even better so when you are near water (e.g. the sea) or snow you will get more lux and in term more sleep (apparently this is why people sleep well when they’ve been outdoors a lot). Also, the closer you are to the equator the more lux you get.
• Dips at 11am and 2pm due to circadian rhythms are normal and a siesta for half an hour in the mid afternoon can be good.
• Keeping a consistent room temperature all night is best – between 16-18 degrees.
• Also, consistent sounds or silence are good rather than random noises.
• Keep the lights low close to bedtime and do not turn on the light in the bathroom to do your teeth.
• Limit fluids after 8pm so you don’t need the toilet.
• Coffee takes ages to get the caffeine out of your system so stop drinking it by 2pm.
• Go to bed when you first feel yourself yawning in line with your circadian rhythm.

Notes

(i) https://pubmed.ncbi.nlm.nih.gov/29673553/

https://www.nobelprize.org/uploads/2017/12/rosbash-lecture.pdf

(ii) https://www.nobelprize.org/prizes/medicine/2017/press-release/

Also listen to a podcast from 2018: https://drchatterjee.com/episode-21-circadian-rhythms-and-time-restricted-feeding-with-professor-satchin-panda-part-1/

(iii) http://www.stop-being-tired.com/understanding-cortisol-and-the-circadian-rhythm